With the Iowa presidential caucuses starting Feb. 1,considerable attention has focused on the argument between Democratic candidates Bernie Sanders and Hillary Clinton over whether it's better to fix the Affordable Care Act or switch to a single-payer government health insurance program, and on Republican candidates' repeated calls for repealing Obamacare.
But in Iowa, many healthcare providers, patients and public officials are more immediately concerned about Branstad's Medicaid privatization effort, which he says will save money and improve care. They note that other states have implemented their Medicaid managed-care programs much more gradually, moving disabled people into MCOs only after the programs have been well established. Now some Democrats are making it a political issue, with Hillary Clinton warning Branstad's plan could mean cuts in services.
"I would say it's one of the top issues in Iowa, but I don't know if it translates to the presidential candidates,” said Brian Johnson, a Republican lobbyist in Des Moines.
On Monday, the head of Iowa's Medicaid program told state legislators that she's "very confident" the $4.2 billion Medicaid program will be ready for private management beginning March 1, although some lawmakers have expressed lingering concerns about the deadline. The plan's launch depends on approval from the CMS.
Like the state's Medicaid beneficiaries, Iowa healthcare providers are worried about privatizing the program, and some hospitals have tried unsuccessfully to block it in court. One of those hospitals, Mercy Medical Center in Cedar Rapids, still has not signed contracts with any of the three participating Medicaid plans, which are AmeriHealth Caritas, Anthem-owned Amerigroup and UnitedHealthcare. But Mercy expects to do so by March 1.
None of the three plans responded to Modern Healthcare's requests for comment.
Tim Charles, CEO of MercyCare Service Corp., which operates the independent Mercy Medical Center, said his fear is that the governor's stated plan to save $51 million in the first six months of the program will translate into provider rate cuts and reduced access to care for beneficiaries. “If you pay the MCOs 15% off the top while the state was running the program with administrative costs of 10%, the only way to get cost savings is to manage utilization, meaning access to services,” he said.
Sabra Rosener, vice president of government relations at UnityPoint Health, which operates St. Luke's Hospital in Cedar Rapids, said she's worried about the utilization-management methods the Medicaid plans will use, based on what she's seen in other states. Additionally, the plans have hired a massive number of nurses to handle care management, adding to the state's nurse-staffing squeeze, she said. Nevertheless, UnityPoint recently signed contracts with two of the plans, UnitedHealthcare and Amerigroup.
"All my Medicaid patients ask me if I can still be their doctor,” said Dr. Clete Younger, a family physician at the UnityPoint Health clinic in Cedar Rapids, where all the exam rooms have yellow signs indicating which Medicaid plans the clinic is contracting with. “These patients are already struggling, and now they're having to deal with a complex private system,” he said.
Anticipating payment delays because of the Medicaid plans' tough utilization management, Joe Lock, CEO at Eastern Iowa Health Center, a federally qualified community health center in Cedar Rapids, said he has increased his organization's credit line by 500%. “It's not that we won't get paid, but we were worried about how soon we'd get paid, because there are three MCOs with three separate processes and sets of paperwork,” Lock said.
Mikki Stier, from the Iowa Department of Human Services, told state lawmakers that the Medicaid plans currently have signed contracts with 45% of Iowa's Medicaid providers. "It's a broad network of providers that have signed up, our communication plans are strong and we are modifying those daily," she said.
Stier added that wait times at call centers averaged about three minutes, an improvement following earlier complaints that people with general questions had been kept on hold for long periods. She also said training was being implemented around the state to prepare health providers for the shift.
Meanwhile though, both Democratic and Republican state legislators continue to question the program, particularly the Branstad administration's cost-saving projections. And a new state report finds that Iowa needs to hire 134 additional ombudsmen, and spend up to $17 million more a year to properly oversee services and care quality for Medicaid beneficiaries under the privatization program.
MCO Watchdog's Shouse said her group will make the privatization program an election issue in any congressional or state legislative contest where a candidate is not responsive to their concerns.
“Medicaid beneficiaries are not known for organizing,” she said. “They have trouble looking ahead at next month, let alone next November. But I feel it's important to speak out for those who can't.”