Des Moines Register. November 1, 2017
Let Iowans buy Medicaid health insurance.
Republicans call idea ’half baked’ but offer no plan to address faltering private market.
Sen. Matt McCoy and Rep. John Forbes are exactly right. Iowans who cannot find affordable, private health insurance should be able to buy into Medicaid coverage.
The proposal, unveiled last week by the two Democratic state lawmakers, is especially welcome now, as the state’s individual private insurance market is faltering.
Why not allow more Iowans - and the premiums they will pay - into an established government health insurance program that already insures more than 600,000 of their neighbors?
The proposal could offer an eventual lifeline to more than 70,000 Iowans who shop on their own for coverage without help from an employer. It would also repeal former Gov. Terry Branstad’s costly and disastrous privatization of Medicaid management.
Unfortunately, Republicans, who control the Iowa Legislature and governor’s office, immediately attacked the proposal.
“It’s a half-baked idea that hasn’t even worked in the most liberal of states,” said House Speaker Linda Upmeyer, R-Clear Lake.
What states would those be? Because when lawmakers in Nevada unveiled a similar idea this year, the problem was not the plan. It was politicians.
The Nevada Legislature passed a bill to offer Medicaid coverage alongside private health insurance on the state’s health insurance exchange. All residents could be covered. The state would need permission from the federal government, but the lawmaker who sponsored the bill said Washington officials were open to the idea.
Then Republican Gov. Brian Sandoval vetoed the legislation.
Upmeyer rightly notes details would need to be worked out for Medicaid to cover more Iowans. But the so-called “half-baked” idea is more than Republicans have in the oven. The majority party isn’t offering any recipe for helping constituents.
Those constituents include Bill Zook, 57, of Ankeny. After retiring early and losing coverage through his employer, he bought a plan on his own from Wellmark Blue Cross & Blue Shield. He currently pays $1,458 per month for a policy with a $13,000 annual deductible.
But Wellmark is among the insurers exiting the individual market next year. A comparable policy from the only remaining insurer, Medica, will cost Zook and his wife about $2,400 per month, he said.
Zook is frustrated and took the time to travel to the Statehouse last week to hear what McCoy and Forbes were announcing. Now he and other Iowans should consider contacting Republican lawmakers and Gov. Kim Reynolds and telling them to support the idea of letting Iowans buy into Medicaid. Premiums could be based on income and would likely be much cheaper than private coverage.
That’s because Medicaid costs much less per beneficiary than private insurance. The program contains costs by using its market power to ratchet down reimbursements to health providers. It dedicates its money to paying for actual health care instead of shareholder dividends and CEO salaries.
State efforts to build on existing Medicaid could move the country toward a universal system of health insurance. It could create a desperately needed “public option” alternative to private coverage.
The government program already insures 75 million Americans. Created in 1965, Medicaid is a reliable insurer with an existing infrastructure in every state. It has low administrative costs and provides comprehensive benefits, including coverage for prescription drugs and hospitalization.
Three-fourths of the public, including a majority of Republicans, have a positive view of Medicaid, according to a recent poll from the Kaiser Family Foundation.
Most important, it is operated by the government. And the government will be there for Americans - even when private insurers jump ship or charge an Iowa couple $2,400 per month for health coverage.
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Dubuque Telegraph Herald. November 1, 2017
Preparation needed to meet ’Alzheimer’s tsunami’
Chances are, every person reading this will know someone whose life has been impacted by Alzheimer’s disease.
And for those who have not yet been hit by the diagnosis of a close friend or relative, 2025 is looming.
By then, if no cure is found for the dementia-related illness, more than 7 million Americans over age 65 will be affected - a 35 percent increase over today’s figures.
In Iowa, where the population older than 65 is higher than the national average, 64,000 people are living with the disease, and that number that will climb to 73,000 in the next eight years.
Similarly, Wisconsin figures will rise from 110,000 to 130,000 by 2025, and Illinois, cases will go from 220,000 to 260,000.
