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.
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