ON THE ISSUES 2014: Health care

ON THE TABLE THIS SESSION

• Staying with federal-state insurance exchange or switching to state system.
• Financing transition from a county-run mental health system to new regions.
• Reviewing plans to close the Iowa Juvenile Home in Toledo.
• Reviewing management changes at the Iowa Veterans Home in Marshalltown.
• Overseeing new Iowa Health & Wellness Program startup.
• Monitoring a court battle over a decision to curtail telemedicine abortion services.

WHERE WE'RE AT

• Federal officials have granted a three-year waiver for the Iowa Health & Wellness Plan designed to expand Medicaid coverage to about 150,000 low-income Iowans - some who will be required to undergo health assessments to avoid paying a small monthly premium for coverage.
• Also, there have been snafus in processing Iowans' health-insurance applications via the government's new online marketplace because of a lack of communication between federal and state officials.
• Mental health also is a front-burner topic of conversation as counties continue to experience growing pains in moving to a new system of administering programs regionally while delivering services locally.
• Some legislators and Toledo-area residents also would like to revisit a Branstad administration decision to close the Iowa Juvenile Home. Iowa Department of Human Services officials are finding alternative placements for the remaining youth served at the Toledo home and have given layoff notices to 93 employees at the facility effective Jan. 16.

TIMELINE

• The Iowa Health & Wellness Program takes effect Wednesday under a three-year federal waiver, but no recipient will be required to pay the newly established minimal monthly premiums in the first year and then only if they decline to undergo a health assessment.
• Plans call for closing the Iowa Juvenile Home in Toledo by Jan. 16.
• The newly configured regional mental health services regions will become effective no later than July 1, 2014.

PROSPECTS FOR PROGRESS

Given the problems associated with Obamacare and the startup of the federal-state insurance exchange, some legislators want to discuss converting to a state-run system. Much of this year's focus will be on making sure the bipartisan Iowa Health & Wellness program for low-income Iowans proceeds as envisioned once the enrollments gear up. “We thought we had a system that would work for Iowa, but the rollout of Obamacare has been such a mess on so many fronts it's hard to know which way to go now,” said House Speaker Kraig Paulsen, R-Hiawatha. Sen. Jack Hatch, D-Des Moines, a gubernatorial candidate and co-chair of the Legislature's human services budget subcommittee, blames Branstad's decision making and mismanagement for problems facing health care, mental health and the Toledo home.

On the mental health front, Branstad vetoed about $13 million in transition money for counties after lawmakers left town last May and Democrats want to revisit that issue. A state report showed the need for supplemental funds to cover a projected $1 million deficit in six counties, but officials say more counties would be experiencing shortfalls had they not curtailed services, established waiting lists and taken other cost-cutting measures that run counter to the spirit of an equalized regional approach. Counties are objecting to a DHS directive seeking to “claw back” Medicaid savings under the Affordable Care Act, saying the new regional delivery system needs time to get established before imposing new requirements on counties.

Source: Iowa Department of Human Services; Curated by Rod Boshart, Michael Chevy Castranova, Jim Riley/The Gazette