Lawmakers split over need for more managed-care oversight

DES MOINES — In 2015, Iowa governor Terry Branstad shifted management of the state's Medicaid program to private health care companies.

In 2016, state lawmakers have an opportunity to get involved, if they choose.

The merits of the state's shift to privately managed Medicaid have been debated vociferously — supporters say private companies will run the program more efficiently and offer better services, while critics worry those for-profit companies will save money by reducing services.

And the transition itself has been rife with delays and legal challenges. Implementation is set for March 1, pending federal approval.

State legislators will get their opportunity to weigh in on the transition when the Iowa Legislature convenes Jan. 11.

One in five Iowans receives health care services from Medicaid, and one in five state dollars is spent on the approximate $5 billion government-run health care program, according to the state's non-partisan fiscal estimating agency.

With that much at stake, Democratic state legislators said they believe an extra layer of oversight is appropriate.

'I think what we're asking here is, this is a new program, and ($5 billion annually) that's a chunk of change here,' said State Sen. Amanda Ragan, D-Mason City, who is co-chairwoman of legislative committees on health care policy and spending. 'I think when you have that big a change, there's certainly some reason to have people looking out for folks.'

The Senate in 2015 unanimously approved legislation that created stronger oversight of the shift to managed Medicaid, including a commission of state legislators. But the bill was not considered in the Republican-controlled House.

Then-House Majority Leader Linda Upmeyer, R-Clear Lake, at the time said the Legislature's natural oversight powers were sufficient to monitor the managed Medicaid shift.

Upmeyer, who will take over as House Speaker for the coming session, said the same in recent interviews.

'As a Legislature, we always have the oversight role. That's one of the things we're going to be watching to see how this works. If there are adjustments or tweaks needed, we certainly have the capability of doing that,' Upmeyer said.

'I think the oversight role is an absolutely legitimate one, but we need to let this happen.'

Democratic leaders said they believe the Legislature's natural oversight is insufficient to oversee what they called a dramatic program shift.

'The bill that passed in the Senate (in 2015) provided far more authority than the usual committee process,' said Senate President Pam Jochum, D-Dubuque, whose adult daughter has intellectual disabilities and receives Medicaid services.

'I hope the House will realize this time that regardless of what party has the governor's office that the legislative branch needs to have an active role whenever this kind of monumental change is occurring in state government.'

Upmeyer and Senate Minority Leader Bill Dix, R-Shell Rock, accused Democrats of politicizing the issue.

Democrats said they are acting on behalf of their constituents, who have flooded state phone lines with concerns over the Medicaid management shift.

'I can't imagine other (legislators) aren't hearing from providers and consumers and Medicaid beneficiaries in their families that there are some issues out there,' Ragan said.

'We still have to deal with it. Maybe all of us, together, can come to some reasonable solution.'