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.

For months, I’ve been wondering if and when some Republican lawmakers would balk at supporting Governor Terry Branstad’s “costs more, covers less” alternative to expanding Medicaid in Iowa.

For the first time yesterday, an Iowa House Republican said he may not vote for Branstad’s plan. I doubt it’s a coincidence that the wavering lawmaker is unusually knowledgeable about health care services in Iowa.

Last week Governor Terry Branstad finally introduced legislation to enact his Healthy Iowa Plan instead of the Medicaid expansion foreseen under the 2010 federal health insurance reform law. Strangely, neither the governor’s office nor the Iowa House Republican caucus held a news conference or even posted a press release about House Study Bill 232. The bill arrived at the statehouse on Thursday, April 4, after many legislators had left for the weekend.

So far House and Senate Republicans appear united behind Branstad’s approach, while the governor’s office strives to counter the obvious case against his plan (costs more, covers less). I’ve posted arguments for both sides and other news links after the jump.

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.

What’s on your mind this weekend, Bleeding Heartland readers? This is an open thread.

Governor Terry Branstad didn’t draw the right lessons from Indiana’s experience when he proposed his Healthy Iowa Plan as an alternative to expanding Medicaid. Below I’ve posted excerpts from Laura Hermer’s recent commentary on the Healthy Indiana Plan.

Iowa’s top economic development official, Debi Durham, still can’t answer basic questions about why the state offered more than $100 million in tax incentives to a company that was going to build a fertilizer plant in Iowa anyway. Follow me after the jump for Durham’s non-responsive response on the Orascom deal during this week’s “Iowa Press” program.

Speaking of which, the Branstad administration is stonewalling Iowa Watchdog reporter Sheena Dooley’s efforts to obtain more information about the Orascom deal.

UPDATE: For the hundredth time, family budgets are not comparable to the federal budget. Plus, Michael Tomasky summarizes three basic principles of fiscal policy that should be conventional wisdom already: “Modest deficits are perfectly sustainable. Budget cutting, far from being ‘responsible,’ hurts the economy. And balanced budgets don’t create jobs-it’s the other way around.”

Iowa Senate Democrats offered Governor Terry Branstad a compromise this week to address his concerns that the federal government will not keep its promises to fund the Medicaid expansion provided under the 2010 health care reform law. Follow me after the jump for details on their latest offer and a cost comparison of Medicaid expansion and Branstad’s “Healthy Iowa Plan.”

It’s been a while since I posted about the 2016 Iowa caucus campaign. Wisconsin Governor Scott Walker agreed to headline the Polk County Republican Party’s spring fundraiser in May. According to Kevin Hall’s report for The Iowa Republican blog, Governor Terry Branstad helped make arrangements for Walker’s appearance. Like Branstad and unlike eight other GOP governors around the country, Walker opted against taking federal funding to expand Medicaid in his state.

Hall reports that retired insurance executive Cameron Sutton “played a key role in securing Scott Walker’s appearance” as well. Sutton was one of seven Iowa Republican donors from the business community who flew to New Jersey in May 2011 to urge Governor Chris Christie to run for president. (Christie’s star has fallen in Republican circles since he praised President Barack Obama’s handling of Hurricane Sandy and later agreed to expand Medicaid in New Jersey.) Sutton endorsed Newt Gingrich for president before the Iowa caucuses but wasn’t pleased with the way Gingrich bashed Mitt Romney during the GOP primaries.

Any comments about the next presidential campaign are welcome in this thread.

U.S. House Budget Committee Chair Paul Ryan presented his new federal budget blueprint today. As before, he would end Medicare as a single-payer system for all Americans under age 55, slash spending on programs for the poor such as food stamps and Medicaid, and cut taxes for some, though the details there are fuzzy. He would not cut the defense budget or Social Security. Ryan says his budget would be balanced in 10 years, but he relies on some assumptions that won’t happen, such as repeal of the 2010 health care reform law.

I’ve enclosed Iowa political reaction to the Ryan budget below and will update this post as needed.

Expanding Medicaid in Iowa would add nearly $2.2 billion to the state’s economy, create an estimated 2,362 jobs, and save state government about $1.6 billion, according to a new study. For now, Governor Terry Branstad is sticking to his alternative plan for covering some low-income Iowans, but Senator Tom Harkin predicted last week that federal officials will not approve a waiver for Branstad’s approach.

