Editor's note: Every other Sunday through the conclusion of this year's session of the Iowa Legislature, our local lawmakers will share their Statehouse views.
Rep. Jacob Bossman, R-Sioux City
UnitedHealthcare has decided to leave the Iowa Medicaid program after demanding more money and less accountability. Negotiations broke down, and I support the governor’s decision to not give in to their demands. Governor Reynolds is committed to getting the best deal possible for Medicaid members, providers and taxpayers. Also, accountability to those in need of these services and accountability to those providers performing these services is important. For the last three years, the Legislature has passed, in a bipartisan manner, some of the strongest managed-care oversight in the country. I supported accountability measures last year and continue to believe they are absolutely necessary to ensure quality service.
Iowa Total Care is coming into the state (in addition to Amerigroup) and DHS will be coordinating with Medicaid members to ensure a smooth transition with minimal disruption. I am committed to helping my constituents during this transition to ensure that there are no gaps in service for vulnerable Iowans. During the transition, Medicaid members will have a choice between the two remaining MCOs and be able to switch plans for 90 days from the date they are moved from UnitedHealthcare. Even after that 90-day period, members will be able to change MCOs at any time for “good cause,” which includes their provider not being in their current MCO’s network.
The old Medicaid system was unsustainable; its growth was limiting our ability to fund other priorities. Before this challenge, most people, Republicans and Democrats alike, felt the managed Medicaid program was improving significantly. We must continue to make improvements to ensure that it remains successful and meets the needs of all the people it serves.
Rep. Chris Hall, D-Sioux City
Governor Kim Reynolds announced UnitedHealthcare is leaving Iowa's managed-care program. Since United currently manages 70 percent of Iowans on Medicaid, it means 425,000 Iowans will have their health care disrupted again, including thousands of our most vulnerable who have long-term disabilities or debilitating illnesses.
The announcement follows years of bad news surrounding the governor’s venture into private Medicaid. United is the second company to leave the state following the exit of another last year. Proof of the failed experiment is a trail of unpaid bills and savings that never materialized. All this despite the fact Gov. Reynolds negotiated a $105 million increase for the companies. It isn’t saving money for Iowa’s taxpayers and it isn’t improving access to health care.
I’ve listened to story after story - from patients and health care providers - fed up with Medicaid privatization. That’s why I joined colleagues last week to offer a common sense plan to end Medicaid privatization and prevent another health care disruption for Iowans. First, the most vulnerable Iowans in need of long-term assistance (LTSS) would have their care returned to public oversight. It would guarantee they receive needed care and providers won’t be shortchanged. Second, Medicaid privatization would end on June 30 and the governor and lawmakers would be forced to work together to develop a system that ends disruptions and actually improves access to health care.
Following a committee meeting last week, I discussed the idea with one of my Republican colleagues. He said, “Ending the program in ninety days might be too fast, but my God we’ve got to do something.” I appreciate his concern. We should be thoughtful about the timeline, but my friends across the aisle can no longer ignore the expense and heartache created by this program.
Rep. Tim Kacena, D-Sioux City
Two issues that need attention during the last month of the legislative session are health care and homelessness. Governor Reynolds recently announced UnitedHealthcare was leaving Iowa’s managed-care program. UnitedHealthcare has been managing the care of 70 percent of Iowans on Medicaid after another managed-care organization, AmeriHealth Caritas, left the program in late 2017. UnitedHealthcare’s departure leaves 425,000 Iowans facing another disruption in health care because many had just switched to UnitedHealthcare and have already had multiple case workers.
I voted for two amendments last Monday to end Medicaid privatization and provide the health care Iowans need. The amendments would move the most vulnerable Iowans who need long-term assistance back to the fee-for-service system in place before Gov. Branstad acted unilaterally to privatize the system in 2015, would end Medicaid privatization at the end of the fiscal year and would force the governor and legislators to develop a system that actually improves access to health care. Unfortunately, the majority party rejected both amendments.
Homelessness is an often-overlooked problem in politics, but like privatized Medicaid this issue negatively impacts the most vulnerable populations in Iowa. Of the Iowans in supportive housing last year, 62 percent faced severe disabilities and 46 percent were children. In 2018, 9,836 Iowans spent their evenings in an emergency shelter, 2,083 in transitional housing and 4,111 in permanent and rapid rehousing units. Approximately 73 percent of those served entered the shelter for the first time, so the problem is ongoing. In my district, 196 homeless Iowans were served.
Senate File 325 is one proposal that can help meet the challenge by doubling the amount of funds transferred from the real estate transfer tax collection to the shelter assistance fund. The bill would have to be offered as an amendment at this point.
Sen. Jackie Smith, D-Sioux City
After touring western Iowa flood damage last week, Sen. Rob Hogg and I have proposed a recovery plan. For the sake of our livelihood, we must keep farms and businesses going while they bounce back from the damage they’ve suffered.
We’ll need more help than the federal government can provide. Since the Legislature is in session, I hope we can come together to address unmet needs.
Senator Hogg is a good ally in this cause. He’s from Cedar Rapids, where he helped lead flood recovery and prevention efforts after that city’s devastating 2008 flooding. He has given me a lot of great advice and is committed to helping western Iowa as much as he did his own community.
Our proposal would use $50 million in one-time money from the $190 million projected surplus for the 2018-19 budget year. The money would be dedicated to six purposes:
1. Small Business and Farm Disaster Grants: Farms and businesses that have sustained property damage and commit to keeping their employees on the job could get $1,000 per month per employee, up to $10,000 per month, for up to five months.
2. Supplemental High Quality Jobs Appropriation: An additional $5 million to the High-Quality Jobs Program would help disaster-affected businesses in economically distressed counties.
3. Disaster Recovery Revolving Loan Fund: No-interest loans that could be repaid over 20 years would provide local governments and non-profits money for uses not covered by federal disaster recovery funds.
4. Flood Hazard Mitigation Grants: By putting $24 million into an existing Iowa Flood Mitigation Program, we could pay for levee repairs and improvements and other infrastructure projects to keep floodwaters at bay.
5. Restore past cuts: $443,000 for the Department of Natural Resources Floodplain Management Program and the Iowa Flood Center, which help prevent flooding and improve flood response.
6. One-time appropriation: $500,000 for the Iowa Flood Center and DNR to assess causes of 2019 Missouri River floods.