In Iowa, A Possible Opening On Medicaid Expansion

Iowa has been among the most steadfast of the states in the Midwest against expanding Medicaid eligibility as part of the Affordable Care Act. But its Republican governor began to signal a softening on that stance this week.

At a Monday press conference, Gov. Terry Branstad indicated he would support Medicaid expansion to those earning as much as 138% of the federal poverty level if the federal government provides some assurances about long-term funding.

Under the ACA, the federal government has guaranteed to pay all costs associated with expanding Medicaid between 2014 and 2016. After that, it would pay 90% of those costs.

In Iowa, about 150,000 residents would qualify for Medicaid coverage should the state expand its rolls under the ACA guidelines, with the program's total enrollment growing to about 580,000. Altogether, the uninsured rate would fall by about 25% with a full Medicaid expansion in place, according to data from the Kaiser Family Foundation.

Although the Obama Administration has said that funding commitment would remain in place indefinitely, GOP lawmakers in many states have expressed concern that that could change in the future, sticking them with future bills. That is among the reasons that Iowa and some two dozen other states have yet to sign on to expanding their Medicaid rolls.

But Branstad has indicated that if Iowa is provided assurances that funding would remain stable, he would be in favor of some form of expansion.
“That is one of the things we’re willing to consider, provided there’s assurance that if the federal dollars are reduced that Iowa taxpayers don’t get stuck,” he said.

The Iowa Senate back in March approved an expansion of Medicaid under the ACA, but Branstad had said at the time he would not support such a bill.

Branstad's new stance suggests a retreat from his “Healthy Iowa Plan,” which would bring about 89,000 of the state's residents into Medicaid through a collaboration with the state's largest hospitals. Under the Healthy Iowa proposal, the income cutoff would be at 100% of the federal poverty level. It would require a waiver from the Centers of Medicare and Medicaid Services to enact.

Democratic lawmakers have been critical of Healthy Iowa, noting that its provider network would be too small to deliver effective care, and would still cut off tens of thousands of Iowans from receiving coverage.

Branstad indicated that the state would still seek a federal waiver for Healthy Iowa. However, he also said Monday he would support a full expansion of Medicaid if a bill can be crafted that would satisfy both Democratic and Republican lawmakers.