There’s a new wrinkle in on-going statehouse discusses over how best to provide health care coverage to low-income Iowans who are uninsured today.

Democrats in the legislature who simply want to expand the existing Medicaid program to cover 150,000 more Iowans are offering to link co-pays for all current and future Medicaid recipients to health and wellness initiatives. Senator Jack Hatch, a Democrat from Des Moines, says Democrats would waive those co-pays for those who get regular check-ups and take steps to improve their health, like quitting smoking or losing weight, but a trip to the emergency room for a minor health issue would require a co-pay.

“We’re going to ask patients to participate in their own health care,” Hatch says. “…The Republicans have talked about ‘skin in the game.’ We’re going to include that in our proposal.”

Republican Governor Terry Branstad’s “Healthy Iowa Plan” requires a monthly premium payment of $10, but premiums could be reduced for those who take steps to improve their health. Senator David Johnson, a Republican from Ocheyedan, says there’s “still a long way to go” before the gap between Democrats and Republicans is bridged.

“It’s opened the door a crack, I would say,” Johnson says of this latest offer from Democrats.

Johnson is a member of the 10-member conference committee appointed to find a compromise.

“We’ve got one week left to go in this session according to leadership,” Johnson says. “This is some heavy lifting that has to be done in order to reach an agreement, so anything’s possible — including a special session.”

Senate President Pam Jochum, a Democrat from Dubuque, is expressing optimism.

“I think we are actually moving a little closer to the middle,” Jochum told reporters this afternoon, “and I am hopeful that we are going to find some kind of a solution to this before we adjourn.”

Senate Democratic Leader Mike Gronstal says he’s “beyond optimistic” that lawmakers can wrap up the work of the 2013 legislative session next week.

Radio Iowa