A story researched by IowaWatch and HuffPost, published recently in the TH and newspapers across the state, showed grave concerns on the part of health experts who anticipate an “Alzheimer’s tsunami.”
State and federal health care systems are woefully unprepared for what’s to come. The rise in Alzheimer’s coincides with changes in health care support at both the state and national level.
Iowa’s transition to a privatized Medicaid system 18 months ago gets mixed reviews, as outlined in a story on the front page of Sunday’s TH. While Gov. Kim Reynolds points to a J.D. Power survey showing high patient satisfaction, area lawmakers have concerns about the most vulnerable Iowans. Rep. Andy McKean, R-Anamosa, noted constituents have lamented significant declines in services.
Medicaid remains the only government program that covers nursing home care, something more and more Alzheimer’s patients will require. Currently, Medicaid covers half the nursing home patients in Iowa, a number sure to increase as Alzheimer’s numbers rise.
Those changes in the state come as Congress examines options to repeal and replace Obamacare.
Instead of expanding Medicaid, the Republican plan calls for changing the way the program is funded. Though the details are not yet hammered out, Iowa health care officials fear it would likely force states to eliminate benefits or curtail enrollment.
While many readers might view Medicaid as a supplement for the poor, the reality is that private insurance is unlikely to cover most people through long-term nursing home care. About a third of people turning 65 today will eventually reside in a nursing home. A full three-fourths of long-term nursing home patients rely on Medicaid after personal savings runs out.
As Iowa addresses issues with its Medicaid providers, and Congress considers what comes next for the future of the program, elected officials in all states and federal government must look at the looming Alzheimer’s tsunami and begin to make preparations. Support for Alzheimer’s cure research should be a top priority. Providing a safety net for those who will fall to this devastating disease is something lawmakers must address as well.
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Sioux City Journal. November 2,2017
Focus mental health debate on those who need services
As the growing conflict over mental health services in Woodbury County moves forward, we urge involved leaders to not lose sight of the fact individuals and families with consequential needs are caught in the middle of all the squabbling. The longer this drags on without a final solution, the more uncomfortable their positions become.
As we have observed this dispute unfold over the last several months, we have been troubled by a gnawing feeling the dialogue is driven too much by contentious relationships between decision-makers and not enough by what’s best for those affected by their decisions who seek these important services. The result, we fear, is a rush to an-as-yet-uncertain outcome from which there will be no going back.
With that as a backdrop, we offer these thoughts on what, unfortunately, is a mess:
- We want and we believe constituents should want members of the Woodbury County Board of Supervisors to ask questions about how county services are delivered, including mental health services, and how county tax dollars are spent. In our minds, vigilance to identification of opportunities for improvement, whatever the issue, is something all of us should expect of elected leaders.
To these ends, we support a discussion of mental health services aimed at answering this question: Is Woodbury County providing such services in the most beneficial, cost-effective way possible?
- We believe the 3-2 vote on Oct. 3 by the Board of Supervisors to withdraw Woodbury County from Sioux Rivers Regional Mental Health and Disability Services was premature because no replacement plan exists. Woodbury County should have had a replacement plan in place and should have made a convincing case to the public for the replacement plan before voting to pull out of Sioux Rivers.
In our view, the Woodbury County board should reconsider - at least for the time being - its decision to withdraw from Sioux Rivers to allow more time for discussion of Sioux Rivers membership and, if necessary, study of alternatives.
- Having said that, Woodbury County should be allowed to withdraw from Sioux Rivers if it wishes. On Monday, the Sioux Rivers board voted 2-1 to prevent Woodbury County from withdrawal, creating the potential for legal action by Woodbury County.
On the other hand, it isn’t clear to us why a majority of the Woodbury County board wants to dissolve Sioux Rivers altogether. Why is the future of Sioux Rivers a concern of Woodbury County supervisors if Woodbury County withdraws?
