Iowans need clarity on Medicaid savings

Gov. Kim Reynolds has complained repeatedly that critics of Medicaid privatization are simply playing politics. But the governor has been around the Statehouse long enough to know where facts and data are lacking, politics will fill in the blanks.

And there’s been a lack of facts and data surrounding the Branstad-Reynolds privatization push from the very beginning. Consider the administration’s claims about how much money the state will save by handing management of Medicaid health coverage over to private firms.

First, then-Gov. Terry Branstad predicted the change would save as much as $232 million annually. By last December, the savings estimate shrank to $47.1 million. Then, this month, the estimate jumped to $140.9 million. In each case, the administration and Department of Human Services have struggled to show their math or detail how savings are being achieved.

We’ve heard the stories of Medicaid clients who have been denied care, and we’ve heard the accounts of health care providers denied timely payments. The program’s turmoil has been brought, repeatedly, into sharp focus. Its benefits, however, remain hidden in a fog of fuzzy math.

State Sen. Pam Jochum, D-Dubuque, has called on the state auditor to conduct an audit of the Medicaid program to determine the real story. Reynolds has dismissed the idea while promising to soon explain the “complicated” savings estimate to reporters. Jochum wants to attend that meeting, and she wants it to be open to the public.

Audits, explanations and public meetings are good ideas. And yes, we know these maneuvers are steeped in politics. But in this case, we hope political pressure leads to clarity.

Clarity is what Iowans need in this election year, as Medicaid becomes one of the defining issues in the campaign to win the governor’s office and control the Legislature. Accusations and claims will swarm like mosquitoes. So politics actually is the reason Iowans need a clear explanation of projected savings, not a convenient excuse to dodge and equivocate.

Is Iowa’s privatized Medicaid on a path toward improvement or on the road to Kansas? In that state, a yearlong attempt to independently audit its privatized Medicaid program was thwarted by insufficient and unreliable data. Iowa Medicaid Director Michael Randol led the Kansas program for five years, and both states will be served by the same managed care companies in 2019. Comparisons will persist.

Iowans, who weren’t consulted by Branstad when the program was swiftly privatized, now deserve an explanation on how it’s performing. Otherwise, politics will fill the gaps, and it’s the governor’s re-election hopes that may get complicated.

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