RENEE MONTAGNE, HOST:
The Republican governor of Iowa is one of the longest serving in U.S. history. And with a election campaign coming up next year, he's suddenly taken a keen interest in making one controversial part of Obamacare work. That's the expansion of Medicaid, something some states are still deciding whether or not to do. Iowa Public Radio's Clay Masters has more.
CLAY MASTERS, BYLINE: For months now, Iowa Republican Governor Terry Branstad has come out adamantly against accepting federal dollars to expand Medicaid. Here he is back in February.
GOVERNOR TERRY BRANSTAD: There are some that think we can rely on the federal government, that they will do everything for us, and that we don't have to worry about the fact they're spending a trillion dollars more than we're taking in. And what is the biggest driver in this federal deficit? It is their entitlement programs like Medicaid and Medicare.
MASTERS: Now, here's Branstad 2.0, expressing excitement for the plan to take the federal dollars.
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BRANSTAD: I think we'll not only get it approved, I think it'll be touted by HHS as a great example of state leadership in addressing this critical issue of improving health for the citizens.
MASTERS: Parts of it look like Medicaid and sound like Medicaid, but politicians here insist it's not Medicaid.
DAVE PETERSON: They're calling it something slightly different, there's this opt-out offer.
MASTERS: That's Dave Peterson, a political scientist at Iowa State University. The opt-out offer he mentions basically means that if Washington doesn't continue to pay for this alternative, called the Iowa Health and Wellness Plan, Iowa taxpayers won't get stuck with the bill. The deal was struck in the Iowa legislative session's third week of overtime.
Democrats control the Senate here and were pushing a full-on Medicaid expansion. Republicans control the House. Peterson says politically, Governor Branstad played it pretty well.
PETERSON: It's this balance between what's in many ways the at least short-term best interest for the state in taking the federal dollars. But at the same time politically beneficial for him not sounding like he wanted to take the federal dollars and to talk about the sort of long-term benefit for the state to make sure the state is secure in the long term. Because we can't necessarily trust the federal government, though we probably can trust the federal government on that.
MASTERS: In this plan those who are on currently on Medicaid won't see any changes to their services. Those who are not currently on Medicaid and earn up to about $12,000 a year would get a health plan comparable to what state workers have.
Those low-income Iowans who make up to about $16,000 a year, would receive federal subsidies to buy private insurance from the government's online health-insurance exchange. Some participants would have to follow health incentives or risk paying a percentage of their premium costs.
ANN KINZEL: It's difficult for me to see how some of these things are going to be translated to the lives of very low-income people.
MASTERS: That's Ann Kinzel, who's worked extensively on Iowa health care policy reform. She thinks the plan could work, but says the devil is in the details. Currently, there's no organized opposition to the plan. Most groups are combing through the compromise and say they're cautiously optimistic. Kinzel says the state should have more time to study how the compromise would work.
KINZEL: There's a number of issues in this very, very low income population that we just don't know how they will respond. And I think that people's health and well-being is simply too vital to make a gamble on like this.
MASTERS: But with a bipartisan stamp of approval, the feds are likely to take a gamble on anything that doesn't look like more Washington gridlock. And Governor Terry Branstad positions himself nicely for a speculated run for what would be his sixth term. For NPR News, I'm Clay Masters in Des Moines.
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