Journal Express, Knoxville, IA


February 1, 2013

Taxes, Medicaid and Heart Health


Des Moines —


Another hot topic right now is the expansion of Medicaid.  Currently, ten states have decided not to implement Medicaid Expansion, while five other states are leaning against it.  Fourteen states are implementing Medicaid Expansion, with four states leaning toward expansion.  Seventeen states are undecided.  This split shows that many states are struggling with a critically important decision that will impact their state’s budget for years to come.  I’m aware of the news media influencing Americans with reasons Medicaid Expansion is the way to go.  The purpose of my comments is to consider the other side of the coin. 


First, there are no take backs.  Studies show that states almost never rescind Medicaid coverage once it is implemented.  If Iowa expands Medicaid, the estimates are that 150,000 additional people would be covered.  In a state that has seen the old Medicaid program grow 50% in the last 12 years, a decision to cover an additional 150,000 lives should not be taken lightly.


Further, we are dealing with a Federal Government that is flat out BROKE.  Given this, it seems unwise to enter into the agreement that Medicaid is primarily funded in federal dollars.  Not too long ago, when our own state’s budget was in a financial pinch, Governor Culver implemented a 10% across the board cut in our state’s budget.  If the US Government did the same, Iowa’s 6 billion dollar handout would be reduced by $600 million dollars.  That is pretty significant to our state budget, which brings me to my next point.


Nationally, Medicaid has eclipsed K-12 as the largest single share of total state spending.  Medicaid would have to rise significantly to do that in Iowa, but the point is that every state dollar that is spent on Medicaid Expansion is one less dollar for other programs in the state budget.  Many folks also want the state budget to include allowable growth for schools and funding of our crumbling infrastructure.  The problem is that the pot of money is only so big.  We can’t guestimate how much Medicaid will truly impact our budget; therefore we will either need to reduce benefits elsewhere or raise taxes to keep the state fully funded.  Neither choice is a popular one!   

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