Under the Golden Dome, Too

Looking forward
     This week brings the Legislature’s first “funnel” deadline, where House bills must pass at least one House committee and Senate bills must pass at least one Senate committee, to remain eligible for debate. With that deadline fast approaching, House members are working hard in subcommittees and committees to make sure that priority bills remain eligible for discussion this session.
     This week, House Republicans released their budget targets for the upcoming fiscal year. Our budget plan is realistic and responsible in setting funding amounts for Iowa’s priorities. Our budget fits within the projected ongoing revenue and does not rely on one-time funding sources like the Ending Balance, Cash Reserve or Economic Emergency funds. Iowa families and businesses budget in this common sense way, and government should do no different.
     The House Republican budget plan makes education our top priority, devoting 93 percent of new available revenue to K-12 education. With revenue growth of $153 million, schools are receiving $143 million of that increase. In order to make this fit within ongoing revenue, other areas of the budget will see reductions that will be worked out by individual budget subcommittees.
     House Republicans have kept our promise to Iowans of fiscal restraint by continuing to abide by the budgeting principles that we set forth five years ago:
     • We will spend less than the state collects;
     • We will not use one-time money to fund ongoing needs;
     • We will not balance the budget by intentionally underfunding programs; and
     • We will return unused tax dollars to Iowa’s taxpayers.
     Our budget principles have served the state well. It’s because of these common sense principles that we have been able to avoid disastrous across-the-board cuts like we saw during the Culver Administration.
     Medicaid continues to get much debate. The program has been, and continues to be, the safety net for the neediest Iowans. These Iowans deserve a plan that focuses on access to care, quality of care and coordination of care with a goal of a more healthy future. Our current system is a very bureaucratic and inflexible system that pays for episodes of illness instead of paying for outcomes.
     The governor has the authority and responsibility to create a system of care. The Legislature is responsible for funding the program and providing oversight, as we do with all activities of government. After much input, rules have been adopted and the department is awaiting approval of the program. When CMS delayed the plan, it was the Department of Human Services’ job to fix the problems identified. If they have done so, CMS will approve the move to Medicaid Modernization.
     Attempts to terminate the state’s transition to managed care are short-sighted and take us backwards, rather than moving us forward. It is confusing to both providers and those receiving services. Some contracts have ended, others are not in place and everyone suffers. It is time to accept the decision from CMS and move forward.
     Medicaid has been growing at an unsustainable rate over the years and is crowding out other parts of the budget like education, public safety and courts. Since I first entered the House, the cost of Medicaid has grown 133 percent, and all the while patients have not become any healthier. Reform isn’t optional, it’s necessary.
     We can’t be satisfied with protecting the status quo.
     Managed care is an approach used in 39 other states, and Iowa has used it for a portion of the Medicaid population since the 1990s. It has shown to be successful in other states, so I’m optimistic that this approach will improve patient outcomes while also bringing more predictability to the budget.
     Some are using the health care of Iowans as a political football, which is unfortunate. Iowans would be much better served, if rather than trying to complicate the state’s transition, we worked to make managed care as successful as possible.
     If there is anything that I can do to be of assistance during this transition, please let me know.
     One final topic I’d like to touch on in this newsletter that still needs to be addressed this session is coupling with the federal tax code. In late December, the federal government passed a number of tax code changes. Historically, Iowa has coupled with those changes each year.
     There are many individuals and small businesses waiting for the Senate to act on this.
     As always, please keep in touch. As legislation moves forward, feel free to send me comments, questions or feedback that you have regarding issues before us in the House. I can be reached at linda.upmeyer@legis.iowa.gov or (515) 281-3521.