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.

Continue Reading...

Budget looms large, social issues largely absent on the Iowa legislature's opening day in 2016

Governor Terry Branstad wore a pink tie and many colleagues remarked on history made yesterday at the Capitol, as Linda Upmeyer became the first woman to preside over the Iowa House as speaker, as well as the first child of an Iowa legislative leader to rise to the same position. Erin Murphy’s take on the milestone is worth a read.

As in recent years, social issues were almost entirely absent from the leaders’ opening remarks to their Iowa House and Senate colleagues. State budget priorities dominated the comments relating to public policy, with Republicans emphasizing the importance of not spending too much and Democrats emphasizing the need to spend enough on education and other vital services. No one mentioned Branstad’s call to extend the penny sales tax for school infrastructure and divert part of the revenue stream to water programs.

Continue Reading...

Who's who in the Iowa Senate for 2016

The Iowa legislature’s 2016 session began on Monday. For the sixth year in a row, the 50 state senators include 26 Democrats and 24 Republicans. Just seven senators are women (six Democrats and a Republican), down from a high of ten women serving in the chamber during 2013 and 2014. All current senators are white. To my knowledge, the only African-American ever to serve in the Iowa Senate was Tom Mann, elected to two terms during the 1980s. No Latino has ever served in the Iowa House or Senate; Nathan Blake fell 18 votes short of becoming the first in 2014. No Asian-American has served in the state Senate since Swati Dandekar resigned in 2011.

I enclose below details on the Iowa Senate majority and minority leadership teams, along with all chairs, vice chairs, and members of standing Senate committees. Little has changed since last year, in contrast to the Iowa House, which saw some big changes in the majority Republican caucus since the legislature adjourned in June.

Term limits are a terrible idea generally but would be especially awful if applied to the Iowa Senate, as the longest-serving current senator bizarrely advocated last year. The experience gap between Democrats and Republicans is striking. As detailed below, only four of the 24 Senate Republicans have ten or more years of experience in the Iowa legislature, compared to seventeen of the 26 Democrats. No current Iowa Senate Republican has more than 20 years legislative experience, whereas six Democrats do.

Some non-political trivia: the 50 Iowa Senate members include three Marks, three Bills, three Richards (who go by Rich, Rick, and Dick), two Mikes, two Toms, two Joes, and two men named Charles (one goes by Chaz).

Continue Reading...

"The View from Nowhere" in Iowa legislative news coverage

When politicians lie, opponents often echo longtime Senator Daniel Patrick Moynihan’s famous words: You’re entitled to your opinion, but you’re not entitled to your own facts.

Politicians can get away with deception, however, when journalists present conflicting facts as opposing viewpoints in a "he said/she said" frame. So it was when Governor Terry Branstad recently touted phony job creation numbers, and reputable Iowa journalists hid behind "critics say" rather than acknowledging reality: no serious economist would recognize those statistics.

And so it was when the Des Moines Register again covered the Iowa Department of Revenue’s unprecedented attempt to rewrite tax code through the rule-making process. Statehouse reporter Brianne Pfannenstiel’s attention to the topic is welcome. The rule change has been an under-reported Iowa politics story this fall, even though it could have a huge impact on the state budget in coming years. Unfortunately, as was the case in earlier articles for the Register on the same controversy, Pfannenstiel avoided stating some important truths about the Branstad administration’s efforts, attributing such observations to "others" including "Democratic lawmakers."

The journalist’s reflex to appear impartial by presenting factual statements as partisan opinions is part of what media critic Jay Rosen has called the View from Nowhere.

Continue Reading...

Feds say Iowa not ready, must delay Medicaid privatization until March 1

For months, Governor Terry Branstad has dismissed warnings from patients, advocates, doctors, hospitals, editorial boards, and lawmakers that the state’s rush to privatize Medicaid would disrupt health care for some 560,000 Iowans. Today the governor finally got the message in a form he can’t ignore. Director Vikki Wachino of the federal government’s Centers for Medicare and Medicaid Services wrote to Iowa Medicaid Director Mikki Stier,

Based on our review last week of Iowa’s progress, as well as the information you have provided, CMS expects that we will ultimately be able to approve Iowa’s managed care waivers. However, we do not believe that Iowa is ready to make this transition Jan. 1. CMS previously outlined the requirements to provide high quality, accessible care to Medicaid beneficiaries, and Iowa has not yet met those requirements, meaning that a transition on January 1 would risk serious disruptions in care for Medicaid beneficiaries. While you have made progress in some areas of readiness, our review also identified significant gaps that need to be addressed before CMS can authorize your waiver requests. For that reason, CMS will work with you toward approval of your request effective March 1, 2016, provided that the state demonstrates progress toward readiness consistent with the actions in the attachment to this letter.

