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“A Familiar Premise Of Free-Market Conservatism”: Iowa’s Radical Privatization Of Medicaid Is Already Struggling

On Jan. 1, 31 days before Iowa caucus-goers cast the first votes of the 2016 presidential race, the state will gain another national distinction, but of a dubious variety: It plans to launch the most sweeping and radical privatization of Medicaid ever attempted.

In an extraordinary social policy experiment, Iowa’s Gov. Terry Branstad (R) is kicking about 560,000 of the state’s poorest residents out of the traditional Medicaid health-care program for the poor and forcing virtually all of them to sign up with private insurers. The trend toward managed care for Medicaid has been underway for decades and some 39 states do it to some extent. But experts inside and outside government say no state has tried to make such a wholesale change so quickly — in Iowa’s case, launching the program fewer than 90 days after signing contracts with private health-care companies.

Iowa is conducting an extreme test of a familiar premise of free-market conservatism: that the private sector is more efficient at management and service delivery than government. But the results so far should give pause to those who automatically make such assumptions. The transition of Iowa’s $4.2 billion Medicaid program has made the rollout of HealthCare.gov look orderly.

An Iowa administrative law judge late last month recommended that Iowa throw out the contract it awarded to WellCare, one of the four companies hired to manage the new program, noting that the company failed to disclose details of its “integrity agreement” with the federal government after the 2014 convictions of three former executives involving the misuse of Medicaid money. In addition, WellCare had paid $138 million to resolve claims that it overbilled Medicare and Medicaid, and the firm had also hired two former Iowa legislators, who improperly communicated with the Branstad administration during the bidding process.

The Des Moines Register has reported that the four companies selected to operate the Iowa program have had more than 1,500 regulatory sanctions combined and have paid $10.2 million in fines over the past five years. These involved canceled appointments, privacy breaches, untimely processing and failure to obtain informed consent.

The Iowa rollout has been hampered by delays, and some beneficiaries of the program are only now getting their enrollment packets, though the deadline for signing up is Dec. 17. Health-care providers complain that they are being forced to sign incomplete contracts or face a penalty, and they complain that some contracts don’t cover services that had been covered under the existing Medicaid program.

Branstad’s administration has answered critics by saying the new program will save $51 million in its first six months. But he has been unable to come up with documentation to justify the cost savings for Iowa, which already has a low-cost Medicaid system.

Branstad had the authority to implement the new program without input from the state legislature. But officials with the Centers for Medicare and Medicaid Services (CMS) were in Iowa this week and will make a ruling next week on whether the plan can proceed.

“The rollout has been an absolute unmitigated disaster,” said Democratic Sen. Joe Bolkcom, the Iowa chamber’s majority whip. “CMS and the Obama administration need to protect vulnerable Iowans from this train wreck.”

Branstad has implicitly acknowledged some difficulty. This week he extended until April the “safe harbor” in which Medicaid providers will receive 100 percent reimbursement regardless of managed-care network.

In response to my inquiry, Branstad’s office sent me to the state’s Department of Human Services, where a spokeswoman, Amy Lorentzen McCoy, said all is well. The state, which now has 12 percent of Medicaid recipients in managed care, would have gone this way anyway, she said, but the urgency increased with the recent Medicaid expansion. (Branstad was one of the few Republican governors to accept the Obamacare expansion of the program.)

Now, as the nation’s attention turns to the Iowa caucuses, Iowans will likely be witnessing either a fight between Branstad and President Obama (if the federal government forces a delay in the Iowa program) or chaos (if the program is allowed to proceed). Other states, such as Kansas and Kentucky, have tried similar experiments, but they either moved more deliberately or didn’t extend the private program to vulnerable populations such as the disabled.

“A lot of issues have been raised with the pace of the rollout” in Iowa, said Julia Paradise, a Medicaid expert with the Kaiser Family Foundation. “The provider networks for the plans have not yet been established. There’s a lot of confusion among beneficiaries.”

Branstad could recognize this, and slow things down. In failing to do so, he’s relying more on dogma — faith that the private sector always does things better — than reality.