Follow me after the jump for details on those stories and more about Medicaid in Iowa. I’ve also enclosed a moving personal statement State Senator Mary Jo Wilhelm delivered today about Iowans who can’t afford health insurance.

Governor Terry Branstad announced his administration’s alternative to Medicaid expansion this morning at his regular weekly press conference. The “Healthy Iowa Plan” would cover approximately 89,000 Iowans with income below the federal poverty level. In contrast, Medicaid expansion would cover up to 150,000 Iowans with income below 133 percent of the poverty level.

Details on the new plan are after the jump. Early reaction from Senate President Pam Jochum suggests that the Iowa Senate will not be inclined to approve this proposal. I also question whether the U.S. Department of Health and Human Services will grant a waiver for Branstad’s plan. Federal officials have already denied requests from Branstad and other governors to allow a smaller Medicaid expansion than what the 2010 health care reform law provides.  

A Terrace Hill mystery: why doesn’t Governor Terry Branstad have more details to share about his proposed alternative to expanding Medicaid in Iowa?

Answer: Outside consultants are still working up a plan for him. CORRECTION: Branstad rolled out his “Healthy Iowa Plan” on March 4.

Cutting property taxes has long been a policy goal for Governor Terry Branstad, so why is he rejecting a path to save Iowa counties tens of millions of dollars a year on mental health services? As Tony Leys reported yesterday for the Des Moines Register, the Iowa Department of Human Services has estimated that expanding Medicaid as foreseen under the 2010 federal health care reform law would save counties between $27 million and $60 million each year.

This week New Jersey’s Chris Christie became the eighth Republican governor to recognize that only a chump would turn down 100 percent federal funding to provide Medicaid coverage to low-income constituents. But Governor Terry Branstad doubled down on his determination not to allow Medicaid to expand in Iowa.

While some advocates are hoping Republican legislators will help pass a Medicaid expansion bill by a veto-proof majority, that scenario appears extremely unlikely. A prolonged standoff between Branstad and Iowa Senate Democrats seems unavoidable.

Five years ago this week, I was hospitalized with an infection that might have become life-threatening or permanently debilitating had I not had health insurance coverage, which allowed me to receive a relatively early diagnosis. Every day in this country, uninsured people hunker down, hoping their health problem will go away without an expensive doctor’s visit. That’s one of many reasons studies have shown that expanding Medicaid saves lives.

Governor Terry Branstad sounds determined not to expand Medicaid, but none of his arguments can withstand scrutiny.

UPDATE: Branstad confirmed on February 23 that he will not agree to expand Medicaid. Added details and other related news below.

Do you want the good news first, or the bad news? President Barack Obama has reportedly settled on a strong candidate to replace Lisa Jackson as Environmental Protection Agency administrator. On the flip side, Steven Chu’s successor at the Department of Energy is likely to be a nuclear physicist with connections to major polluting industries. Details are after the jump. Still no word on the next secretary of transportation.

Florida Governor Rick Scott is the latest Republican governor to decide to expand Medicaid under the 2010 health care reform law. He was one of those leading the charge to have the law declared unconstitutional. Some comments from today’s press conference are after the jump as well. Arizona Governor Jan Brewer, Ohio Governor John Kasich and Michigan Governor Rick Snyder are all Republicans who opposed the Obama administration policy but have agreed to expand Medicaid in their states. I hope that when Iowa Governor Terry Branstad meets with U.S. Health and Human Services officials later this week, he will find some face-saving way to agree to expand Medicaid here. So far he sounds determined to resist the policy, despite the consensus of every major Iowa medical group as well as a wide array of religious and social justice organizations.

This is an open thread: all topics welcome.

Nine days from now, approximately 85 billion in federal spending cuts will go into effect unless Congress and President Barack Obama can agree on an alternative to the so-called “sequester.” After the jump I’ve posted details on how the spending cuts might affect Iowa, as well as recent comments and actions by some of the Iowans in Congress.

What’s on your mind this weekend, Bleeding Heartland readers? This is an open thread.

The Des Moines Register continues to release bits and pieces from the latest Iowa poll conducted by Selzer & Co. After the jump I’ve posted some of the more important findings, other than the IA-Sen numbers, which I discussed in this post. Like the Iowa .Gif-t Shop blog, I found it bizarre that the Register asked respondents whether they’d be “thrilled,” “mildly happy,” or “don’t really care” about the prospect of certain national retailers opening an Iowa store.

