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.
William Petroski reported for the Des Moines Register:
Sen. David Johnson, R-Ocheyedan, voted for the Senate bill, saying he recognizes oversight is necessary for the changes to be successful.
"We know that this isn’t just about money. It isn’t just about cost containment and balancing the budget," Johnson said.
Sen. Mark Chelgren, R-Ottumwa, said he agreed with the intent of the bill, but he disagreed with some of the language, such as a phrase suggesting Iowa "hastily" embarked on the managed care program, a view of many Democrats.
"This program has to go forward to be successful and the only way it is going to be successful is if we all work together on it," Chelgren said.
Sen. Rita Hart, D-Wheatland, spoke emotionally about a nephew who was paralyzed from the neck down after he was shot in the neck at age 19 while being in the wrong situation at the wrong time. He has remained optimistic in the more than two decades ever since, and Hart said she could hear his voice urging lawmakers to calm down and do their jobs. Similarly, Senate President Pam Jochum, D-Dubuque, who has a developmentally disabled adult daughter, told of how parents with children who have intellectual disabilities have thanked her for standing up for them because the governor's Medicaid plan is letting them down.
Senate Majority Leader Michael Gronstal, D-Council Bluffs, made a rare speech on the Senate floor, arguing in support of the bill. He noted the state has had problems in the past with private-sector contracts, such as when Branstad shifted cleaning duties at state highway rest areas to private firms. The result — at least initially — was that toilets were filthy and garbage bins overflowed with trash. Those problems have since been fixed.
O.Kay Henderson reported for Radio Iowa,
Senator Joe Bolkcom, a Democrat from Iowa City, said private companies have been racking up “significant” profits in other states that have switched Medicaid patients into managed care plans.
“Is this a great country or what? Making money off vulnerable, frail, sick Iowans; people with disabilities; our seniors and our kids,” Bolkcom said. “The managed care companies will make money by cutting provider rates and denying services to our most vulnerable citizens. We need this oversight bill more than ever.”
Senator Brad Zaun of Urbandale, another Republican who voted for the bill, said the process of awarding contracts to the three companies that will manage Iowa’s Medicaid program was “polluted” and “shameful”.
“I’m just disgusted. I’m disgusted we’re having this conversation,” Zaun said. “What we’re trying to do is make the best of a bad situation.”
I've never been a big fan of Zaun's, but all credit to him for speaking out about the tainted contract awards and other problems with Medicaid privatization. Also during yesterday's debate, he said, "I resent any kind of communication that this is a partisan issue because it’s not with me." Health care issues must be important to Zaun, who last year provided the crucial 26th vote for a bill that would expand access to medical cannabis for severely or chronically ill Iowans.
Rod Boshart reported for the Cedar Rapids Gazette,
“This is a day for 560,000 Iowans. It’s about them,” said Sen. David Johnson, R-Ocheyedan, who called S.F. 2213 “an answer to a situation that we didn’t initiate, but it’s moving forward and we know that.” He said legislators need to be vigilant as a coequal branch of government by doing “the right thing” to protect Iowa’s most-vulnerable citizens.
Senate Majority Leader Mike Gronstal, D-Council Bluffs, said House Republicans aren’t going to take up a Senate-passed bill to halt privatization, so he told his colleagues the oversight is needed to prevent corporate “bean counters” from turning managed care into less care and to send “a strong message this is too fast, too much and people are going to get hurt.”
Before passing the bill, senators rejected a scaled-back amendment offered by Johnson that Sen. Joe Bolkcom, D-Iowa City, called a “cynical play” that would have “gutted” robust oversight. He said it was important that Iowa officials closely track “how these questionable Wall Street companies use our money.”
Bolkcom warned the MCOs had engaged in questionable practices in other states that have adopted privately managed care, as well as jacking up rates and holding states “hostage” for more money once they were established. He predicted Iowans will “regret the day” they moved to Medicaid privatization.
