Branstad, federal officials reach agreement on Medicaid expansion alternative

Governor Terry Branstad announced today that his administration and officials in the U.S. Department of Health and Human Services have struck a deal over the Iowa Health and Wellness Plan, our state’s alternative to a straightforward Medicaid expansion. Earlier this week, federal officials approved most of the proposal but rejected a provision that would have kicked some low-income Iowans off the plan if they failed to pay monthly premiums. Under the tentative agreement, Iowa would still be able to charge premiums to some people who did not meet wellness criteria, but those people would not lose coverage for not paying the premiums. A statement released by the governor’s office is after the jump.

Branstad had the option of appealing the HHS decision, and Iowa House Speaker Kraig Paulsen suggested yesterday that Iowa officials should fight for the whole plan state legislators approved in May. Iowa Senate Majority Leader Mike Gronstal argued that the governor should “take the deal” federal officials approved: “It wasn’t the whole nine yards, but it was about 8.9 yards. It was most of what we asked for.” Commenting on this evening’s news, Senate President Pam Jochum said, “Hallelujah. Amen. […] I can’t imagine the governor would have wanted to be held responsible for 55,000-plus people losing coverage come Jan. 1.”

Any relevant comments are welcome in this thread. Charging even small health insurance premiums to people making less than $11,000 a year is stupid in my opinion, but this compromise is better than no coverage for tens of thousands of Iowans.

P.S.- Can’t help noticing how just like the messaging from his re-election campaign, the governor’s press releases invariably mention Lieutenant Governor Kim Reynolds whenever possible. I doubt she played any role in these negotiations or the governor’s decision not to appeal the HHS decision on the Iowa Health and Wellness Plan.

UPDATE: Added comments from Representative Bruce Braley (D, IA-01) below. Last week he wrote to Health and Human Services Secretary Kathleen Sebelius urging the federal government to approve a waiver for Iowa.

Governor’s press release, December 12:

Gov. Branstad and Lt. Gov. Reynolds Reach Agreement with Federal Officials for Approval of Bi-Partisan Iowa Health and Wellness Plan

December 12, 2013

(DES MOINES) – Gov. Terry Branstad and Lt. Governor Kim Reynolds have reached agreement with United States Department of Health and Human Services (HHS) officials for approval of the bi-partisan Iowa Health and Wellness Plan.

The HHS December 10th approval establishes the terms and conditions allowing Iowa to move forward, with the addition, by agreement, of premium contributions promoting healthy behaviors, without loss of coverage, for certain Iowa Health and Wellness Plan members in accordance with Iowa law.

Branstad was enthusiastic, saying, “This is an Iowa plan that fits the health needs of our state. The Iowa Health and Wellness Plan will improve health outcomes for Iowans. I am pleased we reached agreement with the Federal Government on our unique alternative approach and we are ready to move forward to serve Iowans.”

Eventually, more than 150,000 Iowans will be served by this innovative plan that includes incentives for members who complete Healthy Behaviors, such as a physical or health risk assessment. The Iowa Health and Wellness Plan will focus on quality in health care with health care professionals receiving incentive payments for addressing the quality of outcomes and overall health of the plan population. With the inclusion of premium assistance for members above the Federal Poverty Level, more Iowans will receive private insurance as an option.

Reynolds touted Iowa’s readiness, “More than 55,000 Iowans have already signed up for the Iowa Health and Wellness Plan. This waiver agreement allows Iowa to move forward in improving the health and wellness of our state while respecting the law that passed with bi-partisan support.”

The specific final terms of the agreement are being worked out between the state and HHS.

Press release from Bruce Braley’s office, December 12 (emphasis in original):


Washington, D.C. – Rep. Bruce Braley (IA-01) today released the following statement after news broke that Iowa and the US Department of Health and Human Services had reached an agreement on a waiver application to implement the Iowa Health and Wellness Plan:

“Working together is the Iowa way, and I’m glad to see an agreement has been reached to implement the Iowa Health and Wellness Plan. The governor and the legislature crossed the party divide to ensure that as many as 150,000 Iowans can be insured under this plan. It’s a common sense approach that will improve the health of Iowans and help reduce healthcare costs.  This agreement is an important step forward for Iowa.”

On December 5, after meeting with Governor Branstad, Braley wrote HHS Secretary Kathleen Sebelius to call on her to approve Iowa’s Health and Wellness Plan waiver request. More information can be found at the following link:

Press release from Braley on December 5 (emphasis in original):

After meeting with Gov. Branstad, Braley sends letter to push for the approval of Iowa’s new low-income health insurance program

Washington, DC – After meeting with Iowa Governor Terry Branstad today, Rep. Bruce Braley (IA-01) sent a letter to the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius calling on her to approve Iowa’s Health and Wellness Plan waiver (IHWP). Iowa’s program is different from traditional Medicaid, requiring special approval from HHS.

Braley said, “Governor Branstad and the Iowa legislature crossed the party divide to improve health care access, coverage and quality. Working together is the Iowa way.

“The administration needs to approve Iowa’s waiver request so as many as 150,000 Iowans can receive health insurance. This is a common sense approach that will improve the health of Iowans and help to reduce healthcare costs. I’m committed to working with Governor Branstad to do everything we need to in order to get this wavier approved. It’s the final step needed to give thousands of Iowans the peace of mind they need that they will have access to health insurance beginning next month.”

Earlier this year, Branstad, the Iowa legislature, and Iowa stakeholders worked together to establish the Iowa Health and Wellness Plan, Iowa’s approach to expand Medicaid coverage for up to 150,000 Iowans.

Iowans making up to $11,500 a year would qualify for a new type of insurance similar to Iowa’s current Medicaid program. Those making between $11,500 and $16,000 would purchase private insurance policies on the state’s insurance marketplace and the government would pay the cost of their premiums.

Many of those eligible for the IHWP are currently on the IowaCare health insurance program, which expires at the end of the year.

Braley and Branstad met today in Washington, DC, where in addition to discussing the need for the wavier approval, they talked about Braley’s Hire a Hero Act, legislation to make permanent the Work Opportunity Tax Credit for Returning Heroes and Wounded Warriors, as well as the Renewable Fuel Standard and its impact on the Iowa economy.

Full text of the letter follows; a copy can be downloaded at the following link: http://1.usa.gov/193Ummm

December 5, 2013

Honorable Kathleen Sebelius

Secretary

Department of Health & Human Services

200 Independence Avenue, SW

Washington, DC 20201

Dear Secretary Sebelius,

I’m writing to express my concern over the delay in receiving formal approval for the State of Iowa’s Health and Wellness Plan waivers.

The Iowa Health and Wellness Plan is the result of a deliberative, bipartisan process by the Iowa Legislature and Governor Terry Branstad.  The Governor, the Legislature and Iowa stakeholders worked together to accomplish shared goals in a way that reflects the core principles of improving health care for Iowans while addressing costs.

Under the Plan, as many as 150,000 Iowans could receive health coverage, and more than 60,000 are already signed up and anxious for their coverage to begin on January 1, 2014. The Plan represents an opportunity for many Iowans to increase coverage, improve their health, and ultimately bring down health care costs.

I’m proud of the work that we’ve done in Iowa, across party lines, to improve health care access, coverage and quality. One of the final steps is for the Department of Health & Human Services to approve the Plan, and give Iowans peace of mind that they will have quality health care beginning January 1, 2014. Time is running short, the need for action is great, and I urge you to promptly approve this request from the State of Iowa.

Thank you for your assistance in this matter.

Sincerely,

Bruce Braley

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