Medicaid Expansion is the Wrong Direction for Iowa



DSCN0410We’ve heard a lot of discussions about the federal Affordable Care Act since it was proposed nearly four years ago. Preliminary reports indicated it would provide affordable healthcare to all Americans. Iowans and Americans are now being told their insurance premiums are rising.

The same folks who passed this legislation are now continuing their push toward universal healthcare by asking the states to do their part by expanding the Medicaid program. This has been a topic of conversation at the Iowa Statehouse and it has generated concerns among my constituents who are sharing their thoughts about the federal government’s request of Iowa and the other 49 states.

Iowa’s hospitals are being saddled with unpaid debt accumulated from patients who receive care and are unable or choose not to pay their bills. I comprehend the situation our hospitals are experiencing in bad debt. I have received numerous phones calls, emails and personal contacts from the hospital officials in my district sharing this information. In some cases, that bad debt exceeds one million dollars.

Let me share my concerns about the federal government’s request to expand Medicaid. First of all our government is $16 trillion in debt. For states electing to expand Medicaid, it isn’t as easy as saying, “sure, we’re in.” The risky expansion of Medicaid comes with promises of additional money only if conditions are met.  I believe those funds could be very uncertain as the federal government struggles with its own spending issues. The reason for my skepticism is due to how the federal government has reimbursed the state in the past 10 years. Since fiscal year 2004, the federal reimbursement rate has dropped from 63.82 to 58.35 percent, which is a funding decrease of 5.47 percent.

Iowa’s expansion of Medicaid would include growing the enrollment by an additional 150,000 Iowans at a projected cost up to $537 million through 2020. Proponents see the Medicaid expansion as free federal money with few strings attached; rather, it is an unsustainable program with massive costs, few measurable outcomes, and no new solutions for making Iowans healthier.

Here is the question I ask of you: would you keep taking your car to a mechanic who fails to fix your vehicle properly the first, second, third and even eleventh time. Probably not, right? The last thing you want to do is spend your hard-earned money on something you know could come to a screeching halt in a matter of seconds, minutes or days. That is how I view the federal government’s specific strings-attached proposition.

I truly believe there are more affordable and better options to give all Iowans the healthcare they deserve with the overhaul of the IowaCares program, which is currently in place to help low-income Iowans receive healthcare. I would propose the state reimburse local hospitals when qualified low-income Iowans receive care. There are less than a handful of IowaCares facilities and expanding the number that provide care could be a significant first step in insuring low-income Iowans.  Expanding IowaCares seems more reasonable instead of throwing millions of taxpayer dollars into a system that is currently flawed and its funding future uncertain from the federal government. Instead of just jumping in to say, “sure, we’re in,” it might behoove us to bring our hospital administrators, physicians, legislators and interested parties to discuss this further to address any potential problems with this expansion.

Returning to the analogy with your car, let me pose one last question to you. Would you pay your mechanic a monthly retainer in the event your car breaks down or are you more likely to pay when it stops working properly? This is something I am continuing to look into and research with folks in my district.

Photo Credit: Sarah Brooks

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