Iowa is waiting again for outsiders to take care of health care

Lt. Gov. Kim Reynolds speaks during a press conference at Kirkwood Community College on Wednesday, July 27, 2016. Alliant is making a $1 billion investment to expand wind energy operations in Iowa. (Liz Martin/The Gazette)
Lt. Gov. Kim Reynolds speaks during a press conference at Kirkwood Community College on Wednesday, July 27, 2016. Alliant is making a $1 billion investment to expand wind energy operations in Iowa. (Liz Martin/The Gazette)

Gov. Kim Reynolds is waiting for the feds to render a verdict on her administration’s stopgap plan to shore up Iowa’s teetering health insurance exchange under the Affordable Care Act. Her focus, she contends, is on 72,000 Iowans who could lose coverage at year’s end.

That’s laudable. And her administration deserves credit for trying to mitigate the damage, spawned both by the ACA’s inherent fixable flaws (Thanks, Obama!) and by heavy turbulence caused by Republicans’ ill-fated repeal push. (Thanks, Trump!) Iowa’s insurance commissioner has floated a series of actions to help keep Iowa’s marketplace alive. But federal officials must first give the green light. “I’m going to let all that take care of itself out there,” Reynolds told reporters this week, insisting she’s repeatedly made the state’s case to federal officials.

Swell. And yet, why does it seem like we’re always waiting for someone else to take care of it when it comes to health care issues affecting tens of thousands of Iowans?

After Obamacare became law, former Gov. Terry Branstad refused to take advantage of provisions allowing Iowa to craft its own health insurance exchange. He thought the U.S. Supreme Court would take care of it by striking down the ACA. When that didn’t happen, he figured Mitt Romney would take care of it by ousting Barack Obama. Nope.

I once wrote Branstad was like a kid who skipped his homework betting on a snowstorm. Snow didn’t show.

So, at the last minute, Iowa created a hybrid state-federal exchange. Would a state exchange have fared better? We can only speculate, but it may have been easier for Iowa leaders to fix its problems.

Branstad resisted expanding Medicaid under the ACA. But he did reach a bipartisan compromise with lawmakers in 2013 that expanded the program while relying less on uncertain future federal funding. At last, an Iowa-based health care solution.


But after he won re-election in 2014, Branstad decided to hand Medicaid over to three private out-of-state managed care companies. Once again, someone else would take care of it, and we would save big bucks. Probably. Maybe.

A new GOP president and Congress would take care of the health insurance mess.

But Congress turned a mess into a fiasco. The new president’s stopgap plan is rooting for the ACA to collapse and for millions of Americans to lose coverage. Stay tuned! Iowa’s privatization has sparked angst and outcry among patients and providers, and may not save big bucks. To the contrary, Reynolds says Medicaid is “taking over state budgets.”

So if we find out privatization is more expensive than we thought, we know whose fault it will be. (Thanks, Obama!)

Instead of waiting for the kindness of strangers, Iowa leaders should have addressed the exchange collapse months ago. We already should be candidly addressing the future of Medicaid in Iowa, its private management and prospects for big federal changes and slashed funding. All hands on deck, Iowa hands.

Branstad once went toe-to-toe with Ronald Reagan to help farmers mired in debt. Reynolds should go toe-to-toe with Donald Trump to help Iowans caught in health limbo and who would be harmed by deep Medicaid cuts, especially in rural Iowa. Take care of it, and Iowans, governor.

l Comments: (319) 398-8262; todd.dorman@thegazette.com



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