Iowans support expanding Medicaid as provided under the 2010 health care reform law by more than a two to one margin, according to a new poll commissioned by the American Cancer Society Cancer Action Network, which supports the policy.

Forty years ago today, the U.S. Supreme Court announced its decision in Roe v Wade. Any relevant comments are welcome in this thread. I’ve posted many links about abortion rights and availability below.  

What’s on your mind this long weekend, Bleeding Heartland readers? This is an open thread. I posted some links below to get a conversation going.

UPDATE: Scroll down for excerpts from the inaugural speech and some reaction from Iowa political figures.

The Iowa House and Senate began their 2013 session yesterday with the usual welcoming speeches from legislative leaders and the ritual of choosing desks for each lawmaker in the chambers. Judging from this photo, returning legislators get first dibs.

As was the case in 2012, social issues like abortion and same-sex marriage were absent from the opening-day speeches. Republican leaders emphasized the need to cut both property and income taxes. Iowa House Speaker Kraig Paulsen also claimed credit on behalf of Republicans for Iowa’s improving fiscal condition. House Majority Leader Linda Upmeyer spent a fair amount of time criticizing Congress before calling for state action to improve education and cut taxes. House Speaker Pro Tem Steve Olson repeated some themes of last year’s election campaign and quoted U.S. Senator Marco Rubio of Florida. Similarly, Senate Minority Leader Bill Dix concentrated on tax reforms.

Senate Majority Leader Mike Gronstal focused on education and workforce training programs to address “Iowa’s skill shortage.” Senate President Pam Jochum focused on health-related issues: improve mental health services, helping elderly people stay in their own homes, and expanding Medicaid, which she described as “the biggest opportunity for this session to make a positive difference for Iowans.” Iowa House Minority Leader Kevin McCarthy emphasized the need for bipartisan work on a range of issues: education, mental health care delivery, the transition to a new maximum security prison, and protecting natural resources.

Follow me after the jump for excerpts from the opening-day speeches by legislative leaders (as prepared for delivery). I included the full text of Jochum’s remarks, because her personal journey says a lot about who she is. Jochum also paid a lovely tribute to former Republican State Senator Pat Ward, who died last year.  

Last week Iowa Governor Terry Branstad confirmed that Iowa will pursue a “partnership” health insurance exchange next year, rather than setting up its own insurance exchange for implementing the 2010 health care reform law, or letting the federal government set up an exchange for Iowa.

In addition, the governor again signaled that he is against the now-optional Medicaid expansion for states, because he believes it would become too expensive for Iowa in the future.

Links and recent news about health care reform in Iowa are after the jump.

Medicaid coverage of abortion has been a contentious issue in the Iowa legislature since 2011 and will be on lawmakers’ agenda during next year’s session. I was surprised to learn that Iowa is already more restrictive than most other states when it comes to Medicaid coverage of abortion in cases of rape.

Medicare and alleged “job-killing” policies are the focus of the latest television commercials from Representative Dave Loebsack and his GOP challenger John Archer. Meanwhile, the National Republican Congressional Committee is taking cheap shots over a committee hearing Loebsack attended three and a half years ago.

Videos and transcripts of the latest television commercials in Iowa’s second Congressional district are after the jump. Bleeding Heartland covered previous ads from this race here, here, and here.

U.S. Health and Human Services Secretary Kathleen Sebelius, a former governor of Kansas, made clear last week that the Obama administration will work with governors who are reluctant to expand Medicaid eligibility in their states.

A bidding war between Iowa and Illinois ended yesterday, as an Egyptian company’s representative stood with Governor Terry Branstad to announce plans for a $1.4 billion fertilizer plant in Lee County. A package of state, federal, and local tax incentives worth hundreds of millions of dollars will support the project, costing taxpayers more than $1 million for each of the 165 permanent jobs created.

Voting for the so-called “failed stimulus” has become a stock phrase in Republican attack ads against Congressional Democrats. But as Bleeding Heartland has discussed many times before, the “Great Recession” would have been more devastating without the 2009 American Recovery and Reinvestment Act.

State budget cuts are a huge drag on the economy. Follow me after the jump for a picture that’s worth a thousand words on how a favorite conservative punching bag helped soften the recession’s impact in Iowa.

The Iowa Hospital Association’s board has “unanimously agreed that expanding Medicaid in Iowa is the appropriate public health policy for Iowa.” After the jump I’ve posted the full text of the association’s policy brief explaining why Medicaid expansion would be good for Iowa individuals, businesses, and the state as a whole.

