DES MOINES | The day after a key deadline that states needed to meet to comply with the new federal health-care law, Gov. Terry Branstad's insurance commissioner fired off a letter saying Iowa won't meet it.
According to the guidelines set out by the Patient Protective and Affordable Care Act -- also called Obamacare -- states had until Sept. 30 to choose the "essential health benefits," or minimums, that would be covered under the plans that will be offered through their state exchanges.
The state exchanges are places where people who don't have access to or can't afford insurance could buy policies as the health-care act requires most people to carry a health insurance policy.
"Unfortunately, too many questions persist for the State of Iowa to make an informed decision about its preferred Essential Health Benefits Package," Iowa Insurance Commissioner Susan Voss wrote in her Oct. 1 letter to U.S. Secretary of Health and Human Services Kathleen Sebelius. "The state of Iowa will await further information via a formal rulemaking process before making a decision on an Essential Health Benefits package that will significantly impact the State's health insurance market."
Iowa was not alone. Only 16 states and Washington, D.C., made it in time, according to the Kaiser Foundation, although another 16 indicated they would submit their plans in the coming weeks.
Branstad says he's being pragmatic. Republicans, from presidential nominee Mitt Romney on down, have taken aim at the health-care program and say its days are numbered if Republicans sweep into power on Nov. 6.
"He's not being pragmatic, he's playing politics," said Sen. Jack Hatch, D-Des Moines, co-chair of the Legislature's Health and Human Services Appropriation Committee and the Senate Democrats' leading expert on the health-care law. "This is a big problem. It's infuriating that you have a governor willing to defy federal law for political purposes."
Because Iowa missed the September deadline, the U.S. Department of Health and Human Services could choose the essential health benefits the state must offer through its exchange. These would be determined by looking at what the biggest insurers in the state offer as their minimum coverage options in their policies.
Hatch said the governor is being hypocritical because the blown deadline gave the federal government an excuse to get involved in the state exchange even though Branstad has said that's exactly what he doesn't want.
"Gov. Branstad does not believe he is asking too much to have clear answers from the federal government on the unclear issues of Obamacare. Instead of answers, we have been stiff-armed at every turn," Branstad spokesman Tim Albrecht wrote in an email. "Delaying such answers may serve political purposes, especially those of Jack Hatch's party, but that delay doesn't serve Iowans."
Meanwhile, Iowa has accepted close to $30 million in federal grants offered to states so they can set up their health-care exchanges. Administration officials say the money has mostly been spent on infrastructure — computer hardware, software and training — that could be used for other purposes if the law is overturned.
Donna Hoffman, chairwoman of the University of Northern Iowa political science department, said by taking the money on one hand and missing deadlines on the other, the governor is "being cagey."
"This has been a waiting game all along," Hoffman said. "First it was for the Supreme Court decision, which upheld the law. Now it's the election."
The next deadline is Nov. 16. It requires that every state have a blueprint in place for its state-run exchange.