 

By: Dana Milbank, Opinion Writer, The Washington Post, December 11, 2015

December 14, 2015 Posted by | Free Markets, Medicaid Privatization, Terry Branstad | , , , , , , , , | Leave a comment

“Willful Republican Obfuscation”: The GOP Takes Another ObamaCare Study Way Out Of Context

It’s no secret that Republicans are pinning their midterm election hopes on ObamaCare.

So it should be no surprise that the GOP has tried to cast virtually all news about the health care law as proof that ObamaCare will kill jobs and send insurance costs soaring. The only problem with that strategy is that the underlying arguments are often disingenuous.

In the latest case, a new report from the Centers for Medicare & Medicaid Services estimates that ObamaCare could raise insurance premiums for nearly two-thirds of small businesses, affecting some 11 million employees. Before ObamaCare, those small businesses were paying below-average rates — often by having younger, healthier workers whom insurers could charge less to cover — but new rules designed to level the insurance marketplace will cause those rates to rise, according to the report.

Naturally, right-wing blogs and Republican lawmakers seized on the report to bash ObamaCare. The report revealed another “broken promise” from the Obama administration, House Speaker John Boehner (R-Ohio) said in a statement, calling it “another punch in the gut for Americans already struggling in the president’s economy.”

The reality of the report’s conclusions, though, are a bit more nuanced.

While the report did find that insurance premiums would probably go up, it did not determine that insurance costs overall would spike. That’s because the report focused only on the impact of ObamaCare’s new rules, and not, crucially, on the impact of its new benefits.

ObamaCare contains a wealth of subsidies, tax breaks, and the like — many of them geared specifically toward small businesses — that are intended to drive down individuals’ insurance costs. When you factor in all the positives, “Obamacare may well be the best thing Washington has done for American small business in decades,” The New Yorker’s James Surowiecki wrote last year.

The CMS report acknowledged that fact, hedging that there was “a rather large degree of uncertainty associated with this estimate” and that the true impact “will be based on far more factors than the three that are focused on in this report so understanding the effects of just these provisions will always be challenging.” And the report specifically mentioned one nongovernmental analysis of the entire law which found that it would have a “minimal” impact on small business premiums.

Moreover, the report estimated that costs would drop for the remaining one-third of small businesses. Why? They’re currently paying above-average rates, so the market-leveling rules will actually benefit them.

The GOP hand-wringing comes on the heels of its failed attempt to claim a separate federal report confirmed that ObamaCare will be a job killer. That nonpartisan Congressional Budget Office report actually found that the law would lead to a reduction of labor, not jobs, as incentives made it easier for people to work less or retire early. The GOP’s claim was so bogus, in fact, that the CBO released a follow-up statement thoroughly debunking it as an egregious distortion of the truth.

Republicans understandably want to make the health care law look bad to boost their election prospects. But skewing the findings on ObamaCare only hurts their credibility and reveals the party’s willful obfuscation on the issue.

 

By: Jon Terbush, The Week, February 25, 2014

February 26, 2014 Posted by | Affordable Care Act, GOP, Small Businesses | , , , , , , | Leave a comment

“More Bark Than Bite”: Tomorrow’s Obamacare Controversy, Today

If past is precedent, Republicans on the House Oversight Committee will soon release a draft memo they requested and received from the Health and Human Services Department just before most Washingtonians decamped for the Christmas holiday.

At first glance, the memo, obtained by National Journal, looks very bad for the Obama administration. In the Sept. 24 document, a top information security officer for the agency overseeing the Obamacare insurance exchanges warns that the marketplace “does not reasonably meet … security requirements” and that “there is also no confidence that Personal Identifiable Information (PII) will be protected.” Teresa Fryer, the chief information security officer at the Centers for Medicare and Medicaid Service, continues: The federal marketplace will likely “not be ready to securely support the Affordable Care Act … by October 1, 2013.”

It plays right into the Republican narrative about HealthCare.gov: The administration knew the website would not be ready by the launch date but went ahead with it anyway. And the site may still not be adequately protecting consumers’ information.