Governor Terry Branstad issued two new executive orders last week. One directive rescinded 12 executive orders issued between 1998 and 2009, including two that were intended to make state government operate more efficiently. Branstad’s other order granted “stakeholder groups” new levers for blocking potentially “burdensome” administrative rules.

Highlights from the new and the disappeared executive orders are after the jump.

Governor Terry Branstad confirmed yesterday that his administration will not take steps to limit Medicaid funding of abortions without further action by the Iowa legislature.

Republican presidential candidate Mitt Romney announced his running mate this morning: Representative Paul Ryan of Wisconsin, the chair of the U.S. House Budget Committee. The two men are launching a four-day bus tour today. I don’t know what surprises me more: Romney not choosing Senator Marco Rubio of Florida, or Ryan’s willingness to give up his committee chairmanship for a shot at the vice presidency.

Democratic House incumbents and challengers have already been running against the Ryan budget. Iowa’s representatives split on party lines when the House approved this plan in April 2011, and Representative Leonard Boswell was eager to draw this contrast between himself and IA-03 opponent Representative Tom Latham. Having Ryan on the Republican ticket ensures that tax and budget issues will be at the center of the presidential campaign discourse this fall. Ryan’s approach to solving the long-term deficit problem asks virtually nothing of wealthy people but would devastate Medicaid, not to mention the Medicare program for future retirees. After the jump I’ve posted excerpts from a new report on the Ryan plan’s impact on state budgets, along the Iowa Policy Project’s comment on how the Ryan budget would affect Iowa in particular.

Any relevant comments are welcome in this thread. I will update this post with Iowa reaction and more news and links after the jump. Representative Steve King was enthusiastic about the pick.

Opposing all government funding for abortion is settled dogma among Iowa Republican activists and elected officials. For two years in a row, Senate Democrats have blocked attempts to write new restrictions on Medicaid abortion coverage into the budget for the state Department of Human Services. Now DHS Director Chuck Palmer has signaled that taking control of the upper chamber may not give Republicans the power to restrict the choices of low-income women.

Palmer’s action puts Governor Terry Branstad in an awkward position, and a legislature completely under GOP control could create a political nightmare for Branstad, a proud “pro-lifer” throughout his career.

Roughly 150,000 people, or about 5 percent of Iowa’s population, will not receive Medicaid coverage under the 2010 federal health insurance law if Governor Terry Branstad gets his way. The governor repeated yesterday that he does not intend to go along with the Medicaid expansion, because he doesn’t believe the federal government should or will provide the promised funding to cover the cost.

Congressional Republicans including Representative Steve King are urging governors to reject other aspects of the Affordable Care Act, such as the state-based health insurance exchanges. Branstad has not yet decided whether to take that route. More details on these stories and other fallout from last Thursday’s U.S. Supreme Court ruling are after the jump.  

The U.S. Supreme Court today upheld the constitutionality of the 2010 Affordable Care and Patient Protection Act, better known as health care reform. I am shocked not only by the decision, but by the 5-4 breakdown with Chief Justice John Roberts (not Justice Anthony Kennedy) being the swing vote in favor of upholding the law. Most commentators and the betting site Intrade thought the court would strike down at least the individual mandate to purchase health insurance, if not the whole law. To her credit, Linda Greenhouse of the New York Times consistently predicted that Roberts would vote to uphold the law.

Any comments related to health care reform are welcome in this thread. I will update this post frequently during the day as Iowa elected officials, candidates, and activist groups weigh in on the decision.  

Cedar Rapids resident Katie Beckett passed away last week, prompting many tributes to the woman whose fluke childhood illness helped change federal policy on caring for the disabled.  

Yesterday the U.S. House approved a bill to require additional Congressional Budget Office analysis on legislation with a large price tag. The concept is intended to reduce the apparent cost of tax cuts to the federal budget. Iowa’s representatives split on party lines over this bill and proposed amendments, including one offered by Democrat Leonard Boswell (IA-03).

Iowa’s current fiscal year ends on June 30, which gives Governor Terry Branstad, Republican leaders in the Iowa House and Democratic leaders in the Iowa Senate just ten days to approve a 2012 budget without disrupting state government operations. Although the parties have settled on a total spending target for the next fiscal year, they are still at odds over funding for key programs. They appear to have made no progress toward a compromise on commercial property tax reform, which Branstad demands as part of any final budget deal.

