Iowa Senate approves Medicaid expansion along party lines

Last night the Iowa Senate approved Senate File 296, a bill to expand Medicaid, on a strictly party-line vote of 26 to 23. You can listen to the entire Senate debate (approximately 90 minutes) at Radio Iowa. I’ve posted highlights from the debate after the jump, along with the full list of 52 organizations that have registered their support for Senate File 296. Some corporations and organizations have have registered their lobbyists as undecided on Senate File 296, but at this writing, not a single organization is registered against the Medicaid expansion.

Senate President Pam Jochum’s opening remarks are on YouTube. She emphasized that Democrats have addressed some of Governor Terry Branstad’s concerns by adding more accountability to the Medicaid program and by giving Iowa a chance to opt out of the expansion in the future if the federal government does not meet its funding commitments.

Here’s my partial transcript of Jochum’s opening remarks:

Senate File 296 has many provisions that the governor’s office and the Senate agree on. For example, we agree to focus on wellness and prevention. We agree to move away from fee for service. We agree to pay health providers to keep people healthy and change our health care system to a system of wellness rather than a system of sickness. We agree. We agree.

Senate File 296 includes the governor’s innovation grant language. We, like the governor, believe in an integrated system, and we agree that moving to outcome-based Medicaid is the way to go. […]

So here’s a brief summary of the bill before us. It allows working Iowans between the ages of 19 and 64 to enroll in the Medicaid program if their incomes are below 138 percent of the federal poverty level. […] This is what it means. These are Iowans who, if they are single, are earning 15,800 dollars [annually]. Or if you are a family of four, you are living on 32,400 dollars a year or less. That’s who we’re talking about. They aren’t people who are trying to game the system. They are our neighbors and friends, and they have a face.

Democratic Senator Chris Brase spoke from his experience working as a paramedic with people who resist going to the hospital. You can view Brase’s floor remarks on YouTube. Here’s my partial transcript, beginning around the 0:50 mark:

As most of you are aware, my full-time job is I’m a firefighter/paramedic for the city of Muscatine. We talk about the working poor, we talk about the uninsured.

From my vision, these are my patients. Patients that I get called into their homes because their medical condition got to the point that it’s a crisis, and the only option that they have is the emergency room.

And I hear time and time again, people telling me they don’t want to go to the emergency room. They can’t afford it. “I don’t have insurance.”

And I have to look at them and respect that they do have that concern […] But I also know through my diagnostics that we do, the treatments that we do, these people need to go [to the hospital]. They need to go be seen because of worse conditions.

Hopefully we can get them to an ER, they can get treated where there’s not a long-term disability, or a long-term cost to them.

This is not the way to treat our citizens of Iowa. We have an opportunity to help all these people get basic health insurance, to get ongoing care, to be able to see a physician on a regular basis without traveling 50 or 60 miles or waiting eight to ten weeks for an appointment.

As I mentioned above, all 23 Republicans who were present last night voted against expanding Medicaid. O.Kay Henderson posted highlights from their remarks at Radio Iowa.

Senator Jack Whitver, a Republican from Ankeny, said he shares the governor’s fear that the federal government will fail to fulfill its promise to pay the bills.

“We need a solution that is best for Iowa and the care of our citizens,” Whitver said, “not a one-size-fits-all federal entitlement program that is unsustainable and is bankrupting both the federal government and many states.”

Whitver ignores the fact that Branstad’s Healthy Iowa Plan would involve substantial federal funding too. And I wish some Republican would explain why they’re not concerned about the more than $6 billion Iowa already receives from the federal government every year for various programs.

Several Republicans, including Mark Segebart and David Johnson, urged senators not to vote to expand Medicaid until more details are available about Branstad’s plan. Senate Majority Leader Mike Gronstal’s response was excellent.

Senate Democratic Leader Mike Gronstal of Council Bluffs said legislators have been waiting nine months for Branstad to produce details.

“The governor will leave out 65,000 Iowans – we do have one detail,” Gronstal said. “I’m pretty sure if that’s where we end up, that will not be our finest hour.”

Another detail we already know should be a deal-breaker too: unlike Medicaid, Branstad’s Healthy Iowa Plan will not cover mental health care.

Any relevant comments are welcome in this thread. Here’s the latest list of 52 organizations registered in support of Senate File 296.


AFSCME IA Council 61

Alliance for Residential Treatment Services

Alzheimers Association Greater Iowa Chapter

American Cancer Society Cancer Action Network

Brain Injury Alliance of Iowa


Child and Family Policy Center

Community Health Charities of Iowa

Des Moines University

Epilepsy Foundation

Eyerly Ball CMH Services

Family Planning Council of Iowa

Genesis Health System

HCI Care Services

Hospice and Palliative Care Association

Iowa Alliance in Home Care

Iowa Alliance of Community Mental Health Centers

Iowa Annual Conference of United Methodist Church

Iowa Association for Marriage and Family Therapy

Iowa Association of Area Agencies on Aging

Iowa Association of Community Providers

Iowa Behavioral Health Association (IBHA)

Iowa CareGivers Association

Iowa Catholic Conference

Iowa Chronic Care Consortium

Iowa Citizens for Community Improvement Action Fund

Iowa Federation of Labor, AFL-CIO

Iowa Hospital Association

Iowa Medical Group Management Association

Iowa Mental Health Counselors Association

Iowa Nurses Association

Iowa Primary Care Association

Iowa Psychiatric Society

Iowa Psychological Association

Iowa State Association of Counties

Iowa State Association of County Supervisors

League of United Latin American Citizens LULAC

League of Women Voters of Iowa

Leukemia & Lymphoma Society

Linn County Board of Supervisors

March of Dimes Iowa Chapter

Mercy Health Network

National Association of Social Workers, Iowa Chapter

National Multiple Sclerosis Society-Upper Midwest Chapter

Orchard Place

Planned Parenthood of the Heartland

Polk County – Board of Supervisors

Polk County Medical Society

South Central Iowa Federation of Labor AFL-CIO

Urban County Coalition

Visiting Nurse Services of Iowa

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