desmoinesdem

Cash-strapped Iowa DHS agrees to pay private Medicaid managers more

No matter how strained Iowa’s fiscal condition may be, count on Governor Terry Branstad to lend a sympathetic ear to corporations asking for more handouts. Tony Leys brought the latest example to light in a late Friday scoop for the Des Moines Register. The Iowa Department of Human Services will “help private Medicaid management companies shoulder huge losses they’ve suffered in covering more than 500,000 poor or disabled Iowans.” DHS officials estimate the deal struck in February will cost the state about $10 million, “which would be paid more than a year from now.”

The Branstad administration agreed last fall to transfer an extra $33.2 million to the three private firms picked to manage the state’s Medicaid program. It wasn’t enough to satisfy Amerigroup, UnitedHealthcare and AmeriHealth Caritas. They soon asked for much higher payments from the state, saying they were losing money under their contracts. Documents indicate each company lost at least $100 million during the first year of managing care for Iowans on Medicaid, Chelsea Keenan reported earlier this month for the Cedar Rapids Gazette.

One salient fact from Keenan’s story: administrative costs for the insurers totaled 6.8 percent, 11.6 percent, and 11.9 percent of expenditures. Before Branstad unwisely rushed to privatize Medicaid, our state-run program was only spending about 4 percent on administrative costs.

DHS Director Chuck Palmer told reporters in January that the state would not offer the Medicaid managed-care providers more money for the 15-month period running through the 2017 fiscal year. Only weeks later, officials amended the current-year contracts with “risk-corridor agreements” calling for the DHS “to shoulder the management companies’ financial losses if they grow beyond a certain point.”

Federal officials “have signed off on the contract amendments,” but no one informed key legislators about the development. Republican State Representative Dave Heaton, who co-chairs the Health and Human Services Appropriations Subcommittee, found out from Leys.

Speaking of appropriations, where will Iowa find extra money to pay the Medicaid managers? Around the time DHS leaders signed the contract amendments last month, the department was forced to absorb $25.5 million in spending cuts before June 30.

State lawmakers have not yet set fiscal year 2018 budget targets, but money will surely be tight following a recent downward revision to revenue projections. Mid-year budget cuts can’t be ruled out for next year either.

Meanwhile, Medicaid recipients are getting less care than before privatization or having to fight insurance companies over denied claims. Managed-care companies have slashed in-home services for Iowans with disabilities. About a quarter of the Iowans on Medicaid cannot access a program providing transportation to and from medical appointments. AmeriHealth Caritas is cutting payments to agencies that serve people with disabilities, leaving some caseworkers out of a job. Reimbursement problems drove some providers out of business last year.

Given Branstad’s track record of doing whatever big business asks of him, it wasn’t hard to predict that the DHS would end up shoveling more money to the Medicaid managers. The governor’s imminent departure creates an opportunity for Lieutenant Governor Kim Reynolds to learn from her predecessor’s mistakes. Here’s hoping she will demonstrate her capacity for independent thinking by pulling the plug on Iowa’s failed Medicaid privatization.

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Seven years of false promises finally caught up with Republicans

Among the U.S. political developments I never would have predicted: the Republican-controlled Congress was unable to repeal the Affordable Care Act under a president ready to sign the bill into law. After canceling a planned floor vote today on the American Health Care Act, House Speaker Paul Ryan acknowledged, “Obamacare is the law of the land. … We’re going to be living with Obamacare for the foreseeable future.”

In the depths of my despair after the November election, I felt sure that the Affordable Care Act would be history by now, and Congress would be well on the way to privatizing Medicare.

Among the many reasons Republicans failed to draft a coherent health care alternative and could not coalesce around the half-baked American Health Care Act, the most important is this:

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Josh Mandelbaum taking on Des Moines City Council member Christine Hensley

Promising to be a “voice for strong neighborhoods and strong schools,” defending local interests and fighting harmful state policies, Josh Mandelbaum confirmed Thursday night that he will run for Des Moines City Council against 24-year incumbent Christine Hensley. I enclose below the audio and full transcript of Mandelbaum’s first campaign speech, along with background on the candidate and a map of Ward 3, which covers west-side neighborhoods south of University Avenue and much of the south side.

I’ve been acquainted with Mandelbaum since before he was a policy advisor for Governor Tom Vilsack and Lieutenant Governor Sally Pederson. More recently, I’ve closely observed his work on renewable energy and clean water issues through our mutual involvement in Iowa environmental circles. I’m an active supporter of the non-profit Environmental Law & Policy Center, where Mandelbaum is a staff attorney. Last year Midwest Energy News named Mandelbaum to its “40 Under 40” list of list of “emerging leaders” working on “America’s transition to a clean energy economy.” He was one of only two Iowans to receive that recognition.

