The Des Moines Register. March 22, 2015.
Medicaid plan is gift for private firms
From Social Security to Medicare, Republicans have pushed to privatize government entitlements. Now Gov. Terry Branstad seeks to hand over management of Iowa's $4.2 billion Medicaid program to a few private companies.
The public should be skeptical. The more than 500,000 poor and disabled individuals and families in Iowa who rely on Medicaid should be asking questions. The federal government should be reluctant to approve the waiver that Iowa needs to privatize a program funded by state and federal dollars.
In recent presentations to the public, state leaders have unveiled a lot of numbers intended to show Medicaid is expensive. What they do not provide is context.
For example, they emphasize the cost of Medicaid has grown 73 percent since 2003. They do not share that the cost of employer-based health insurance in Iowa has grown about 80 percent over the same time period, according to researcher David P. Lind Benchmark.
In fiscal year 2013, a Medicaid recipient in this state cost an average of $5,491 — less than the per-person cost in 29 other states and much less than people insured by private coverage. For an adult who is not a senior or disabled, Iowa spent an average of $2,000 on health care, less than that spent in 47 other states, according to research from the Kaiser Family Foundation. Health insurance for a state lawmaker costs Iowa taxpayers about $9,000 per year.
Iowa's Medicaid spending is not out of control.
Administrative costs are low because the program is largely managed by the government, which is not beholden to stockholders or obligated to pay huge CEO salaries. The cost of operating the program is currently 4 to 8 percent, according to the Iowa Department of Human Services, which oversees Medicaid. When privatized, the cost could grow to as much as 15 percent. Those are dollars not spent on actual health care.
The Branstad administration needs to explain how funneling public dollars to profit-seeking companies will cost less. Generic promises about managed care resulting in "efficient, coordinated and high-quality health care" are not enough. Iowans need evidence the managed care model will actually save money and improve care.
Such evidence is hard to come by. In fact, several studies have shown managed care either saves no money or ends up costing more than traditional, fee-for-service Medicaid, according to a 2012 report from the Robert Wood Johnson Foundation. The reason: Medicaid has already taken many steps to rein in costs.
In the past, the state has trumped its successes in reducing fraud, keeping seniors out of expensive nursing homes and holding down spending on drugs. The program saves a huge amount of money paying providers less than other insurers for health services. Now, however, they argue managed care companies can do a better job.
Privatizing Medicaid will make the cost of the program more predictable, as the state will pay fixed monthly fees to companies that assume responsibility for Iowans' care. But will the number of visits to providers be limited? Will records remain available to the public? How much money will be shifted from covering care to paying administrative costs? Will fewer physicians accept Medicaid patients?
In its comments to state officials, the Iowa Hospital Association noted that managed care companies reduce costs by denying coverage for services, including emergency room visits. The association is "deeply concerned" that the private model could reduce access to care and reimbursement rates for providers.
All health-care providers should be concerned. So should anyone who relies on Medicaid. So should anyone who cares about vulnerable Iowans.
Globe Gazette. March 22, 2015.
Iowa lawmakers owe schools a decision on aid
Iowa legislators and Gov. Terry Branstad make a big show of saying they want to be good managers of the state's programs and resources. And they maintain that the state's education system is a top priority.
Neither claim looks very convincing in light of the current debacle that is the Iowa school funding debate.
Not only are lawmakers more than five weeks past a legal deadline for setting the school aid formula, they appear to be no closer to making a decision now than when they were supposed to.
The Iowa House, controlled by Republicans, has passed a 1.25 percent aid increase. The Senate, controlled by Democrats, has passed a 4 percent increase. Even though a conference committee has been in place for more than two weeks to forge an agreement, no progress has been made and the sides are dug in.
This is more than just poor managing and poor governing on the state level. This inability to come to an agreement causes serious problems for local school districts. They are in the process right now of setting their budgets for next year, and those budgets must be certified soon. But without knowing how much state funding they will receive they are operating by guesswork.
The Clear Lake School Board is looking at cutting about half a million dollars in general fund spending because it doesn't know how much money it will receive. Possible reductions include in French class and vocal music.
In Mason City the School Board is looking at cuts in administrative positions, services and programs. An early retirement program and resignations will save about a million dollars, but only about two-thirds of the staff who are leaving will be replaced.
At least one school district is considering simply ignoring state law, figuring if the Legislature can't meet its legal obligations then why should schools be held hostage. As we reported recently, the superintendent of the Davenport School District has advocated for spending more per pupil than state law allows by dipping into the district's reserves. He's daring the state to call him on it.
These situations beg the question: If our schools are so important, why are state lawmakers treating them with such neglect?
