Letter to the Editor

Guest Commentary: Medicaid expansion assures access to health care

Saturday, May 4, 2013

A recent poll showed 90 percent of Iowans believe every person in the state should have access to preventive health care like year check-ups, screenings and immunizations. But for thousands of low-income Iowans, routine health care with a family physician is financially out of reach because they are uninsured.

So they let their health care go until it is so far gone that they need emergency treatment, which they also can't pay for. For the hospital, the cost of that trip to the emergency department becomes charity or uncompensated care that, one way or another, we all pay for.

The best way to resolve this situation is to insure as many Iowans as possible. Insurance is the key; it's how our health care system works. And that's why Iowa hospitals, including Spencer Hospital, support expanding Iowa Medicaid program to provide coverage for more low-income Iowans.

Like nine out of 10 Iowans, we believe Governor Branstad understands that more Iowans need access to health care and that insuring them is the best way to do it. This is why he has proposed his Healthy Iowa Plan.

But the governor's plan falls short of what can be accomplished with Medicaid expansion. The Healthy Iowa Plan will insure fewer people, cost more money and will probably force some people to go to doctors and hospitals far from their hometowns.

The governor's plan will cover only Iowans who make about $11,500 a year or less, while Medicaid expansion will insure Iowans who make up to about $15,000. Under the governor's plan, anyone making that salary would be provided a limited subsidy to help pay for an insurance policy. Everyone under the plan will have to pay deductibles or co-payments and it's not yet clear if these will be affordable for people at such low incomes.

The governor would pay for part of his plan using state income and property tax dollars. And even though he and others who are against expansion say they are wary of taking federal funds, the Healthy Iowa Plan requires more than $225 million from Washington, D.C.

Medicaid expansion would be fully paid for by the federal government for the first three years. After that, the state of Iowa would pay a small part, beginning with 5 percent in 2017, but never more than 10 percent (beginning in 2020). Iowa's share under the governor's plan will be 42 percent from Day One.

The Healthy Iowa Plan requires physicians and hospitals to be part of an "Accountable Care Organization" (ACO) to serve patients in the plan. ACOs are designed to help better coordinate care and bring down costs, so, conceptually, they are a good idea. Many Iowa hospitals are evaluating ACOs, but few actually exist and it's not clear just what the governor's plan expects from these ACOs.

However, one thing is clear: if you are on the plan and your local hospital or physician doesn't meet the plan's requirements, you will have to travel to find a hospital or physician that does. In this way, the Healthy Iowa Plan is similar to IowaCare, the much-maligned plan we have today that forces patients to drive to Des Moines or Iowa City for hospital care.

Many other details of the governor's plan are unknown, but perhaps the greatest unknown is whether or not the federal government would approve it. If not, even more Iowans will be uninsured.

We do know the details of Medicaid expansion. We know it will provide a good insurance package to Iowans who need it, as it has for decades. We know expansion will save county governments as much as $60 million in property taxes for mental health services.

Finally, we know most Iowans support Medicaid expansion because it will insure as many people as possible in a way that is financially reasonable and sustainable.

This letter is in response to the commentary of Gov. Terry Branstad which appeared in the April 27 edition of the Spencer Daily Reporter

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