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Your Capitol Voice: Medicaid alternative not perfect, but a starting point
by Bobby Kaufman, State Representative · Op-Ed · April 12, 2013


Last week brought more floor debate. It was also the second funnel week which means any Senate bills to be considered in the House had to pass through committee.


Education reform and funding have finally come to a conference committee. This means the Senate plan and the House plan will be discussed and a compromise will be formed by the committee and then recommended to both chambers. I am very aware that our schools back home need to know their funding situation as they are dealing with their budgets. The House sent our bill to the Senate on Feb. 20. Below is the timeline in each chamber recognizing that the process has been slow and there were opportunities for speeding it up without compromising due process.

The House 2013 timeline for the Education bill: Jan. 15 – HSB 4, the Governor’s language, introduced; Jan. 21, 28, 29, Feb. 5 – Subcommittees; Feb. 13 – Education Committee consideration; Feb. 14 – Ways and Means and Appropriations Committee consideration; Feb. 19 – 20 – House Floor Consideration; Feb. 20 – Message to the Senate

The Senate 2013 timeline for the Education bill: Jan. 22 – SSB 1058, the Governor’s language, introduced; Jan. 31, Feb. 6, and 14 – Subcommittees; March 4 – SSB 1228, the Senate’s language, introduced; March 6 – Subcommittee; March 7 – Education Committee consideration; March 26 – Senate Floor consideration; April 1 – HF 215, the House’s language, subcommittee; April 2 – Education Committee consideration; April 3 – Senate Floor consideration

This week Governor Branstad introduced the specifics for his alternative to Medicaid expansion. Medicaid expansion is not the perfect solution and the Governor’s plan is not a perfect solution either. The Senate has passed Medicaid expansion and I expect the House to pass the Governor’s alternative. At that point, the work of compromise will begin and there are signs that both sides are willing to move.

I will be working for a solution that addresses the positives and negatives of both the Governor’s plan and Medicaid expansion. We need to ensure that the working poor have coverage. (We have a joint program for the poor already.) If we don’t deal with this issue it will be difficult for those families who can’t afford coverage and the taxpayers who will ultimately pay the expenses. We will seek the best coverage and the most reliable and consistent funding. The Governor has made the following points:

• Medicaid has some fundamental problems. Patients are relegated to being recipients rather than participating in their health care. Medicaid is not insurance – it is merely a payment program.

• Each year the state’s Medicaid costs go up without any options for us to manage it.  Expansion will only compound the problem.

• Once Medicaid is expanded, there are no take backs. Without any new kind of expansion, the number of Iowans covered by Medicaid has already grown by 65 percent since the year 2000 and the states costs have gone up 180 percent.

The Healthy Iowa Plan Alternative:

• Would replace the expiring Iowa Care program that currently provides limited coverage to about 67,000 Iowans. Under Healthy Iowa, about 89,000 uninsured Iowans would gain access to care in their communities.

• The Healthy Iowa plan more closely resembles a private insurance plan and would provide incentives to health care providers to provide higher quality health care focused on better outcomes for patients.

• Finally, the Healthy Iowa plan requires participants to contribute a small amount to the program based on their income and includes incentives for Iowans to take action to improve their health.

I am torn. I am not convinced that blindly accepting the premise that the federal government will be able to keep its ever-growing financial commitment to us after three years is the proper way to plan for sustainability. The fact remains that our federal government is 16 trillion dollars in debt. Something will have to “give” and forcing more costs to the states will be one way. It is not unimaginable to me that in 3 years it would be a convenient cost savings for the feds to force Iowans to cover a significantly higher percentage of Medicaid costs than they are currently promised – forcing Iowans to make cuts elsewhere.

I appreciate the part of the Governor’s plan that promotes personal responsibility and provides incentives for better health care. However, I also understand that the Governor’s plan covers less people than Medicaid expansion. I look forward to hearing from you on this issue and I will be working for a compromise that takes the best parts of both plans and involves a decades-long vision and not just federal reliance.

Next week, I will write about my veteran’s bill that has survived funnel and the Cedar/Muscatine county man that inspired it.  

Capitol Visitors: Melanie Moore of Wilton, Emily Gookin of Wilton



You may contact Rep. Kaufmann at Bobby.Kaufmann@legis.iowa.gov, 563-260-3355 or 1527 330th St. Wilton, IA, 52778

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