Category Archives: Iowa

Health Reform and Oversight, Ombudsmen, and Obfuscation

“Iowa has two ombudsmen to investigate and advocate for the 560,000 poor or disabled recipients on the (Medicaid) program.”

— The Des Moines Register, February 28, 2016

I salute Jason Clayworth, the reporter who wrote the Des Moines Register article from which the above quote is taken, as well as Tony Leys, another Register reporter, and the Des Moines Register editorial staff. Their tireless efforts to investigate and comment on the upcoming transformation of the Iowa Medicaid program to a for-profit managed-care model has brought some clarity to the issue, as well as exposed some potential flaws. Iowa is only the fourth state in the country to completely adopt this new model across its various Medicaid programs.

Continue reading →

Health Reform and Wrapping Up

I should wrap up this blog with this post. This was to be the last entry. I said at the beginning, two and a half years ago, that I would chronicle the first two years of progress for health-care reform and the Affordable Care Act (ACA) in Iowa. Now, at the end of the second year of the ACA, we are able — to some extent — to count the successes, some sad outcomes, and end the blog.

Continue reading →

Health Reform and “Under Duress”

I was quoted in the Des Moines Register on Friday, November 27, regarding the Medical Assistance Advisory Council (MAAC) meeting that I attended on Wednesday, November 25. The topic is familiar in this blog: Medicaid managed care. The federally mandated council advises the state of Iowa on Medicaid issues and is one of the major overseers of the upcoming Medicaid managed-care “modernization” that is currently scheduled to begin on January 1, 2016 — four short weeks from today. The approximately 30 other members of the council and I spent two hours raising questions and concerns with the Iowa Department of Human Services and representatives from the four managed-care organizations (MCOs) that will divide 550,000 Medicaid patients and more than $3.5 billion in state and federal monies.

Continue reading →

Health Reform and Public Service

The world became a lesser place on Friday, August 28. My mother-in-law died. I had known her for 41 years and never once heard her speak a cross word. She died three months short of her birthday. She would have been 90 years old. She worked her entire professional life in public service. Her first position was as a Head Start teacher in the first year of the Head Start Program in Alabama at the time of the Selma march. Her major role, once she returned to Iowa, was as a county home economist, initially in Kossuth County, then for more than 20 years in Crawford County. She added Ida County toward the end of her career. She taught rural families how to survive and thrive in the changing world of the 1960s, ’70s, and into the 1980s. At her retirement dinner, her supervisor said, “In many ways, Norma has been in the vanguard. When you look to see what Norma is doing and, in two or three years, all Iowa counties will be doing it.”

Continue reading →

Health Reform and the Letter of the “Court”

June 25, 2015, was a banner day for many reasons. The U.S Supreme Court decision in King v. Burwell allowing 6 million Americans (more than 40,000 in Iowa) to maintain federal subsidies to help pay for individual health-insurance premiums that were purchased under the Affordable Care Act (ACA) federal Exchange was uplifting. The decision will allow the ACA to become a permanent part of our lives and our culture. In Iowa, Republican Governor Terry Branstad responded to the decision saying the ACA was “unaffordable” and “unsustainable.” I would respond to his comments here, but Paul Krugman’s commentary in The New York Times published same day as the decision is a far better response than anything I could write.

In concluding his commentary, Krugman wrote, “Put all these things together and what you have is a portrait of policy triumph — a law that, despite everything its opponents have done to undermine it, is achieving its goals, costing less than expected, and making the lives of millions of Americans better and more secure. … And it’s a beautiful thing.”

Continue reading →

Health Reform and Quid Pro Quo

This week, a high-ranking politician left a phone message for me at my clinic. He asked that I call him. The purpose of his call, according to the note from my receptionist, was “politics.” I did return his call and left a message. He called me back while I was out at a movie. Stepping out of the movie to look at my phone, I found that the purpose of his call was direct and to the point: He asked for money for his political campaign fund. Another politician currently running for office has called me at various times during my work hours. He called once just as I prepared to do a knee injection for a patient and again while I was making rounds at the hospital. During each call, this politician asked for campaign money.

Continue reading →

Health Reform and Aligned Incentives

In further discussing the now-dissolved CoOportunity Health, as well as Governor Branstad’s proposed plan to turn over the Iowa Medicaid program to a private managed-care company or set of companies, I was going to title this blog entry Health Reform and the Need for Nonprofit Entities, which may, in the end, be what the readers of the blog may feel is my conclusion. Instead, I chose the current title to reflect a refinement of my views over the years. To understand this refinement, I want to start this post by going back to 1993.

Continue reading →

Health Reform and CoOportunity Health

It is with sadness that I acknowledge the takeover of the cooperative health-insurance company, CoOportunity Health, by the Iowa insurance commissioner. I have touted CoOportunity Health many times in this blog, and I have strongly felt it was a critical part of the current health-reform efforts in Iowa. My sadness is even greater for the 100,000 individuals who had insurance with CoOportunity Health. These individuals’ confidence and coverage are jeopardized because of this action. The health and peace of mind of friends, family, and patients who I know are insured by CoOportunity Health are a major concern for me at this time.

Continue reading →

Health Reform and Drugs, Drugs, Drugs

The good news. On Wednesday, November 19, CoOportunity Health, the Iowa-Nebraska health-care-cooperative insurance entity that I have touted in several blog posts, insured its 100,000th person for health-care coverage. As I have said before, its projection for the end of this year, its first year of operation, was 15,000 policyholders.

The bad news. CoOportunity Health announced that next year, 2015, it would not participate in the Iowa Medicaid expansion for individuals whose incomes were between 100 to 133 percent of the federal poverty level (FPL). CoOportunity Health simply could not sustain the financial losses for this group of 11,000 Iowans. From my non-insurance and non-actuarial level of understanding, the major issues were 1) the federal government being unwilling to allow for a separate, more accurate actuarial premium amount for this population of newly insured individuals and instead requiring this population to be part of the entire population’s actuarial projection of CoOportunity Health’s premium holders, and 2) the high cost of drugs for treatment of diseases such as Hepatitis C and HIV. For now, this group of individuals will be part of the Medicaid program instead of utilizing the Exchange and being part of the private insurance system.

In this post I’ll discuss several incidents of how the high cost of medicines has negatively affected my patients and the health-care system. The question is: Can health reform, or for that matter the health-care system, survive the upward trajectory of the price of medications?

Continue reading →

Health Reform and the 2014 Iowa Senate Race

I ask the few remaining independent voters — those who have not yet decided for whom they will vote in the U.S. Senate race between Iowa State Senator Joni Ernst and U.S. Congressman Bruce Braley — to give me two minutes of your time.

I am Dave Carlyle, a family physician and hospice medical director from Ames. I grew up in Denison. This is where, during my summers home from college, I learned the value of hard work by sweating 10 hours a day at the Iowa Beef Packers slaughterhouse. After medical school at the University of Iowa and family-medicine residency in Waterloo, I practiced nine and a half years in Kossuth County. I have now practiced 21 years in Ames. My family has been serving Iowans for 160 years. My two daughters, both of whom are physicians, also care for Iowans.

Continue reading →