DES MOINES — An Iowa House panel considering expanding access to health care for low-income Iowans was advised to be bold.

“Set the bar high,” AARP lobbyist Anthony Carroll told a House Appropriations Subcommittee on Wednesday afternoon. Whatever plans the legislature adopts, it should at least be equal to the Medicaid expansion that is part of the federal Affordable Care Act. “Then let’s figure out how to get there.”

For most of the speakers at the 90-minute hearing, the quickest and easiest route there was through Senate File 296, a plan approved by the Democrat-controlled Senate.

Lobbyists did not whole-heartedly endorse Senate File 296, but were significantly less supportive of Gov. Terry Branstad’s alternative, House Study Bill 232, the Healthy Iowa Plan.

Iowa Medical Society lobbyist Kate Walton noted that Medicaid reimbursement is inadequate, but the organization supports expansion because of the benefit to patients.

The society has reservations about both plans. The Senate measure would put 600,000 people into medical homes by 2015. That’s unworkable, she said. There are only 500 Iowa providers signed up to provide medical homes and only seven are successfully billing Medicaid.

In regard to House Study Bill 232, the society believes it would be “administratively burdensome” to collect the $3 per visit co-pay from low-income Iowans, Walton said.

Greg Boattenhamer, lobbyist for the Iowa Hospital Association, said adopting the federally financed Medicaid expansion would give the state “great latitude” in addressing some of the governor’s concerns such as personal accountability and improving outcomes.

Medicaid is unlikely to approve a program requiring the House bill's requirements that low-income Iowans pay premiums and co-pays, he said. However, those components may be allowed under a state Medicaid expansion plan.

Although the hospital association sees Medicaid expansion as being extremely flexible, House Republicans see it as being extremely restrictive, Rep. Linda Miller, R-Bettendorf, said.

“That’s why we are not eager to embrace it,” the chairwoman of the House Human Resources Committee said. “We don’t know what we would be embracing.”

For Linda Hinton, Iowa State Association of Counties lobbyist, the concern was the $43 million in county mental health property tax dollars HSB 232 would scoop.

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“Those dollars are part of the linchpin of what we are doing with mental health redesign,” she said, referring to another priority of the legislature.

Access to health care a basic human right and SF 292 extends it to more Iowans, according to lobbyists for the Catholic and Methodist conferences.

Medicaid expansion should be considered economic development, added Sarah Eide, a lobbyist for Mercy Health Network. Health providers have taken cuts in reimbursement and without Medicaid expansion, she said, “it will cost jobs around the state.”

“Going forward, look at this as an economic engine,” Eide said.

Subcommittee Chairman Walt Rogers, R-Cedar Falls, plans to have another meeting after a House Appropriations Committee public hearing at 5:30 p.m. April 16 in the House Chamber. Speakers will have three minutes or may submit written testimony at with “Testimony” in the subject line.


I'm the city editor at the Quad-City Times. You can reach me at or 563-383-2450.