DES MOINES -- Six candidates looking to unseat Gov. Kim Reynolds in 2018 - four Democrats and two Republicans - agreed Thursday they would repeal privately managed Medicaid and replace it with a state-run system offering quality, reliable services and paying Iowa providers on time.
Democrats Andy McGuire, Cathy Glasson, Jon Neiderbach and John Norris shared the stage with Republicans Ron Corbett and Steven Ray at a Rebalancing Health Care in the Heartland forum co-hosted by the University of Iowa Health Science Colleges and the Iowa Rural Health Association.
All of the 2018 gubernatorial hopefuls in attendance questioned whether the switch to a privately managed $5 billion Medicaid system in April 2016 actually has saved money and now likely faces continued instability and uncertainty with one of the three managed care organizations exiting, forcing thousands of Iowans to switch company enrollments.
"I have never witnessed more imbalance in health care across the state," said Norris, who has served in a variety of roles in the state, federal and private sector.
"This privatization of Medicaid is a failure and the sooner they admit it and take this back into the successful government-run program it was before, the better off we're all going to be in this state," said Norris. "It's hard for anyone to admit failure, but the longer they deny it, the longer our most-vulnerable Iowans will suffer."
McGuire, a former Iowa Democratic Party chairwoman who is a medical doctor, said she encounters a lot of Iowans while campaigning who "feel like they're not getting a fair shake" and see the current administration at the Statehouse as "putting profits ahead of people" by contracting Medicaid services with private insurance companies.
"What they're doing right now with Medicaid privatization isn't working," McGuire said. "I'm somebody who is a health care expert. I can help fix this."
Corbett, a former speaker of the Iowa House and now mayor of Cedar Rapids, said Iowa faces problems in the Medicaid and mental health areas because in both instances former Gov. Terry Branstad made "top-down decisions" without proper vetting or input from Iowans.
"It wasn't a bottom-up desire from the citizens of the state of Iowa or the providers of the state of Iowa - we want change, we need change," Corbett said of Medicaid privatization, "it was a top-down decision, and when the top-down decision was made, the people weren't even brought in as a part of the process."
Private companies aren't bad, Corbett said, they just have a different mission to turn a profit, which sometimes results in beneficiaries being denied services and providers being denied reimbursements.
He said he would support some services for elderly, disabled and other vulnerable Iowans returning to a fee-for-service basis and enlisting nonprofit Iowa entities to manage other Medicaid services rather than out-of-state companies.
"We have definitely got a health care crisis in this state and in this nation," said Glasson, a Coralville registered nurse and union organizer, who called for a "Medicare-for-all system" at the federal level, but, if need be, Iowa should step forward and establish a universal single-payer plan in the meantime.
"Real people are forced to make gut-wrenching decisions every single day about their care," Glasson said. "When it comes to saving people's lives, we can't just tinker around the edges. We have to stand up for bold, progressive ideas and solutions."
Neiderbach, a former Des Moines school board member who previously worked as a state government policy analyst, described himself as a "common-sense radical" who sees the need for deep reform "from the ground up" beyond just health insurance issues to address structural problems and improve outcomes while making quality health care accessible and affordable.
He also proposed having the state take over funding of the mental-health system, which ranks among the nation's worst, but Corbett advocated for maintaining low control while easing the burden on property taxpayers.
Ray, a Boone City Council member and former state public safety employee, expressed concerns that the state has shifted costs to local government entities and questioned whether privately managed Medicaid was providing the savings, control and accountability that were promised when the changeover was made.
"I think we're better off going back to have the state run it myself," he said.
Organizers of Thursday's event said all announced candidates for governor in 2018 were invited to the forum, including Reynolds, but neither the governor nor acting Lt. Gov. Adam Gregg could attend due to scheduling conflicts.