DES MOINES, Iowa (AP) — The Republican-majority Iowa House approved Gov. Terry Branstad's health care proposal for low-income Iowa residents Tuesday, setting up a tough negotiation with the Democratic-controlled Senate, which favors a Medicaid expansion.
In a 51-49 vote split mostly along party lines, the House approved legislation for the "Healthy Iowa" plan. The plan revamps an existing program for low-income residents and would provide coverage to an estimated 89,000 people with incomes at or below the poverty line using state and federal dollars.
Branstad opposes the Medicaid expansion permitted under President Barack Obama's health care overhaul, saying the long-terms costs are unsustainable for the federal government. During the House debate, Rep. Walt Rogers, R-Cedar Falls, said the Healthy Iowa plan would best serve the state, arguing that it would promote healthy behavior.
"There's a reason why we want to be healthy. There's a reason why a plan like this is a good thing. It helps us as a state, as a community, as people working together to be healthy," Rogers said.
But Democratic lawmakers argued that a Medicaid expansion would cover more people and cost the state less.
"Who do you stand with? Do you stand with the governor that wants to deny 150,000 Iowans health insurance?" said Rep. Tyler Olson, D-Cedar Rapids.
The Medicaid program that provides health care for financially needy children, families and disabled people in Iowa is run jointly by the state and federal governments. About 400,000 people in Iowa are enrolled in Medicaid, with an additional 70,000 on a limited benefit program for low-income adults called IowaCare, paid for through state and federal funds.
Healthy Iowa is a revamped version of IowaCare. The state cost for Healthy Iowa is estimated at $162 million per year, with the funding coming from the state general fund, local property taxes and other sources. The state would need to get a federal waiver to put the plan in place. Participants would be responsible for contributions, though they could seek to avoid those due to hardships.
The Senate has passed a bill that would expand the Medicaid program in Iowa. An expansion to include those with incomes up to 138 percent of the poverty level would add an estimated 110,000 to 180,000 to the state's Medicaid rolls. Under Obama's health care overhaul, the federal government would pay the full cost for the new enrollees during the first three years of the expansion and then 10 percent of the cost would gradually be shifted to the state.
The legislation will now move to the Senate, but given the differences between the sides, the bill is likely to end up in a joint negotiating committee where lawmakers from both sides and parties try to reach a compromise.
Rep. David Heaton, R-Mount Pleasant, a longtime lawmaker who is considered an expert on health care issues, said he wasn't sold on the Healthy Iowa proposal, but he would vote for it to move the process forward.
"I'm going to vote for this bill today so we can get together with the Senate and figure out a better bill," Heaton said.