Iowa House barely approves alternative to Medicaid expansion

Last night the Iowa House approved by 51 votes to 49 a version of Governor Terry Branstad’s alternative to expanding Medicaid. Two Republicans opposed the plan, but State Representative Dave Heaton fell in line despite his major doubts about the bill.

Details on the vote and highlights from the debate are after the jump.

Branstad’s Healthy Iowa Plan was introduced to the legislature a few weeks ago as House Study Bill 232, but instead of moving that legislation, House leaders opted to amend Senate File 296, the Medicaid expansion bill state senators approved in March on a party-line vote. A new House bill would have been rejected by the Iowa Senate, so passing a House version of Senate File 296 was the fastest way to get this legislation to a conference committee.

During last night’s session, House Republicans approved the House Appropriations Committee amendment replacing all text in the Medicaid expansion bill with language about the Healthy Iowa Plan. You can read that amendment here (H-1373). You can find details on the House debate in the House Journal (pdf).

A couple of minor changes to the Appropriations Committee amendment passed overwhelmingly, but the vote to substitute the Healthy Iowa Plan language for the Senate’s Medicaid expansion language barely passed, 51 to 49. Republicans Josh Byrnes and Brian Moore joined all 47 House Democrats to vote no. Just one day after warning that the governor’s plan was full of problems, House Health and Human Services Appropriations Subcommittee Chair Dave Heaton gave GOP leaders the 51st vote they needed to approve the Healthy Iowa Plan.

The subsequent vote on final passage reflected the same 51 to 49 split, with Byrnes and Moore joining the 47 Democrats. It’s not the first time Byrnes has moved away from his own party’s orthodoxy. Moore represents the most Democratic Iowa House seat currently in GOP hands. At last count, registered Democrats outnumbered Republicans in House district 58 by more than 3,000.

Republican State Representative Walt Rogers, floor manager of the Healthy Iowa Plan bill, asserted during last night’s debate,

“It’s important for us to embrace the Healthy Iowa Plan, […] “It’s a good plan, and it counters what we’ve seen in Medicaid for years. Medicaid is devouring budgets, nationwide and state budgets.”

Rogers was unable to explain one small problem: not only does the Healthy Iowa Plan require more funding from state and local governments, covering about 89,000 people through the Healthy Iowa Plan would also cost the federal government more than simply expanding Medicaid to cover up to 150,000 additional people.

No wonder Democratic State Representative John Forbes said last night,

“The math doesn’t work for me,” said Rep. John Forbes, D-Urbandale and a pharmacist who said he’s spent much of his career serving Medicaid patients. “I think if I took this Healthy Iowa business plan model to my banker, he’d probably just laugh at me and throw it in the garbage.”

The math doesn’t work for Republican Heaton either, but he decided to put aside his misgivings in order to improve the plan in conference committee negotiations.

“I’m going to vote for this bill today so that we can get together with the senate and sit down and figure a better bill,” Heaton said, “to correct some of the things that I think are wrong with it and I think a lot of the people in this room think is wrong with it.”

Heaton faults the governor’s plan for creating waiting lists for health care services and using $85.5 million in property taxes to help pay for the coverage.

I believe Heaton made a tactical error. Joining Byrnes, Moore, and the House Democrats to reject this bill would have made clear that Branstad’s plan is a non-starter. Then the discussion would have shifted to finding a way to amend the Medicaid expansion bill to address some additional Republican concerns. Senators have already added language about wellness and prevention and given Iowa an “out” in case the federal government doesn’t meet its Medicaid funding obligations.

There are lots of ways to tweak a Medicaid expansion bill, but no real middle ground between expanding Medicaid and doing something completely different. The House and Senate conference committee will waste additional time arguing about whether to expand Medicaid, with Republicans invested in something they can call “our own.”

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