But, in context, the draft memo becomes much less exciting.

On the Friday before Christmas, Rep. Darrell Issa, the chairman of the House Oversight Committee, released a partial transcript from an interview conducted by the panel’s staff with Fryer. That partial transcript, shared with ABC and CBS, suggested that Fryer warned the administration that there were two findings of serious vulnerabilities in the system.

However, when Democrats on the Oversight Committee released parts of the transcript omitted from Issa’s version, Fryer’s comments looked far less explosive, and ABC updated its story to reflect the change. It turns out that by Sept. 27, a few days after Fryer raised her concerns about the security at launch, extensive new security measures were added.

As she told the committee’s investigators, “The added protections that we have put into place in accordance with the risk decision memo … are best practices above and beyond what is usually recommended.” She went on to describe her confidence in the three-level security system and to note that there have been “no successful breaches [or] security incidents.”

Which brings us back to the draft memo we obtained. We should note that it was just a draft, and was never sent or reviewed by more senior officers in the chain of command, and was written three days before the mitigation strategies went into effect. She later told Oversight Committee investigators that her earlier recommendation against giving the go-ahead to launch the site—the “authority to operate,” as it’s called—did not take into account the mitigation strategies laid out in the Sept. 27 Authority to Operate memo.

The investigators asked Tony Trenkle, then-CMS’ top information executive, this: “So as long as the mitigation strategy described in the [ATO] memo was carried out, you considered that it was, it would be sufficient to mitigate the risks described in the memo?” He responded, “Yes.”

She added that she was “satisfied” with the current security testing, and that she did not object when another CMS information security officer decided to move ahead with the launch. Again, she stated: “All systems are susceptible to attacks. There have been no successful attempts.”

As the Los Angeles Times‘ Pulitzer Prize-winning business columnist Michael Hiltzik noted, “Issa has absolutely no evidence” to support his broader claims that the system’s deep vulnerabilities put all kinds of consumers’ government data at risk, and that CMS moved ahead anyway to avoid embarrassing the White House.

Of course, sleight of hand with opaque bureaucratic documents is nothing new for Issa, but the potential to dissuade Americans from obtaining health insurance through the federal exchanges because of trumped up security fears has pushed relations between the committee chair and the administration to a new low. It’s one thing to say without evidence that the administration is corrupt, but it’s another to tell Americans that their Social Security number is at risk when there’s nothing to suggest that’s true.

But perhaps we can head off another round of this farce by putting out Fryer’s memo before Issa does—in its full context.

By: Alex Seitz-Wald, The National Journal, December 24, 2013

December 29, 2013 Posted by | Affordable Care Act, Republicans | , , , , , , , | Leave a comment

“Darrell Issa’s Credibility Collapses”: Feeding Bogus Stories To Unsuspecting Journalists

House Oversight Committee Chairman Darrell Issa (R-Calif.) has a favorite trick: his staff puts together a partial transcript of closed-door testimony, they edit it in a misleading way to advance a far-right narrative, and then they look for a news organization who’ll fall for the scam.

This week, the trick involved Henry Chao, HealthCare.gov’s chief project manager at the Centers for Medicare and Medicaid Services, and an alleged memo involving security risks. CBS News fell victim to Issa’s swindle, and as was first reported right here on Maddow Blog, the story was quickly proven fraudulent.

At an Oversight Committee hearing yesterday, Rep. Gerald Connolly (D-Va.) questioned Chao on this point directly, made clear that the CBS report was wrong, and saw Chao explain that his words had been “rearranged” by the partial transcript Issa released.

But wait, there’s more.

Issa also insisted this week that the White House directed the CMS to disable the so-called “anonymous shopper” function of the Affordable Care Act’s website in order to prevent “sticker shock.” How’d that work out?

Three weeks ago, Issa alleged that the White House ordered contractors to disable the “anonymous shopper” function that would allow people to compare plans. “The White House was telling them they needed these changes,” he told CBS News. Why? He told Fox News that the administration “buried the information about the high cost of Obamacare” so that consumers wouldn’t get “sticker shock.”

