DES MOINES - Lawmakers in the Democratic-controlled Senate approved an expansion of Iowa's Medicaid program Monday, though Republican Gov. Terry Branstad remains firmly opposed to growing the program in the state.
In a 26-23 vote, split down party lines, the Senate backed the legislation. During the 90-minute debate, Democratic lawmakers argued that expanding Medicaid will provide care to more low-income Iowans with little cost to the state.
"It's not the Iowa way to turn our back on 100,000 uninsured Iowans," said Senate President Pam Jochum, D-Dubuque. "They are the working poor. They work. They just happen to earn a low wage and happen to work for an employer who doesn't offer health care, nor can they buy it on their own."
Branstad opposes the Medicaid expansion permitted under President Barack Obama's health care overhaul. He says the cost of the program is unsustainable for the federal government and has questioned the long-term price tag for states. Republicans in the Senate echoed those sentiments Monday.
"I share the governor's concern that the federal government will not be able to keep their promise," said Sen. Jack Whitver, R-Ankeny. "My friends on the other side of the aisle my not be worried about federal deficits and debt, but I am. "
Branstad has offered an alternate plan called Healthy Iowa, which revamps an existing health program for low-income residents and would use state and federal funds to provide coverage.
"We think it's important we do something that is sustainable for the long term," Branstad said Monday.
Responding to Branstad's concerns about funding, Democrats amended the legislation so that the state could back out if federal funding fell short. Democrats said Healthy Iowa would provide people with fewer benefits than a Medicaid expansion and would cost the state more.
"The governor's plan could still leave as many as 100,000 Iowans uninsured," said Sen. Jack Hatch, D-Des Moines. "Let us remember those Iowans and not get caught up in the partisan bickering over ideology."
The Medicaid program that provides health care for financially needy children, families and disabled people in Iowa is run jointly by the state and federal governments. Under Obama's health care overhaul, the federal government would pay the full cost for the new enrollees during the first three years of the expansion and then 10 percent of the cost would gradually be shifted to the state.
About 400,000 people in Iowa are currently enrolled in Medicaid, with another 70,000 on a limited benefit program for low-income adults called IowaCare, paid for through state and federal funds.
If Branstad agreed to expand Medicaid to those at or below 138 percent of the poverty level, an estimated 110,000 to 180,000 people could be added to the Medicaid rolls, including those currently on IowaCare.
Branstad's Healthy Iowa proposal is a revamped version of the soon-to-expire IowaCare program. The plan, which would need federal approval, would offer health coverage to those with incomes below the federal poverty level who don't qualify for Medicaid, mostly childless adults.
Details on Branstad's plan have been limited, though officials have said it would include prescription drug coverage and offer services in locations around the state. When he unveiled the plan, Branstad said the benefits would not be as "rich" as under Medicaid.
State officials estimated that as many as 89,000 could be eligible for the new program. Unlike Medicaid, participants would be responsible for small contributions to their coverage, though Branstad said some or all of that cost could be waived if they participate in wellness programs.
The state cost for Healthy Iowa is estimated at $162 million per year, with the funding coming from the state general fund, local property taxes and other sources. Under the plan, the federal government will provide another roughly $220 million. Branstad previously said the combined state and federal cost was lower, but aides Monday affirmed the $162 million state price tag.
The Medicaid expansion legislation will now go to the Republican-majority House, where lawmakers thus far have shown little interest in the plan.