Compromise needed for Iowa Medicaid


Iowa’s most vulnerable citizens — children and adults with low incomes and/or disabilities — are at the mercy of a governor rushing to implement privatization of Medicaid without any explanation for the urgency. That’s why the federal government delayed implementation. That’s why Iowa’s Senate Democrats have asked President Obama to reject privatization of Medicaid in Iowa. “… We have seen no evidence that the Iowa Medicaid Enterprise and the out-of-state companies picked to help privatize Medicaid have taken the steps necessary to ensure the health and well-being of more than 560,000 Iowans,” State Sen. Chris Brase, D-Muscatine, says.

One in five Iowans receive medically necessary healthcare coverage through Medicaid. Children make up 58 percent of beneficiaries. “Nearly everyone has someone affected by (privatization),” says State Sen. Rita Hart, D-Wheatland. “This is something I’m concerned about.” And so should we; Pope Francis exhorts us to work for the common good. The challenge is discerning what best serves the common good.

Iowa’s Department of Human Services, meanwhile, anticipates approval March 1 to begin privatization of Medicaid. No one knows for certain whether transferring administration of Medicaid from the state to private, for-profit companies will benefit or hurt vulnerable Iowans. But the train is already out of the station as Managed Care Organizations (MCOs) are signing on clients and providers. Gov. Branstad claims privatization will create a more efficient health system, resulting in cost savings, based on the experiences of other states. However, some of those states’ experiences have backfired.

If our governor is convinced that privatization will benefit the common good, he ought to be willing to put the brakes on this out-of-control train so that lawmakers can sort through issues that need to be resolved. Among them: an arbitrary and unrealistic implementation timeline, failure to establish adequate provider networks in advance, disruption of longstanding patient-provider relationships and diminished quality and access to health care services, Sen. Brase says.


Supporters of privatization, including State Rep. Linda Miller, R-Bettendorf, believe that moving to managed care will help make Medicaid members healthier, fit individuals’ needs, save money through efficient management and provide greater predictability in state budgeting. Medicaid spending grew from $2.6 billion for Fiscal Year 2007 to $5 billion for Fiscal Year 2017, she said. The federal government funds 55 percent and the state, 45 percent.

Medicaid is the second-largest expense in the state budget (22 percent), just behind education, she noted. However, much of the growth in numbers can be attributed to the inclusion of previously uninsured children and adults in Medicaid as a result of the Affordable Care Act. Access to affordable health care meets a basic human right, as our church calls for.

“Despite the dramatic growth in spending and coverage, health care has not improved,” Miller says. She notes that the existing system doesn’t reward preventative care, but rather hospitalization. The governor’s sense of urgency in moving to managed care doesn’t serve the common good.

The federal government made that clear on Dec. 17 when it delayed permission to implement Medicaid privatization on Jan. 1. In fact, the Centers for Medicare and Medicaid Services (CMS) stated that a transition on Jan. 1 “would risk serious disruptions in care for Iowa Medicaid beneficiaries.” A target date of March 1 was set for Iowa to begin managed care.

A Jan. 25 hearing of the Health and Human Services Budget Subcommittee convinced some lawmakers that Iowa will not be ready for privatization March 1, which prompted the letter to President Obama. The Senate Democrats call for replacement of the privatization proposal with what they describe as a return to Iowa’s focus on rewarding improved patient outcomes, increasing access to care and delivery efficiencies. But that’s what Miller said the managed care system would provide.

Our state lawmakers should be good stewards of the financial resources with which we entrust them. Miller says the old Medicaid system wasn’t perfect. Duplication and ineffective communication were among the challenges. The letter-writing senators disagree, saying that Gov. Branstad took one of the nation’s best Medicaid systems and created an unworkable mess. Lawmakers need to come together to straighten things out.

The Iowa Legislature should resurrect Senate File 452, a bill that would provide legislative involvement and oversight of Medicaid. The Senate passed the bill in 2015, but the House didn’t take it up. Establishment of an oversight committee would ensure that Iowa’s health care delivery system provides whole-person, patient-centered and family–centered care while moving toward a value and risk-based model for reimbursement. Contact your legislators, and urge them to take up and support the oversight bill, now! The train is loaded with precious cargo. We call that the common good.

Barb Arland-Fye, Editor

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