Health care debate explodes myth of Kim Reynolds the researcher

This year’s Congressional health care debate exposed a lot of hypocrisy and dishonesty among Republicans who never had a solid plan for how to repeal and replace the Affordable Care Act.

Politicians may yet revive something resembling the health care legislation that is dead for now.

The image of Governor Kim Reynolds as some kind of policy wonk should be destroyed beyond repair.

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Early clues about the Kim Reynolds leadership style are not encouraging

Lieutenant Governor Kim Reynolds will likely begin performing the duties of our state’s highest office very soon, following Governor Terry Branstad’s expected confirmation as U.S. ambassador to China. Speaking to journalists, some Republicans who have worked with Reynolds have enthused about her willingness to study the issues and be engaged in policy-making as part of her long preparation for the job.

Unfortunately, the way Reynolds has handled the controversy surrounding her authority to appoint a new lieutenant governor has revealed a willful disdain for research and opposing views.

Now, she admits she may have trouble working with Attorney General Tom Miller, whom she views as “my legal counsel” interfering with “my plan.”

If recent events reflect how Reynolds will approach other complicated and contentious issues, Iowans have reason to worry.

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WellCare loses battle to maintain Iowa Medicaid contract

One of the four companies the Iowa Department of Human Services initially selected to manage care for Medicaid recipients has given up the fight to keep a contract that would have been worth hundreds of millions of dollars. Follow me after the jump for details on the final stages of WellCare’s unsuccessful effort to overturn state officials’ decision to terminate that contract.

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Well-placed allies couldn't save WellCare's Iowa Medicaid contract

They were so close. Florida-based WellCare played the game almost perfectly to win a contract for its Iowa subsidiary to manage care for Medicaid recipients, which could have been worth hundreds of millions of dollars over the next three years.

The first sign that WellCare’s ambitions might come to nothing attracted little notice, appearing just before the long Thanksgiving weekend. More bad tidings for WellCare arrived yesterday in a late Friday afternoon dump, the classic way for government officials to bury news. Reading Jason Clayworth’s report for the Des Moines Register, it’s easy to see why the Branstad administration sought minimal attention for fixing an embarrassing oversight.

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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.

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