Capitol Comments

This week I wanted to keep my communication squarely focused on this week’s most important topic, Medicaid Expansion. In addition, I wanted to share the positive data on Iowa preschool programs found in research by Early Childhood Iowa.

Below is a compilation of information on Medicaid and IowaCare from our Democratic research analysts at the Capitol:

Branstad Continues Opposition to Affordable Health Care

After a meeting in Washington D.C. earlier this week with federal officials, Governor Branstad is still opposed to an expansion of affordable health care for 150,000 Iowans. Hundreds of Iowans also gathered here at the Capitol this week to urge the Governor and legislators to expand health care this year.

Due to changes at the federal level, every state has the option to expand Medicaid and provide access to affordable health care for an estimated 150,000 working Iowans. The federal government will pay for the expansion at 100% for the first three years and then pick up no less than 90% of the costs after that.

Instead, the Governor wants to continue the IowaCare program, which is Iowa’s health care program for low-income Iowans who don’t have private health insurance. Under the Governor’s plan, 8,900 Iowans who now have health care would lose it, over 90,000 Iowans still would not be able to get health care, and Iowa taxpayers would pay over $200 million in the next three years alone.

According to a recent non-partisan poll, nearly 60% of all Iowans support expanding health care to cover uninsured and underinsured adults who do not have private health insurance. A coalition of 50 different groups, like Iowa hospitals, the American Cancer Society, and AARP are encouraging lawmakers and the Governor to expand Medicaid.

Only available to US citizens, Medicaid helps children who need to go to the doctor, people with disabilities, pregnant women, and seniors who need in-home care to stay in their home longer or nursing home care. If Iowa expands Medicaid, working adults with no insurance making less than $15,414 a year would now have access to quality, affordable health care.

A committee in the Iowa Senate approved a bill to expand Medicaid this week.

Background Medicaid

Medicaid provides medically necessary health care coverage to low income Iowans who fit into a certain category. Generally, this includes needy children, parents with children, people with disabilities, elderly people, and pregnant women. Medicaid is also only available to U.S. citizens. As of January 2013, 402,450 people are on Medicaid in Iowa. Currently, 69% of the cost of Medicaid comes from 27% of the enrollees. This is due to the high cost of long-term care. In addition under Medicaid, the federal government covers 58% of the costs, and Iowa pays for 42% of the total Medicaid costs.

Medicaid Expansion

Under the federal Affordable Care Act, Iowa is in a position to expand the program to cover all lower income adults. As a result, all Iowans making less than 138% of the Federal Poverty Level will qualify. This means a single, childless adult making less than $15,414 a year would qualify for Medicaid under Medicaid Expansion. For a family of four, the annual income limit would be $31,809. Many adults who fall in this category are working and underinsured or uninsured. If Iowa chooses to expand Medicaid, the categories for qualifying will be eliminated.

Medicaid Expansion would cover an estimated additional 100,000 to 150,000 Iowans from now through 2020. According to the Department of Human Services contractor’s report, Iowa is estimated to save some money the first couple of years on Medicaid. In addition, the same report says Medicaid Expansion will cost Iowa an estimated $117 million to $536 million of additional state funding over the same time period. However, other national non-partisan reports estimate Iowa’s cost for Medicaid Expansion will save Iowa more money and the cost is significantly less. The federal government will pick up over 100% of the costs for the new enrollees for the first few years. Then the match rate will gradually decrease to 90% by 2020.

Support for Medicaid Expansion

There is broad support for the Medicaid Expansion. According to a recent poll by the American Cancer Society Cancer Action Network, nearly 60% of Iowan adults support expanding Medicaid to cover uninsured and underinsured adults in Iowa. Only 27% of those polled, opposed Medicaid Expansion. In addition, according to the Iowa Hospital Association, Iowa hospitals provide more than $600 million in uncompensated care, mainly from services provided to individuals who would qualify for Medicaid Expansion. This money is recouped by the hospitals in some ways, including increasing the costs on to Iowans with health insurance. On January 29, 2013, 48 groups from across Iowa released a statement in support of Medicaid Expansion. This included providers, consumer and patient advocates, and faith groups.

In addition, Republican Governors in Arizona, New Mexico, North Dakota, Nevada, Ohio, Florida, Michigan, and New Jersey have come out in support of Medicaid Expansion. It was an opportunity to help those in need and one that could not be passed up.

Options for Iowa

The Legislature has some options to cover the Iowans eligible for Medicaid Expansion. House File 83 has been introduced which implements Medicaid Expansion. Another option is to extend IowaCare, but it is not the preferred option for many advocates. IowaCare is a limited benefit plan for adults in Iowa below $22,340 with nearly 65,000 members. The Legislature will have to decide the future of IowaCare and the members of the program. The majority of IowaCare members will qualify for Medicaid under the expansion. It is possible that IowaCare will be extended past this year, yet Iowa will have to pay a larger share of the cost of the program than expanding Medicaid. If Iowa lets the IowaCare program expire and does not expand the Medicaid program, then 60,000 Iowans will lose their health insurance.

