Iowa Senate Approves Medicaid Expansion

The Iowa Senate passed a bill on Monday that would expand Medicaid under the auspices of the Affordable Care Act, but Gov. Terry Branstad is still firmly against such a plan.

The Senate passed the bill, SF 296, by a 26-23 mostly party-line vote with overwhelmingly Democratic support. Lawmakers in support of expanding Medicaid spoke at length regarding how not expanding Medicaid would put pressure on hospitals to continue to care for uninsured patients without hope of reimbursement.

“We talk about the uninsured, we talk about the working poor...those are my patients,” said Sen. Chris Brase, D-Muscatine, who works as a paramedic. Brase noted that many locals whom he treats do not want to be taken to a hospital emergency room because they cannot afford it.

But Sen. Jack Whitver, R-Polk, argued that the federal government would likely not keep its promise to pay for the expansion. Under the ACA, the federal government would pay for 100% of the cost of Medicaid expansion for the first three years starting in 2014.

“Adding 150,000 people to an unsustainable program without first fixing Medicaid makes no sense,” he said, citing two other programs that focused on education for disabled children and correctional services for criminal illegal immigrants have not supported at the level initially promised by the federal government.

Like many Republicans, Whitver voiced his support for Healthy Iowa, a plan supported by Branstad that would expand Medicaid to about 89,000 Iowans. However, the income cutoff would be at 100% of the Federal Poverty Level, not the 138% of the FPL under the Affordable Care Act, and would involve only a handful of hospitals involved.

But Sen. Michael Gronstal, D-Pottawattamie, noted that Branstad's plan is sketchy at best, mocking a widely circulated document about Healthy Iowa that is only four pages long.

“You would have thought he would have had people working on this issue and have more than we have now...the details are incredibly sparse,” he said.

Gronstal added that the nearly 60,000 Iowans who would not be covered by Branstad's plan versus straight Medicaid expansion would still burden the state's providers by requiring uncompensated care.

The bill has yet to be debated in the Iowa House, which is controlled by Republicans.