Sure, the Presidential Election is only about 18 months away, but the campaigns--especially among the crowded Republican field--are well underway. With its first in the nation primary--the Iowa Caucuses--the state I currently call home is in the news often these days as the next hopeful makes their trek to America's Heartland. But recently, Iowa has been in the news--on a national level--for a very different reason and it's one you should pay attention to no matter where you live, because it's either happening in your state already, or there's a very good chance that it will be soon.
The issue is simple: Iowa wants to hand over control of its Medicaid program to private managed care organizations. There's a popular word that often gets used for this, but I refuse to repeat it here, lest it legitimate the idea further. Last month, one of the doctoral students in my department wrote this guest post about the issue. It provides a good overview of what's being proposed. And it's being proposed swiftly, which should make anyone a little bit suspicious.
The reason that this is such a big deal is because, while Governor Branstad is making bold claims that the move to managed care will save the state $51 million a year, there is little reason to believe that will be the case. Indeed, most (but not all) research has found that Medicaid managed care does not significantly improve health outcomes, does not save money, and in fact often ends up costing more than traditional Medicaid. The much higher administrative costs of private firms are one potential driver of this. Moreover, it matters tremendously how Medicaid is transitioned from a state program to a private managed care organization, including how those private entities are regulated and by whom. In short, the best option is for the state to leave the Medicaid program intact. It is for these reasons that the Centers for Medicare and Medicaid Services (CMS) just issued a proposed rule that would put in place additional regulations for Medicaid managed care organizations, including consumer protection provisions to enforce an adequate medical loss ratio, sufficiently large provider networks, and transparency around costs.
Recently, an editorial penned in the Des Moines Register took up the issue, and this has made it's way to the level of national news. See Exhibit A: Its mention in the Kaiser Health News Morning Briefing (you'll have to scroll to the end of the page). The real kicker, as I see it, is that the people of Iowa--you know, the people whose tax dollars will be paying for this Medicaid program one way or the other--are highly opposed to transitioning Medicaid to managed care. As the editorial notes, "Only 22 percent [of voters surveyed] supported the idea." Yet the Branstad Administration is moving full-speed ahead.
Usually, this kind of disregard of public opinion by public officials engenders enough outrage to stir up a major backlash. In this case, however, there is little of that urgency. This is because, although the issue affects nearly 1 in 6 Iowans directly and all Iowans indirectly, the directly affected Iowans are poorly organized and lack the resources to be effectively engaged in policy matters, while the indirectly affected Iowans are likely unaware of the issue and/or fail to see how it affects them. Rest assured, however, that the well-heeled private insurers who stand to gain richly from this transition to managed care if it is approved are not so politically inactive.
The key phrase in that last sentence is "if it is approved." The Federal government ultimately must approve Iowa's waiver application for the Medicaid program to be transitioned to managed care. Rather than appeal to the Governor, who doesn't seem to mind ignoring the wishes of the overwhelming majority of Iowans, you can make your voice heard at the Federal level. If enough pressure is applied to the Obama Administration (and CMS, specifically), there's a chance that Iowa's Medicaid Managed Care waiver won't be approved, which would be a huge victory for all Iowans. To speak up and make your views known, you can contact several people, including Manning Pellanda, Director of the Division of State Demonstrations and Waivers at CMS, Vikki Wachino, Acting Director of CMS, or you can call the regional CMS office in Kansas City at (816) 426-5925. You can also visit www.cms.gov and send a message to the offices through the website. This matters, and you can make a difference.