Editorial Roundup:

Des Moines Register. January 16,2020

Another Medicaid insurer, another round of stiffing Iowa’s health care providers

Iowa Total Care is one of the for-profit insurers hired by the state to participate in the fiasco known as privatized Medicaid.

The company was not among Iowa’s first picks for a contract. It landed a gig here only after two other insurers abruptly jumped ship during the first three years of privatization.

The entity is a wholly owned subsidiary of Centene, which built a reputation for denying care to patients in other states and operating some of the “worst performing Medicaid plans” in California, according to Governing magazine.

A 2018 Des Moines Register investigation revealed the company faced serious accusations of mismanagement resulting in at least $23.6 million in penalties in more than a dozen states.

What did Gov. Kim Reynolds and her Medicaid director, Mike Randol, have to say to a company with such a history?

Please come to Iowa. We will give you billions of public bucks to “manage” health care for low-income Iowans and pay health providers for their services.

How did that work out in the first few months?

Iowa Total Care gladly took the state's money but did not pay an estimated 106,000 claims submitted by health care providers.

After watching the GOP-orchestrated privatization for three years, this should not surprise anyone.

For-profit insurers failing to pay providers is one of the hallmarks of privatization — along with secrecy, denying care to patients, making it difficult to file appeals, demanding more taxpayer dollars and pocketing hundreds of millions of them to boost profits.

What's perhaps surprising is that the Reynolds administration is admitting Iowa Total Care’s failures. Randol announced the state would temporarily withhold $44 million in payments to the company.

That is a welcome first.

But $44 million is pocket change, not a real penalty, for an insurer that located itself in a West Des Moines building on what is considered among the nation’s most expensive streets for commercial office space.

The withheld money amounts to about one-fourth of what the company collects from the state in a single month. Randol can reverse course and fork over the dough, which seems likely.

It would be risky to anger the insurer too much. After all, Iowa Total Care can simply walk away from its state contract and leave, just like UnitedHealthcare and AmeriHealth did.

Another departing insurance company would mean even more disruptions for Iowans whose coverage is managed by Iowa Total Care; they would be forced to change plans again. It would mean more layoffs of insurance workers, more unpaid medical claims owed by an absent company and more paperwork for health providers.

It would mean more desperate attempts by the Reynolds administration to beg yet another private insurer to sign yet another contract with the state and start the cycle all over again.

Unfortunately, Reynolds’ longer-term plan for addressing private insurers stiffing Iowa’s health providers is insufficient. She said she wants to give the state more power to hold the companies accountable.

Here’s a tidbit for the governor to mull over: The state has all the power when it comes to Medicaid.

It controls the $5 billion in state and federal Medicaid money. It writes and approves the contracts with the private insurers. It can cancel those contracts at any point and send the companies immediately packing. Most important, Reynolds has the power to choose to return the program’s management to the state, which spent little on administration, contained costs and reliably paid claims for decades.

Iowa Total Care would not be operating here if Reynolds didn't insist on continuing to embrace privatization. Our health care providers, including those struggling to provide service in rural areas, would be getting paid for the care they have given instead of taking out loans to cover expenses and closing their doors.

Privatized Medicaid is not working. It will not work going forward.

Temporarily withholding public money from Iowa Total Care is, ultimately, not the answer. Neither is changing administrative rules or state law to supposedly give the state more teeth in dealing with private insurers.

The answer is saying goodbye to these insurers and returning the Medicaid program to state management — where it worked well for 50 years and where it belongs today.


Quad-City Times. January 12, 2020

A superhighway of goods

Some might think it odd to label a 221-mile stretch of Mississippi River a single port. For many, a port is thought of as a geographically confined space, where goods are shipped in and out.

That's not the way it is any longer.

In fact, on inland waterways it hasn't been that way for a long time.

"The ports on inland waterways are really long and linear things," says Bob Sinkler, the former commander of the Rock Island District of the Army Corps of Engineers.

Across the country, communities have formed port designations that stretch for tens, even hundreds, of miles. Places like Pittsburgh, Cincinnati, Huntington, West Virginia, St. Louis and south Louisiana, among others, have recognized this reality.

We haven't.

It's not too late to catch up.

A coalition of Iowa and Illinois counties along the Mississippi River have signed on to a proposal to create an inland port designation stretching from Dubuque to Keokuk. It's to be called the Mississippi River Ports of Eastern Iowa and Western Illinois.

If approved, we think this would be something to be reckoned with.

There is a much to be gained in seeing this stretch of the Mississippi River as a single entity. It could mean more federal funds, greater interest from economic development prospects – jobs for the Quad-Cities.

That prospect alone is enough to catch our eye.

We’ve always known the Mississippi River is a highway of goods that move daily through our community. But when you consider the wider area from Dubuque to Keokuk, this section of river would be an even greater force, a superhighway if you will — the 68th largest port in the country and among the top 20 inland ports.

Sinkler has spent months on getting such a designation approved. Ten of 15 counties along this part of the river, among them Scott County, have already signed on. Advocates are hoping the other five do, too.

