Under the Golden Dome, Too – Week Eleven

Upmeyer UTGD

Much discussion has been had in recent months about our country’s health care system and particularly about the topic of Medicaid expansion.  Many proponents of expanding Medicaid in Iowa will lead you to believe that there will be no increased cost to Iowans by expanding the program.  They will say the federal government will cover the cost of Medicaid expansion; therefore no additional costs will be charged to individual states.  The fact is the cost of funding Medicaid services in Iowa already increases year after year, with or without expanding this program.

Iowa currently has 400,000 people enrolled in Medicaid and the number of individuals who qualify under the program’s current requirements continues to grow each year.  It is estimated that in FY 14 the cost to our state will be $1.2 billion- an increase of $88.5 million over last year.  Since 2000, Medicaid enrollment has gone up 88% and Medicaid expenditures are up 226%.

The Affordable Care Act gives states the option of expanding their Medicaid programs to enroll individuals earning up to 138 percent of the federal poverty level.  In Iowa, this would add approximately 150,000 individuals to the program.  The federal government claims they will pay 100% of the cost for the expanded population for three years.  After three years, the federal share will decrease.

With so much uncertainty regarding funding at the federal level, I have concern that it may not be wise to enter into an agreement that relies so heavily upon federal funding.  If the woes of the federal government continue, we will end up promising benefits that we will not be able to provide.

Both sides of the aisle can agree that the current system is broken and a solution is needed.  Somewhere along the way, we stopped talking about the quality and value of health care services, and instead simply started talking about expansion.

We need an Iowa-based solution that makes sense for our unique state.  Iowans receiving Medicaid services are being treated for the same chronic diseases and medical issues over and over, while Iowa taxpayers continue to pay for it.  At the same time, the recipients are not getting healthier.  We must have an outcomes-driven program in Iowa in order to have any hope of containing costs and making Medicaid recipients healthier.

The Governor’s Healthy Iowa Plan has three goals.  The first is to improve the quality of care for Medicaid recipients.  His plan provides a benefits package similar to private care that includes both inpatient and outpatient services, prevention services, prescription drugs, home health, durable medical equipment, therapies, and transportation for emergencies.

The next goal is to lower the costs of services.  The Governor’s Healthy Iowa plan would reward healthy behavior mechanisms that have worked in other states and the private sector to encourage members to be cost-conscious consumers of health care.  We must each be responsible for our own health.

The final goal of the Healthy Iowa plan is to make Iowans healthier.  The plan will reward patients for improving their overall health and wellness and will also reward health care providers for helping to make Iowans healthier.

We need to be focused on an Iowa-based solution that best serves the needs of Iowans- a solution based in Iowa, not with decisions made in D.C.

Thank you for providing me with your feedback over the past few weeks.  It is always great to hear from you and I strongly value your input.  Do not hesitate to contact me with your thoughts and concerns anytime at linda.upmeyer@legis.iowa.gov or 515-281-4618.