Maternal health in Iowa is experiencing a crisis. Maternal mortality has increased at an alarming rate in recent years. Maternal deaths went from fewer than 15 in 2008 to almost 50 in 2019, according to Dr. Stephen Hunter, co-director for Perinatal Care at the Iowa Department of Public Health.
A big part of the problem is Iowa’s shrinking health care options and workforce:
Iowa has seen 34 labor and delivery units close since 2000.
Our state has the lowest number of obstetricians per capita in the country; 64% of rural Level 1 hospitals have no obstetrician on staff.
Iowa has a high rate of cesarean births, as a result, which can lead to future health problems.
About 40% of births in Iowa are covered by Medicaid, but privatized Medicaid doesn’t cover the costs for delivering babies if health care providers follow the recommended standard of care, so hospitals lose money by providing labor and delivery services.
That’s why we are proposing the Healthy Moms and Babies Act (SF 2062), which will:
Adjust Medicaid rates so that hospitals are adequately reimbursed for the care they provide.
Ensure labor and delivery units use proven practices—known as “safety bundles”—that save lives during delivery.
Expand home visiting services for pregnant women, new moms and babies.
Changes to reproductive health care have real consequences
During a recent visit to the State Capitol, former State Senator Chris Brase of Muscatine shared his daughter’s devastating pregnancy experience during the summer of 2019.
Sen. Brase’s daughter experienced a loss of amniotic fluid at around 24 weeks, meaning that her baby’s lungs and other vital organs would be harmed and her baby would not survive birth.
Because of legislation approved by the Republican-controlled Legislature and signed by the Governor in 2017, she was forced to continue the pregnancy, risking her own health, while knowing that her baby would suffer after birth.
She was only able to receive the medical care she needed when sepsis set in and her life was at risk.
It is time for Governor Reynolds to also share those goals with Iowans. The Reynolds Administration has been working behind closed doors on a ‘new direction’ for the department for nearly a year. Yet Governor Reynolds has continued to keep Iowans in the dark about what to expect.
Like most Iowans, Senate Democrats are hopeful the new Iowa DHS director will have the courage to help Governor Reynolds fundamentally change course. Her to-do list should start with:
1) Fixing Iowa’s privatized Medicaid system, a failure that is unsustainable, unaffordable and unaccountable.
2) Reversing the policies that destroyed Iowa’s once successful family planning network. The result has been more unintended pregnancies, more risky births, and more teenage mothers.
3) Addressing Iowa’s maternal health crisis which has more than doubled maternal mortality in less than three years. Reynolds Administration policies have contributed to making Iowa a more dangerous place to have a baby.
4) Establishing a comprehensive, adequate source of funding for child and adult mental health services.
5) Ending dangerous practices and procedures in use at Glenwood, Eldora and other state-operated facilities.
6) Rebuilding Iowa’s child protective safety net by mending the holes that have resulted in abuse and death.
The Reynolds Administration does not have a good record on helping Iowa families. Senate Democrats hope the Garcia appointment signals real change rather than more failure. Iowans deserve better.
Iowa Senate News Release For Immediate Release: July 10, 2019
Statement from Senate Democratic Leader Janet Petersen on outrageous new contracts for privatized Medicaid
“The outrageous contracts with two out-of-state corporations are more evidence that privatized Medicaid in Iowa is unsustainable, unaffordable and unpredictable.
“Governor Reynolds has once again agreed to give the MCOs the largest dollar increases for Medicaid in the last decade. The publicly managed Medicaid system grew at an average of 5% each year over a 10-year period before privatization. Last year, the increase was 8.4%. The increase announced today is a whopping 8.6%!
“Just imagine how much better off Iowans would be if K12 public schools, job training programs and family planning services received that kind of increased state support!
“The big cheerleaders for privatized Medicaid – Governor Reynolds and Republican legislators –cannot back up their claims that privatizing would save money and make people healthier. That’s because it hasn’t happened.
“Privatized Medicaid continues to be a bad, bad deal for Iowa Medicaid recipients, health care providers and taxpayers.”