Within the Corps, this designation will carry resonance, he says. "The port is the natural customer for a Corps of Engineer district, or one of the natural customers," he says. Sinkler, who was the Rock Island district commander from 2006 to 2009, is now an adviser at Washington, D.C.-based Dawson & Associates, though he says this is a volunteer effort and his firm is not involved.

It seems to us that, working together, the communities along the Mississippi River, under the umbrella of a single port, would be a more effective force lobbying for funds. Already, we're told that the Rock Island district can sometimes see money siphoned away to other districts that are affiliated with ports.

"We love this idea," says Denise Bulat, executive director of the Bi-State Regional Commission.

The coalition hopes to apply for the designation by the end of this month and gain approval by September. A unit of the Corps of Engineers, the Waterborne Commerce Statistics Center, would grant the designation.

It’s hard to see a downside to this. The port would not have taxing or land-use authority, officials say. It doesn’t have the power to take on debt. Instead, advocates say, it is meant to be a single entity for collection of data, a marketing tool and – essentially – a brand to make it easier to attract attention and funding.

One potential target: Communities along the river could work together to seek federal funding from the federal Water Resources Development Act, an important piece of legislation that occurs every few years authorizing water resource projects.

Around here, WRDA, as it's known, doesn't get a lot of attention. But in places with well-established ports, it's a big deal. Among the possibilities: Securing funding for ecosystem restoration projects.

The communities within the Quad-Cities have long seen the value of bi-state cooperation. We work across the river to provide for basic infrastructure, to build and maintain new bridges and protect federal jobs.

This cooperation has paid dividends for our community. Just look at the new Interstate-74 bridge.

We think that cooperation can only be enhanced by working as a Mississippi River region, connecting our community with others all up and down the river to seek out new prospects, be they commercial or environmental.

We're looking forward to seeing the Mississippi River Ports of Eastern Iowa and Western Illinois become a reality.


Fort Dodge Messenger. January 15,2020

Reynolds offers a challenging game plan

Gov. Kim Reynolds delivered her Condition of the State Address on Tuesday. She asked lawmakers to join with her in making our state fully ready to seize the opportunities open to it in the years ahead.

The governor emphasized that the Hawkeye State is well-positioned to approach the future with confidence because it has made great strides in the last decade.

“When this body met in January 2010, our unemployment rate was 7.3 percent. Just months earlier, our state faced a near billion-dollar deficit. School funding was drastically cut and Iowans were worried about their future,” Reynolds said. “A decade later, the condition of our state is truly strong. Because of the vision and tenacity of Iowans, our unemployment rate has gone from a near-record high to a record low. Instead of cutting school budgets, we’re cutting taxes. Our cash reserves are full, wages are going up, and Iowans once again believe we’re headed in the right direction.”

The stage has been set for Iowa to make great additional progress. With that in mind, the governor asked legislators to approve the Invest in Iowa Act, which she will soon send to them. This visionary measure has four main components. According to Reynolds it will:

• significantly cut income taxes,

• create a sustainable funding source for our mental health system,

• reduce the burden of property taxpayers, and

• fund the Natural Resources and Outdoor Recreation Trust.

Her goal in calling for approval of this game plan is straightforward.

“We need to seize the opportunities that exist so that years from now, the next generation of Iowans will inherit an Iowa whose greatness comes as no surprise to anyone,” Reynolds said. “But that kind of planning also takes a bold vision. … It’s an investment in our future. And it’s an investment in those who are our future.”

Reynolds outlined a variety of changes that will strengthen Iowa’s ability to remain a highly successful state. She called for further improving the mental health system. The governor said telemedicine options need to be more available across the state. She advocated action to modernize the state’s professional licensing system. Reynolds recommended additional state funding for education and advocated continued progress in making schools compatible with our digital world. She urged the Legislature to take a hard look at making childcare more affordable for more Iowans. The governor called on the Iowa Senate to pass a constitutional amendment restoring the voting rights of felons who have completed their time in prison. (The Iowa House has already taken this action.) Reynolds urged support for changes that will help expand the use of renewable fuels. And all that is was just part of her bold message.

The governor took time at the beginning of her address to acknowledge the passing in 2019 of a number of Iowans who have made significant contributions to our state. She paid special tribute to Fort Dodger Mark Cady who was chief justice of the Iowa Supreme Court.

“He loved his state,” Reynolds said. “And he loved the law. To his family and colleagues in the Iowa Judicial Branch, our entire state shares your loss.”

In concluding her message, Reynolds summarized powerfully the positive can-do theme that has been the hallmark of her tenure as governor.

“So as we move into the next decade, let’s put Iowans first,” she said. “Let’s be bold and visionary. Let’s seize this opportunity and make the next decade Iowa’s best. It’s time to show the world that opportunity lives here.”

The Messenger commends Reynolds for the sensible agenda she has proposed. She once again demonstrated that the faith Iowans have placed in her is well-founded. The Legislature should give her recommendations careful and respectful consideration.