Jace Brady
[email protected]

Gov. Terry Branstad has endeavored to accomplish what was almost an impressive Machiavellian feat but instead has unraveled into another episode of government incompetence. In 2014, under mounting political pressure, Branstad agreed to expand Medicaid in Iowa. The governor, in true conservative form, unveiled a plan to privatize Medicaid in two forms. First, individuals under 100 percent of the poverty line would be enrolled in managed care under the Iowa Wellness plan and those between 100-138 percent of the poverty line would receive insurance premium support to purchase private plans under the Iowa Marketplace Choice Plan. After the governor’s announcement, a blitz ensued to roll out the plan as expeditiously as possible. Just over a year after an agreement was reached, an inadequate Medicaid-managed care plan is scheduled to take effect Jan. 1.

The premise of managed care is that Medicaid patients will have to see a primary care doctor before receiving any non-emergency treatments, and physicians will have to seek pre-approval before performing the majority of procedures. While ensuring Medicaid patients don’t receive unnecessary care is wise, excessive bureaucratic controls in the hands of a private firm could lead to an under-utilization of necessary services in a pursuit of profits. This concern is especially robust, considering a judge recently threw out Iowa’s contract with one of the managed-care companies, WellCare, because it failed to disclose a fraud settlement. WellCare was accused of fraud by nine other states before Branstad hired it to make health-care determinations for Iowa’s indigent population.

Recognizing the incompetence of his own administration, Branstad was forced to inspire buy-in from hospitals, physicians, ambulance companies, and all other health-care providers affected by this decision. In order to ensure compliance with the new Medicaid program, the governor extorted providers by threatening reduced Medicaid reimbursements if they failed to contract with the managed-care companies. The majority of Medicaid treatment is already provided at cost, or more likely at a loss, because of low reimbursement rates. Now, providers face a 10 percent reduction in payment if they fail to comply with the government’s “request.”

Providers will not be the only ones to suffer because of the rushed roll out. Medicaid recipients have begun to receive benefit information in the mail explaining the changes in Medicaid in the form of 20-plus page pamphlets. Many will be forced to find new primary-care providers and may not understand the process required to seek out specialized care.

Furthermore, an influx of Medicaid recipients and lower reimbursement rates for providers will likely decrease access to care for many of those who are already enrolled in Medicaid.

For some reason, Branstad is determined to push through the mayhem that surrounds the managed-care roll out. Much of those opposed to the change in Medicaid are more appalled by the rushed roll out rather than the plan itself. They feel if a change must be made it should be made correctly, even if it takes more time. Over the next few weeks, the Center for Medicare and Medicaid services will be in Iowa to see if we truly are ready for our rollout. Hopefully, the governor will realize that a short delay to facilitate this massive change in Medicaid would be the most politically expedient decision he could make.