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Iowa Medicaid hearing

Cynthia MacDonald, Plan President at Amerigroup (from left), Kim Foltz, Health Plan CEO for United Healthcare, and Cheryl Harding, Market President at AmeriHealth Caritas Iowa, answer questions during an out-of-session Human Resources Committee meeting on the Medicaid transition at the Iowa State Capitol in Des Moines on Tuesday, July 26, 2016. (Liz Martin/The Gazette)

Nothing to see here. It's just Iowa's health care safety net that's ablaze.

Complaints about Iowa's Medicaid have doubled in the past year, says a scathing report issued by the state's ombudsman Kristie Hirschman. For-profit contractors, hired in 2016 when then-Gov. Terry Branstad hurriedly privatized the system, are denying claims at an increasing rate, which Hirschman labeled "stubborn and absurd." Health care providers recently griped that the entire system is an unsustainable house of cards that's undercutting necessary programs for the handicapped and infirm.

Gov. Kim Reynolds earlier this year acknowledged systemic problems, though she's been less than forthcoming with corrective measures. Iowa Legislature this past month basically admitted this whole Medicaid boondoggle isn't going well, passing legislation that, at the very least, established timetables for payments to providers. 

Iowa's experiment with privatized Medicaid is a failure by every objective measure. The promised savings to state coffers are a tiny fraction of what was predicted. Almost daily, Iowans are telling their stories about a claim denial for treatment required for them to function. Profit-driven Managed Care Organizations (MCOs) have every motivation to deny services. They, too, have complained that the $4 billion program isn't generating the expected revenue. And a general lack of transparency is pervasive throughout the failing system.

And yet, nearing the end of the Legislative session, there's not a whiff of substantive change. 

The 2018 session has been one filled with admissions of mistakes, but short on meaningful action to right them.

Take, for example, the state's mental health crisis, which is directly related to Medicaid. This past week, Reynolds signed a bill that mandates local governments create six short-term care centers. But, like so many other things, the legislation passed the buck down to local taxpayers, who are expected to fund the crisis centers. Iowa's GOP-run Legislature excels at manufacturing new mandates without offering a bit of financial aid. 

Or, how about the historic inequity in school funding that's bilked school districts such as Davenport and Maquoketa for generations? Last month, Reynolds rolled into Davenport to sign a one-year fix, a miserly one at that, dubbed a $5 per-student "down payment" on an issue that would take a decade to fully correct, under the current structure. Speaker after speaker got up — including state Sen. Robi Smith, a Republican who worked his tail off on the issue — and asked Reynolds to commit to a long-term fix.

Instead, Iowa's governor walked to the podium and refused to make any promises.

"We look forward to continuing to see what's possible in the years to come," Reynolds said.

Women's health, mental health, education funding, state universities and, yes, Medicaid: These are but a few of the key state services that have, so far, been left to rot in 2018. 

The statewide decay should come as a surprise to no one. Tax cuts are the sole focus of this session. It's an addiction for which lawmakers and the governor will seemingly undermine even the most core programs. And they've done so while freely admitting that these programs are, in fact, crumbling. They're just unwilling to do anything about it.

So Iowa's poor and vulnerable will continue to have their health care claims denied for no reason other than greed. Its universities will struggle. Its public school district will receive functionally less state support due to inflation.

And nothing will change until those running Iowa understand that the state is more than its tax rate. 


Local editorials represent the opinion of the Quad-City Times editorial board, which consists of Publisher Deb Anselm, Executive Editor Matt Christensen, Editorial Page Editor Jon Alexander, Associate Editor Bill Wundram and community representative John Wetzel.


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