Dear Iowa Legislators, Branstad Plan Is Just Plain Dumb

medicaid-rallyThis is an open letter to my legislator, Tom Sands. Mr. Sands is a banker in Columbus Junction.

There have been two competing versions of Medicaid Expansion passed in the Iowa legislature. The one passed in the Senate is the one offered by the Affordable Care Act. The version passed in the House is one that was created by Gov. Branstad. There are major differences between the two, both in coverage and in financing for the program.

I am not going to pretend that I am an expert. You should have had many of those already lay out the differences between the programs for you. But the differences are stark, and easy to understand even for a common person like me.

On the one side, the Affordable Care Act offers to pick up almost everyone who is caught in between in the current system – not covered at work or don’t have enough to buy their own, yet have too much money to be covered under the current Medicaid system. Under the Branstad system, only about half of these folks are covered. And then those covered would have to pay a co-pay that they would not under the ACA. This co-pay would act as a great deterrent to seeking medical care. We want people to seek medical care early in a disease for a couple of reasons – first is that the earlier a person is seen, the cheaper it is to treat and second is a question of public health – we want to encourage Typhoid Mary to seek medical help before the plague has a chance to start.

The ACA offers to pay the whole freight for the first couple years and then to lower its share to 90% of the whole cost and never lower than that. One of the big criticisms is that we can’t depend on the federal government for that money. However, we have depended on the federal government for Medicaid for 50 years and they haven’t failed yet. As a matter of fact the only times we have had problems with federal funding is when Republicans have changed policies. The best example is Ronald Reagan pulling revenue sharing.

In the Branstad model we have a strange mish-mash of revenue sources. The main source is that same federal government you claim you can’t trust. So maybe you trust them a little bit? Other money would be taken from the U of Iowa Hospitals. I can’t tell you how nonsensical this sounds. We want the hospital to service people and yet we cut their funding. Then the public will be making up those funds in higher insurance payments to cover bills for those who are not covered. WHY NOT JUST COVER THEM TO BEGIN WITH? One more source of money would be to access the 99 counties property tax accounts. So counties will have to cut services to cover something that could have been paid by the federal government.

So in essence, we will still be paying federal taxes for the ACA plan and getting nearly nothing back while at the same time looking at possible tax raises, raises in insurance premiums and cuts in services to pay for the Branstad plan? That seems kind of – well – dumb.

You have said that the ACA is WELFARE! Well if the ACA is welfare, then so is the Branstad plan. One is much more streamlined and cost-effective and delivers services at an earlier part of the course of illness or accident. The Branstad plan uses its money in a very ineffective way covering far fewer citizens, places barriers to access which may have a potential great effect on public health and simply costs much more. For a banker, the choice should be easy.

One other argument I have heard is that this is a moral question. I guess that is because the perception that someone is getting something for nothing is deemed immoral by some. Maybe you can enlighten me on that. From what I know of religions and ethics, most every school of such philosophy I have ever heard of condemns allowing people to suffer and die when help could have been offered. Especially allowing people to suffer and die when a plan is available that could answer most of the those situations. Especially when that suffering happens amidst plenty and the the help is simply withheld.

If you were to chart the pluses and minuses side by side, one could easily see that the ACA is by far the best buy for our state and its uninsured. Viewing without the filter of party ideologies, I think you can easily see that Medicaid Expansion through the ACA is also the most thorough approach to covering our uninsured.

I view this as a public health issue. I want Typhoid Mary treated before the plague breaks out. I don’t want her to wait until she is in the emergency room burning up after having contact with 100 others.

And as a moral issue, well Jesus didn’t ignore anyone because they couldn’t pay, did he?

About Dave Bradley

retired in West Liberty
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