Debate Over Medicaid Expansion Continues Across Iowa
Des Moines, Iowa – The debate about the future of Medicaid expansion in Iowa continues, and will draw more attention as debate begins in the Senate this morning.
Iowa Governor Terry Branstad has made his case against Medicaid expansion in the state, while the hospital association has continued to lobby for the program. Branstad introduced is own plan, called ‘Healthy Iowa Plan’.
Branstad said in an interview with Oskaloosa News earlier this month, a big part of the the plan is, “to focus on things that are going to help people to help themselves. To encourage people to take ownership of their own health and for the state to provide assistance.”
Branstand explained who would be eligible for the program, “Those people below the poverty level would be eligible for the Healthy Iowa Program and would be delivered by accountable ACO’s. (Accountable Care Organization) which we anticipate to be all over the state of Iowa.”
Governor Branstad last month visited Washington D.C. and recently met with Health and Humans Services Secretary Sebelius. He was joined by Nick Gerhart, Iowa’s new insurance commissioner and Bill Palmer, Director of Human Services, where they informed the HHS that, “we would be presenting a request for a waiver for our Healthy Iowa Plan.”
“I think this is a much better alternative than buying into the 1960’s Medicaid program which has not gotten us better health results and has cost a tremendous amount of money and is frankly unaffordable and not sustainable for the long term.” explained Branstad, who remarked about his belief that “Embarking on another expansion of the entitlement programs and at the same time they’re looking at cutting everything else. So now we have sequestration of domestic discretionary spending and national defense…sooner or later the president and the congress has to quit pointing the finger at each other, calling each other names and start to get serious about getting this deficit under control.”
Branstad explained that being concerned about the potential hit the Iowa taxpayer could experience if the federal government defaults on its obligations is a major motivator for his proposal.
During Saturday’s Eggs & Issues, District 40 Senator Ken Rozenboom (R) commented that he continues to get hundreds of emails over the subject, “Jay just informed me that he saved me another hundred by calling off the dogs, and I appreciate that Jay.” Rozenboom went on to say, at the local venue, “This is a huge decision for Iowa… It’s the balancing act between how we deal with the uninsured Iowan’s and how much we want to expand and rely upon an entitlement.”
Jay Christensen is Chief Executive Officer of Mahaska Health Partnership in Oskaloosa, and has spoken about the need for the expansion for hospitals and health care providers in the state. Christensen addressed Rozenboom at Saturday’s Eggs & Issues saying, “I saved ya the hundred, not because we’re less passionate about it, as I know you know how we already feel. What I guess I would challenge you to think about, as you prepare to debate that bill Monday night, is that whether we believe the federal government can come through with that money over an extended period of time or not, uninsured is really a federal problem. That burden is going to get passed on locally one way or another. We’ve seen our own bad debt and charity care go up 35%. To the extent that’s not covered at a federal level, we’ll all be challenged to figure out how to handle that locally. It isn’t that the burden is going away, that 150,000 people that need that care, a lot of them get that care, they get it in our emergency room at the highest cost possible. We think having a good plan in place will allow that to be delivered at a lower level of care.”
Christensen told Rozenboom, “I understand some of the issues with the Governor’s proposal about having some skin in the game to improve your own health, and I’d be all in in having that go into the bill.”
In an interview earlier this year with Oskaloosa News, Christensen explained why Medicaid expansion is important to not only MHP, but all of the health care industry in Iowa. “Medicaid expansion really is a piece of the Affordable Care Act we affectionately call Obamacare. From a providers standpoint, it’s the piece that makes it work mathematically. It doesn’t really matter if you like the Act or not, it doesn’t work for providers without all of the pieces. And I’ll kind of explain. 158 billion dollars of the cost of Obamacare are provided by provider cuts. So, 158 billion dollars nationally over the next 10 years comes away from the hospitals and physicians to help pay for that. Well, the promise we got on the front end was, there would be Medicaid expansion that would not increase individual payments but cover more people, and so, we should net. It wasn’t going to be a financial gain, but it wasn’t going to be a big financial loss, with the real potential advantage being with people being covered, maybe more of their care would be done in a primary care setting, which is a lot less expensive than having it done in the emergency room, which we know is the highest price point in health care.”
In our interview, Branstad did cover that by saying, “I would much rather do something that really kind of fits with our philosophy of our goal to be the healthiest state and getting people to take ownership of their own health and have the state partner and provide some help especially to those people below the poverty level, but expecting them also to get involved in prevention type programs like health risk assessments and things like that, Wellness programs – in return for not having to make a co-payment.”