Click through to read the full four-page letter and four-page attachment from Wachino to Stier, which the Des Moines Register posted online. CMS officials found that "significant areas of the state did not have many provider types within a reasonable distance," and that "Relying too heavily on out-of-network providers is likely to create confusion among beneficiaries and providers, result in access issues for beneficiaries, and disrupt continuity of care for beneficiaries." Many of the points raised echo concerns three Democratic state senators expressed during meetings with CMS officials in Washington last month.

The CMS readiness review also showed that nearly half of Medicaid recipients who tried to call the state’s call centers earlier this month could not get through. Many Iowans who did reach a staffer on the phone were not able to find out whether any of their current doctors had signed contracts with the four managed care providers approved to run Medicaid. The CMS findings are consistent with what I’ve been hearing from acquaintances: the enrollment packets sent to Medicaid recipients did not include basic details they would need to make an informed choice of managed care provider (such as where their family’s current doctors will be in-network).

I enclose below reaction to today’s news from Branstad, who struck an upbeat tone, and key Democratic lawmakers, who vowed to keep fighting to improve legislative oversight of the Medicaid privatization. The Democratic-controlled Iowa Senate approved such a bill during the 2015 session, but the Republican-controlled Iowa House declined to take it up. Oversight is the very least state lawmakers could do to prevent the transition to managed care from becoming a pretext for denying services to vulnerable Iowans.

David Pitt noted in his report for the Associated Press,

Two legal challenges continue including one from the Iowa Hospital Association, a trade group for the state’s hospitals. It sued the state claiming the privatization plan is illegal because it takes millions of dollars from a dedicated hospital trust fund and gives it to the four managed care companies.

Any relevant comments are welcome in this thread. I am grateful that so many Iowans took the time to contact federal officials about Branstad’s disastrous policy. Bleeding Heartland reader Rhonda Shouse has been one of the superstar organizers in that fight.

UPDATE: Added below reaction from Representative Dave Loebsack (D, IA-02). I expect that during next year’s re-election campaign, Loebsack will highlight his efforts to shield constituents from the negative consequences of shifting Medicaid to managed care. His only declared Republican opponent is State Senator Mark Chelgren, who like his GOP colleagues in the upper chamber has done nothing to slow down the privatization or strengthen legislative oversight of the process.

SECOND UPDATE: Added more news and commentary related to this issue.

Continue Reading...

Iowa Republican lawmakers not eager to block Branstad's latest power grab

Iowa Capitol photo Fotolia_24694213_XS_zpsbnpz4jnl.jpg

Among the many examples of corporate cronyism Governor Terry Branstad’s administration has provided these past five years, getting the Iowa Department of Revenue and Finance to rewrite tax code without legislative approval "on behalf of the Iowa Taxpayers Association” is among the most brazen.

Not only does this unprecedented use of the rule making process usurp legislative authority, it may end up being more expensive than "the worst economic development deal in state history.” At least tax incentives benefiting Orascom (for a fertilizer plant the company would have built anyway) have an end point. The Iowa Department of Revenue’s proposed sales tax cut for manufacturers will cost the state of Iowa tens of millions of dollars in revenue every year, indefinitely.

Democratic state lawmakers weren’t happy that the Branstad administration unilaterally decided to let private insurance companies manage the state’s Medicaid program, especially since some corporate representatives were briefed on that managed care plan long before state officials informed lawmakers or the general public. But state lawmakers didn’t have a way to block the Medicaid privatization.

In contrast, the Iowa House and Senate could stop the Iowa Department of Revenue’s proposed rule and thereby assert the authority of the legislative branch to approve tax code changes. Alas, signs from Tuesday’s meeting of the legislature’s Administrative Rules Review Committee (ARRC) point to House Republicans going along with the Branstad administration’s ”serious overreach of executive power.”

Continue Reading...
View More...