DES MOINES, Iowa (AP) — Gov. Terry Branstad said Tuesday that he had a "cordial" recent meeting with the U.S. health secretary about his decision not to expand Medicaid in Iowa and will soon give the federal government his full proposal that aims to instead extend another program set to expire later this year.
The Republican governor said he pressed Health and Human Services Secretary Kathleen Sebelius at their meeting Friday in Washington for a federal waiver to continue IowaCare, which provides limited health benefits to some 70,000 low-income adults in the state using state and federal funding.
"One of the big concerns I have is just expanding Medicaid has not worked to improve health. In fact the health of the American people has gone consistently downhill. We've become more obese and less healthy," Branstad said.
Branstad said the information he provided to Sebelius about IowaCare acknowledged the program would need to be revised to offer incentives to those who seek preventative services. He said a fuller proposal would be submitted soon. He did not predict whether the waiver would be granted but described the meeting as positive.
Department of Health and Human Services spokeswoman Erin Shields Britt said the department could not comment on whether they'd approve the waiver before seeing the proposal.
Critics of Branstad's plan have said expanding Medicaid in Iowa would provide more services to a larger number of people. An estimated 150,000, including those on IowaCare, could be added to Medicaid rolls if the state expanded the program. The federal government would pick up all costs for three years, then 10 percent of expenses would gradually shift to the state. In contrast, IowaCare gets a lower federal reimbursement rate.
A growing number of Republican governors have proposed accepting federal funding to expand Medicaid to cover more low-income adults, a key part of the Obama administration's health care overhaul. New Jersey Gov. Chris Christie announced Tuesday that he supports expanding the program.
Branstad has clashed with Senate Democrats who support expanding Medicaid and have passed legislation to extend the coverage to more people out of a subcommittee. But Branstad noted that Medicaid costs and enrollment have grown in Iowa and said the program is unsustainable.
"Expanding Medicaid without any attention to the long-term funding at the federal and state level fails the people we intend to help," Branstad said.
Sen. Jack Hatch, D-Des Moines, said Tuesday that he continues to believe the state will expand Medicaid. Hatch also met with federal officials on Tuesday and said he has a meeting with Branstad scheduled for Wednesday.
"(New Jersey) Gov. Chris Christie has decided yes, (Wisconsin) Gov. Scott Walker. All those states have decided you can depend on the federal government. I think it would be inherently difficult for the governor to isolate himself," Hatch said.
Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities, said it wasn't clear if Branstad would get an IowaCare waiver. She noted that those enrollees could qualify for an expanded Medicaid.
"That's a million-dollar question. I think there are serious questions and there are legal questions about the role of waivers in providing coverage to this group that now is really considered a mandatory group in the meaning of Medicaid," Solomon said.