There’s been another statehouse breakthrough today. This one comes on a health are issue that had threatened to derail efforts to conclude the 2013 legislative session.

A tentative agreement has emerged that would use federal funds to provide government subsidies so low-income Iowans can buy private health insurance. Republican Governor Terry Branstad had resisted Democrats’ call to simply enroll up to 150,000 more Iowans in Medicaid. This new plan will be called Iowa Health and Wellness Plan and House Republican Leader Linda Upmeyer of Clear Lake is one of its architects.

“I’m really pleased with the outcome,” Upmeyer says. “Everybody moved their position a little bit in order to do the right thing by Iowans and the result is an Iowa solution for Iowans and I’m excited about that.”

Senate President Pam Jochum, a Democrat from Dubuque, is another legislator involved in the behind-the-scenes negotiations.

“We all really wanted to make sure that these 150,000 Iowans had health insurance,” Jochum says. “So there was a lot of give and take on both sites and at this point there’s a tentative agreement and we’re hoping that it becomes law.”

Nearly 90,000 Iowans who have an income that’s below the poverty line would get a government subsidy to buy into a health insurance plan just like those offered to state employees. Iowans who have an income that’s within 101 and 138 percent of the poverty line would get a subsidy, too, to buy a plan that’ll be offered on the new “insurance exchange” being set up in Iowa.  The state would accept federal money to cover those subsidies, something that had been a sticking point for Republicans who say the federal government can’t afford it.

Governor Branstad has repeatedly said he wants an “Iowa solution” that ensures participants have “skin in the game” and under this compromise those who fail to follow doctor’s orders for a healthier lifestyle — like giving up cigarettes — would have to start paying a part of their premiums in year two.

Dave Heaton

Key legislators say there could be a breakthrough in negotiations over exactly how the state may ensure more low-income working Iowans get health care coverage.

Representative Dave Heaton, a Republican from Mount Pleasant who is involved in the negotiations, puts it like this:  ”I think reassurance from the governor’s office that he is respecting our work at trying to find a compromise between his plan and the Senate plan would be very helpful in helping us move forward.”

Democrats have been pushing to use available federal dollars to expand the government’s Medicaid program to provide coverage to up to 150,000 uninsured Iowans.

Republican Governor Terry Branstad’s proposed alternative creates a whole new “Healthy Iowa Plan” the is heavily subsidized by the state and federal government and requires a monthly premium payment of $12 from the roughly 90,000 uninsured Iowans it’s designed to cover.

“We believe that there are things going on now that are opening the door for us to determine whether or not the executive branch is serious,” says Senator Jack Hatch, a Democrat from Des Moines who is also involved in the private negotiations.

Hatch and Heaton are part of a 10-member committee that was appointed a couple of weeks ago to try to hammer out a compromise. Heaton says once everyone is on “the same wavelength” negotiations may take off.

“If you’re going to sit down and you’re really going to find a real compromise, it takes a lot of trust…that we really are sincere in what we are saying and doing in trying to find a final conclusion to what the differences are,” Heaton says, “and can trust each other that somebody isn’t going to go out and try to do something else.”

Legislators have a host of issues to resolve before their 2013 session can end — and the end won’t come this week. Lawmakers will come back to the capitol next week to continue debate on this topic and a host of others.