A top Democrat in the Iowa legislature says it’s time for the state “to declare victory” and move forward with the plan to expand the number of Iowans eligible for Medicaid, while a key Republican says he doesn’t know what the next steps should be.

Federal officials issued a waiver for the Iowa Health and Wellness plan Tuesday, but Republican Governor Terry Branstad may appeal the decision because the agency will not let the state collect premiums from those who live at or below the poverty line. Senate Democratic Leader Mike Gronstal of Council Bluffs says it’s time to “take the deal” the feds have offered.

“It wasn’t the whole nine yards, but it was about 8.9 yards. It was most of what we asked for,” Gronstal says.

According to Gronstal, the federal government has given Iowa officials the opportunity to pursue their “private sector solution” that will subsidize private insurance plans for low-income Iowans rather than enrolling them in Medicaid. Plus, Gronstal says the state will be able to collect small monthly premiums from some, just not all of those who’ll be covered.

“The differences are tiny in the overall scheme of things, absolutely tiny,” he says, “and their impact is tiny.”

But House Speaker Kraig Paulsen, a Republican from Hiawatha, says if premiums cannot be collected from all participants, that would violate the bipartisan deal legislators struck.

“This is the agreement we came to and I think, on the whole, it serves the state very well,” Paulsen says, “and it’s the plan we need to implement.”

Paulsen says he was surprised by the federal decision to forbid some of the premiums rather than allow the entire plan to operate as proposed.

“I don’t know how they can in good conscience back us into a corner,” Paulsen says. “I mean we’re 16 days from the end of the year and they’re going to cause trouble on it? I mean I just think that’s, in general, bad form.”

If the new plan isn’t implemented, up to 70,000 Iowans who’re being shifted out of an existing state program into the Iowa Health and Wellness Plan will lose health care coverage and another 80,000 who would have qualified for the new program won’t be able to enroll.