Amid criticism from Democrats over his steadfast refusal to expand Medicaid in Iowa, Gov. Terry Branstad and Lt. Governor Kim Reynolds offered an alternative proposal on Monday.

“The Healthy Iowa Plan is a modern health plan that will pay providers to care for their whole population and based on the quality of care they deliver, while rewarding positive health outcomes,” Branstad said in a release. “Under our Healthy Iowa Plan, more Iowans will be served by the private insurance market, with access to affordable plans available through health benefits exchanges.”

The proposal, if passed, would provide reimbursements for tax credits from private insurances instead of the state government. The Healthy Iowa Plan will cover approximately 89,000 uninsured Iowans earning below 100 percent of the federal poverty line.

IowaCare currently serves uninsured Iowans who cannot get Medicaid. IowaCare is set to expire this summer, and proponents talk about the expansion of Medicaid to replace the current system.

IowaCare serves 4,000 patients in Linn County alone.

The governor’s plan was received with mixed reactions in the Iowa Senate, which Democrats control.

Sen. Joe Bolkcom, D-Iowa City, said the governor’s proposal was “second-class health care,” and Iowans would be better off with an expansion of Medicaid under the Affordable Care Act.  However, he said, Senate Democrats would continue to work with the governor as more details of his plan emerge. Bolkcom said Branstad is “simply out of touch” with Iowans on his proposal.

“For [Branstad’s] whole adult life, he has the best health-care insurance you could have,” he said. "He has no idea what families who work for employers who don’t provide insurance go through.”

Peter Damiano, the director of the Iowa Public Policy Center, said the Affordable Care Act established Medicaid expansion, because it did not allow people who fell into certain categories — under the 100 percent and 400 percent based on the federal poverty level — to purchase health-care insurance from the newly created health-care exchange. The poverty levels are based upon income and family size.

However, after the U.S. Supreme Court ruled that states could opt out of the expansion under the act, the once-assumed expansion was in jeopardy — forcing governors to allow the expansion or come up with alternatives like the one Branstad proposed.

“There’s a catch in the way the law was written, and right now [Branstad’s plan] appears to be an attempt to partially fill the gap,” Damiano said.

One Republican senator said the governor’s proposal would be received with open minds from members of his party.

“Medicaid expansion is not the only option,” Sen. David Johnson, R-Ocheyedan, said. “All Republicans are asking for is to give it a fair hearing. There’s an assumption that Medicaid is the best we can do, and it isn’t. It’s not based on healthier outcomes, it’s pretty weak on health standards, and it isn’t supported by health-care professionals.”

Sen. Liz Mathis, D-Cedar Rapids, said she believes the plan was not a better alternative to replace the expansion of Medicaid.

“This doesn’t look like it’s modernizing anything,” she said. “It still doesn’t address people receiving access for that. Medicaid goes far beyond that, it addresses quality care.”