February 13, 2016

‘Premium’ rate offered to Iowa doctors who treat Medicaid patients

A key Republican legislator says Iowa doctors who sign contracts with one of the three companies hired to manage care for Medicaid patients will be paid more than they would get in other states.

Representative Dave Heaton, a Republican from Mount Pleasant, is chairman of a budget panel that deals with this issue. Heaton says based on action in congress, many other states are reducing payments to doctors who provide care to low income and disabled patients who are on Medicaid.

“Iowa has elected as their base rate for primary care physicians to hold onto that enhanced rate and that is the base from which these docs are negotiating with these managed care companies…paying a premium above what other states are offering their doctors,” Heaton says. “Now, I want to go on and say this, that if these doctors don’t agree really with what is being offered them as a base, I think that they are putting my Medicaid population at risk.”

Nearly a year ago Governor Branstad unveiled plans to shift Medicaid patients into private managed care plans. About 560,000 Iowans get their health care coverage through the government’s Medicaid program.

“The greatest number of them will be affected from the outset on March 1, but the long-term care –people in the nursing home area of Medicaid, they’re still a year and a half away,” Heaton says.

State officials are still waiting for a federal agency to approve a waiver for Medicaid privatization to begin in Iowa on March 1. Heaton says he hopes that decision is announced next week to give everyone involved two weeks to get ready. Heaton made his comments today during taping of the “Iowa Press” program that airs tonight on Iowa Public Television.

House Republicans propose less spending than Branstad recommended

Pat Grassley

Pat Grassley

House Republicans are proposing a $7.32 billion state budget for next year.

“This budget has been put together in a mindful manner to make sure that we are living within our means, but also funding the priorities of Iowans,” says Representative Pat Grassley, a Republican from New Hartford who is chairman of the House Appropriations Committee.

Republican Governor Terry Branstad has drafted a slightly larger budget of more than $7.4 billion. Senate Democrats are proposing a spending level in between the targets set by Branstad and House Republicans.

State tax collections have not been as robust as previously predicted and Grassley says nearly all the new state tax revenue expected will be directed to K-12 public schools.

“Every budget should be very difficult as we’re spending the money of the taxpayers of Iowa,” Grassley says, “and I think we’ve done a good job of sticking to our commitments that we all made when we were all out campaigning and living within our means and that’s what this budget does.”

Grassley says House Republicans used the current year’s state budget as a starting point for their budget plan rather than using the budget documents Governor Branstad delivered to legislators on January 12.

ISU, U-I & UNI presidents ask legislators for $20 million more

ISU President, Steven Leath. (file photo)

ISU President, Steven Leath. (file photo)

The presidents of Iowa’s three public universities were at the statehouse Thursday, asking legislators to boost state funding for the schools by more than $20 million.

That is two-and-a-half times what Governor Branstad has recommended — and Republican legislators suggest $20 million is an excessive request.

Iowa State University president Steven Leath wants more than $8 million more — just for ISU where enrollment has soared.

“I believe we’re now at a ‘tipping point’ in terms of support for the tremendous demand we have at Iowa State,” Leath said.

Bruce Harreld (file photo)

Bruce Harreld (file photo)

University of Iowa president Bruce Harreld said other schools are poaching his professors and he wants $4 million more to boost faculty salaries.

“The core of an institution like ours is not only fantastic students, but fantastic faculty teaching, doing scholarship and doing research and we’ve lost roughly 100 faculty over the last decade,” Harreld said.

University of Northern Iowa president William Ruud said his institution’s budget needs a boost because most UNI students are Iowans — and pay the cheaper in-state tuition rates.

“Our request to meet financial stability: $7.65 million,” he told legislators.

Republican legislative leaders say nearly all the new state tax money available to spend in the next budgeting year is dedicated to K-12 schools and there would have to be cuts elsewhere in the state budget to accommodate a $20 million increase for the three Regents universities.

