November 24, 2015

Iowan named U.S. director of Asian Development Bank

Swati Dandekar

Swati Dandekar

President Obama has nominated a woman from Iowa to be a director of an international development bank located in the Philippines.

The Asian Development Bank was formed in the 1960s and modeled after the World Bank, to finance development in the Pacific Rim. President Obama has nominated Swati Dandekar of Marion to serve as the bank’s U.S. director.

Dandekar, who is 64 years old, is a native of India who has lived in the U.S. since 1973. Dandekar represented the Cedar Rapids area in the Iowa House and Senate for nine years. She resigned her senate seat in 2011 when Republican Governor Terry Branstad named her to the Iowa Utilities Board.

Dandekar left her job as a state utility regulator in 2013 to run for congress. She finished third in a five-person Democrat primary in 2014 and she had considered running again for congress in 2016.

Dandekar’s nomination must be confirmed by the U.S. Senate. Senator Chuck Grassley issued a written statement, saying the president had made a “good decision” in selecting Dandekar for the Asian Development Bank.

Three Democrats in DC to raise concerns about Branstad’s Medicaid plan

Three Democrats from the Iowa Senate are in Washington, D.C. to raise “issues and concerns” about Governor Branstad’s plan to shift 560,000 Iowa Medicaid patients into managed care plans. Iowa Senate President Pam Jochum of Dubuque says she left meeting with five agency decision-makers “feeling somewhat positive” the federal government may put the brakes on Branstad’s plan.

“They have truly great concerns right now about whether or not Iowa is truly ready to do this January 1,” Jochum says.

Senator Amanda Ragan of Mason City says she went to D.C. to make the case that it is “very unrealistic” to make this shift so quickly.

“The system really isn’t ready for this at all,” Ragan says.

Republican Governor Terry Branstad says 26 other states have moved Medicaid patients into managed care plans. But the three Democrats say only four other states have shifted all Medicaid patients into managed care plans, while the rest of the state use managed care for small groups of Medicaid patients, like those being treated for mental illness.

Senator Liz Mathis of Cedar Rapids says federal agencies are finding “inconsistencies” with what Branstad Administration officials are telling them about the plan compared to what health care providers and Medicaid patients in Iowa are saying.

“No one should be left without care. Everyone should know who they need to go to for care. They should have basic access to care,” Mathis says. “…They are most concerned about that as well.”

Federal officials plan a “site visit” in Iowa next month to talk with Iowa Medicaid patients as well as Iowa health care providers about managed care.

Branstad met with the head of the U.S. Department of Health and Human Services last week about the proposed Iowa Medicaid changes and he called it a productive meeting. The three Democrats from the Iowa Senate who are in Washington, D.C. today say they can “only be hopeful” that federal officials will reject Branstad’s bid for a federal waiver, so he can implement the managed care plan on January 1.

Iowa hospitals to Branstad: ‘Put the brakes’ on managed care for Medicaid patients

Iowa-Hospital-AssocA spokesman for the state’s 118 hospitals says there’s too much uncertainty about the Branstad Administration’s push to switch more than half a million Medicaid patients in Iowa to a managed care plan on January 1, 2016. The Iowa Hospital Association has filed a lawsuit, asking a judge to intervene.

“Put the brakes on this,” says Scott McIntyre, the vice president of communications for the Iowa Hospital Association. “Allow people time to talk things out, make things work and implement a plan that works for everybody.”

According to McIntyre, the Branstad Administration still hasn’t provided hospitals with the “rate card” hospitals must use in discussions with the four private companies that will manage care for Medicaid patients.

“Hospitals really don’t have that starting point from which to negotiate a contract or from which to make financial plans,” McIntyre says.

State officials have given hospitals and other Iowa health care providers a January 1 deadline to sign contracts with the managed care companies. On Monday, Branstad confirmed his administration will enforce a 10 percent penalty in Medicaid reimbursement to Iowa health care providers that fail to sign managed care deals by January 1st. McIntyre says lawyers tell him the state doesn’t have the authority to impose that 10 percent penalty.