Services Covered under IowaCare program

• Prenatal Care
• Yearly physicals
• Limited inpatient and outpatient hospital care
• Some dental services, if available at medical home
• Primary care services at assigned medical home
• Smoking cessation
• Transportation

Services NOT Covered under IowaCare

Iowa DOT launched limited “TransitCare” to provide low cost public transportation

• Mental Health Care
• Prescription Drugs
• Home Health Services
• Medical Equipment & Supplies
• Rehabilitative or other services at any non-IowaCare provider

Governor Branstad favors an extension of the IowaCare waiver that will provide coverage up to 100% FPL. That would leave at least 8,900 IowaCare members without health insurance. These individuals could find coverage from the health care exchange, but it will be a lot more expensive than Medicaid. In addition, the Governor would like to require monthly contributions, copays, and deductibles which would be waived if preventative services are completed. The schedule for the waiver process is the following:

May 30, 2013 – Complete waiver submission

June 1, 2013 – Public notice and comment period begins

July 1, 2013 – Submit application to the federal government (expect six months of negotiations)

December 31, 2013 – Current IowaCare waiver expires (needs Iowa Legislature approval to extend to this date from October 31, 2013)

January 1, 2014 – Extension of IowaCare waiver begins (if approved by the federal government)

Groups that Support Medicaid Expansion

AARPAmerican Cancer Society Cancer Action NetworkAFSCME American Heart Association AMOS (A Mid-Iowa Organizing Strategy) Brain Injury Alliance of Iowa) CAFE Iowa CAN) CHAIN (Community HVI/Hepatitis Advocates of Iowa Network) Community Health Charities Iowa Communications Workers of America Iowa State Council Easter Seals Iowa Epilepsy Foundation of Iowa Every Child Counts (Child and Family Policy Center Initiative) HCI Care Services (formerly Hospice of Central Iowa) Hospice & Palliative Care Association of Iowa Iowa Alliance for Retired Americans Iowa Alliance in Home Care Iowa Annual Conference of the United Methodist Church Iowa Association of Area Agencies on Aging Iowa Care Givers Association Iowa Catholic Conference Iowa Citizen Action Network (ICAN) Iowa Community Action Association

Iowa Developmental Disabilities CouncilIowa Federation of Labor, AFL-CIOIowa Hospital Association Iowa Human Needs Advocates Iowa Medical Society Iowa Mental Health Planning Council Iowa Nurses Association Iowa Occupational Therapy Association Iowa Olmstead Consumer Task Force Iowa Public Health Association Iowa Primary Care Association Iowa Psychological Association Iowa Statewide Independent Living Council League of Women Voters of Iowa Leukemia and Lymphoma Society, Iowa Chapter Mercy Health Network NAMI (National Alliance on Mental Illness) Greater Des Moines National Association of Social Workers, Iowa Chapter National Multiple Sclerosis Society, Upper Midwest Chapter Polk County Progressive Action for the Common Good Progress Iowa Results (The Power to End Poverty) South Central Iowa Federation of Labor, AFL-CIO Visiting Nurse Services of Iowa

 

For more information, the Iowa Hospital Association, which supports Medicaid Expansion, has developed more in-depth position papers. They can be found at: http://www.ihaonline.org/imis15/IHAOnline/Issues/Issue_Areas/Medicaid.aspx

I will be supporting Medicaid Expansion in Iowa and look forward to the opportunity to vote for it in this session of the Iowa House.

Representative Art Staed

 

 

 

 

 

 

 

 

 

 

 

 

 

Research Shows Postive Effects of Preschool

With legislators considering an expansion of early childhood education this year, lawmakers received more research showing the positive effects of preschool for 3 and 4 year-old children from Early Childhood Iowa. Some of the highlights of the research include:

• Studies show that a universal, high-quality preschool program would increase the employment rates of state residents by 1.3%.
• A high-quality pre-kindergarten program that served both 3 and 4-year-olds would yield relatively quick budgetary savings and would begin to pay for itself through reduced special education costs and reduced juvenile justice costs.
• Within 42 years, the total benefits of such a program, including reduced crime rates, higher income earnings by participants, higher tax revenues, savings from reduced grade retention and special education usage, would outweigh costs by a ratio of 8.4 to 1.

Snapshot of Iowans in Poverty

The Education Appropriations Subcommittee also heard an update on the rising level of poverty and how that impacts Iowa children.

• 20% of Iowa kids that are ages 0-5 are living in 100% poverty, while 44% of those kids live in 200% poverty.
• The number of single parents and parent work involvement has risen sharply over past decades. The percent of single mothers in Iowa grew from 7% in 1970, to 34% in 2010.
• Iowa has one of the highest shares of young children with both parents in the workforce (74%).
• 21% of Iowa children four months to five years are at moderate or high risk of development, behavioral, or social delays. This results in 50% of Iowa kindergartners starting behind in at least one area of special need.

Read More from the Iowa House

To read the rest of the Statehouse News go to: http://iowahouse.org/StatehouseNews/3-1-13.html