A key legislator says changes in the government-run health care program for Iowa’s poor and disabled won’t be made anytime soon. Senate President Mary Kramer says the Medicaid budget is in the red because of skyrocketing medical and pharmaceutical costs, but the fix won’t be in ’til this fall. Kramer, who is a former insurance company executive, says the goal is to have alternatives prepared and reviewed by a panel of legislators, state officials and representatives of the insurance industry. Their recommendations would be submitted to the feds this summer, so the state could get waivers for the new program ideas. She says it’s a pretty big undertaking and they need to have the actuaries and design people to examine the plan. Last year, legislators suggested raising the co-payment Medicaid recipients are required to make when they get a prescription filled as one way to deal with the rising costs. This time around, more radical ideas are being considereded, like some sort of private insurance component for the government program. Just over 230,000 Iowans are enrolled in Medicaid.