Even if I couldn’t personally vouch for Mandelbaum’s talent and work ethic, I would be excited to see a progressive willing to take on this incumbent. Hensley’s 2015 vote to extend a tax abatement program was indirectly a vote to benefit her employer. Timothy Meinch reported for the Des Moines Register at the time that the city attorney “warned of an ‘appearance of impropriety’ and ‘potential of a conflict of interest’” before Hensley “cast a pivotal vote in favor of developers.” Des Moines Cityview’s Civic Skinny column explained here how Hensley’s deciding vote benefited Midwest Housing Equity Group, “an Omaha-based firm that syndicates and sells tax credits from developers” where she “is a director and paid consultant.”

Hensley has given Des Moines residents plenty of other reasons to look for new representation. Mandelbaum covered several of them in the remarks I transcribed below. Her most egregious act was joining the small board of directors of the Orwellian-named Iowa Partnership for Clean Water. This advocacy organization grew out of the Iowa Farm Bureau’s desire to discredit the Des Moines Water Works, which delivers drinking water to half a million central Iowans, including all of Hensley’s constituents. My theory is that Hensley hitched her wagon to this cause in the hope of becoming Cedar Rapids Mayor Ron Corbett’s running mate in the 2018 race for governor. Whatever her motives, she chose to stand with Big Ag against her own city’s utility, despite evidence connecting farm runoff with high nitrate levels and toxic algae blooms that threaten the local water supply.

This year Hensley urged the city council to support legislation that would disband the Des Moines Water Works. The bill is widely understood to be retribution for the Water Works lawsuit against drainage districts in northwest Iowa (see the first part of this post). Mandelbaum spoke against House File 484 at a public hearing earlier this month; scroll down to view the video.

Taking on an entrenched incumbent is always an uphill battle, especially for a first-time candidate. Hensley will raise a ton of money. Even so, this race is winnable for Mandelbaum. City council elections are low-turnout affairs. Hensley didn’t have a challenger in 2005 or in 2009 and defeated challenger Cal Woods by 3,536 votes to 2,248 four years ago.

Ward 3 “has an overwhelming Democratic registration advantage and has a D+20 performance index,” Pat Rynard noted last month. The Water Works issue alone is highly salient for Des Moines residents. A large number of teachers and public workers live on the west and south sides of Des Moines, as do many progressives interested in economic and social justice. If Mandelbaum can tap into outrage over statehouse Republicans destroying collective bargaining rights and lowering the minimum wage in Polk County, don’t bet against him turning out a few thousand Democrats who have never voted in a local election before. He won’t be able to match Hensley’s fundraising, but with Pederson and former Attorney General Bonnie Campbell co-chairing his campaign, he should raise enough money to get his message out to Ward 3 residents.

This race will be one of the most important local elections in central Iowa this November. Please spread the word.

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Todd Prichard officially exploring run for governor (updated)

Saying Iowa needs “new vision,” “fresh leadership,” and “better than what we have seen during this legislative session,” State Representative Todd Prichard announced today that he is “considering” a gubernatorial campaign. The rollout leaves little doubt that Prichard will eventually join the Democratic field. His campaign website now features a Todd Prichard for Governor campaign logo. His “leadership team” includes heavyweights like Marcia Nichols, former political director of AFSCME Council 61; Brad Anderson, who ran Barack Obama’s re-election campaign in Iowa; former Iowa Democratic Party state chair Sue Dvorsky; and State Senator Bob Dvorsky.

I enclose below Prichard’s news release and background on the candidate from his website. Last month Prichard discussed his life experiences and values at a Democratic gathering in Des Moines; you can read or listen to that speech here. Prichard talked more about his work and thoughts about a 2018 Democratic campaign message with Iowa Starting Line. Prichard has a political page on Facebook and is on Twitter @RepPrichard.

Two other Democrats launched gubernatorial campaigns earlier this year: Rich Leopold and Jon Neiderbach. (Neiderbach spoke to the Northwest Des Moines Democrats group on March 21, and Bleeding Heartland will soon post excerpts from his stump speech.) Former Iowa Democratic Party chair Andy McGuire is widely expected to announce a gubernatorial campaign in the coming months.

UPDATE: Prichard spoke at the Our Future–Iowa Starting Line event in Des Moines on March 23. Here’s the full audio, for those who want to listen.


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Branstad's office withholds invitation list for collective bargaining bill signing

Governor Terry Branstad’s staff have rebuffed repeated efforts to obtain a list of those invited to watch the governor sign sweeping changes to Iowa’s collective bargaining law last month.

