Less than 24 hours after the Republican-controlled Iowa House approved language to enact Governor Terry Branstad’s Healthy Iowa Plan, the Iowa Senate voted on party lines today (26 to 24) to reject the House version of Senate File 296. A conference committee will now attempt to work out a compromise on whether to expand Medicaid to all Iowans earning up to 138 percent of the poverty line, as the 2010 federal health care reform law envisioned.

After the jump I’ve posted a video of Senate President Pam Jochum speaking on the Senate floor today to contrast Medicaid expansion with the governor’s plan. I’ve also enclosed details on Branstad’s highly implausible claim that his plan would cost poor Iowans less out of pocket than expanding Medicaid. Senate Democrats have pointed out that Iowans living in poverty could never afford the co-pays and premiums envisioned in the Healthy Iowa Plan.

Finally, I’ve added below excerpts from the Iowa Hospital Association’s latest blog post explaining why Medicaid expansion is a better choice than the governor’s plan.

Excerpt from Tony Leys’ report for the Des Moines Register on April 30:

Branstad’s office released the eight-page memo Tuesday [April 30] explaining his plan and comparing it to an expansion of Medicaid, which President Barack Obama’s health reform program calls for. The Branstad document says that “current Iowa Medicaid members must pay co-payments each time they utilize services, which leads to unpredictable annual costs and can discourage patients from needed health care services.”

The document then includes a chart showing that under federal rules, a state could charge $589 in co-payments during a year to a recipient who uses medical services such as prescription drugs, an inpatient stay for pneumonia and rehabilitation visits for a broken leg.

Sen. Jack Hatch, a Des Moines Democrat and leading supporter of expanding Medicaid, called Branstad’s cost claim “laughable.” In an e-mail response, Hatch said Iowa is allowed to charge co-payments to Medicaid recipients, but isn’t required to. He said Branstad’s plan faces likely rejection from federal officials for several reasons, including that it would kick participants off if they didn’t pay the premiums.

According to an Iowa Department of Human Services website, current Medicaid co-pays include $3 for doctor visits, $2 for ambulance services, and $1 to $3 for prescription drugs.

Michael Bousselot, Branstad’s health care adviser, said the point of his office’s comparison was to rebut Democrats’ claim that charging premiums would be disallowed by the federal government. Bousselot said the $589 example was just a demonstration that the federal government allows states to charge fees to poor people who participate in public insurance programs.

From Scott McIntyre’s May 1 blog post, “Medicaid Expansion Sustains Iowa Priorities.”

Much of the argument against Medicaid expansion hinges on its alleged sustainability with regard to its reliance on federal funding.  Of course, right from the starting line the wheels begin to fall off that argument once the opponent is confronted with the reality that (1) expansion is paid for through the existing taxing and fee provisions of the Affordable Care Act and (2) the majority of funding for the governor’s alternative plan comes from Washington, D.C.

So it’s really not about sustainability; it is about priority and will.  For the last several decades, the federal government and presidential administrations from both major parties have willingly made Medicaid a priority and supported it as such.  This is consistent with the general will of voters, who desire to assist our most vulnerable citizens with the most basic needs, from food and shelter to transportation and education.  […]

There are too many Iowans who lack access to health care because they are uninsured – that much of this debate is all but settled. The unsettled question is how do we change that.  The governor advocates a plan that is overly limited in terms of the people it assists, the providers they can use and the services they can receive.

Proponents of this plan cloud these shortcomings with talk about patient buy-in, coordinated care and incentives for wellness and outcomes, as if Iowa health care providers had never heard of such things or could not manage their implementation without government involvement.  […]

Innovation becomes meaningless when basic access is denied.  Legislators need reminding that providing access is not so much a matter of dollars, but of remembering our Iowa priorities and mustering the will to sustain them.