Iowa Senate News Release
For Immediate Release: 18 June 2019
Statement from Senate Democratic Leader Janet Petersen
on Governor’s latest statement on departure of DHS Director
“The Governor’s latest statement on the departure of Jerry Foxhoven is as clear as mud.
“If the Governor has been working behind closed doors for nearly six months on a new direction, a new team and a new vision for the Department of Human Services, she needs to back up her rhetoric with positive action. This includes outlining her specific plans to:
Fix a privatized Medicaid system that is unsustainable, unaffordable and unaccountable.
Reverse course on policies that decimated the state’s successful family planning network, resulting in more unintended pregnancies, more risky births, more teenage mothers.
Present a comprehensive plan for adequately funding mental health services for children and adults.
Stop dangerous practices and procedures at Glenwood, Eldora and other at state-operated facilities.
Rebuild the child protective safety net instead of putting dangerous holes in it.
Explain to Iowans why she made the decision to replace Foxhoven (a) when her Administration is in the middle of negotiations with both out-of-state managed care organizations (MCOs) and (b) when hundreds of thousands of Iowans are two weeks away from transitioning to a new MCO.
“Finally, I repeat my call for the Governor to immediately launch a nationwide search for a new Director of the Department of Human Services who is truly committed to watching out for the most vulnerable children and adults in Iowa.
Iowa Senate News Release
For Immediate Release: 17 June 2019
Statement from Senate Democratic Leader
on departure of DHS Director
“The Governor needs to immediately launch a nationwide search for a new Director of the Department of Human Services who is truly committed to watching out for the most vulnerable children and adults in Iowa.
“This means finding an advocate who will fight for more resources, push for stronger policies, and ensure that those policies are enforced for the betterment of all Iowans.
“After years of mismanagement and neglect by Governor Reynolds and legislative Republicans, Iowans deserve a new Director with the backbone necessary to put quality care and proper oversight ahead of special interests.
“The damage they’ve done to Iowans includes:
Creating and supporting a privatized Medicaid system that is unsustainable, unaffordable and unaccountable. It’s so bad that the federal government has launched an investigation into whether officials in Iowa and other states are providing sufficient and appropriate oversight to ensure that people with Medicaid are receiving the care to which they are entitled.
Decimating the state’s successful family planning network, resulting in more unintended pregnancies, more risky births, more teenage mothers.
Inadequately funding mental health services for children and adults.
Allowing dangerous practices and procedures at Glenwood, Eldora and other at state-operated facilities.
“Finally, it’s especially bad news for Medicaid recipients, health care providers and Iowa taxpayers that the Governor’s Director is leaving (a) in the middle of negotiations with both out-of-state managed care organizations (MCO) and (b) when hundreds of thousands of Iowans are two weeks away from transitioning to a new MCO.”
“Governor Reynolds and legislative Republicans worked in lock step to pass a budget rich with perks for special interests and out-of-state corporations rather than putting Iowans first. They supported taking away the civil rights of Iowans; implementing policies that will result in more unplanned pregnancies and abortions; and ignoring the concerns of Medicaid recipients, health care providers and taxpayers who are being harmed by privatized Medicaid.
“Senate Democrats remain committed to expanding civil rights for Iowans, supporting policies that will result in fewer unplanned pregnancies and abortion, and making Medicaid accountable, affordable and sustainable again.”
Iowa Senate News Release For Immediate Release: April 17, 2019
Key Iowa Senators applaud investigation by U.S. Inspector General
DES MOINES – The U.S. Office of Inspector General has launched an investigative review of whether federal officials are providing sufficient and appropriate oversight to ensure that people with Medicaid are receiving the care to which they are entitled.
Citing the lack of oversight of privatized Medicaid by Governor Reynolds and the Republican-controlled Legislature, two key Iowa State Senators today praised the new investigation.
“Since it was launched three years ago in Iowa, privatized Medicaid has been unsustainable, unaffordable and unaccountable,” Senator Amanda Ragan of Mason City and Liz Mathis of Hiawatha wrote in a letter to U.S. Inspector General Daniel R. Levinson. “There has been little effort by the Governor or majority party in the Iowa General Assembly to provide proper oversight for the out-of-state managed care organizations (MCOs).”
