State’s privately run Medicaid system should be dropped, 47% of Iowans say – DesMoinesRegister.com

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In April 2016, three for-profit companies took over management of Iowa’s Medicaid program. Then-Gov. Terry Branstad says the program is saving the state money, but the companies say they are losing money. Critics worry about a loss of services.

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Iowa’s shift to a privately managed Medicaid system continues to draw more detractors than fans, a new Des Moines Register/Mediacom Iowa Poll shows.

Forty-seven percent of Iowa adults think the state should go back to having a state-run Medicaid system, according to the poll. Thirty-seven percent think the state should continue to have private companies run the program. Sixteen percent are unsure.

Former Gov. Terry Branstad decided in 2015 to hire national companies to run the $4 billion program, which covers health care for about 600,000 poor and disabled Iowans. Branstad, a Republican, said the switch would lead to more efficient, effective care and would save the state hundreds of millions of dollars. Critics say it has caused snarls of red tape for health-care providers and cuts in services for Medicaid recipients.

Branstad’s successor as governor, fellow Republican Kim Reynolds, has enthusiastically endorsed the shift to privately run Medicaid. Her administration is now negotiating new payment rates for the three national managed-care companies, which have complained they’re facing “a catastrophic experience” in Iowa due to wildly low estimates of how much health care Medicaid participants would use. State officials have predicted the closed-door negotiations will wrap up this month, though they won’t estimate how much more the state and federal governments will agree to pay the private management companies. The new rates were supposed to take effect July 1.

The new Iowa Poll shows a sharp partisan split in how Iowans feel about the issue. Fifty-nine percent of Democrats would like to see Iowa resume having state administrators run the Medicaid program. That’s more than double the 28 percent of Republicans who feel that way. Among political independents, 56 percent would like to see Iowa revert to a state-run Medicaid program.

The poll of 800 Iowa adults, conducted July 9-13 by Selzer and Co., has a margin of error of plus or minus 3.5 percentage points.

Poll participant Diane Chaplin of Spirit Lake would prefer the program be run by state administrators. Chaplin, 61, is a bar owner who doesn’t believe the government saves money by contracting out for tasks public employees used to do. She likened it to if she hired a cleaning service to sweep and mop her tavern instead of having her staff do it. “It seems redundant and wasteful,” she said. “A private contractor isn’t going to do it without making a profit.”

Chaplin is a Democrat who backed liberal champion Bernie Sanders for president. She would like to see the country go to a “single payer” health care system, in which everyone would be covered by a government program like Medicare. “The for-profit health care system in this country sucks,” she said.

Chaplin has little hope that Reynolds will overturn Branstad’s decision to privatize the state’s Medicaid system. The new governor seems like a nice person, Chaplin said, but she’s a follower of the same political philosophy as her predecessor. “She’s not going to reverse anything unless somebody holds her feet to the fire.”

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Marilyn Doocy’s son Marty Matteson has Down syndrome and lives in his own home with assistance paid for by Medicaid. Iowa’s shift to privatized Medicaid is making changes that could leave Matteson without a safe option for staying in his home.

Poll participant Frank Buechel is glad Branstad decided to hire private companies to run the Medicaid program.

Buechel, 65, is a Republican who lives near a south-side Des Moines office building where state Medicaid administrators are headquartered. That building used to be much more crowded with state bureaucrats, he said.

“It was a typical waste of money and duplication of services,” he said. “They had everything go through four or five people when one or two would do.”

Buechel is semi-retired after helping open Dollar General stores in new markets. He believes private businesses are inherently more efficient than government agencies. He is not worried about complaints of delayed payments on bills from the Medicaid management companies to clinics, hospitals and other health-care providers. Such problems will be ironed out by the management companies, he said.

“In the first year, they may stumble,” he said. “But from then on, we should be able to save a lot of money and serve more people with better results.”

The new Iowa Poll echoes findings from five months ago, but more Iowans have formed an opinion about private Medicaid management, and more oppose it. In the February Iowa Poll, 33 percent of Iowans said the state’s shift to privately run Medicaid was a bad change, 13 percent said it was a good change and 54 percent were unsure.

Amy McCoy, a spokeswoman for the Iowa Department of Human Services, expressed confidence this week that the state’s privately run Medicaid system will gain support. “The health care system in the U.S. is complex, and any change creates anxiety,”  she wrote in an email to the Register. ”With time, opinions will continue to shift as people gain experience with managed care.”

McCoy, whose department oversees the project, said payment problems between the management companies and service providers are being resolved as the system is being improved.

“A growing majority of states have managed care as part of their Medicaid programs, and that trend continues as the nation works to curb over-utilization and reward quality care that helps Medicaid members live healthier or more stable lives,” she wrote.

Reynolds, Iowa’s new governor, told reporters Tuesday that she hopes to see the state’s contract negotiations with the managed-care companies conclude soon without requiring significantly more money from the state and federal governments.

“We don’t want to spend more than we did for fee-for-service,” she said, using a common description of the government-run version of Medicaid. “That was one of the main priorities.”

Reynolds noted she discussed the situation last week with two leading Democratic state senators, Liz Mathis of Robins and Amanda Ragan of Mason City. The senators help oversee the Medicaid system, and they’ve criticized service cuts and late payments to care providers under private management.

Mathis said Tuesday she wasn’t surprised to hear the new Iowa Poll found more detractors than supporters of the privately managed Medicaid system. She said the state could strike a middle ground between continuing with full private management of Medicaid and going all the way back to full government management. Iowa could decide to have state administrators resume oversight of Medicaid members with particularly complex health problems or disabilities, she said. Other Medicaid members could continue under private Medicaid management.

“We could step back and do that, but it would be up to the governor. She’s in the driver’s seat,” Mathis said. But the senator said the governor didn’t appear to be inclined to pull back at all from the privately managed Medicaid system. “She seemed to feel we need to give it more time to work,” Mathis said. “I respectfully disagree.”


About the poll

The Iowa Poll, conducted July 9-13 for The Des Moines Register and Mediacom by Selzer & Co. of Des Moines, is based on telephone interviews with 800 Iowans ages 18 or older. Interviewers with Quantel Research contacted households with randomly selected landline and cell phone numbers supplied by Survey Sampling International. Interviews were administered in English. Responses were adjusted by age and sex to reflect the general population based on recent census data.

Questions based on the sample of 800 Iowa adults have a maximum margin of error of plus or minus 3.5 percentage points. This means that if this survey were repeated using the same questions and the same methodology, 19 times out of 20, the findings would not vary from the percentages shown here by more than plus or minus 3.5 percentage points. Results based on smaller samples of respondents — such as by gender or age — have a larger margin of error.

Republishing the copyright Iowa Poll without credit to The Des Moines Register and Mediacom is prohibited.

Mobile readers: Click here to see methodology.

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