A leading Iowa Senate voice on health-care policy says the bottom line is straightforward: Iowa will have expanded Medicaid - in spite of spirited opposition from Gov. Terry Branstad.

State Sen. Jack Hatch, D-Des Moines, the chairman of the Senate Health and Human Services Budget Subcommittee, said expansion is the right move for Iowa. The federal money is there, and if Iowa doesn't use it, the funds will flow to other states, including many led by conservative Republican governors such as Florida, Arizona and Ohio, he said.

The expansion will help lift people out of vulnerable stations in society, Hatch said.

"These people are the working poor," Hatch said. "They're not in the welfare state."

Hatch spoke with The Daily Times Herald Friday following a meeting at St. Anthony Regional Hospital. Hatch joined 17 other Democrats in visiting medical facilities in Iowa over the weekend to cull input on health care.

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.

Branstad, a Republican, has 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 chief stated opposition to Medicaid expansion is that he doesn't trust the federal government.

"We can't out-promise the federal government, but I really don't believe they can deliver," Branstad said last Monday during a town-hall meeting at the Greene County Community Center in Jefferson.

Hatch and fellow Democrats have said they will address that concern head-on with a floor amendment that would allow Iowa to pull out of Medicaid expansion should Branstad's fears be realized and the state-federal program fall short on Washington, D.C., dollars.

A current IowaCare plan involves coverage for about 67,000 Iowans who could lose those health-care services if there is no Medicaid expansion and the Branstad plan is rejected by the U.S. Department of Health and Human Services. Hatch and U.S. Sen. Tom Harkin, D-Iowa, say the Branstad plan is dead in Washington.

In 2009, Hatch was appointed chairman of the White House Working Group of State Legislators for health reform. Like Harkin, he has spoken with top officials in the U.S. Department of Health and Human Services. Iowa is not getting a waiver, regardless of what Branstad says, Hatch said - noting that the governor didn't serve Iowa well when he lectured HHS Secretary Kathleen Sebelius on the national debt during a recent trip to Washington, D.C., rather than sticking to specifics on health-care planning in Iowa.

Hatch said the choice before Iowans will be clear: embrace Medicaid expansion or eliminate coverage for thousands of Iowans.

"We will not adjourn until we have Medicaid expansion," Hatch said. "You can't throw 70,000 people off of insurance."

The Des Moines Register reports that 88 lobbyists representing a sweep of health-care concerns in Iowa are supporting expansion of Medicaid. There are no lobbyists registered at the Statehouse in opposition to it, the newspaper reported.

"I think the governor is really pushed by his ideology and not the greater good," Hatch said.

Hatch said 80 percent of families on Medicaid have someone in the workforce, something Hatch contends Branstad isn't acknowledging in his continued assault on Obamacare, now the law of the land, with a stamp of approval from the U.S. Supreme Court.

"He equates people being uninsured with being a welfare recipient," Hatch said.

Hatch said he suspects Branstad is seeking to use the issue to elevate his stature among conservatives.

"He's not an up-and-comer," Hatch said. "He's Father Time. He wants to emerge as a national leader."

Hatch, who said he is exploring a bid for governor himself in 2014, said Branstad's "disdain for the federal government" will, if left unchecked, hurt local taxpayers as health care that could be funded through Medicaid will fall in many cases to property tax-supported counties.

According to The Des Moines Register, counties spend about $130 million per year on mental-health services. Iowa's Medicaid officials estimate Medicaid expansion could remove $27 million to $60 million of those expenses from counties. County hospitals also are absorbing uncompensated care costs for the uninsured who come to emergency rooms where treatment is mandated by law.

Hatch said Iowans understand the intersection of Medicaid expansion and property taxes.

"His (Branstad's) standing with the middle-of-the-road Iowan became more questionable," Hatch said.