DES MOINES — Among the myriad policies, programs and other ideas to provide better mental health care in Iowa, nearly all of the 13 candidates for governor agreed on one thing: Administration of the state’s $5 billion Medicaid program should return to the state.
At a forum hosted this week by Des Moines University and organized by the Des Moines Register, 13 candidates for governor fielded questions on how to improve Iowa’s mental health care delivery system. Roughly 400 people attended the forum, organizers said.
The only declared candidate not in attendance was incumbent Gov. Kim Reynolds, who is on a family vacation this week and sent a video statement.
Reynolds has been a staunch defender of Iowa’s privately managed Medicaid program, and that delivery system was on the chopping block at Tuesday’s forum.
“To fix this problem, first end the privatization of Medicaid,” said John Norris, one of the seven Democratic candidates for governor, each of whom attended the event. “Commercial (managed care organizations) will never be motivated for health care first. Need to admit failure. The governor needs to admit failure. That’s a part of being a leader.”
During her video statement, Reynolds said the state’s regional system is providing more mental health care services in modernized and community-based settings.
Reynolds recently defended the state system after one of the three companies paid by the state to administer Medicaid dropped out, and one of the two remaining said it cannot handle any additional Medicaid patients, leaving the third to absorb the more than 200,000 patients in need of a new MCO.
“It’s not perfect. I’ve never said it was perfect,” Reynolds, the Republican governor, told reporters during her weekly news conference in late November. “I’m willing to put the time and the effort into making sure that Iowans get the care that they deserve in a managed and coordinated and more modern delivery system. I’m not going back.”
That puts her at odds with most of the candidates at Tuesday night’s forum, including independent, Libertarian and even Republican candidates.
“I also believe that the reversal of the privatization is a key issue here,” GOP candidate Steven Ray said.
Candidates also discussed the need for my mental health care beds after the 2015 closure of two state-run mental health institutions, although the field was divided over whether those facilities should be reopened or recreated.
Democratic candidates Cathy Glasson and Nate Boulton said the mental health institutes should be reopened, as did independent candidate Brent Roske. The other candidates were less committed to reopening the facilities, or said a shift to community-based care has been appropriate.
“I’m sure many of you that work in the field know, this is a complex issue,” said Democratic candidate Andy McGuire, a physician who practiced medicine for nearly 30 years before getting into politics full-time. “Acute care beds are not the only beds we’re talking about here. There are transition beds, there are long-term beds. And we have a real problem right now with, we don’t have enough acute care beds, but honestly we don’t have anywhere for people to go who can’t go home after they’re done with their acute care and their medicines haven’t quite worked yet. ... This is a cascading issue.”
The candidates were asked how they would pay for the myriad solutions they presented during the course of the evening.
Most said they would allow local governments to raise their property tax levy to help pay for more mental health care services. Some were critical of the current status of the state budget. Ron Corbett, a Republican candidate and outgoing mayor of Cedar Rapids, said reducing administrative costs would help free more resources for services.
Glasson and Roske said their campaign calls for a universal health care system would provide more mental health care services.
“It’s not OK to shrug your shoulders and say, ‘How are we going to pay for it?’ and have that make the problem go away,” Roske said. “We need to look at this as something that we expect, just like police and fire (departments), K-through-12 (public education). It’s a benefit of citizenship and it has to be addressed now.”