Rep. Dave Heaton, one of the Legislature’s experts on health care issues, understands the seriousness of the debate over expanding Medicaid under the federal health reform law to provide insurance to more than 100,000 low-income Iowans.
Rather than blindly following a lesser alternative proposed by Gov. Terry Branstad, the Republican from Mount Pleasant has publicly raised concerns about various provisions in the Branstad bill.
“This is the most significant vote that I will have made in the 20 years that I’ve been here,” he said Monday in reference to House legislation pursuing the governor’s Healthy Iowa Plan.
Though Heaton could have joined two other Republicans (Joshua Byrnes of Osage and Brian Moore of Bellevue) and voted against the problematic legislation Tuesday, he didn’t. There’s a silver lining: The bill’s passage allows lawmakers to finally get serious about working out differences between the Senate and House versions of legislation in a conference committee. Ultimately, the Senate bill should prevail.
The Senate knows expanding Medicaid makes sense. It is a time-tested program with low administrative costs and an existing infrastructure. Washington will pay the entire cost for new enrollees the first three years and at least 90 percent after that. Iowa can insure its poor while receiving millions of federal dollars that will create jobs in the health care field. The Register’s editorial board, as well as Iowa’s hospitals, physicians and AARP, have been supporting the Medicaid expansion for months.
The governor was alone in his opposition to expansion until House Republicans fell in line. Now they are supporting his alternative, which will insure fewer Iowans, leave millions of dollars of federal Medicaid aid on the table and cost Iowa taxpayers $156 million — including money siphoned away from the property taxes in all 99 counties. Numerous questions remain about where an Iowan could go for health care under the Healthy Iowa Plan.
Then there is the huge elephant in the room: In the unlikely event a majority of Iowa lawmakers, both in the House and in the Senate, agreed to pursue the governor’s plan, Iowa would still need to apply for and secure a waiver from the federal government to proceed. That is neither simple nor automatic.
According to many critics, including U.S. Sen. Tom Harkin, the Obama administration likely will not approve the waiver anyway.
Iowa lawmakers and Branstad have set up a terrifying scenario: The Legislature will adjourn, and it may not agree to expand Medicaid. It may not agree on the governor’s alternative plan, either. A program known as IowaCare, which provides limited health services to more than 60,000 Iowans, expires at year’s end. While our elected officials ring in the New Year with the comfort of knowing their own taxpayer-paid health insurance is safe and sound, thousands of their low-income constituents won’t have any health coverage and won’t have the money to pay for their own care.
Iowans will pay federal taxes to provide health insurance to poor people in other states. Iowans will get nothing.
So Heaton is right. The votes on legislation to get poor Iowans health insurance are the most important in a lawmaker’s career. It’s time for all of them to set aside the politics and do what makes fiscal and moral sense: Expand Medicaid to finally insure more poor Iowans.