Upmeyer says too many ‘unanswered questions’ about marijuana as medication

House Speaker Linda Upmeyer. (file photo)

House Speaker Linda Upmeyer. (file photo)

The top Republican in the legislature is making it clear she will oppose any attempt to legalize medical marijuana in Iowa this year. House Speaker Linda Upmeyer, a Republican from Clear Lake, is a nurse practitioner and she says it “makes sense” to have the federal Food and Drug Administration make that decision.

“I still really believe that the FDA is the arbiter of what is a medication,” she says, “and making sure that the safety, the quality — all those things is the same for any medication.”

Upmeyer says Iowa doctors worry they’ll lose their licenses write prescriptions if they advise patients to use marijuana as treatment for a medical condition.

“Physicians that hold DEA licenses have just a real bit of a concern or a large concern over whether or not that jeopardizes those at all,” Upmeyer says.

And Upmeyer says on January 20th of next year when a new president takes over, the federal approach to medical marijuana may change.

“There are a lot of unanswered questions out there, but I still believe the FDA is the arbiter of medication and how that is managed,” Upmeyer says.

One of Upmeyer’s fellow Republicans in the House has introduced legislation that would allow the cultivation of marijuana in Iowa — for producing cannabis oil to treat chronic epilepsy. That bill faces a February 19 deadline to win approval in a House committee to remain eligible for legislators to consider in 2016.

Utilities Board schedules more time for discussion of Bakken pipeline

Board members Nick Wagner, Geri Huser and Libby Jacobs discuss the pipeline.

Board members Nick Wagner, Geri Huser and Libby Jacobs discuss the pipeline.

The chair of the Iowa Utilities Board announced today that they have scheduled at least three more meeting to discuss the request for a construction permit for the Bakken oil pipeline.

That announcement ended speculation the three-member board would make a decision on the issue following today’s meeting. Board members continued discussion on several issues that will help them determine if they will approved the permit.

Libby Jacobs

Libby Jacobs

Board member Libby Jacobs of West Des Moines says the safety of the pipeline is one of the critical issues that has come up in the discussion. “There are several parties who indicated safety records were better for pipelines versus for rail and for truck lines. Others indicated just the opposite of that,” Jacobs says. Jacobs says they need to look at the severity of the safety issues with each.

“When you look at the records for the trucking and the railroads, there have been some fairly significant incidents that have occurred that have been presented in the evidence before us. And so one must weigh the significance of those versus the leakage of the pipeline,” according to Jacobs.

Nick-Wagner-IUBBoard member Nick Wagner of Marion says he agrees with Jacobs and talked about the rail accidents.

“With the rail we’ve seen the incidents that have happened, have happened in populated areas — because that’s typically where railroads run because of the history of railroads linking cities and towns and populated areas,” Wagner says.

He says the route of the pipeline may make it safer.”I think because the pipeline is not going through major populated areas and does avoid those, from that perspective, I think it is somewhat safer than by shipping by rail or truck,” Wagner says.

Board Chair Geri Huser of Altoona, says the method of shipping is not her biggest issue. “I don’t see that whether it’s rail, pipeline or truck that there’s any inherent increases in safety,” Huser says. “I think they all have risks. And I think the real issue is whether there is any leakages or spill from any of those entities.” Huser says there’s evidence that pipeline accidents could have a bigger impact.

Geri Huser

Geri Huser

She says some of the information she has read has shown there have been some larger accidents by pipeline than there are by rail or truck transportation.

Huser says she is more concerned overall by how the spills are handled. Huser says having looked at the information on the various types of accidents, the decision comes down to how the board views the safety factors that have been put in place to protect against an accident.

The three discussed many other details during the meeting. The board will hold another meeting on February 19th and Huser says they have also reserved March 9th and 10th for additional days of deliberation.  You can go to the Iowa Utilities Board website to find out more.

Halt to managed care for Iowa Medicaid patients passes Senate; House won’t consider it

David Johnson

David Johnson

Three Republicans have joined all 26 Democrats in the Iowa Senate in voting for a bill that would “terminate” Republican Governor Terry Branstad’s plan to shift 560,000 Medicaid patients in Iowa into managed care plans.

