How Many Iowans Must Die Before Reynolds Reverses Medicaid Privatization?

This week the Des Moines Register reported another Iowan on Medicaid died following refusal of Medicaid providers to pay for adequate care. Her nursing home’s decision to refuse accepting Medicaid patients on ventilators would require her to move 90 miles from Des Moines.

The Register reported, “the Fleur Heights nursing home blames insufficient and untimely payments from Iowa’s Medicaid program” for their inability to afford to take patients on ventilators in the future. There are only six of Iowa’s 417 nursing homes remaining that will accept ventilator patients.

The family had moved their loved one into a temporary facility at Des Moines’ Mercy Medical Center following the nursing home’s decision. Her husband said, “he would have to choose between quitting his truck-driving job in Des Moines and moving or keeping his job but being able to visit her only one or two days a week instead of every day.” Tragically, his wife died last week after she was moved to the Mercy facility. Her Husband said, “she was just so tired, and she was at peace with going home. We just decided to let her body do what it was going to do.”

This case highlights the failure of Reynolds’ Medicaid privatization to meet basic needs of Iowa’s most vulnerable. There has been a massive and growing number of complaints since former Governor Branstad and then-Lieutenant Governor Reynolds arbitrarily ended the state’s successfully managed Medicaid program and moved it to for profit private companies. They promised that the three private Managed Care Organizations (MCOs) would provide quality services and save the state money.

Instead, the number of grievances and appeals brought against these three companies has mushroomed. Providers continuously have reported that they get paid late or their claims are delayed or denied.

The Des Moines Register summarized the failure of Reynolds Medicaid privatization in a July editorial following a suit filed against Reynolds and her Department of Human Services (DHS).

“If the claims of Iowa’s health care providers and Medicaid beneficiaries are any indication, Medicaid privatization has been, and remains, a spectacular failure. It is a rolling dumpster fire of a program that has resulted in catastrophic consequences for vulnerable Iowans and the private agencies that attempt to serve them.”

That same editorial suggests Reynolds’ claim that privatization is saving the state money is pure fantasy. The Register reported, “federal and state governments which fund Medicaid jointly might have to pay an extra $235 million to help offset losses claimed by the hired managed-care companies during the first year of privatization.”

Disability Rights Iowa filed the lawsuit against Reynolds and the director of DHS. The group is asking a federal judge to force the state to “halt discriminatory cuts in services to 15,000 Iowans with serious disabilities.”

“They are violating very basic human rights, but also very basic Medicaid law, rules and regulations. They’re just totally disregarding them,” said Roxanne Conlin, a civil-rights lawyer who helped in preparing the lawsuit. “It’s kind of amazing to see how callous they are toward Iowa’s most vulnerable people.”

One of the results of that lawsuit is an admission by Jerry Foxhoven, the newly appointed DHS Director, that privatization isn’t working. In September Foxhoven suggested the possibility that some disabled recipients should be exempted from MCO care. That was finally an honest acknowledgment that these disabled Iowans weren’t getting adequate care under the privatization plan. That was revealed following secret negotiations with the for-profit management companies. These companies are demanding more money claiming they can’t fulfill their contract obligations without additional payment.

Governor Reynolds must quit pretending that Iowa’s Medicaid privatization is working or saving money. She should listen to her own DHS Director who admits the private companies aren’t able to adequately meet the needs of many desperate Iowans.

Reynolds isn’t the only one responsible for this catastrophic failure. The Republican controlled Senate and House Health Policy (Medicaid) Oversight Committee was established in 2015 to evaluate the state’s privatization of its Medicaid system. It is supposed to meet a minimum of twice a year, but hasn’t held one hearing in 2017! It was scheduled to hold its first hearing yesterday, October 18, but postponed it again until November 8.

It’s obvious Reynolds and Republican legislators would prefer to cover up their Medicaid disaster by avoiding tough questions from the public. It’s time for Governor Reynolds and Republican legislators to end their disastrous privatization experiment and stop jeopardizing the lives of thousands of Iowans.


by Rick Smith
Posted 10/19/17

4 Comments on "How Many Iowans Must Die Before Reynolds Reverses Medicaid Privatization?"

  • When you buy your health care from the lowest bidder, you should know that there is a disaster on the way. The Medicaid mess will be solved only when Iowa elects a new governor who has some compassion and respect for the disadvantaged of our state.

  • As if the current problem created by Governors Branstad and Reynolds isn’t a big enough disaster, it is about to get worse with the policies coming down from the Trump Administration in Washington. With Medicaid expansion hospitals saw a decline in charitable care expenses and this will now be reversed as Medicaid coverage is curtailed. It is well to remember that these policies were endorsed by the Legislature that gets its health insurance coverage at bargain rates.

  • Many other States have switched from public Medicaid management to private companies. It would be helpful to determine where and how this has worked, if at all. Certainly there may be cases where public administration of Medicaid was fraught with incompetence. But there has been no evidence of this in Iowa except the fact that public workers have a target on their backs from Republicans. I am familiar with a program in Florida covering residents receiving therapy services. Insurance companies hired a firm, Therapy Review Services–TRS, that capped their reimbursement costs on the premise there was substantial fraud that the public and private insurers couldn’t excise from the system. Florida has been a notorious State for fraudulent scams. Efforts to withhold or deny payments were based on TRS-documented cases of misrepresentation of services provided or outright fraud. After two years TRS was forced to quit when a fraudulent provider sued to oppose TRS denial of service and the insurer refused to back them up to cover extensive costs of litigation. This game is all about money and the Republican attitude toward privatization. They claim that added costs to the delivery of public services by privatization has been offset by “greater efficiency” and added private sector employment (ignoring the offsetting loss of public sector jobs). Iowa is becoming a classic case of how these arguments, like trickle down economics, are a fraud themselves. The hope is that if Republicans are unwilling to raise taxes to pay for essential public services, the slow degradation of our quality of life will, eventually, lead to a correction with either enlightened Republicans or Democrats in control. If public services are inefficient or incompetently delivered (the VA and Obamacare come to mind) politicians should demand they be fixed and paid for, not “repealed and replaced” with more costly privatization and no accountability to the taxpayer.

  • People also died when they shut down two mental health facilities, nobody seems to know what happened to the children that resided at the Toledo Juvenile Home after they shut it down, and what about the jobless Iowans who lost access to Workforce Development Centers. This is part of a trend.These actions along with the Medicaid disaster prove that the “Branolds” administration has targeted the most vulnerable members of our society because they have the least power and resources to fight back- Bully Politics

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