Lingering question about Iowa Medicaid expansion debate answered?

During the past year, Republican governors have been split on expanding Medicaid as foreseen under the 2010 Affordable Care and Patient Protection Act. The U.S. Supreme Court made Medicaid expansion optional for states in its decision upholding most of the health care reform law. More than a dozen GOP governors were happy to opt out, but many prominent state leaders came around to supporting the Medicaid expansion, including Chris Christie of New Jersey, John Kasich of Ohio, Susana Martinez of New Mexico, Rick Snyder of Michigan, and even Jan Brewer of Arizona. Kasich has emphasized the moral imperative to give the poor better access to health care. Snyder has made a more pragmatic case, citing the over-use of emergency rooms by the uninsured and the burden that uncompensated hospital care places on businesses and insured individuals. Christie emphasized cost savings to New Jersey taxpayers.

Despite Governor Terry Branstad's posturing against the health care reform law before and after the Supreme Court's ruling, I figured he would eventually come around like Snyder and Christie did. Branstad used to be president of a medical school in Des Moines, so I thought he would be influenced by the Iowa Hospital Association's case for Medicaid expansion. I expected him to return from a meeting with U.S. Health and Human Services Secretary Kathleen Sebelius saying he had negotiated a great deal for Iowa on Medicaid.

Instead, Branstad stuck to his guns throughout the 2013 legislative session, insisting on a more costly alternative that would cover fewer Iowans. I suspect that he promised to sign the final compromise only because Iowa Senate Democrats appeared unwilling to approve commercial property tax changes or education reform without a deal to expand health care access to low-income Iowans.

Branstad's not a policy wonk. He's always been strongly influenced by other people's advice. So one question in my mind was, who kept telling him to ignore the Iowa Hospital Association, county officials and many other health care organizations and advocacy groups, which lobbied for Medicaid expansion?

This week Iowans may have gotten the answer.

Yesterday the Des Moines-based lobbying and public relations group LS2 announced that Branstad's former chief of staff Jeff Boeyink was joining the firm.

"Jeff's talent, knowledge, and experience will add tremendous value to our clients' efforts," LS2 Partner Joe Shannahan said in a statement. "Our expanded bipartisan team will continue to offer high quality solutions to clients for their public affairs relations, public, government affairs, and marketing needs."

Boeyink spent most of his adult life lobbying for the conservative advocacy group Iowans for Tax Relief, so no one will be surprised that he left the governor's office for a job in "government affairs" (the politically correct term for lobbying). Here's an excerpt from Boeyink's bio on the LS2 website:

Jeff also served as Governor Branstad's chief policy advisor and his key successes in this area include:   (1) the largest property tax cut in the state's history (for all classes of property) and reform of the commercial property tax; (2) landmark educational reform that, at its center, provides for a new teacher-leadership career ladder that rewards outstanding teachers for taking on expanded leadership roles in their schools that will work to boost student educational performance; and (3) a new modern health care delivery system for Iowa's poor that promotes healthy activity and health outcomes.

We'll see how well the Healthy Iowa Plan works as "modern health care delivery system for Iowa's poor." It's better than leaving people without health insurance, but will probably turn out to be less efficient than adding tens of thousands of additional people to the Medicaid program.

Whether low-income Iowans are well-served or not, Boeyink and his new employer will always be able to tout the law's passage as a "key success." Being a lobbyist means never having to say you're sorry.

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