U.S. Sen. Tom Harkin
U.S. Sen. Tom Harkin
March 8, 2013

U.S. Sen. Tom Harkin, D-Iowa, Thursday made it clear he was throwing his considerable influence on health-care policy behind an expansion of Medicaid in Iowa, a direct challenge to Gov. Terry Branstad's state-led reform of IowaCare for lower-income people.

At issue: how poor Iowans will be covered - and how many of them will be covered. And who pays for it.

GOP Gov. Terry Branstad has signaled his support for an a new version of IowaCare, stressing concerns about being tied to the federal government.

In a conference call with The Daily Times Herald and other media, Harkin said flatly that Branstad's efforts to waive the Medicaid expansion in Iowa won't earn U.S. Department of Health and Human Services approval. That means Iowa will have to opt in to Medicare expansion or see poor people lose coverage.

Harkin said he spoke with HHS Secretary Kathleen Sebelius, a Democrat, about the Branstad alternative to Medicaid expansion, and she judged it inadequate.

"They're just not going to approve it," Harkin said.

He added, "Believe me, I have weighed in very heavily on this. The Branstad waiver will not be approved, OK."

When asked if he personally urged Sebelius to reject the Branstad plan, Harkin said: "Let me put it this way. We had a discussion about it, and she understands my position as the chairman of the committee that funds her department. But I didn't have to convince her because she's there anyway."

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.

"That is a great deal for our state and any state," Harkin said.

He said the 60,000 Iowans now covered by IowaCare will get better care and access to physicians and hospitals with Medicaid expansion. Harkin said hospitals would save millions in uncompensated care. State and local governments in Iowa should save more than $530 million over the next decade with the expanded Medicaid plan, Harkin said.

Harkin said hospital and physicians' groups and other health-care stakeholders broadly support Medicaid expansion.

"I can't find anyone who's opposed to this expansion of Medicaid," Harkin said. "Why the governor is digging in his heels on this is just bizarre."

Harkin referenced the fact that other states with Republican governors have opted into the expanded-Medicaid plan.

"Last November, Iowans voted to re-elect President Obama and rejected the candidate who would have repealed the Affordable Care Act," Harkin said. "Since then, a growing number of governors have said that Medicaid expansion is not about 'liberal' or 'conservative.' It's simply about common sense."

According to the Miami Herald, Florida Gov. Rick Scott said he supports expanding Medicaid and funneling billions of federal dollars to Florida, "a significant policy reversal that could bring health care coverage to 1 million additional Floridians."

"While the federal government is committed to pay 100 percent of the cost, I cannot, in good conscience, deny Floridians the needed access to health care," Scott, a former hospital executive, said.

New Jersey Gov. Christie, a Republican, said the Medicaid expansion will save money for state taxpayers and cover more people.

"For these leaders the political season is over, and it's time to govern," Harkin said.

Harkin dismissed Branstad's warning about the federal government not making good on its pledge to fund Medicaid expansion long-term.

"Well, look at it this way, with all of these other governors signing on from states like Florida, and Texas, California, New Jersey, Wisconsin, all these other states, looking ahead, if a future administration ever decided to cut back on that, what do you think the congressmen and senators from those states would do?" Harkin said. "Would they allow that to happen? No way. That's the guarantee."

Branstad earlier this week unveiled a Healthy Iowa Plan - his alternative to the Medicaid expansion and the reform of IowaCare - 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.