Iowa Is Ground Zero for the Republicans' Disastrous Approach to Healthcare

By Charles Pierce, Esquire

09 April 18

Street-'surance and Medicaid privatization do not make a pretty picture.

orry to harsh your Monday mellow, but there are politicians skulking around Iowa these days, and they’re not there for the spring planting. Unless you count the planting of the idea that one of them should be President of the United States, and, yes, it’s 20-bloody-18 and why should that matter anymore?

Jason Kander, the Democratic former secretary of state in Missouri, has been out there 14 times, and his first trip was a little more than a month after the 2016 election. Eric Swalwell, the California congressman who’s on TV every week more than Jack McCoy, spent last weekend touring Ames, Des Moines, Cedar Rapids, and Muscatine, while Steve Bullock, the governor of Montana, was kicking around Polk County as well. We are not at the swinging-a-dead-cat portion of our program yet, but it’s coming up fast. Plan your visit to this year’s State Fair now. The line for the Butter Cow is probably already around the block.

Meanwhile, among the people who live in Iowa fulltime, Governor Kim Reynolds and the state legislature are going out of their way to make more difficult the lives of Iowans who need healthcare. First, in an example of what healthcare expert Charles Gaba calls “medical gerrymandering,” the legislature went out of its way to make sure every Iowan has a chance to buy completely worthless insurance that very likely will not help them at all if and when they get sick. From The Des Moines Register:

Supporters contend Senate File 2329 would create a much-needed, low-cost option for Iowans who can no longer afford rising premiums and out-of-pocket costs on the individual insurance market. "All we're trying to do is help those who can't find insurance," said Sen. Randy Feenstra, R-Hull. Feenstra said anyone excluded from the new plans because of a pre-existing health problem could go and buy policies from a carrier offering insurance that complies with the Affordable Care Act. But for others, he said, the new plans would offer a less expensive option. But critics fear the change would further destabilize Iowa's already fragile health insurance market and undermine Affordable Care Act rules designed to protect consumers."We're going to be throwing a soggy life jacket to people that need our help," said Sen. Joe Bolkcom, D-Iowa City…several Democrats noted the new coverage would technically not be defined as health insurance, and would not be regulated by Iowa's insurance commissioner. "This just doesn't pass the smell test," said Sen. Matt McCoy, D-Des Moines.

So now you can buy health insurance that not only doesn’t cover you if your health goes bad, you can buy health insurance that isn’t even called health insurance.

And the level of obliviousness on which the debate was conducted is best exemplified by something said by one of the state legislators who jumped on the street-‘surance bandwagon. Again, from the Register:

Sen. Mark Chelgren, R-Ottumwa, defended the legislation, saying it is an example of how health care was provided before Congress enacted the Affordable Care Act. "We have tried this before. This was how the system worked. In the past, we gave people choice. We said, 'We trust you with your health care decisions,' " Chelgren said.

Is this the next weapon in the fight against having this country join the rest of the industrialized world? Nostalgia for the way things used to be? For the system that was so bad that it was killing 40,000 people a year? For the system that was so bad that Mitt Romney begged a new plan out of the Massachusetts legislature because he knew the Republicans had to have some answer to the broken healthcare system in 2008, when he was planning to run for president? Remember when being a woman was a pre-existing condition? Boy, as Mr. Dooley said, thim was the days!

Meanwhile, at the same time, Iowa is also serving as the test-track for the Medicaid system with which Paul Ryan wants to bless the nation. This is not going well, as the Register explains.

The casualties are patients like 4-year-old Tatum Woods of Vinton, Iowa, who for nearly six months was forced to crawl because a private Medicaid provider said it would pay less than a fifth of the cost of his $3,500 customized walker. It’s an experience multiple officials and lawmakers contend is widespread in Iowa, and it's driving Medicaid patients and their families to new depths of frustration. “These kids shouldn’t have to fight to get their equipment," said Kristie Woods, Tatum's mother. "They’ve already got enough struggles." At issue is the reimbursement rate the private companies that manage Iowa’s $4.8 billion Medicaid program are paying to medical equipment providers for specialized equipment. Medical device providers say Iowa's privatized Medicaid managers are willing to pay only pennies on the dollar — if anything at all — for the medical devices that doctors are authorizing for their disabled patients. It's another example of what critics say is Iowa's flawed Medicaid system since then-Gov. Terry Branstad turned over management to for-profit companies in April 2016 in an attempt to save money and in his view improve care.

Right. It was all about saving money. Let’s not pretend we all came to Vinton on a turnip truck.

Officials from Total Respiratory and Rehab in Hiawatha said Amerigroup classified Tatum’s equipment as a “miscellaneous” expense, capping the maximum reimbursement at less than 20 percent of its cost. Total Respiratory said Tatum is one of dozens of clients it has been forced to deny equipment in the last year because Iowa's Medicaid system refused to pick up the cost. The company — and four other medical equipment providers across the state — have outlined multiple billing problems associated with the Medicaid companies that they say has resulted in underpayment by tens of thousands of dollars and forced them into denying equipment to patients who need it.

This story is part of a very good series by the Register on the consequences of privatizing Medicaid, which has brought about denial of basic needs, bureaucratic stonewalling, and corporate buckpassing.

Each of the medical equipment companies said they are experiencing problems from both of Iowa’s Medicaid management companies, Amerigroup and UnitedHealthcare. UnitedHealthcare tends to limit claims or issue blanket denials, while Amerigroup incorrectly codes and underpays, they contend. “They’re trying to reimburse us well below our cost,” said Jon Novak, CEO of Total Respiratory. “If we dispense the equipment at this cost, we would go broke.”

In short, it’s brought back all the highlights of the American healthcare system for which some Iowa legislators seem so damn nostalgic. This is the next fight and, as silly as it sounds, they mean to bring us back to the system that everybody knew had failed. Forward, as the Firesign boys used to say, into the past.