In testimony Wednesday, however, an administration IT expert testified that he ordered the “shopper” function disabled until defects could be repaired and that there had been no political interference.

“So when Chairman Issa stated on national television that the White House ordered you . . . to disable the shopper function in September for political reasons, to avoid consumer sticker shock, that’s not true, is it?” asked Rep. John Tierney (D-Mass.).

Issa immediately objected, but it was too late – Issa’s lie (which is to say, his latest in a series of lies) had been exposed. The Republican said Tierney was mischaracterizing his claims, so Tierney read Issa’s discredited arguments out loud. (See the video http://youtu.be/oNSQn2zVdSU.)

I’m sure Issa and his office will continue to feed bogus stories to unsuspecting journalists. I’m less sure why anyone would keep falling for the same nonsense from someone lacking all credibility.

 

By: Steve Benen, The Maddow Blog, November 14, 2013

November 15, 2013 Posted by | Darrell Issa, Journalists | , , , , , , , | 1 Comment

Extortion Politics: A New Form Of Governing

Josh Marshall made an interesting point in passing yesterday, asking whether conservative Republicans could achieve massive spending cuts through “old-fashioned majority votes.” Josh answered his own question: “Of course not.” The cuts on the table were only made possible by Republicans “threatening the health” of the United States.

I think this arguably one of the more important realizations to take away from the current political landscape. Republicans aren’t just radicalized, aren’t just pursuing an extreme agenda, and aren’t just allergic to compromise. The congressional GOP is also changing the very nature of governing in ways with no modern precedent.

Welcome to the normalization of extortion politics.

Consider, for example, the Republican decision to reject any and all nominees to the Consumer Financial Protection Bureau, regardless of merit, unless and until Democrats accepted changes to the agency’s structure. Traditionally, if the GOP wanted to alter the powers of the CFPB, it would write legislation, send it to committee, bring it to the floor, send it to the other chamber, etc. But that takes time and effort, and in a divided government, this “old fashioned” approach to policymaking probably wouldn’t produce the desired result.

Instead, we see the latest in a series of extortion strategies: Republicans will force Democrats to accept changes to the agency, or Republicans won’t allow the agency to function. Jonathan Cohn wrote a good piece on this a couple of weeks ago, noting the frequency with which this strategy is utilized.

Republican threats to block nominees to the consumer board are at peace with their opposition to Don Berwick, Obama’s first choice to run the Center for Medicare and Medicaid Services; to Peter Diamond, whom Obama tapped to sit on the Federal Reserve Board; and most recently to John Bryson, Obama’s nominee to take over the Commerce Department. It’s nothing short of a power grab by the Republican Party — an effort to achieve, through the confirmation process, what they could not achieve through legislation. And it seems unprecedented, at least in modern times.

Republicans effectively tell the administration, over and over again, that the normal system of American governance can continue … just as soon as Democrats agree to policy changes the GOP can’t otherwise pass.

The traditional American model would tell Republicans to win an election. If that doesn’t work, Republicans should work with rivals to pass legislation that moves them closer to their goal. In 2011, the GOP has decided these old-school norms are of no value. Why bother with them when Republicans can force through policy changes by way of a series of hostage strategies? Why should the legislative branch use its powers through legislative action when extortion is more effective?

It’s offensive when it comes to nominees like CFPB nominee Richard Cordray, but using the full faith and credit of the United States to force through desired policy changes takes this dynamic to a very different level. And since it’s working, this will be repeated and establishes a new precedent.

Indeed, it’s a reminder that of all the qualities Republicans lack — wisdom, humility, shame, integrity — it’s their nonexistent appreciation for limits that’s arguably the scariest.

By: Steve Benen, Contributing Writer, Washington Monthly-Political Animal, July 31, 2011

August 1, 2011 Posted by | Class Warfare, Congress, Conservatives, Consumers, Democracy, Democrats, Elections, GOP, Government, Ideologues, Ideology, Lawmakers, Politics, Republicans, Right Wing, Teaparty, Voters | , , , , , , , , , , , , | Leave a comment

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