We suggest a compromise: If Woodbury County insists on withdrawal, today or tomorrow, the Sioux Rivers board shouldn’t stand in the way. In return, Woodbury County supervisors should abandon their push for dissolving Sioux Rivers.
- Before this dispute reaches the point of no return (if it hasn’t already), however, we urge those involved on all sides to put whatever happened in the past in the past, turn down the temperature of dialogue, refocus this conversation in more productive fashion and give the spirit of compromise every opportunity for success. We’re not convinced that’s happened to this point.
Individuals and families in need deserve nothing less.
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Quad-City Times. November 1, 2017
Would Grassley protect Mueller from Trump?
U.S. Sen Chuck Grassley is the king of understated code-speak. But Monday was no time for parsing words as indictments and plea deals rolled out of the probe into Russian interference in last year’s presidential election.
Either Grassley is willing to protect Special Counsel Robert Mueller from President Donald Trump or he’s not.
Grassley wasn’t entirely mute after Mueller announced charges against former Trump campaign chairman Paul Manafort and a plea deal with former adviser George Papadopoulos. But Grassley’s position atop the Senate Judiciary Committee basically barred a standard “no comment.” Instead, in classic Grassley fashion, he drove headlong into the weeds while offering a smidgen of substance served with a twist of deflection and confusion.
“As always, it’s important to let our legal system run its course,” Grassley’s statement reads. “While we don’t have any more information regarding the current status of the special counsel’s investigation other than what has already been made public, it’s good to see the Justice Department taking seriously its responsibility to enforce the Foreign Agents Registration Act.”
He then went on about enforcement of FARA, which requires disclosure from those working with foreign entities, which former Trump campaign chairman Paul Manafort is accused of violating. Nowhere did Grassley mention Manafort, Trump or the campaign. He even offered the old “Democrats do it, too” defense. Later Monday, Grassley turned tail and fled a press conference before reporters could ask about the news of the day.
So, in essence, the only statement with any political weight was “let our legal system run its course.”
What does that mean, exactly? And, of greater import, is he prepared to push back should Trump succumb to his rage and crush Mueller’s investigation, a possibility that, in less partisan times, would create a legitimate constitutional crisis? Grassley intentionally ducked the matter altogether, a troubling signal to send to a White House with a history of leaning on investigators.
Orrin Hatch, R-Utah, wasn’t afraid to demand Mueller’s investigation continue without interference. Same goes for Utah peer Sen. Mike Lee. Neither of these men are liberals. Both have a long conservative records. And yet, unlike Grassley, they were willing to unequivocally demand that the White House leave Mueller to his work. It’s a testament to the seriousness of the situation.
A pair of bills would make it much more difficult to fire Mueller. But those two pieces of legislation are basically stalled. Yet, legislation in the House that’s gaining traction among Trump’s allies would hamper Mueller by starving him of cash. These are the realities of the moment. No matter how uncomfortable, Grassley has a duty to defend the judicial system against political meddling. His politically driven lack of clarity was especially concerning due to his incessant attempts at justifying investigations of Democrats who do not reside in the White House, a transparent effort to deflect and distract.
One cannot stress the importance of this moment. Trump’s former campaign chairman, the man who kept twitchy delegates in line at the Republican National Convention, faces a raft of charges, including conspiracy and failing to disclose his work for pro-Russian separatists in Ukraine under the Foreign Agents Registration Act. That same day, a plea deal with Papadopoulos was made public. Papadopoulos attempted to collude with Kremlin-linked agents and then lied about it.
Grassley is no small fish here. His committee wields oversight authority over the Justice Department. Several of the president’s most reactionary partisan allies - who have spent weeks attempting to tarnish Mueller’s credentials - again pressed for Mueller’s firing. Trump, mind you, couldn’t directly sack Mueller. He could, however, summon the ghost of Richard Nixon and purge the Justice Department until he found a lackey who would quash the investigation into Trump’s presidential campaign.
But Grassley would rather talk about something - anything - else.
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