Seeing is believing

Cedar Rapids-Iowa City Gazette “On Topic” column from Aug. 14, 2016

Gov. Terry Branstad calls them haters — those who see a very different picture in the current state affairs of Iowa’s Medicaid managed-care situation.
“Democrats don’t like it, and the Des Moines Register hates it. We’re not going to be deterred by that,” he told the Westside Conservative Club in Des Moines late last month.
“These great so-called progressives are the ones that are the most against progress. They’re stuck in the past.”

Bear in mind, I intend to maintain both my feet rooted on my side of The Gazette fence, where I write about business while Todd Dorman and Lynda Waddington weigh in on politics on theirs.
But, gee willikers, I continue to marvel at the governor’s seeming myopic lack of concern not only for Iowa’s 560,000 Medicaid recipients and their families, but also — again, keeping to my business side of the fence — his disregard for health care providers, large and especially small.
He told the Westside Conservative Club that the providers who are kvetching are doing so “because we’re checking on them now.”
Is Branstad suggesting these providers — many of them fairly small operations with extremely thin profit margins even before the managed-care rollout, small businesses that help the elderly and disabled — had been cashing in big time on Medicaid payments during the state-run fee-for-service program?
“They want to keep doing it the expensive, old-fashioned way that doesn’t work as effectively and efficiently as what we’re doing today …,” Branstad went on to say.
But, listen, “effective” and “efficient” are words that come to few minds when viewing today’s managed-care landscape in Iowa.
Reports have continued to come in since the April 1 launch of managed care — to members of the state Senate Human Resources Committee, to The Gazette and to other news media in Iowa — that detail incomplete, inaccurate, delayed and simply MIA payments to not-for-profit agencies, nursing homes and individual home health providers.
Many of them have had to cut back on the services they offer Medicaid patients to keep their doors open. Some have needed to extend their credit line. Some are firing employees.
As Sen. Joe Bolkcom, D-Iowa City, noted during a July 26 Senate hearing, “I don’t think any of you three companies” — meaning the MCOs — “are borrowing money to make your payroll.”
The current managed-care system is, in effect, standing with its feet on the garden hose of cash flow for many of these businesses.
And in particular that would bode poorly the smallest of Iowa’s providers — those without the wherewithal to hire lawyers, accountants or other staff to show up at Senate sessions or try to make their way by phone to getting their payment issues resolved by the MCOs.
Everyone, including representatives of the three managed-care organizations, has admitted there have been challenges thus far. But the governor doesn’t see it that way.
To be clear, Medicaid privatization — turning over the operation of insurance business to insurance carriers — is not a bad thing. Many states do it. Some — raise your hand, Kansas — have done it very badly.
But here’s the deal: To deny the current state of affairs is anything other than “rugged,” to use Human Resources Chairwoman Liz Mathis’s words, isn’t good business.
Sen. Mathis, D-Cedar Rapids, has expressed concern in particular for smaller providers in Iowa’s rural areas. She and others have called for more oversight and accountability.
And accountability in business, any CFO worth her salt will tell you, always is a smart, farsighted idea.