A Plan To Fix Iowa’s Medicaid Mess And Expand Healthcare Access

Excerpt from Jack Hatch’s new book, now on sale at Amazon and available at Barnes and Noble.

Iowa acted before the passage of the federal Affordable Health Care Act with insurance reform, a limited expansion of Medicaid and enrolling the highest percentage of children with health insurance than any state in the nation. And then in 2013, the bi-partisan legislature passed Obama’s full expansion of Medicaid adding upto 200,000 Iowans with access to quality health care services.

But our job is far from done, for America’s health care system is still evolving. It remains both the most expensive and the highest quality system in the world. It also produces irrational inequality in delivering services to middle-class families and to businesses. Iowa Democrats new challenge is to improve upon those initiatives for the future. But we have a problem!

Democrats lost badly in the 2016 election and President-elect Trump, Congressional Republicans and the Branstad/Reynolds administration have all announced they will repeal Obamacare. The problem is they can’t do that without millions of Americans, including Iowans, losing healthcare coverage or losing significant benefits. What will they do? Who really knows? President-elect Trump has already reneged on several campaign promises. We are now in political purgatory.

This governor and Lt. governor are not known for soliciting public comments. Progressive Democrats will have to make separate proposals and force a public discussion. Let us begin with the four policy decisions the legislature has to address:

1. Medicaid Privatization – Iowans need a better system. The first Iowans learned about privatizing Medicaid was the governor’s budget message to the General Assembly in January, 2015.  There was zero public input, no legislative discussion and no provider or stakeholder input or advice.  The governor’s office simply put out a request for proposals in February, 2015, as if he was building a new parking ramp.

What he replaced was the Iowa Medicaid Enterprise. It managed the $4.9 billion program with an administrative cost of 4% while being recognized nationally as one of the best Medicaid administered programs. His proposal was to turn it over to private managers and increase the administrative costs to 12%. All this time the governor and Lt. governor were saying they were going to increase services and benefits for more Iowans! Even the great magician Houdini couldn’t perform that magic trick!

To date, the bi-partisan legislative oversight committee has easily identified the utter failure of the governor’s program. A provider survey demonstrated the program is near collapsing under its own weight with nearly half of the providers reducing their  services, more than 60 percent say privatization has reduced the quality of their services, almost all reported an increase in administrative costs, and nearly 30 percent of all providers  have been forced to secure loans to cover expenses while awaiting payments from the insurers.

The call to return the Medicaid program back to the state is not just coming from Democratic legislators, patients and providers. The Des Moines Register called for the state to “Break the contracts. End this madness. Return to Medicaid administered by the state, which has worked well for decades. Salvage the state’s health care infrastructure before it’s too late.”

However, the election results in 2016 make any legislative proposal difficult. But Progressive Democrats have to propose something to ignite a vocal public discussion on how to protect health care to those Iowans. The following are required legislative actions:

• The Legislature should conduct a performance and financial audit of each managed care contractor.
• Democrats should push for a “Private Right of Action” for Medicaid patients who have been improperly denied services.
• Triple the number of health care ombudsmen from 4 to 12 to work with patients, especially seniors having difficulty navigate through these complicated changes.
• Prepare to fund all the waiting lists of eligible Iowans to receive Medicaid services even though they are not included in Iowa’s state plan.

2. Public Option – Iowa needs an alternative to private insurance. Progressive Democrats should not wait until the system is frozen and thousands of Iowans are out in the cold. We must offer a more cost-effective alternative. But since the Republican’s 2016 election victory, the progressive battle line is clearly drawn. How do we prevent 20,000,000 Americans and up to 200,000 Iowans from losing health care coverage entirely? It is time Progressive Democrats go on offense and propose our logical “next step” and draw a contrast with the Republicans.

The “Public Option” is such an alternative. Simply stated, the Public Option would allow any legal resident to sign up for Medicaid type services directly and without income qualifications. It eliminates the health insurance company that drains patient revenue to large financial companies, but retains the structure to ensure accountability. In Iowa, 85% of the individual health care insurance market is written by one company, Wellmark, a monopoly that protects its profit margin more than its patient care.

The system will remain rigged until the state legislature enacts reform benefiting Iowans. Progressives need to push for another “Blue Ribbon Commission” and create a public option for Iowans.

3. Medical Cannabis – Iowa needs a family friendly effective law. Our state’s inability to pass an effective Medical Cannabis Law is the best example of a political system rigged against American families.

There is evidence that the use of cannabis oil has medically accepted benefits including the alleviation of chronic pain and the significant reduction of epileptic seizures.

In 2013, the legislature passed a bi-partisan bill but it was so “watered-down” by political compromise, few, if any, families could obtain treatment.

Unsatisfied, the parents returned to the legislature with new polling that showed 76 percent of those surveyed support a medical cannabis law, with the support cutting across party lines.

Progressives have to make this a significant issue for our legislature. Attitudes are changing and Progressive Democrats need to show real leadership and have our legislators reintroduce the 2015 Senate bill, SF 484, which followed the strict guidelines of Minnesota’s law.

4. Mental Health – Iowa needs to correct its significant shortcomings in our mental health system. A comprehensive approach to health care reform in Iowa cannot be successful unless we address the crisis in mental health care. Iowa has fallen to the bottom of the pack among all states due to the actions of the current administration. Progressives must address the crisis while updating and reforming mental health care in a user-friendly way.

By closing two state mental health institutions, one child psychiatric hospital and one juvenile care facility without a plan to provide equal or better treatment is a complete failure.

The administration made their decision without seriously understanding all the consequences. To restore reliability, the following policy issues need to be addressed:

First, the funding for the mental health system is too complicated to adequately determine what services are eligible for payment.  To simplify funding, the state should equalize the county funding, fund more intervention services and ensure adequate professional capacity in both rural and urban Iowa. Second, progressives have long been speaking about reducing prison sentencing for mentally ill and substance abusers. Greater emphasis needs to be placed on non-violent offenders, eliminate mandatory sentences and expand mental health treatment services.

In summary, in the past 6 years, state government has created more problems in health care, now it is time to resolve our promise to provide health care to all.

by Jack Hatch
Posted 1/2/17