Category Archives: Medicaid managed care

Health Reform and a Primer for Democratic Presidential Candidates in Iowa

What every presidential Democratic candidate — many of whom will be speaking at the Iowa State Fair this week — should know about Iowa health reform:

1. Iowa suffered greatly by having a Republican-dominated state government (governor, Senate, and House) during the aftermath of the enactment of the Affordable Care Act (ACA). With a Republican governor and most recently a Republican Senate and House in Iowa, we had a miserable attempt at a Marketplace/Exchange; no support for our attempt at a health-care Co-Op (Co-Oportunity Health, which had 120,000 members in one year of operation); passage of association health plans, which allow for discrimination against persons with co-existing conditions; and, overall, an unbelievably negative atmosphere in general regarding anything that concerned the ACA.

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Health Reform: 2019 and Representative Cindy Axne

As my Health Reform blog returns in a new format, I wish to comment on two more significant startups — a new year and a new 3rd District congresswoman from Iowa. In relationship to health reform, by which I mean improving health-care coverage for Americans and especially Iowans, I think these new developments have meaning.

In Iowa, a new year will start with health costs continuing to go up, the individual insurance market pricing people out of the ability to have health insurance, a state-legislated health-association insurance plan that legally allows for the discrimination of individuals with pre-existing conditions (further perverting the individual insurance market), and a besieged Medicaid for-profit managed-care scheme that will continue to reward these companies’ shareholders at the expense of Iowa patients.

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Health Reform and Primum Non Nocere Revisited

Several months ago in this space, I discussed my concerns about a Trump presidency regarding the Latin phrase “primum non nocere,” which means “first do no harm.” Now, at the end of the 2018 Iowa Legislative session, I revisit this phrase to discuss my concerns about the results that this Republican-dominated Legislature and the Republican governor have created or are creating.

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Health Reform and Continuity of Care

In the chaos of health-care efforts both nationally and in Iowa, today I seek to go back to two basic beliefs: 1) the hope of future generations to learn from past generations’ mistakes and 2) the value of continuity of care for primary health care and, ultimately, health care in general.

The U.S. Senate is now debating a tax-cut bill that includes eliminating the Affordable Care Act (ACA) individual mandate for health-care coverage — a basic tenet for true health-care reform — and, in Iowa, the for-profit, managed-care Medicaid fiasco now has one managed-care organization (MCO) leaving the state and another MCO not able to take new patients. These actions leave the state with only one MCO left to serve Medicaid patients. Given these realities, I shift gears by presenting to you a guest blogger.

She is a third-year medical student who recently spent a month with me in my clinic. She plans to be a pediatrician. I choose not to provide her name. Although she would allow it, I am not sure her medical school would.

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Health Reform and Why Words Should Matter

Ah, words! Especially to writers, they are more precious than jewels, as essential as air, and powerful enough to create entire worlds. We chase them, massage or mince them, we roll them around in our mouths, savoring every delicious subtlety. Mostly, we love them.

~Tammy Letherer

Ms. Letherer wrote these words on a blog entry titled Why Words Matter (In and Out of the Locker Room), on October 16, 2016.  In that post, she discussed her unhappiness with Donald Trump’s language regarding women.

In Iowa, former U.S. Representative Bruce Braley lost his Senate race with Joni Ernst in large part to an audiotape of his words to political contributors in Texas disparaging our senior senator, Chuck Grassley, describing him as “a farmer from Iowa who never went to law school.”

This year’s health-care debate, centered on the Republicans’ efforts to repeal the Affordable Care Act (ACA), has led to many statements by Republican leaders in Iowa that should come back to haunt them this Halloween season and for seasons to come, as Bruce Braley’s words haunted him.

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Health Reform and Spudnutz

I stood in line at 6:45 Sunday morning to purchase donuts at a very popular local donut shop — Spudnutz — at Lake Okoboji. The line of donut-seekers stretched far out the door. I did not receive donuts until 7:50 a.m. I waited more than an hour for donuts. (Yes, very good donuts). Nine people were working in that donut shop that once housed an auto mechanic shop.

If either the Senate bill or the House bill that was intended to repeal and replace the Affordable Care Act (ACA) became law, I fear none of those nine hardworking people would have health-care coverage in the future. For many of my patients and for, I believe, the employees of Spudnutz, I give thanks for the defeat of the Senate “skinny” repeal legislation.

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Health Reform and Confusion

It should be so easy: A patient should receive his or her needed and entitled health care.  Medicaid should be the conduit that connects the patient and the physician and then pays the physician or other health-care provider for services rendered.

Furthermore, if Medicaid contracts with a for-profit managed-care organization (MCO) to provide care to patients, there should be adequate state oversight to ensure the safety and well-being of these patients. As the 2016 Conference Report for the Health and Human Services, passed this week by the Iowa House and Senate, states, “The primary focus of the general assembly in moving to Medicaid managed care is to improve the quality of care and outcomes for Medicaid members.”

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Health Reform and the “Vulnerables”

In the health insurance industry, young adults are known as the “invincibles.” Like the superheroes that inhabit movies and TV now, these young men and women believe they are impervious to illness, disease, and injury. Therefore, they do not acquire health-care coverage, believing they are invincible. It is human nature to create groupings of individuals and name that grouping. We commonly talk about “baby boomers” and “millennials.” Tennessee Williams said that he wrote about the “incomplete.” Studs Terkel, in his book, Working, said he interviewed and wrote about the “uncelebrated.” Today for this blog, I create my own grouping. Here’s why.

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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.

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Health Reform and Enhancing Patients’ Lives

Family medicine is creating and maintaining relationships with patients in order to enhance their lives.That is the definition I gave to the University of Iowa’s family-medicine residents at their resident retreat on Saturday. During my talk with this group of young physicians, I described my family-medicine team and how we help our patients to maintain their health, recover, and become healthy from an illness or improve their quality of life if diagnosed with chronic illness or a terminal disease. My team includes a head nurse, two health coaches who share a full-time position, a “roomer” nurse who seats patients in examination rooms and charts their vitals signs, and a “shot” nurse. Together, we are responsible for the family-medicine needs of 2,100 patients. I have described the use and value of health coaches in a previous entry.

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