Lots of links on spending priorities, rival tax proposals and government shutdown scenarios are after the jump.

UPDATE: Scroll to the end for further details Senate Democrats released on June 20 regarding a budget compromise.

The U.S. Senate rejected motions to proceed with considering four draft budgets for the 2012 fiscal year yesterday. Democratic leaders scheduled the vote primarily to get Republicans on the record supporting the budget that passed the Republican-controlled House of Representatives last month. That blueprint, also known as Paul Ryan’s budget, foresees big changes to the Medicare program and became a central issue in Tuesday’s special election in New York’s 26th Congressional district.

Senator Chuck Grassley voted for two out of the three Republican proposals on the table, including the Ryan budget, while Senator Tom Harkin voted against all three GOP budgets as well as President Barack Obama’s budget blueprint.

Details on the votes and proposals are after the jump.

Governor-elect Terry Branstad announced today that ophthalmologist Dr. Mariannette Miller-Meeks will run the Iowa Department of Public Health in his administration. A press release noted that Miller-Meeks “has served as the first woman President of the Iowa Medical Society and was the first [woman] on the faculty in the Department of Ophthalmology at the University of Iowa and councilor for Iowa to the American Academy of Ophthalmology.” Miller-Meeks was the Republican nominee in Iowa’s second Congressional district in 2008 and 2010. She worked hard during both campaigns but lost to Dave Loebsack in Iowa’s most Democratic-leaning Congressional district.

Also on December 9, Branstad announced that he will tap Chuck Palmer to head the Department of Human Services in his administration. Palmer did that job during Branstad’s previous time as governor from 1989 to 1999. Most recently he has been president of Iowans for Social and Economic Development, “an asset development organization with the mission of creating opportunities for low and moderate income Iowans to increase income and achieve financial stability.”

Branstad has pledged to reduce the size of state government by 15 percent, and keeping that promise would likely require significant cuts in the departments Miller-Meeks and Palmer will be running. The current budget (fiscal year 2011) allocated $935.5 million from the general fund to health and human services. That’s 17.7 percent of the general fund budget alone, or 15.9 percent of total state expenditures, including federal stimulus money and reserve funds as well as general fund spending. More than $200 million in federal stimulus money supported Iowa’s Medicaid budget in the current budget year, but similar support won’t be forthcoming in future years now that Republicans have a majority in the U.S. House of Representatives.

Branstad administration press releases on Miller-Meeks and Palmer are after the jump.

When Congress passed $26 billion in fiscal aid to the states, including $96.5 million in education funding and $128 million in Medicaid assistance for Iowa, Republican gubernatorial candidate Terry Branstad avoided commenting on the issue. Scott Keyes of Think Progress was in Iowa recently and got Branstad to speak on the record about the issue. Click the link for the audio and the full transcript. Excerpt:

[Think Progress]: They just passed that big state aid bill out in Washington. I was curious how you felt about that.

BRANSTAD: I have real concerns because there’s strings attached to that. And it’s one-time money, so it doesn’t solve the problem, it just puts it off a year. And it increases the federal debt. I don’t think they should have done it. I’m not sure, we’ve got to see what the strings are and whether or not we should even accept it or not.

Branstad added that he was against the 2009 stimulus bill and wasn’t sure whether he would accept or reject stimulus funding for Iowa.

Perhaps Branstad has never heard of economic cycles. Congress approved the stimulus bill when the U.S. was in the middle of the worst recession since World War II, and state revenues were dropping at the sharpest rate seen in 60 years. Although the recession is technically over, and state revenues are increasing in Iowa, shortfalls are still projected in key social services.

Branstad says federal assistance “doesn’t solve the problem, it just puts it off a year.” But if the economy continues to improve, state budgets will be under less strain in the 2012 fiscal year. Branstad would rather give up an additional $96.5 million for Iowa schools during the current fiscal year, which would cost approximately 1,800 teachers’ jobs. He would rather do without an extra $128 million for Medicaid, and I doubt he’ll offer an alternative budget showing how he would meet the need for those services. Branstad can’t explain how he would have balanced the current-year budget without stimulus funds, just like he can’t explain how he would pay for his new spending promises.

Branstad is wrong about the $26 billion fiscal aid bill adding to the federal deficit, by the way. The Congressional Budget Office confirmed that the bill’s costs are fully offset by closing tax loopholes and various spending cuts.