For about 20 years Iowa has had a law that calls for the Legislature to approve the next school year's educational aid formula within 30 days of receiving the governor's budget proposal. This year that deadline passed on Feb. 12. That law is combined with another that requires the Legislature to set the state per-pupil funding formula two budget years ahead.
The goal of these two provisions is to provide some degree of certainty so school districts can set their annual budgets and plan ahead.
It was designed to get the important school aid decision out of the way early in a legislative session so it would be less likely to become embroiled in the horse-trading and political game-playing that come fast and furious as the end of a session nears.
So why has the Legislature broken this law for the last five years? Why has Gov. Branstad been complicit in allowing it to happen?
We blame both parties for a failure to come together on this important decision. The Senate at least met the Feb. 12 deadline, but the lack of progress since then makes that accomplishment meaningless.
The Legislature has proved that it can move quickly and decisively when members want to. It passed a needed increase in the state fuel tax in short order to address deficiencies in state highway infrastructure funding.
Roads and bridges are important. But even more important are our children and our schools. It's time to quit posturing and make a decision.
Quad-City Times. March 22, 2015.
Traffic cameras work
The Iowa Department of Transportation passed judgment on traffic cameras deployed by six Iowa communities and the verdict is clear: According to the DOT analysis, traffic cameras work.
The DOT report issued last Tuesday showed effective use of more than two-thirds of the state's traffic cameras. The agency ordered nine cameras removed and suggested further documentation to support continuing a 10th.
Davenport introduced Iowa to automated traffic enforcement back in 2004. Two years ago, state legislators took a measure of control away from local governments and ordered the DOT to determine the effectiveness of cameras on state highways.
This initial DOT study seems to focus on one factor, simply counting reported crashes before and after camera installation. There's no suggestion researchers considered other recognized factors that could influence crash numbers: weather, type of vehicle, time of day, traffic conditions.
Still, on that narrow DOT crash count assessment, the vast majority of Iowa traffic camera sites reported fewer accidents after cameras appeared. Crash counts are down. Speeds are down. And full-time, trained officers who used to point radar guns from their squads for hours, now are deployed more effectively to other crime-fighting duties.
Headlines last week focused on the handful of cameras the DOT ordered cities to remove. Davenport will lose one of four intersection cameras. The DOT allowed it to keep both fixed speed cameras. Muscatine loses one of three intersection cameras.
The biggest DOT concerns seemed to be interstate speed cameras. The DOT feedback instructed Cedar Rapids to better deploy two I-380 speed cameras and remove two others. Sioux City was ordered to remove both of its portable speed cameras from a stretch of Interstate 29.
We worried that legislators' political fears might prevail over autonomous Iowa cities' traffic concerns. We're pleased to see the Iowa DOT research affirm camera enforcement success in the vast majority of situations.
There will always be concerns that any enforcement - automated or otherwise - can be driven by revenue. This first study confirms verifiable safety improvements across Iowa from the camera enforcement launched more than a decade ago in Davenport.
The Messenger. March 22, 2015.
It's time for spring and farming
Agriculture is at the very heart of life in the Hawkeye State and especially so as spring unfolds. The renewal of the earth is also a time when the pace quickens on Iowa's 88,000 farms.
According to the National Agricultural Statistics Service of the U.S. Department of Agriculture a huge portion of the state's land is devoted to farming — an estimated 30,600,000 acres as of 2012. That's hardly a surprise to anyone familiar with the Iowa economy because agriculture has been the key to prosperity here since pioneers first arrived.
Even though farms have always been center stage in Iowa, the business of agriculture is changing rapidly.
The impressive scope of Iowa agriculture can't be captured fully in numbers, but the statistical portrait the USDA has assembled provides an intriguing overview of the 21st-century Iowa farm world.
Here are some of the numbers:
Iowa ranks first in the nation in production of corn and soybeans.
Iowa leads the nation in hog and egg production.
As of Jan. 1, 2015, the state's livestock inventory included almost 4 million cattle and calves, about 21 million hogs and pigs, and 175,000 sheep.
Iowa ranks near the top of American states in total agricultural exports.
Conservation is widely practiced by Iowa farmers. Nine out of every 10 acres in crop land is farmed using some type of conservation practice.
Innovation in farming techniques and the development of new products have helped keep the agricultural economy vibrant. A good example of the latter is Iowa's central role in the booming renewable fuels industries. It already leads the nation in the production of ethanol and the rapidly growing biodiesel sector is becoming an important market force.
Soon the Iowa landscape will be transformed as the state's farmers - assisted by hopefully gentle rains and warmer weather - bring now empty fields alive.
The bounty those farms produce is the lifeblood of our state.