Fake compromise lets Iowa GOP save face on Planned Parenthood capitulation

The Iowa House and Senate adjourned for the year this evening. As usual, the health and human services budget was one of the last deals Senate Democrats and House Republicans agreed on. Both sides gave significant ground on oversight of Iowa’s recently-privatized Medicaid program; a future post will look more closely at the terms of that agreement. In another example of history repeating itself, key negotiators had trouble finding common ground on what to do about Planned Parenthood funding through the Iowa Family Planning Network.

The outcome of last year’s budget talks left little doubt that Republicans wouldn’t achieve their goal of creating a new state family planning program, excluding abortion providers. Yet House Speaker Linda Upmeyer had promised a "deliberate and unwavering battle" on "pro-life issues," and specifically to make defunding Planned Parenthood a "priority" for her caucus.

I’ve been wondering what Democrats might offer Republicans in exchange for preserving status quo language on state funding for Planned Parenthood’s non-abortion services.

As it turned out, they didn’t have to make any real concession.

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Medicaid oversight bill passes Iowa Senate with bipartisan support

Since Terry Branstad returned to the governor’s office, the overwhelming majority of Iowa Senate votes on contentious political issues have fallen along strict party lines: 26 Democrats one way and 24 Republicans the opposite. However, the Branstad administration’s rush to privatize Medicaid has created space for bipartisanship, as a growing number of Republicans acknowledge the dangers of shifting to managed care for a program through which one in six Iowans access health services.

Last month, three GOP senators joined their Democratic colleagues to vote for a bill that would have halted Iowa’s Medicaid privatization. That legislation is going nowhere in the Republican-controlled state House, and federal officials recently approved waivers to allow the Iowa Department of Human Services to implement the managed care policy as of April 1.

Yesterday a quarter of the GOP state senators voted with all 26 Democrats for a Medicaid oversight bill that had cleared the Senate Human Resources Committee unanimously. In her remarks to open floor debate on Senate File 2213, Human Resources Committee Chair Amanda Ragan said the bill was designed "to safeguard the interests of Medicaid members, encourage the participation of Medicaid providers, and protect Iowa taxpayers." She told colleagues, "we must require DHS and the managed care companies to protect consumers, preserve provider networks, address the unique needs of children and assure accountability."

I enclose below highlights from the debate on SF 2213, the roll call on final passage, and Ragan’s full remarks, along with a Democratic staff analysis summarizing the bill’s key points.

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IA-Sen: Patty Judge thinking about challenging Chuck Grassley

The Des Moines Register’s Jason Noble snagged a surprising scoop yesterday: former Lieutenant Governor and Iowa Secretary of Agriculture Patty Judge is considering running for the U.S. Senate this year. Referring to Grassley’s approach to the U.S. Supreme Court vacancy, Judge told Noble,

“Iowans have always been straight shooters, and up until the recent time I would have said the same thing about Chuck,” Judge said. […]

“I don’t like this double-speak,” Judge said. “I don’t like this deliberate obstruction of the process. I think Chuck Grassley owes us better. He’s been with us a long time. Maybe he’s been with us too long.”

To qualify for the Democratic primary ballot, Judge would need to submit nominating papers with the Secretary of State’s Office by March 18, three weeks from today. That doesn’t leave much time to collect at least 2,104 signatures, including minimum amounts in at least ten Iowa counties. But Judge could pull together a campaign quickly, having won three statewide elections—for secretary of agriculture in 1998 and 2002 and on the ticket with Chet Culver in 2006.

Three other Democrats are seeking the nomination to run against Grassley: State Senator Rob Hogg, former State Senator Tom Fiegen, and former State Representative Bob Krause. Former State Representative Ray Zirkelbach launched a U.S. Senate campaign in November but ended his campaign last month, Zirkelbach confirmed by phone this morning.

Dozens of Democratic state lawmakers endorsed Hogg in January. I enclose the full list below. Any comments about the Senate race are welcome in this thread.

UPDATE: Rebecca Tuetken notes, "Patty Judge does meet one apparent Iowa requirement: she told @SenatorHarkin ‘08 steak fry that she can castrate a calf." Truly a classic moment for Judge, when Joni Ernst was still the little-known Montgomery County auditor.

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Feds approve Iowa's Medicaid privatization, effective April 1

Iowa’s Medicaid program will shift to managed care for some 560,000 recipients on April 1, in accordance with waivers granted by the federal Centers for Medicare and Medicaid Services. CMS had previously denied the request from Governor Terry Branstad’s administration to privatize Medicaid by January 1, citing numerous signs that the state was not ready. In a letter the Branstad administration released today, Vikki Wachino of CMS noted "significant improvement" in several areas: the provider networks of three insurance companies picked to manage care for Medicaid recipients; plans for reimbursing out-of-network providers for services; better communication between state officials and Medicaid providers and recipients; and training of case managers to assist Medicaid beneficiaries during the transition.

I enclose below reaction to today’s news from the governor, key state lawmakers, and other stakeholders, as well as the full five-page letter from CMS to Mikki Stier, director for Medicaid in the Iowa Department of Human Services. Federal officials set several conditions on their approval of Iowa’s plans, such as monitoring the actions of the three managed-care organizations, making sure call centers are running their helplines competently, and preserving some "continuity of care" for Medicaid recipients.

