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DSCN0404The state of Iowa is facing a very big decision. Should we opt-in to Affordable Care Act and face mountains of rules and regulations and the possibility that the federal government will not be able to follow through on their promise of funding. Should Iowa stay independent and follow through on its promise to deliver Medicaid to citizens and demand better health outcomes.

Currently, states are asked to opt-in to the system, essentially expanding Medicaid, enrolling more people and becoming dependent on the federal government for additional funding. This buy-in would cost billions and mandate that states meet many requirements for years to come. Expanding this program and being dependent upon the federal government is not a sound financial decision. We simply cannot count on the federal government to fulfill its promise.

Proponents will say that the benefit of the expansion is that the federal government will pay 100% of cost for the newly eligible person for the first three years. After that, the federal government will cover up to 90% for newly eligible persons. It is doubtful that the federal government will be able to uphold this promise. They are bankrupt. Federal government revenue totals around $12.5 trillion and expenditures total around $13.8 trillion. In order to balance the budget, the feds would have to cut around $1.3 trillion out of the budget. With a $1.3 trillion deficit and $16.4 trillion debt, it is hard to believe that they will be able to keep a commitment to fund Medicaid let alone the additional expansion costs. Any federal cuts to Medicaid will mean additional spending requirements for Iowa and make future funding commitments is next to impossible.

It is not reasonable to Iowans to continue to expand a system and to saddle the hard-working taxpayers with the ongoing expense. Iowans deserve a health care system that works for them and helps them become healthier. We should be working to fix the system and work to have a system with measurable outcomes before we choose to expand a program by nearly 150,000 people.

Photo by Sarah Brooks

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