Federal and state lawmakers are proposing legislation and budget proposal that could affect Medicaid. IPR's Morning Edition host Meghan McKinney spoke to Health Reporter Natalie Krebs about what this could mean for Iowans.
What is Medicaid and how does it work in Iowa?
Medicaid is a program funded and run jointly by federal and state governments that gives health coverage to low-income and disabled people. States have flexibility on how they run it. About 700,000 Iowans are on Medicaid — or about 1 in 5 people, according to state data.
Former Gov. Terry Branstad privatized Iowa's Medicaid system. It’s run by the Iowa Department of Health and Human Services, which contracts with private health insurance companies, called managed care organizations, which are Iowa Total Care, Molina Healthcare of Iowa and Wellpoint Iowa to manage plans for the majority of Iowans on Medicaid.
Medicaid is different from Medicare. Medicare is a federal health coverage program that’s primarily for people ages 65 and older, but it's possible to be on both Medicaid and Medicare at the same time. For example, some low-income seniors qualify for both.
We hear a lot about Medicaid expansion. What is that?
Medicaid expansion is something offered to states by the federal government under the Affordable Care Act to expand their Medicaid eligibility coverage with the reason being to help lower the uninsured rate. Most states have adopted the expansion. Iowa did in 2014, but some states, like Wisconsin and Kansas, still haven’t.
Iowa’s Medicaid expansion program is called the Iowa Health and Wellness plan, and it covers adults who earn up to 133% of the federal poverty level, who wouldn’t otherwise qualify for the program. For a family of four, that’s $32,150 per year for this year. About 182,000 Iowans on Medicaid fall under the program, according to state data.
State lawmakers are proposing adding work requirements to Medicaid. What does this mean?
There are two bills making their way through the Legislature that would require certain Iowans on Medicaid under the expansion to prove they are working in order to remain on the program.
The current House bill requires at least 80 hours of work per month. The Senate bill doesn’t have a set requirement. But both allow exceptions for people who are under 19 or over 64, those certified to be unfit to work and those with dependent children, among others.
These Medicaid work requirements are very controversial, and they’re being pushed by Republican lawmakers like Gov. Kim Reynolds, who said during her Condition of the State address in January that "able-bodied Iowans" who receive government assistance should be required to participate in the work force.
"For the men and women who are receiving these government payments, getting back to work can be a lifeline to stability and self-sufficiency," she said.
However, Democrats say these work requirements will just create more administrative hurdles, causing vulnerable Iowans to lose their Medicaid coverage due to paperwork.
During a subcommittee hearing in February, Sen. Sarah Trone Garriott, D-West Des Moines, called it "a harmful piece of legislation."
"What we know it will do, based on what we’ve seen in other states, is it will result in loss of coverage, even for these protected and exempted populations," she said. "It will result in delays for everyone on Medicaid because that’s what’s happened in every other state that’s implemented a similar program."
Opponents say they’re also concerned because the bills require Iowa HHS to begin the process of discontinuing the state’s Medicaid expansion program, if the federal regulations don’t allow for Medicaid work requirements. This would affect thousands of Iowans’ health coverage.
We’re also hearing a lot about potential Medicaid cuts at the federal level. What’s going on?
House Republicans have proposed a budget plan that directs the House Energy and Commerce Committee to find ways to cut $880 billion from the national deficit in the next decade.
The Energy and Commerce Committee oversees Medicaid and Medicare. Republicans say they don’t want to touch Medicare — a program that's really popular with Americans — but that leaves the door open for cuts to Medicaid, which makes up 8.6% of the federal budget.
House Republicans say these proposed cuts aren’t specifically aimed at Medicaid. But experts say it will be impossible for the committee to reach that proposed budget goal without making drastic cuts to the program.
This could affect Iowa because most federal Medicaid dollars go to states, and Iowa lawmakers would need to figure out a way to make up those dollars. One way they could do that is by cutting Medicaid services.
