(SIOUX CITY, IA) The fight over how to provide healthcare for thousands of Iowans who can't afford it is heating up.
On one side - supporters of the Federal Medicaid expansion made possible by the president's new health care law. On the other - Governor Terry Branstad who has his own plan.
This week a bill that would give health care to 100,000 low-income Iowans passed the State Senate. But it's a long way from getting to the governor's desk.
The affordable care act - also known as "Obamacare" - included a huge expansion of Medicaid.
But last summer... the supreme court ruled states have to opt in to that expansion.
So what does that mean here in Iowa?
It would mean providing health care to more than 100 thousand people at zero cost to the state for the first three years. The governor is pushing back with a plan that's actually more expensive* for Iowa taxpayers while covering fewer people. But he insists it's the responsible choice.
Not everyone can afford health insurance.
"Hospitals are being hit with more and more people who have no insurance. Medicaid would take care of them," says Jim Wharton, Vice President of Mercy Medical Center in Sioux City.
Sounds simple but here in Iowa the debate over how to expand Medicaid is taking priority.
"It's a political battle, there's no doubt about it between the democrats and republicans," says Wharton.
one out of every nine people living in the state of Iowa are uninsured - a costly problem for everyone that Obamacare is trying to fix.
If a state opts into the Obamacare expansion the federal government pays 100% of the cost for the first three years. After that, the state would be responsible for no more than 10%.
But Governor Branstad thinks the federal government won't be able to make good on its promises.
"We think it's important that we do something that's sustainable for the long term. Something that will help Iowans takes ownership of their own health and helps us in our goal of to become the healthiest state in the nation," says Iowa Governor Terry Branstad.
"The Governor's concerned that the federal government may not be able to meet the obligations - there's an opt out so we bring it to an end," says Wharton.
Branstad wants to expand Iowa's current Medicaid program. His plan would only cover 89,000 Iowans at a cost of $162 million just in the first year.
"I think that's a critical mistake. It's a mistake he's making not only for hospitals, but patients in Iowa, residents in Iowa who need coverage," says Wharton.
According to the center on budget and policy priorities - 16 states have already opted into the expansion another 10 are leaning towards it. Here in Siouxland the situation in Iowa and Nebraska is up in the air while South Dakota has already opted out.
So what's next?
At the capitol in Des Moines the Federal Medicaid opt-in passed through the Democratic-controlled Senate but since Republicans control the house that bill appears to be dead in the water for now.