- Associated Press - Monday, March 20, 2017

Des Moines Register. March 16, 2017

Profit-seeking Medicaid insurers vs. Iowans

Iowa has been victimized by Gov. Terry Branstad’s Medicaid privatization for nearly a year. Handing over a $4 billion government health insurance program to profit-seeking companies did not make sense in theory, and in practice, it has been a nightmare for health providers and low-income Iowans.

Enough is enough. It is time to return to the state-managed Medicaid system that had low administrative expenses, timely reimbursement for providers and consistency in coverage for patients.

Under Branstad’s privatization model, Iowa now pays three managed care companies an agreed-upon amount of money per beneficiary. The companies are tasked with managing and paying for members’ health care. The only potential benefit for the state is creating budget predictability for Medicaid spending.

But the private insurers are in the business of making as much money as possible. Iowa is seeing first-hand how this quest for profit works.

First, companies negotiated with the state to pocket millions of public dollars for “administrative” expenses. (That is money not paying for actual health care.) Then they focused on finding ways to hold onto as much of the remaining public money as they can. This is accomplished by denying claims, delaying payments to providers and informing patients that everything from emergency room visits to medication are not covered. Iowans have shared a steady stream of such stories over the past 10 months.

Insurers also knew from experience in other states to immediately start whining about losing money here. They did so within a few months of the April 1 transition. The Branstad administration responded exactly as the insurers hoped: By handing over tens of millions of additional public dollars.

Now AmeriHealth-Caritas is threatening to stop paying for health services provided by the Mercy Health Network, one of the state’s largest hospital-and-clinic systems. In a February letter, AmeriHealth informed about 220,000 Medicaid beneficiaries that the company may end its contract with Mercy this summer due to a dispute over payments.

Fewer health providers for patients to visit means fewer bills for the insurer to pay.

The Mercy Health Network has 2,000 physicians and advanced practice providers. Its network includes hospitals in 13 communities, plus about 200 clinics across Iowa. What should Medicaid patients do if their cardiologist, mental health professional or obstetrician works for Mercy? What about a cancer patient scheduling chemotherapy, radiation or surgery?

“We are working with the provider to find a solution,” the letter from AmeriHealth says.

The solution is for AmeriHealth to pay Mercy what it agreed to pay for services.

“Our original 3-year agreement with AmeriHealth-Caritas was negotiated in good faith less than a year ago,” Mercy Health Network Vice President Janell Pittman wrote in an email to the Register. “Now just a few months after getting this accomplished, they are requesting reduced payment levels.”

That sounds like the private Medicaid insurers Iowans have come to know.

The insurer’s agreement with Mercy helped it meet mandates to provide statewide coverage to Medicaid enrollees. Iowans believed they could get care at Mercy when they selected an AmeriHealth plan. The company’s contract with the state requires it to cover services through an “adequate” network of providers. The federal government, which approved Iowa’s privatization and funds the majority of Medicaid, also expects this.

Mercy has the reputation and market power to stand up to AmeriHealth. But how many smaller health providers are being quietly squeezed or dropped by the private insurers?

Iowans have suffered enough under Branstad’s failed Medicaid experiment. Administration of the health insurance program for more than 500,000 Iowans should be returned to the state, which is not in the business of pleasing shareholders.


Waterloo-Cedar Falls Courier. March 16, 2017

Cedar Falls Schools take logical step in purchasing land

The Cedar Falls Board of Education’s decision to approve a $1.24 million purchase of land, with an eye on a new high school site, is a logical and responsible one.

Some criticisms of that move, before and after the decision, have centered around the fact authority to build a new high school has yet to be granted by district voters.

A purchase agreement was developed more than two years ago with the University of Northern Iowa for the property just west of Hudson Road. However, a September 2014 referendum to build a new school was not approved by voters. Officials plan to seek voter approval again within 10-16 months for a high school on the site, which has an estimated cost of $80 million to $85 million.

The purchase approval simply exercised the option to buy the land - an option that was set to expire at the end of this month. The decision for approval was a move to secure the land for the future. That action makes sense.

The $1.24 million purchase was approved 6-0 with board member Jeff Hassman abstaining to avoid a conflict of interest. He explained farmland near that area has been in his family for years.

Former school board member Duane Hamilton spoke at the meeting, saying buying the land was about “vision.” He compared it to the district’s joint purchase of 40 acres with the city of Cedar Falls years ago for the land where a new elementary school and park will soon be developed.

It shouldn’t become a long-term situation, however. The district should not be in the business of warehousing developable land indefinitely. If future referendums regarding a new high school fail, then there should be a backup transaction plan to sell the land back to UNI or get it on the tax rolls.

It is our hope and recommendation the next new high school referendum be approved by voters.

Most community members realize the high school has been locked in its outdated footprint, with virtually nowhere to expand for future needs. The 50-acre site off of West 27th Street provides plenty of room for expansion. The current site is just 17.5 acres.

The main structure of the existing high school is about 60 years old. The need to expand technology, computer lab space and space to house support for technology has grown immensely over the lifetime of the building.

All along, district officials have been pointing to projections showing the high school will soon be over capacity. Superintendent Andy Pattee reiterated those points after the board’s action last week.

“The high school is going to be over capacity by the 2019-20 school year,” he said. “Our projections are to grow by over a thousand students in the next 10 years (district wide).”

A growing enrollment is good for the community - if the community is prepared for it. Simply put, school district officials are trying to prepare in the best way possible.

Exercising this option to purchase this land is a logical step for the district and the community.


