Chronicle Editorial

More questions than answers
 
     Future changes to Iowa’s Medicaid program need more oversight and explanation before they alter the landscape of this vital service for hundreds of thousands of Iowans across the state.
     Gov. Terry Branstad’s Modernized Medicaid initiative is set to take effect Jan. 1 and exact sweeping changes to the state-run program utilized by more than 560,000 poor and elderly residents. The plan would essentially privatize Medicaid services by hiring four companies to manage the program, in turn saving taxpayers an estimated $51.3 million in the first six months alone. However, the plan has faced scrutiny recently. The state hasn’t been able to provide data indicating where those savings will come from, and many critics have raised ethical concerns about the four companies hired to manage the program.
     A report in the Oct. 15 Des Moines Register raised multiple red flags about the math used to develop the plan. No public data exists showing how it will save $51.3 million, and it appears nobody can provide a worthwhile explanation as to how that number was reached. Officials at the Iowa Department of Human Services have repeatedly claimed the savings will come from better preventative health care and fewer duplicated services. However, that blanket answer simply doesn’t suffice and needs hard numbers to reinforce its claims.
     Skeptics have also raised eyebrows over the four companies hired to manage Iowa’s Medicaid program. Amerigroup, WellCare, UnitedHealthCare and AmeriHealth all have experience with Medicaid administration, but they’ve had their fair share of problems. The Register’s report noted that the companies are facing lawsuits and more than 1,500 administrative reprimands in other states, and they’ve also been forced to pay hundreds of millions of dollars in fines or settlements to resolve fraud and mismanagement claims. Those are some concerning strikes against the companies and it appears public skepticism is warranted. Nobody’s perfect, but when it comes to health care management, they need to be as close to perfect as possible.
     These developments have cast a dark cloud over Branstad’s plan. Large changes like this one are never easy, but they should be given ample time to work. After all, this program was created in response to the ongoing rise in medical care costs and the state’s increasing responsibility to fund Medicaid. Put simply, the state needs to find savings to ensure the financial health of Iowa’s Medicaid program for future generations. This plan seems like a step in the right direction and could improve on the current system if the proper guidelines are implemented.
     However, more numbers and explanation are needed. Simply saying savings will occur doesn’t make it true. The Branstad Administration and other state regulators need show how this plan will save taxpayers money while improving services before its implemented. Medicaid is a sensitive topic that needs a subtle hand to guide changes. While it’s clear changes to Medicaid are needed to create savings and reduce waste, more oversight is needed to guide those reforms and show the benefits to Iowans. The state can’t charge head-on into something like this without showing Medicaid-dependent residents that it has a chance at success.
     More transparency is needed as the reform process continues. If the state fails to provide clear numbers that reinforce its claims, the Medicaid overhaul should be delayed and reevaluated. This plan could work, but the state is doing a poor job of showing how it will.