Gov. Terry Branstad
Gov. Terry Branstad

Gov. Terry Branstad, an avid outdoorsman, knows about bait. And the veteran Republican says he's not taking it from the federal government in the form of Medicaid expansion through Obamacare, in spite of the initial windfall in funding Iowa would receive from Washington, D.C.

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

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 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.

Carl Behne, CEO of Greene County Medical Center, a county operated facility, said his center provides about $800,000 in uncompensated care annually to the uninsured. He urged Branstad to consider the Medicaid-expansion option.

"I struggle with not wanting to take some of those funds," Behne said.

Branstad said relying on federal entitlement programs is not a wise solution.

"In 10 years, these entitlement programs are going to use up the whole budget," Branstad said.

He added, "Congress and the president are going to have to address these entitlements."

While the U.S. Supreme Court did give 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 the waiver Branstad wants. Both Harkin and Branstad recently pressed their respective cases to Health and Human Services Secretary Kathleen Sebelius, a Democrat whose department is funded by a Senate committee Harkin chairs.

Branstad discounted Harkin's prediction on the waiver.

"I think he's wrong," Branstad said in a interview following the one-hour event. "I think he's wrong on this as he is on the Harkin Institute at Iowa State. And I think this is all going to come out in The Wall Street Journal in the very new future."

(Harkin, who is retiring in 2014, recently said he would not give his considerable collection of congressional papers to Iowa State University, his alma mater, citing disputes about academic freedom.)

Branstad said he thinks the Healthy Iowa program will be treated fairly in Washington.

"I see no reason why they'll not work with on this as they have in the past," Branstad said. "They've been very, very willing to provide waivers to other states, so I don't see any reason why we'd be denied."

On other issues, Branstad pressed the case for commercial property tax reform in Iowa. Commercial property, now taxed at 100 percent of its value, would see a 20 percent reduction over the next four years, 5 percent annual cuts over the period, under Branstad's plan.

Branstad said he has heard from numerous business owners who are not hiring or expanding or otherwise investing in Iowa because of the property tax burden.

Jefferson City Administrator Michael Palmer asked Branstad to make certain cities were held harmless with a backfill in state funding should property tax reform take shape in the Legislature.

Branstad today was scheduled to be at a renewable fuels conference in South Dakota. He told the crowd of about 30 people in Jefferson that he would battle to secure the renewable fuels standards that buoy the ethanol industry and other emerging green sources of energy. He said oil companies, who are constantly on the prowl to dismember ethanol, are now making "outrageous" profits. There are 41 ethanol plants in Iowa.

Jefferson resident Sean Sebourn told Branstad he was concerned with entitlement programs after witnessing customers at convenience stores use food stamps to buy prepared foods and junk food - and then see them pull out cash to buy cigarettes.

"I see people wasting money like this, and it's frustrating," Sebourn said.

Branstad said he sympathized with Sebourn's sentiments, but that food stamps are distributed through the federal government.

That considered, Branstad said Iowa is working to promote better decisions with diet and exercise among its residents.

"Our approach is a little different than (New York City) Mayor (Michael) Bloomberg who is trying to outlaw big drinks," Branstad said.

In the health-care arena, Branstad, the former president of Des Moines University, one of the two medical schools in Iowa, said his administration wants to empower Iowa medical providers to recruit and retain physicians. He's proposing $2 million in state funding to support more medical residencies in Iowa as well as a Rural Physician Loan Repayment Program and a cap on non-economic damages for medical malpractice.

For her part, Reynolds advocated the governor's education reform plan, which focuses heavily on teachers.

"It's really an economic and moral imperative," Reynolds said.

The Iowa House, controlled by Republicans, last month passed Branstad's $157-million education-reform plan, which includes an increase in beginning teacher pay from $28,000 to $32,000. The package also would create different teacher levels to promote mentoring.

"The end result for Iowa children will be a better performance in the classroom," Reynolds said.