Although the delay until April 1 will allow more time to prepare for the transition, the policy’s likely impact remains the same: more money for insurance company overhead and profit and less for health care services; a deterioration in care for disabled people, as seen in Kansas and other states; and less access to health care providers (a key issue for the three Iowa Senate Republicans who recently voted with Democrats to terminate Medicaid privatization).

Senate Democrats continue to push for "tough, bipartisan oversight and accountability protections." Chelsea Keenan reported for the Cedar Rapids Gazette that the Senate Human Resources Committee will consider that bill (Senate File 2213) on February 24. I don’t expect that legislation to go anywhere. All I’ve heard from Iowa House Republicans is happy talk, backed up by no evidence, that privatizing Medicaid will save the state money and improve patient care.

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Three Republicans join Iowa Senate Democrats in vote to terminate Medicaid privatization

This morning the Iowa Senate passed Senate File 2125, which would terminate contracts the state has signed with insurance companies picked to manage care for Iowans on Medicaid. Governor Terry Branstad announced his administration’s "modernization" plans early last year and selected four managed care providers in August, with a view to fully privatizing Medicaid by January 1, 2016. The state later terminated a contract with one of those four companies, and the federal government refused to grant the necessary waivers, saying Iowa would not be ready to shift to managed care until March 1 at the earliest.

Iowa Senate leaders made clear on day one of this year’s legislative session that Medicaid privatization would be a pressing concern. Senate President Pam Jochum has been sounding the alarm since last year, worried about how privatization would affect her developmentally disabled adult daughter and other Iowans with special needs. Jochum gave the opening and closing remarks in support of Senate File 2125 today. She repeatedly warned that the Branstad administration has tried to do too much, too fast, without input from state lawmakers or other stakeholders with expertise in the area. Fellow Democrats Chris Brase, Liz Mathis, Mary Jo Wilhelm, Rich Taylor, and Amanda Ragan echoed many of those concerns in their speeches.

During the floor debate, Republican State Senator David Johnson explained why he would vote for the bill. He read e-mails from numerous constituents expressing concern about access to health services for their loved ones on Medicaid. He pointed out that Minnesota took 20 years to transition to managed care, while Iowa is trying to implement the same changes over just one year. "It’s moving too fast. That’s the issue here. We need to put a dagger in this."

Last week Johnson became the first GOP lawmaker to come out in favor of terminating the privatization program; I enclose below excerpts from Jason Clayworth’s report for the Des Moines Register. Johnson’s fears about "children at risk of losing services" stem from the failure of the managed care companies to sign contracts with thousands of providers who have been treating Iowans on Medicaid, including children on HAWK-I (Iowa’s version of the State Children’s Health Insurance Program). Scroll to the end of this post for more details on that access problem, based on data from the Iowa Department of Human Services.

Republicans who spoke against the bill today included Senators Jason Schultz and Mark Chelgren. Schultz claimed Democrats took "ownership" of managed care by putting assumptions about Medicaid savings into the health and human services budget for the current fiscal year. During her concluding remarks, Jochum pushed back hard against the idea that a vote for last year’s health and human services budget was a vote for managed care. Rarely do I ever agree with Schultz, but I think Senate Democrats walked into a trap there. The Branstad administration’s estimates on reduced Medicaid costs after privatization were never grounded in reality, but Democrats accepted those assumptions in the budget they passed—not because they supported the Branstad effort, but likely because doing so gave them an extra $51 million to spend on other health-related priorities.

Chelgren argued that lawmakers should keep their word after voting for a budget that assumed Medicaid would shift to managed care. He likened the situation to Congressional Republicans voting to repeal the 2010 Affordable Care Act without having a plan ready to replace "Obamacare." The analogy fails because terminating Medicaid privatization that hasn’t been fully implemented would not be like repealing Obamacare after several years of operation. The status quo is an available and less disruptive alternative to serving the 560,000 Iowans on Medicaid. Chelgren claimed that halting Medicaid privatization and starting the process over would "betray" those who signed up as providers under the new system. That argument made no sense; public comments from Iowans on Medicaid and health care stakeholders have overwhelmingly opposed the Branstad policy.

During her concluding remarks, Jochum refuted claims that 39 other states have put Medicaid in managed care. In reality, only four states have fully privatized the system, as the governor is doing.

Shortly after the floor debate, senators voted 29 to 19 to approve SF 2125. Republicans Jake Chapman and Tom Shipley joined Johnson and all 26 Senate Democrats. Notably, those three Republicans all represent strongly GOP districts, not marginal seats.

The bill now goes to the Iowa House, where Speaker Linda Upmeyer has indicated she does not plan to bring the measure up for debate. For a nurse practitioner by training, Upmeyer is remarkably insensitive to ordinary people’s health care needs—not only those on Medicaid, but also chronically ill Iowans who could benefit from medical cannabis. A post in progress will catch up on the state of play for medical marijuana in the Iowa legislature.

UPDATE: Added more links and comments on the Medicaid debate below. According to Erin Murphy, Upmeyer confirmed today that the House will not take up SF 2125, because the governor would certainly veto it. Given how unpopular Medicaid privatization is, the public would likely support a legislative override of that veto. But at least five more Republican senators would have to change their stands to override a veto in the upper chamber. In the House, at least 24 GOP state representatives would need to support an override, assuming all 43 House Democrats voted in favor.

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