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
“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.”
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.”
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.
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
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
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.
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.