“Shipping hundreds of millions of dollars out of Iowa won’t save money, won’t strengthen local health care providers and won’t make sick people healthier,” Bolkcom said. “The new sucking sound we’re about to hear is money going out of state to the home offices of these MCO executives to be paid to their shareholders. This is so irresponsible and it is dumb.”
On final passage, SF 2213 passed by 32 votes to 18. Senators in favor: Democrats Chaz ￼Allen, Dick Dearden, Tony Bisignano, Bill Dotzler, Joe Bolkcom, Bob Dvorsky, Tod Bowman, Mike Gronstal, Chris Brase, Rita Hart, Rob Hogg, Tom Courtney, Wally Horn, Jeff Danielson, Pam Jochum, Kevin Kinney, Joe Seng, Liz Mathis, Matt McCoy, Janet Petersen, Steve Sodders, Herman Quirmbach, Rich Taylor, Amanda Ragan, Mary Jo Wilhelm, Brian Schoenjahn, and Republicans Jake Chapman, Brad Zaun, David Johnson, Mark Segebart, Roby Smith, and Amy Sinclair.
The other eighteen Republican senators voted against the Medicaid oversight bill: Bill Anderson, Mark Costello, Jerry Behn, Bill Dix, Rick Bertrand, Randy Feenstra, Mike Breitbach, Julian Garrett, Mark Chelgren, Dennis Guth, Tim Kapucian, Tim Kraayenbrink, Ken Rozenboom, Charles Schneider, Jason Schultz, Tom Shipley, Jack Whitver, Dan Zumbach.
State Senator Amanda Ragan's opening remarks on SF 2213, March 1:
Ragan's opening remarks, as prepared:
Despite its disappointing and troubling start, Medicaid privatization is moving forward.
We’ve been told the problems, the conflicts of interest, and even apparent threats to the continued care of disabled Iowans will be worked out soon. I certainly hope so.
If everything is ready April 1, it will be the first major deadline that the program has actually met.
The Human Resources Committee is bringing this Medicaid oversight legislation before you today with the unanimous support of our Republican and Democratic members.
The task before us now is protecting Iowans with tough, bipartisan oversight and accountability. Our job is to protect the health care safety net for Iowa families. We are all one accident or illness away from depending on Medicaid.
Iowa’s health care safety net is simply too important to turn over to out-of-state corporations.
The intent of this legislation is to safeguard the interests of Medicaid members, encourage the participation of Medicaid providers, and protect Iowa taxpayers.
In addition to vigorous government oversight with significant stakeholder involvement, we must require DHS and the managed care companies to protect consumers, preserve provider networks, address the unique needs of children and assure accountability.
We must also ensure that Medicaid dollars continue to make system improvements
Here are the ways Senate File 2213 will accomplish these goals:
1. Enhance the role and responsibilities of the Health Policy Oversight Committee
2. Execute a comprehensive review of program integrity
3. Create Medicaid Reinvestment Fund (will finance system improvements and fund the Ombudsman program)
4. Assign duties and authority to the Managed Care Ombudsman Program
5. Expand and enhance of the Medical Assistance Advisory Council
6. Direct DHS to make specific improvements in the areas of: consumer protections, children, provider participation enhancement, rates and payments, data collection, and evaluation and oversight
It is undeniable that Governor Branstad took a “too much, too fast” approach to Medicaid privatization.
That’s why the federal government imposed two delays.
Much more importantly, that’s why Iowans are repeatedly, urgently speaking out. Every legislator in the Iowa Senate and the Iowa House, every legislator in both political parties, has been contacted by those Iowans.
There are too many unanswered questions, about who will provide oversight and how and where individuals will get services.
This Medicaid Privatization program is destined to harm the very people it was supposed to help. Apparently, it was designed by those who know the cost of everything but understand the value of nothing.
This legislation is our bipartisan response to those concerns.
Iowa Senate Democratic staff analysis of Senate File 2213: