Governor Terry Branstad announced Monday he would replace the current Iowa Care Plan with a new plan he called The Healthy Iowa Plan, for low-income Iowans. Iowa Care expires at the end of the year. The governor's proposal provides coverage for uninsured Iowans making below the current federal poverty line, which for a family of four is $23,550. Senate Democrats, including Jack Hatch, of Des Moines, who might run against the governor in the 2014 election, prefers an expansion of the state's Medicaid that would raise the threshold for that family of four to $31,322.
Branstad said, "Medicaid is where welfare reform was in the 90's. It's a broken system. It's unaffordable. It's unsustainable. We need to come up with a new model."
The governor's plan would cover about 89,000 Iowans. Hatch's idea would cover about 150,000 Iowans by raising the income eligibility requirements. Hatch said of the governor's plan, "He wants all of us to have personal responsibility. But one of the reasons poor people can't afford health care is they can't afford it. It's not because they don't want to take care of it or wouldn't want to do that."
Branstad said the Medicaid expansion relies too much on the promise that the federal government would follow through with its financial commitment to the coverage, which he doubts because of the country's massive debt. Branstad said with his plan Iowans would "have skin in the game", requiring them to pay something, perhaps a minimal monthly premium that an aide said could be $5 a month toward their coverage. But he would allow them the chance to lower their costs if they focus more on preventative care, such as taking health risk assessments to monitor things like blood pressure and weight. Branstad recalled a story former Minnesota Governor Tim Pawlenty would tell. He said, "It's like going to a wedding where you have an open bar versus a cash bar. There's going to be a lot more liquor consumed with an open bar."
Senator Mary Jo Wilhelm, a Cresco Democrat, took offense to the governor's comment. Wilhelm said on a senate floor, "Governor Branstad, I think you need to apologize. You need to apologize for the comment you made this morning about expanding Medicaid and providing health insurance to tens of thousands of working Iowans. This morning, you compared helping people get health care when they need it to having an open bar or a cash bar at a wedding. That statement is just so wrong, I don’t know where to start."