“We need to put a dagger in this,” said Senator David Johnson, a Republican from Ocheyedan. “It’s moving too fast.” Johnson said it took Minnesota 20 years to make such a shift, while Iowa is trying to do it in less than a year.

Senate President Pam Jochum, a Democrat from Dubuque, has an adult daughter with intellectual disabilities who gets health care coverage through Medicaid. Her daughter’s doctors haven’t signed contracts with the private managed care companies that soon will run the program, so she’s calling doctors in Wisconsin, Iowa City and Cedar Rapids who have.

“I spent an entire day on the phone and got no where,” Jochum said. “Had no idea by the end of all those conversations who to even sign my child up with.”

Jochum said she and other senators are hearing those kind of stories from hundreds of Iowans who are the caregiver for their child, their sibling or their parent who can’t negotiate the system themselves and they’re expressing “frustration, confusion, chaos,” according to Jochum.

Senator Jason Schultz, a Republican from Schleswig, said Democrats passed a budget plan last year that “claims the savings” from shifting Medicaid to private managed care companies.

“You voted for this,” Schultz said. “You own this also.”

Schultz accused Democrats of trying to play a game of “hot potato” with the governor.

“Perchance you’re not planning on this bill going all the way through,” Schultz said. “Maybe this is just for the cameras. Maybe this is just to tell the people back home that you’re fighting for them, even though you signed onto this plan yourself.”

Senator Amanda Ragan, a Democrat from Mason City, said it’s time to slow things down and develop an alternative plan to serve the Iowans who depend on Medicaid.

“(It’s) 560,000 Iowans. That’s a lot of people. It’s the city of Des Moines. It’s big,” she said. “I don’t go anywhere where I don’t have someone come up and talk to me about how this is going to impact someone.”

This senate bill will not be considered in the Republican-led House, however. House Speaker Linda Upmeyer, a Republican from Clear Lake, suggested it’s a waste of time to pass a bill that will be vetoed by Governor Branstad.

“But secondly, isn’t this a point in time that we should all be focused on moving forward?” Upmeyer said late this morning. “Shouldn’t those people who are unaware or who have difficulties within this plan — which has not gone forward yet…Shouldn’t we be helping that happen?”

Governor Branstad’s administration hopes to start switching Medicaid patients into privately managed care March 1, but must obtain a federal waiver to do so. Federal officials ordered a 60-day delay in December, along with a list of steps that had to be taken to address “chaos” associated with the switch.

Ernst bill cutting presidential perks passes senate panel

Senator Joni Ernst.

Senator Joni Ernst.

A senate committee has approved Senator Joni Ernst’s bill to dramatically cut the federal allowance for former presidents.

“This bipartisan effort reforms and updates the benefits provided to former presidents to try and reflect today’s post-presidential life,” Ernst says.

In 1958 congress passed a law that provided a pension to former presidents that was equal to what cabinet secretaries like the secretary of state received. In 1997 congress voted to provide 10 years of Secret Service protection once a president leaves office. The bill Ernst has proposed does not alter the security protection for former presidents and their families, but for everything else there would be a yearly $200,000 yearly allowance.

“By limiting how much taxpayers pick up the tab for presidential perks — things like communications, office space, staff and travel expenses, we are making sure taxpayer money is being spent wisely,” Ernst says.

Similar legislation has passed the House. Ernst says her bill shows lawmakers can act to cut government spending.

“Even though this is just a start — we have over $19 trillion of debt — we have to do it,” Ernst says.

There are four living former presidents. In 2015, former President George W. Bush was paid more than $1 million by the federal government for a pension and benefits. His father, the 41st president, took in almost $800,000. Former President Bill Clinton received over $900,000. Former President Jimmy Carter received $430,000.

Since Gerald Ford left the White House, former presidents have reaped huge sums for giving speeches, making personal appearances and serving on corporate boards. Book deals have been lucrative as well. George W. Bush got a $7 million advance for his 2010 book “Decision Points”. Bill Clinton received a $15 million advance for his book “My Life.”