Lawmakers credited for role in Iowa health deal

After months of partisan bickering seemed to have stalled negotiations on how to provide low-income healthcare in Iowa, two no-nonsense lawmakers from northern Iowa are credited with figuring out a compromise.

Democratic Sen. Amanda Ragan, of Mason City, and Republican House Majority Leader Linda Upmeyer, of Clear Lake, led talks to develop the healthcare plan that won passage in the Legislature before lawmakers adjourned Thursday. The last-minute deal was viewed as a major breakthrough because there had been much speculation that the Legislature would have to return in a special session to deal with the contentious issue.

Both said their longstanding relationship helped pave the way. Less than a week before adjournment, they quietly began seeking a middle ground between the Senate Democrats' proposal to expand Medicaid and the alternate plan from House Republicans and Gov. Terry Branstad to expand an existing health program instead.

"I ventured over and said how can we do what we do and get this done," Ragan said. "We have a relationship. We have a trust relationship. So that didn't have to be established."

The middle ground? The state will seek the federal funding provided to states that expand Medicaid under President Barack Obama's healthcare overhaul. That funding will be used to provide health coverage for as many as 150,000 low-income residents by putting some on a new state-run plan and to pay the premiums for others to get private insurance on the new healthcare exchanges. The state will need federal approval before the plan can be implemented.

"We just never gave up. We just kept working," said Upmeyer.

Lawmakers in both chambers hailed the plan as something everyone could live with.

"I think it's miraculous that this happened," said Sen. Joe Bolkcom, D-Iowa City, who was part of the negotiations, as were Senate President Pam Jochum, D-Dubuque and Rep. Walt Rogers, R-Cedar Falls. "I can't think of any other people that could have opened the door and stayed at the table and worked things through."

Ragan and Upmeyer downplayed their efforts and stressed that other members were part of the process. They said a long relationship and a familiarity with a part of the state that struggles with healthcare access and a can-do attitude kept them focused.

Both have been representing overlapping districts for more than a decade, with Upmeyer in her 11th year in office and Ragan her 12th, and they have attended the same public forums and local festivities. They also both have worked in health and social services. Ragan runs two nonprofits and Upmeyer is a qualified nurse practitioner. And they agreed the current limited benefit program that caters to poor childless adults, known as IowaCare, needed to be changed.

"The delivery system up here has been a problem," said Ragan. "We probably had a familiarity with how the program had impacted the folks in our area. We do know how many folks are impacted."

Upmeyer agreed the state needed to reform IowaCare.

"There was a very large number of people that wanted to do something to provide a much better plan than what we have today with IowaCare. We all agreed that didn't work," Upmeyer said.

In the compromise deal, the Democrats got the federal funding they sought. If approved, 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. And Republicans got some of the health incentives they wanted for patients, as well as a pledge that the state could opt-out if the federal funding changes.

Branstad, who had previously opposed expanding Medicaid, backed the deal because of the health incentives and the opt-out provisions.

Upmeyer said she was prepared to take the federal dollars if the plan was right.

"Why shouldn't we go ahead and take the money. I pay my taxes," Upmeyer said, noting that the state receives a sizable amount of federal funding. "I think we're both pretty common sense people frankly and a lot of this really was common sense."

Upmeyer had one more thought on why she and Ragan might have had an easier time negotiating than some of their colleagues—less politics.

"I don't think either of us are running for another office, maybe that's why," she joked.