Anxiety rises over Medicaid

MARION - Craig Harwood is an engineer, and yet he can't make the math work.

Harwood, of Cedar Rapids, has heard the Branstad administration and officials with the Department of Human Services insist that turning Iowa's $4.2 billion Medicaid program over to four private managed care organizations will save tens of millions of dollars, although administrative costs are likely to rise. But no one will lose services, they say.

'I think it's a magic formula they're using,” said Harwood, whose 34-year-old son, Dan, has Down syndrome. Medicaid pays for staff at his sheltered workshop. And when that workshop closes next year, it will help pay for daytime rehab services, Craig hopes.

'I think, ultimately, we're going to see less services for guys like my son. It's just that simple,” he said.

Harwood was among several dozen people who crammed a meeting room at the public library to ask questions about the rapidly approaching privatization. This massive change was announced abruptly by Gov. Terry Branstad early this year, a decision made with no legislative input. Four companies were chosen in August. Very soon, 560,000 Iowans will be asked to choose a care plan. About 30,000 health care providers must decide whether to sign contracts with the firms.

Changes take effect Jan. 1, although officials insist there will be leeway and no one will be left behind without coverage. But these folks are facing two anxiety-filled months in what critics contend is the broadest, fastest Medicaid privatization push ever attempted. Federal officials must still sign off on the change, but hopes they'll stop it are fading.

Three local Democratic lawmakers critical of the change called the meeting, joined by two DHS officials who tried to answer questions. But too often, the answer was details still to come.

People who have worked years to build fragile care and support systems for loved ones wonder whether a bulldozer is coming. Care providers say they're being asked to sign contracts without seeing any of the policies or procedures they'll institute.

Will I get to keep my doctor? Probably. How will homeless people be informed? Outreach will be robust. Where will all the savings come from? So far, remarkably, the Branstad administration hasn't been able to say.

This is what it looks like when a governor makes massive decisions without any effort to sell, convince, explain or bring people along. This is what you get when a politician with power becomes tired of using our political process, messy and contentious as it can be, to build consensus for sweeping changes.

With six terms, apparently, you no longer have to persuade anyone that your ideas are sound. How will it save money? How will it make Medicaid better? We'll get back to you.

And maybe the ends will be OK. Perhaps managed care will manage to be a success.

But the means have been lousy. The governor never would put a constituency he cares about through a transition like this. I somehow can't imagine a room filled with anguished business executives anxious and fearful of a Branstad policy change.

For the governor's allies, the math always works. No magic required.

l Comments: (319) 398-8452; todd.dorman@thegazette.com