Staff Editorial

Whatever it takes, Medicaid upheavals must end

Department of Human Services Director Jerry Foxhoven at a press conference regarding UnitedHealthcare's exit from Iowa's
Department of Human Services Director Jerry Foxhoven at a press conference regarding UnitedHealthcare's exit from Iowa's Medicaid program on April 1, 2019. (Rod Boshart/The Gazette)

Despite comments by state officials to the contrary, the loss of another for-profit managed care organization from Iowa Medicaid exposes the program’s core weakness.

“I think that this shows the strength of our program that the governor was willing to say, ‘You know what, if you don’t want to meet the performance measures that we’ve required, that you’ve contracted to do, then we’re not going to bend over backward to keep you in this state,’” Department of Human Services Director Jerry Foxhoven said at a Monday news conference on the abrupt departure of UnitedHealthcare from the Medicaid program.

The exit of the MCO that provided services to roughly 70 percent of state Medicaid patients was announced late last Friday, within hours of state officials making the decision, according to Foxhoven.

More than 425,000 disabled and low-income Iowans will need to select one of two remaining MCOs, although one is not scheduled to officially begin managing patients before July 1 and was not expecting to absorb such a large number of clients.

Health care providers, many of whom have already raised alarms about slow, incomplete and denied payments, face an even more uncertain fiscal future.

A monumental change sold to Iowans by Gov. Kim Reynolds’ predecessor, Terry Branstad, as offering better health outcomes and taxpayer savings has provided neither. A state program slowly rising in cost — a situation Iowans were led to believe was dire and unsustainable — has experienced three times greater cost growth with privatized care, according to Des Moines Register compiling of state-reported expenses. Residents have repeatedly heard vulnerable neighbors describe unthinkable and often unjustifiable service changes. Medicaid complaints continue to flow to the Office of Ombudsman.

Worse yet, every quarter following the 2016 unprecedented, unilateral switch to managed care has brought greater unpredictability and distrust.


UnitedHealthcare will now go the way of AmeriHealth Caritas, which exited the program in late 2017. Iowans, blocked by the nearly opaque curtain of privatization, can only sit and wait for the next series of unwelcome headlines and hope the news isn’t of more shuttered businesses or unmanaged health conditions.

Since the Medicaid debacle began, this editorial board has purposefully avoided a direct call for a return to the state-run program. We’ve done so because, before the ill-advised and hasty switch of the entire program, Iowans experienced effective managed care of certain mental health services. But we now struggle to imagine another choice, at least while the state regroups and rethinks the system.

Our disappointment with Reynolds’ lack of leadership, however, is clear. It will never be enough to merely admit mistakes were made. The executive branch, of which Reynolds was an active participant, charted this course and must now take the helm and navigate it, even if that means mustering the courage to abandon ship.

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