Going against longtime standard practice for high-profile legislation, Branstad excluded reporters from attending what staff called a “private” event. Drew Klein, state director for Americans for Prosperity, later posted a picture of himself shaking the governor’s hand at the bill signing. The large number of pens on the governor’s desk suggest that many others celebrated the historic move to take rights away from an estimated 180,000 public workers.

Jodie Butler was determined to find out who else was in that room.

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Rod Blum comes out against Republican health care plan Updated: So does David Young

A little more than two weeks after House Republicans released their alternative to the Affordable Care Act, U.S. Representative Rod Blum (IA-01) announced on Twitter that he will not support the American Health Care Act. According to Blum, the bill “doesn’t do enough to lower premiums for hardworking Americans. I’m a ‘no’ on current version – need to drive down actual costs!” Speaking to The Hill the same day, he added, “We need real competition driving prices down. We don’t need the government telling us what should be in an insurance policy. The government has a role to play. We need to help people who need the help.” Blum had previously said directly and through staff that he was studying the bill.

Like all other House Republicans, Blum has voted multiple times for “Obamacare” repeal bills that would have done nothing “to lower premiums for hardworking Americans,” let alone “drive down actual costs.” However, the stakes are higher now that a GOP-controlled Senate and Republican president might enact new health care legislation. I don’t know what kind of plan Blum is envisioning, but there is no magic wand Congress can wave to “help people who need the help” without the government setting minimum standards for health coverage and regulating the market in other ways.

Blum belongs to the House Freedom Caucus. Although that group has not taken an official stand against the AHCA, some of its prominent members are on various “whip counts” of Republicans opposing the bill. Since no Democrats are backing a plan that would leave millions uninsured and drive up costs for millions more, House leaders can’t spare more than 21 GOP members in any floor vote on their health care bill. Some Congress-watchers have already counted more defectors than that.

Representative Steve King (IA-04) was among the first House Republicans to come out against the AHCA. He supports “rip it out by the roots” repeal of “Obamacare” instead. I doubt the amendments unveiled this week to satisfy House conservatives will change his mind. UPDATE: A staffer told the Des Moines Register’s Jason Noble on March 22 that King is “undecided–leaning no” on the bill. SECOND UPDATE: White House spokesperson Sean Spicer announced that King will support the bill. Seeking confirmation. A member of the House whip team told Jonathan Martin of the New York Times that King “went from no to yes in the WH [White House] today after assurances about Senate tweaks.” UPDATE: King released a video statement explaining his decision to support the AHCA. He’s still committed to repealing Obamacare. He hopes Republicans will strip “essential health benefits” out of the bill, paving the way for other measures he wants, like health savings accounts and selling insurance across state lines. He said he told President Donald Trump in a White House meeting today that he worked very hard for total repeal of the Affordable Care Act, but that legislation won’t be brought up this year, because leaders don’t think they can get the votes. He said he had a “firm commitment” from Senate Majority Leader Mitch McConnell for a manger’s amendment to strip out “mandates” and “essential health benefits” from the House bill. King views this bill as the “best chance” for the “closest thing” to total repeal of Obamacare in the current political environment. He later tweeted that he and Trump had negotiated “the best possible improvement on ObamaCare Repeal.”

Representative David Young (IA-03) has repeatedly said he is studying the bill and the Congressional Budget Office analysis of its impact. Young’s staff have told constituents this week that he is still undecided. I consider him likely to vote yes if the bill comes to the floor–which may never happen, if leaders conclude they don’t have the votes. For what it’s worth, The Hill’s whip count put Young in the “leaning/likely no” camp because he said on March 15, “I want to make sure it is something that works in the end for all Americans, and that it would pass if it gets over to the Senate.” Several GOP senators have said the AHCA will not pass the upper chamber. UPDATE: Young announced in a March 22 statement, “While the American Health Care Act, legislation to repeal and replace Obamacare, is a very good start, it does not yet get it right and therefore I cannot support it in its’ [sic] present form.” I’ve added his whole press release below.

Neither of Iowa’s U.S. senators have clarified how they would vote on the Republican bill. Senator Chuck Grassley has made conflicting statements, telling House members the bill must be changed so that insurance premiums don’t skyrocket for older people not yet eligible for Medicare. On the other hand, Grassley has said Republicans can’t afford to miss what could be their only opportunity to keep six years of promises. Senator Joni Ernst said at town-hall meetings in Cedar Rapids and Des Moines on March 17 that she is studying the AHCA’s potential impact on Iowans and insurance premiums. I hate to break it to her: no alternative plan will magically make cheap insurance widely available while maintaining guaranteed coverage for people for pre-existing conditions and letting children stay on their parents insurance through age 26.

UPDATE: Forgot to mention that the Iowa Hospital Association estimates between 200,000 and 250,000 Iowans would lose their insurance coverage under the Republican plan. More on that story below.

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