The Senators added: “Medicaid advocates, policymakers and other taxpayers deserve an investigation by the Inspector General that provides an answer to the question that we have asked since the start of Medicaid privatization in Iowa: Are some MCOs putting the bottom line ahead of patient health and safety?”
The Inspector General initiated the review of the oversight role of the Centers for Medicare & Medicaid Services (CMS) at the request of U.S. Senator Robert Casey of Pennsylvania, Ranking Member of the Special Committee on Aging.
In his request, Casey cited reports from across the country “alleging that some Medicaid managed care companies (MCOs) continuously deny care to patients sorely in need of care. In some cases, patients have experienced entirely preventable life-altering harms.”
“Medicaid is emblematic of who we are as a nation, reflecting who we value and the ideals we are willing to fight for,” Casey added. “We must ensure Medicaid MCOs live up to these ideals and provide Americans with the health care that they deserve.”
In its description of the investigation, the Inspector General acknowledges that privatized Medicaid “can create an incentive to deny beneficiaries’ access to covered services.”
“Our review will determine whether Medicaid MCOs complied with Federal requirements when denying access to requested medical and dental services and drug prescriptions that required prior authorization,” the agency’s website states.
Iowa Senate News Release Senator Nate Boulton Representative John Forbes For Immediate Release: April 15, 2019
Don’t let Medicaid mess undermine Iowa’s successful children’s health insurance program
Two members of the board of Hawki, Iowa’s nationally recognized Hawki children’s health insurance program, today raised concerns in a letter about maintaining quality as it becomes part of Iowa’s troubled privatized Medicaid program.
“This is another challenging transition for Iowa families,” said Senator Nate Boulton. “Unitedhealthcare had been a Hawki provider for more than five years. Those families need as much support as possible to make sure their care is not interrupted. Specifically, we must make sure providers continue to welcome Hawki kids into their care.”
“The Hawki transition is another opportunity for the Reynolds Administration to show that it has learned from past mistakes,” said Representative John Forbes. “Iowans were promised that a privatized health care system would increase quality and access to care. However, too often they have instead gotten more headaches and problems.”
Hawki provides low-cost health coverage for more than 70,000 children from working families across the state. The Hawki Board of Directors guides the Department of Human Services’ efforts to develop, implement and administer the Hawki program.
The questions for the board included:
How will the Board/DHS communicate with Hawki families about the transition from UnitedHealthcare to one of the two remaining managed-care organizations, Amerigroup Iowa or Iowa Total Care?
How will the Board/DHS communicate with schools across the state to make sure that parents and school officials are aware of the upcoming changes? This is especially concerning for parents/guardians because they will be scheduling annual physicals, immunizations and other routine care during the summer months.
How will parents/guardians learn whether they will be able to keep their current pediatrician or other health care provider if they are transitioning to Amerigroup Iowa or Iowa Total Care?
How will the Board/DHS ensure healthcare providers continue to see Hawki as a secure and trustworthy benefit program, one that they want to be involved with?
Privatized, for-profit Medicaid continues to cause chaos and uncertainty for Iowa families, health care providers and taxpayers.
On Friday, we learned that UnitedHealthcare is leaving Iowa’s managed care program. UnitedHealthcare currently is the MCO for over 70 percent of Iowans on Medicaid. That means 425,000 Iowans will again have their health care disrupted, as they are forced to switch insurance companies. This could put our most vulnerable in life or death situations.
Governor Reynolds says that United HealthCare is unwilling to be held accountable for the quality of its services. United Healthcare claims they’re leaving due “to underfunding and the inability to create a path forward with sustainable funding.”
Iowans are not interested in a “he said, she said” between MCOs and the Governor. The bottom line is that “three years into our costly Medicaid privatization experiment, Iowa’s dominant managed-care organization (MCO) still can’t handle normal business practices like paying health care providers on time.”
