DES MOINES, Iowa (AP) --- As negotiations drag out in the state Capitol over how to best provide health coverage for low-income residents, some Iowans are starting to worry about what the debate means for their doctor visits.
Kyrie Borsay is one of about 66,000 residents enrolled in IowaCare, a limited benefit program funded by the state and federal governments and offered to people with low wages who don't qualify for Medicaid. She's heard conflicting information about what will happen to the program later this year.
"I am a little confused because I've heard different things from different doctors," said Borsay, 40, who lives in Waterloo and has been receiving IowaCare benefits for two years as she tries to get treatment for an undiagnosed chronic condition. "I'm not sure what's happening. I'm very concerned about that."
Just what is next for Borsay and others is unclear. State lawmakers have been arguing for months over how to approach health coverage for Iowa's low-income population. Democrats who control the state Senate favor the Medicaid expansion permitted under President Barack Obama's health care overhaul. But Gov. Terry Branstad and Republicans who hold a majority in the state House oppose the expansion and have proposed revamping IowaCare instead.
Rep. Walt Rogers, R-Cedar Falls, is leading the Republican effort to pass Branstad's plan, known as Healthy Iowa. He said he wants to make sure that Iowans have access to coverage, but he thinks Branstad's approach is better than a Medicaid expansion, which he argues would be too costly to the federal government and may not provide the best care.
"I'm resolute to make sure they're taken care of," said Rogers of the current IowaCare recipients. "I want a better plan, which is what Healthy Iowa is. On the other hand, I'm very concerned as are many in our caucus and nationwide, that the expansion of Medicaid is a serious issue for the country as a whole."
The Medicaid program in Iowa provides health care for more than 400,000 financially needy children, their parents and disabled people using state and federal dollars. The additional people on IowaCare are largely low-income adults. The IowaCare program is set to end on Oct. 31 under current state law. The proposals under debate in the Legislature would likely provide coverage to some of these people, but without resolution many could simply lose coverage.
"We absolutely have to address how we're going to provide insurance for people in this state who are working and just happen to work at low wage jobs and not have health insurance," said Senate President Pam Jochum, D-Dubuque. "We are under the gun, quite frankly."
Borsay, who said she has been happy with her doctors and treatment on IowaCare, said she is concerned she won't qualify for Medicaid, but won't be able to afford private insurance if the program goes away.
"I'm very nervous. I know change is hard for everyone. I'm very nervous for what would happen because I'm in that window of people that would not qualify," said Borsay, who is divorced with two children, one in college, and makes about $25,000 a year managing a bar. "I haven't had a final diagnosis yet."
Tim Albrecht, a spokesman for Gov. Terry Branstad, said in an emailed statement that the governor "will continue working to ensure that these individuals have options."
Branstad has proposed changing IowaCare into Healthy Iowa, a new program that would be paid for with state and federal funds. Healthy Iowa would provide coverage to an estimated 95,000 residents with incomes up to the poverty line. Those with incomes just above the poverty line would seek coverage on the new insurance markets, or exchanges, with the help of federal subsidies.
The state cost for Healthy Iowa is estimated at $162 million per year, with the funding coming from the state general fund, local property taxes and other sources. The state would need to get a federal waiver to put the plan in place. Participants would be responsible for contributions, though they could seek to reduce those through participating in health incentives or avoid the contributions due to hardships.
Democrats argue that expanding Medicaid would cost the state less and would provide better coverage to more people.
The Senate has passed a bill that would expand the Medicaid program in Iowa. An expansion to include those with incomes up to 138 percent of the poverty level would add an estimated 150,000 to the state's Medicaid rolls. Under Obama's health care overhaul, the federal government would pay the full cost for the new enrollees during the first three years of the expansion and then 10 percent of the cost would gradually be shifted to the state.