DES MOINES — The federal government’s mixed response to Iowa’s request for a waiver on the new Iowa Health and Wellness Plan drew mixed reviews from state lawmakers Wednesday.

House Speaker Kraig Paulsen, R-Hiawatha, said it’s unclear what Iowa’s next step should be after federal officials approved most of Iowa’s bipartisan plan but balked at letting the state collect premiums from Iowa participants who live at or below the poverty line.

“This is the agreement we came to, and I think on the whole it serves the state very well, and it’s the plan we need to implement,” Paulsen told reporters at a legislative forum. “I don’t know how they can, in good conscience, back us into a corner. I mean, we’re 16 days from the end of the year, and they’re going to cause trouble on it. I just think, in general, that’s bad form.”

Rather than appeal the federal ruling, Senate Democratic Leader Mike Gronstal of Council Bluffs said he thinks Iowa officials should “declare victory” and move forward with the plan approved last legislative session to expand the number of Iowans eligible for Medicaid.

“I think we’re clearly in a position where we can expand access to affordable health care coverage to 150,000 Iowans,” Gronstal said. “I think it’s worth taking the deal. It wasn’t the whole nine yards, but it was about 8.9 yards. It was most of what we asked for.”

Gov. Terry Branstad, speaking on his monthly radio call-in show, said his administration continues to negotiate with federal officials, and he remains hopeful a waiver for Iowa’s entire plan will get approved.

“I’m still hopeful it will get worked out,” Branstad said. “I think it was premature for them to put that out. We’re very close, and we’re very optimistic that in the very near future we will get the waiver we’ve been working on since last spring.”

Wednesday’s approval, which came from the federal Centers for Medicare and Medicaid Services, would extend Medicaid to eligible Iowans who make up to 100 percent of poverty, or about $11,500 per year for an individual.

Meanwhile, those who make up to 138 percent of poverty, or about $15,900 a year, would get private insurance through the Affordable Care Act's marketplace. Their premiums would be paid for by the government.

The waiver approval also allows Iowa to move ahead on an initiative aimed at encouraging healthier behaviors, and it would let the state charge a fee to people who make more than 100 percent of the poverty line.

The Iowa proposal had asked for approval to charge about a 3 percent premium on people who made more than 50 percent of the federal poverty line.

That fee, which would have amounted to about 3 percent of income, would be waived if participants engaged in certain healthy behaviors.

The administration's decision gave approval for a fee to be charged only on those above the poverty line.

The state has 30 days to agree with the decision or propose an alternative.

“The conversation has been productive, and we’re optimistic that there is a clear path, including premium contributions promoting health behaviors without loss of coverage in accordance with Iowa law,” Branstad said. “We’re working in good faith to resolve this.”

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