Staff Columnist

Iowa's Medicaid experiment still failing

Iowa Gov. Kim Reynolds smiles as she is introduced during a campaign announcement stop in Marion on Thursday, March 8, 2018. (Cliff Jette/The Gazette)
Iowa Gov. Kim Reynolds smiles as she is introduced during a campaign announcement stop in Marion on Thursday, March 8, 2018. (Cliff Jette/The Gazette)

Another scathing report documents the continued failure of former Gov. Terry Branstad’s rush into managed-care Medicaid, as well as Gov. Kim Reynolds’ failure to right the ship. First, the heartbreaking report.

Complaints to Iowa Office of Ombudsman connected to Medicaid managed-care organizations increased by 157 percent in 2017, according to the office’s annual report released Monday. The document comes almost two years to the day that the Branstad-Reynolds administration unilaterally chose to privatize Medicaid despite cautions from patients, providers, lawmakers, small businesses, advocacy groups and the media to move more slowly.

It was a dangerous timeline that Branstad repeatedly defended.

“I know there are people that want to protect their funding stream and are afraid of change, but the truth is this has proven to be effective in other states at improving medical outcomes. That’s what we want to do,” Branstad said.

But most states phase in privatization over time. Although the federal government paused the Branstad-Reynolds plan for three months, privatization became a reality April 1, 2016, shifting all Medicaid recipients to managed care.

And now, two years later, complaints still are pouring in: Hospitals, clinics and nursing homes that provide care say they’ve lost hundreds of thousands in expected reimbursements. Those that have been paid tell of untold hours chasing down claims and payments.

The three companies that initially signed up to manage Iowa Medicaid lost millions. The state had to increase its per enrollee allotment and, even so, saw one insurance company drop from the program and another refuse to absorb more enrollees. The state quietly set up a fee-for-service pool to bridge the gap.

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At least six disabled Iowans who depend on the program launched a lawsuit against the state. That case was dismissed in February because of its focus on the contracted insurance company that dropped from the program.

Promised savings — $110 million the first six months, Branstad said, more than $230 million additional savings in 2018 — aren’t materializing.

While most of this can be linked to the state’s haste, at Branstad’s insistence, to launch privatization, Reynolds repeatedly has voiced her support for the shift and hasn’t eased the transition.

Reynolds hired Mike Randol, known for overseeing the failed privatization of Kansas’ health insurance program for the poor and disabled. Together, they closed the door on public meetings about the $4 billion, publicly funded Medicaid program.

At her Condition of the State address, Reynolds admitted “mistakes were made,” but offered no solutions. Her proposal to balance the state budget included a $10 million cut to Medicaid, which even fellow Republicans questioned.

Reynolds may have smooth sailing through a GOP gubernatorial primary, but the general election is on the horizon.

No one likes that Branstad left a mess behind, but he did. Iowa is in the midst of a potentially devastating storm, a time when strong leaders don’t hesitate to grasp the wheel.

• Comments: @LyndaIowa, (319) 368-8513, lynda.waddington@thegazette.com

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