This is just the latest in a series of problems that have plagued privatized Medicaid since its inception three years ago. Democrats have offered ideas for meaningful improvements—but time and again, they fall on deaf ears.
Elected officials should listen to Iowans who depend on Medicaid, and to health care providers, family care givers and tax payers. Together, Iowans can fix our broken health care system. We can turn this problem into a success that will make our state healthier, stronger and a more attractive place to live.
If you agree, please sign our petition and join Democratic lawmakers in calling on Statehouse Republicans to fix Iowa’s failed Medicaid privatization experiment. Go to iowansforqualitymedicaid.com to sign the petition—and share it with others who share our concerns!
DES MOINES — Two health care leaders in the Iowa Senate have introduced legislation to make significant reforms to Iowa’s privatized Medicaid system.
Senate File 156, the Senate Democratic Medicaid Improvement Bill, has been introduced by Senators Amanda Ragan of Mason City and Liz Mathis of Hiawatha. They are, respectively, the ranking members of the Senate Health & Human Services Budget Committee and the Senate Human Resources Committee.
“Governor Reynolds and legislative Republicans are sticking with privatized Medicaid,” Ragan said. “Given that, our focus is making urgently needed improvements. We are proposing large and small improvements to how privatized Medicaid serves Iowa families and healthcare providers.”
“Iowans need privatized Medicaid to do three things and do them well,” Mathis said. “One, make sure Iowans get the healthcare services they need when they need them. Two, make sure Iowa healthcare providers are correctly paid for the work they do and paid on time. Three, key Medicaid decisions should be made by Iowans rather than by employees of out-of-state, for-profit companies.”
News Conference Video:
Senate File 156 Highlights
Senate File 156 would make these changes to Iowa’s privatized Medicaid on behalf of Iowa patients and providers:
Return the Long Term Services and Supports (LTSS) population to publicly managed Medicaid
The MCOs are supposed to make money by helping sick people get better and thereby lowering costs. Many Iowans suffering the most from privatized Medicaid system are Iowans living with severe, complex, permanent disabilities and conditions. Because these Iowans aren’t going to “get better,” denying care and cutting needed services is largely the only way to “save money.” This is unacceptable.
Require independent conflict-free case management and assessments
There is an inherent conflict of interest in privatized managed care. Case management and patient assessments are both performed by employees of the MCO that pays for the care of those patients. Assessments are more accurate when made by an independent entity and coordinated by case managers who put the patient’s best interest first.
End the practice of requiring prior authorization for substance abuse treatment
Every substance abuse counselor knows that an immediate response is essential when someone requests treatment. “Medication assisted treatment” can quickly take away the cravings once it begins. However, waiting for prior authorizations results in missed opportunities or even overdose deaths that could have been prevented.
Require MCOs to develop and implement workforce recruitment, retention and training programs
Iowa has a severe health care workforce shortage. The MCOs now manage the care of some 600,000 Iowans. Every other major health care provider and insurer in the state of Iowa contributes time, talent, and money to efforts to expand and improve Iowa’s health care workforce. This legislation will require the MCOs to join that effort.
Implement an external review process for providers
Today, when the MCOs deny a claim, an Iowa health care provider can only attempt to negotiate with MCO that denied the claim. When commercial health insurers deny claims, providers can appeal to an external reviewer. This legislation establishes a similar appeal system when the MCOs refuse to pay for care.
Make it easier and quicker for members to switch MCOs
If a local doctor decides to switch the MCO he or she contracts with, that doctor’s patients must be able switch COs if they want to continue seeing that doctor. Currently, patients must wait up to 45 days before they can ask DHS to approve a change for good cause. This is an unusually long and burdensome process for Iowans. This legislation would allow patients to request that DHS approve an MCO switch after 10 days.
Move the Managed Care Ombudsman Program to the State Ombudsman’s Office
Independent advocates for Iowans are an absolute necessary if Iowa managed care is going to work. Iowa’s Long Term Care Ombudsman has only one full-time managed care ombudsman. There could be three to four more working for Iowa families and health care providers if we took full advantage of federal matching funds. The MCO ombudsman services should be moved to the State Ombudsman Office.
