GOP Governor Wins Waiver To Expand Access To Obamacare

Iowa gets approval for privatized Medicaid expansion

Iowa Gov. Terry Branstad is an ardent defender of the Renewable Fuel Standard.
National Journal
Sam Baker
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Sam Baker
Dec. 10, 2013, 10:16 a.m.

The Obama ad­min­is­tra­tion signed off Tues­day on a Re­pub­lic­an gov­ernor’s pro­pos­al for ac­cept­ing the Af­ford­able Care Act’s Medi­caid ex­pan­sion.

Iowa Gov. Terry Bran­stad won ap­prov­al for a plan to es­sen­tially privat­ize the health care law’s Medi­caid ex­pan­sion. Iow­ans eli­gible for ex­pan­ded Medi­caid pro­gram will be covered by private in­sur­ance sold through the state’s ex­change.

Iowa is the second state to win ap­prov­al for a privat­ized Medi­caid ex­pan­sion. The first was Arkan­sas, where Demo­crat­ic Gov. Mike Beebe faced res­ist­ance from the GOP-con­trolled state le­gis­lature. Former Pres­id­ent Bill Clin­ton has re­peatedly talked up the private mod­el as a way to ex­pand cov­er­age even in states that are re­luct­ant to im­ple­ment Obama­care.

Un­der the waiver the Cen­ters for Medi­care and Medi­caid Ser­vices ap­proved for Iowa, the fed­er­al gov­ern­ment will ini­tially pay the full cost of the ex­pan­sion — as it would for tra­di­tion­al Medi­caid. The fed­er­al con­tri­bu­tion gradu­ally falls to 90 per­cent.

People eli­gible for the Medi­caid ex­pan­sion — those with in­comes between 100 and 133 per­cent of the fed­er­al poverty line — are covered, but with private plans sold through the ex­change, rather than tra­di­tion­al Medi­caid. CMS said the private op­tion would give Iowa more flex­ib­il­ity to ex­per­i­ment with struc­tur­al Medi­caid re­forms.

“Iowa has pi­on­eered in­nov­at­ive, state-based solu­tions for Medi­caid ex­pan­sion, and we are pleased to grant this waiver,” CMS Ad­min­is­trat­or Mar­ilyn Taven­ner said in a state­ment. “CMS stands ready to work with oth­er states to ex­plore op­tions that aim to im­prove care and lower costs in the Medi­caid pro­gram.”

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