Quad-City Times. March 15, 2017

King’s hate is an opportunity for GOP

Rep. Steve King’s rampant racism is an opportunity for Iowa Republicans and the party at large. Exorcise the nationalist bent before it’s too late.

The House should make an example of King, and Iowa GOP should be actively seeking a candidate to oust him in next year’s primary.

King’s Sunday tweet, in support of a right-wing Dutch nationalist, Geert Wilders, laid bare that which has infected the party of Lincoln for far too long.

“Wilders understands that culture and demographics are our destiny. We can’t restore our civilization with somebody else’s babies,” King tweeted, a direct shot at Muslim refugees and their children.

King has made a career out of nibbling the edges of white supremacy. Such inflammatory speech is what gets him on national television talk shows. He’s not serving Iowa’s 4th Congressional District. And thanks to his lust for attention, King serves as a self-appointed representative for Iowa. It’s through his actions that the nation sees us.

Many prominent Republicans rightly decried King’s initial statement. They no doubt fumed as he went on CNN and doubled-down.

“First of all, I do not agree with Congressman King’s statement. We are a nation of immigrants, and diversity is the strength of any nation and any community,” Iowa GOP Chairman Jeff Kaufmann said in a statement.

Kaufmann took an even harder swing at former KKK Grand Wizard David Duke, who was, unsurprisingly, overjoyed by King’s declaration.

“Regarding David Duke, his words and sentiments are absolute garbage. He is not welcome in our wonderful state,” Kaufmann said.

Gov. Terry Branstad and governor-in-waiting Kim Reynolds correctly smacked King for his outright bigotry.

Strong words are welcome. But action is necessary. Unchecked, this strain of right-wing nationalism will consume the party. It’s already threatening political orders throughout the West, the very civilization that King claims he wants to save. Austria, France, Greece and the U.K. are all combating racially fueled rightist political insurgencies. It’s a base reaction to the greatest refugee crises in 75 years, a catastrophe that, ironically, was orchestrated by the West’s own foreign policy. It’s been fostered by years of politicians stoking a persecution complex among those who, by every objective measure, enjoy a disproportionate amount of society’s benefits.

Like so many others, King is obviously emboldened by the rise of President Donald Trump. He’s dropped the thin veil that had cloaked his prejudice. Trump might not like to admit it, but the go-to dog whistles that propelled his campaign spoke directly to the hard right’s notion of racial purity and a civilization under siege from the others. That’s why Duke and his ilk are suddenly relevant again. It’s why Jews are suddenly under threat. It’s why angry white men are walking into the local bar, yelling, “Get out of my country,” and attacking fellow citizens for no other reason than the color of their skin.

This is not the rhetoric of your father’s GOP, the party of reason and Reagan. It is, however, the same disgusting drivel that was thrown at Irish, Polish and Italian immigrants a century ago. It’s fear and weakness masquerading as strength.

The GOP, neither in Iowa nor the U.S. at large, should stand for this. King’s words are a direct challenge to its ideals. This is, in a very real sense, a tipping point for a party that dominates most of the country. The moral imperative is real. And the economic one - the GOP’s stated sacred cow - is undeniable. These “babies” work in our businesses, schools, hospitals and universities. They’re no less American than anyone else.

The verbal spankings from Kaufmann, Branstad and Reynolds were apt. But their party’s actions will determine the real value of their words.

King should be censured in the House. His bigotry is protected speech. But the First Amendment does not shield him from professional consequences. And next year, King should face a strong opponent in the GOP primary, one with full backing of the state party.

King’s breed of hate-filled nationalism is a threat to the GOP. But it’s also an opportunity to rebuke such gutlessness in the strongest possible terms.


Sioux City Journal. March 16, 2017

When and where is the next town hall, Rep. King?

If U.S. Rep. Steve King, R-Iowa, doesn’t schedule public meetings, commonly known as town halls, and doesn’t tell everyone about them in public fashion so citizens know where he will be and when, should they wish to attend, he fails constituents and an important responsibility of his office.

The Journal knows of no traditional town hall scheduled by King within Siouxland so far this year.

In a recent interview with The Journal’s Bret Hayworth, King shared his concern paid protesters are disrupting public meetings held by Republican members of Congress.

“People come in and, you know, they are angry and shouting and on-the-borderline violent,” King told Hayworth. “That just discourages the kind of dialogue that can make our country better.”

Although we know of no evidence proving protesters at recent GOP town halls are paid, we do not dismiss King’s concern about them altogether. We have, in fact, used this space to criticize those who seek only to produce disruption at meetings like these.

In our view, those who attend public events hosted by GOP officeholders should practice decorum and follow established protocol, allowing questions and answers to proceed in a civil way.

Despite what happened at some events in the past, however, holding public office demands members of Congress, including King, at least make the effort to meet with Americans (including those who disagree with them) face to face, listen to what they have to say and answer their questions.

That’s essential to accountability.

To dismiss all protesters as paid and thereby hide from town halls is, in our view, nothing but a convenient excuse to avoid facing the music from angry, frustrated constituents at a time of division in our country.

One final note about King, who stirred national controversy this week with a repugnant, racially charged comment on Twitter - a comment praised by former Ku Klax Klan leader David Duke, by the way - in which he said, “We can’t restore our civilization with somebody else’s babies.”

If King wants to take advantage of the platform privilege he enjoys, as a member of the U.S. House of Representatives, to draw attention to his views on the national stage, he should have to answer to whatever fallout ensues and explain himself to constituents back home.

Might we suggest a town hall?


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