March 11, 2013


State Rep. Dan Muhlbauer, D-Manilla, supports an expansion of Medicaid in Iowa, seeing it as the best option for covering Iowa's uninsured poor.

His former colleague on the Crawford County Board of Supervisors, State Sen. Mark Segebart, R-Vail, sees it differently. He's concerned about the increasing reach of the federal government into the state.

But they both agree on this: Medicaid expansion is coming,

"Right now, Medicaid expansion is still the best game going forward," Muhlbauer said.

The issue emerged as a main discussion point Saturday morning during a Carroll Chamber of Commerce legislative forum at Coon Rapids-Bayard High School in Coon Rapids.

An Iowa Senate subcommittee already has passed a measure to expand Medicaid. The federal program, administered through the state, now serves 400,000 people in Iowa. State officials have said the expansion could add 110,000 to 180,000 people.

Under the Affordable Care Act, federal health reform widely known as Obamacare, states can opt into Medicaid expansion with 100 percent of the costs covered by the federal government for three years, with a 90 percent federal and 10 percent state split in ensuing years.

Gov. Terry Branstad last week unveiled a Healthy Iowa Plan - his alternative to the Medicaid expansion - that would cover 89,000 uninsured Iowans whose incomes are less than 100 percent of the federal poverty level. Iowans making more than the poverty level, but up to 133 percent of it, would get subsidies to participate in health exchanges, under the Branstad plan.

The federal poverty level for a family of four is $23,550. For a single-person household it is $11,490.

"Branstad's plan falls way short," said Muhlbauer, who referred to it as "Terry-care."

Muhlbauer said the plan could force an increase in property taxes as many health-care institutions in Iowa are county-run.

Segebart said he doesn't want to tether Iowa's health-care system any more than necessary to the federal government.

"The last time I looked our country is over $16 trillion in debt," Segebart said.

The federal government simply can't guarantee the funding it is promising now, he said, echoing sentiments Branstad has expressed.

He also said the expansion will bring people into the system who don't "really need help."

"That's how the government gets itself into trouble," Segebart said.

A current IowaCares plan involves coverage for about 67,000 Iowans who could lose those health-care services if the Branstad plan is rejected by the U.S. Department of Health and Human Services - and Branstad doesn't follow the lead of other Republican governors from New Jersey and Florida, for example, who opposed Obamacare but took the money for Medicaid expansion in their states.

While the U.S. Supreme Court did gives states the power to reject Medicaid expansion, the federal Department of Health and Human Services makes the call on the acceptability of the replacement programs. U.S, Sen. Tom Harkin, D-Iowa, has said flatly that Iowa will not get a waiver. Both Harkin and Branstad recently pressed their respective cases to HHS Secretary Kathleen Sebelius.

Segebart said he understands the dynamics. The real choice before Iowa, he acknowledged, is whether Iowa cuts loose poor people from coverage or accepts Medicaid expansion.

Moving on to other issues, Muhlbauer said the Legislature is considering an optional flat tax. Iowans could choose between the current progressive system or go with a 4.5 percent flat rate and no deductions - a plan outlined in House File 3.

Muhlbauer said he believes the consensus among the financial-and-accounting community is sticking with one system or moving to another - not offering a choice and confusing matters.

The Manilla Democrat noted that no gun-control measures or hot-button bills on social issues like abortion emerged from the legislative funnel for general debate last week.

He's still at work on water-quality solutions and plans to incent beginning farmers.

The legislators also delved into the issue of a school start in Iowa for K-12.

Segebart said he would prefer that schools not start until the last week of August so families have time to attend fairs. He said he sees the point of view of the Iowa tourism industry, which doesn't want school cutting into the summer.

What's more, Segebart said, he drafted legislation to limit holiday break for state universities with a later start date so college students could work longer at summer jobs, earning more money for college so they leave post-secondary education with lower debt. The plan did not make the funnel, he said.

On the education front, Muhlbauer stressed that the state needs to deal with overall education funding before diving into reform on teacher pay, evaluation and other school issues.

"We still haven't set allowable growth," he said.

Muhlbauer has said the governor is holding legislators "hostage" by demanding a massive reform package by the House be considered in the Senate along with allowable growth - a formula that determines how much state money flows to local school districts based on enrollment. The Republican-controlled House passed an amendment to the reform bill setting it at 2 percent. The Democratic-led Senate set the rate at 4 percent.

Coon Rapids-Bayard superintendent Rich Stoffers said the legislative inaction creates uncertainty for school officials on a variety of fronts.