“We don’t even know the base rates at this point, so we are talking about 10 percent of what?” McIntyre says. “It’s kind of another example of putting the cart before the horse and not being clear on what the state’s plans are.”

After initially opposing the idea, Branstad in 2013 did approve expanding the number of poor Iowans who qualified for Medicaid. That has led to a reduction in so-called “charity care” in Iowa hospitals, but McIntyre says hospital executives fear those gains may be lost in the switch to “managed care” for Medicaid patients.

“Our concern, one of many, regarding this plan is that these companies will deny care. Folks will go to the emergency room anyway, which won’t be covered even if they do have insurance, and once again our charity care costs will go up and those costs impact everybody,” McIntyre says. “The hospitals really don’t have a choice but to pass along that impact.”

On Monday Branstad accused Iowa hospitals of “objecting” to the Iowa Health and Wellness Plan. That’s the state’s version of expanding Medicaid coverage to more Iowans, a move that was authorized under the Affordable Care Act. Critics point out Branstad initially opposed expanding Medicaid coverage to more Iowans and McIntyre says hospitals actually championed the bipartisan Health and Wellness Plan.

“Because of the changes, the tweaks the governor wanted included in that, we went to bat for the state with the federal government and made sure those waivers happened,” McIntyre says, “so certainly it was a collaborative effort.”

Governor Branstad says 25 other states have shifted Medicaid patients into managed care and have saved money in the process.

(This post was updated at 12:30 p.m. after the Iowa Hospital Association notified Radio Iowa it had filed the lawsuit.)

Branstad rejects complaints about managed care for Medicaid

Gov. Terry Branstad

Gov. Terry Branstad

Governor Terry Branstad is blasting Iowa health care providers who’re complaining his administration is moving too quickly to shift management of Medicaid to private companies.

“We started working on this in January, so we’re looking at almost a whole year,” Branstad told reporters this morning. “I know there are people that want to protect their funding stream and are afraid of change, but the truth is this has proven to be effective in other states.”

Branstad said taking the management of Medicaid patient cases away from government workers and shifting it to employees at private companies is saving money in other states and “improving patient outcomes.” Some health care providers are complaining they only recently got notice of the proposed rates for care of Medicaid patients in Iowa. Democrats in the legislature are calling for a delay in a key deadline. Health care providers must agree to the new rates by January 1st — or face a 10 percent reduction in payments from the state for care provided to Medicaid patients in the future.

The governor said this latest round of criticism reminds him of what was said about his Medicaid expansion plan in 2013.

“The providers were up in arms. ‘It was terrible. We’re afraid of this.’ And you know what? Today we have more people insured than we’ve ever had insured,” Branstad said. “The providers are making more money than they ever had. Charity care at hospitals has gone down significantly, so the hospitals that strongly objected to that have really seen that it worked effectively.”

Three Democrats serving in the state senate say the people who “actually do the work” of caring for the more than half a million Medicaid patients in Iowa have asked for help to slow down the governor’s fast track toward managed care.

Branstad made his comments toward the end of his weekly news conference. Find the audio at the bottom of this story.

Two lawmakers seek to expose ‘hidden crime’ of human trafficking

Kraig Paulsen (L) and Kevin Kinney.

Kraig Paulsen (L) and Kevin Kinney.

A deputy sheriff who’s a state senator and the out-going speaker of the Iowa House are teaming up to find ways to make Iowa’s laws on human trafficking tougher. House Speaker Kraig Paulsen of Hiawatha said unfortunately too few Iowans know it’s a problem.

“Probably to most Iowans, this is a hidden crime,” Paulsen said today, “and it needs to not be because it’s obviously having a significant impact.”

Paulsen said it may be time to designate an office in state government to compile the data to show how prevalent the problem is. Senator Kevin Kinney set up a sting in a small town that rescued three young women when he was an investigator in the Johnson County Sheriff’s office.

“In 2005 when I had the first human trafficking case in the state of Iowa, I couldn’t anybody to listen to me. I think it’s wonderful that we have a roomful of people here today that at least get what’s going on,” Kinney said today. “We just have to expand this and train other law enforcement.” K

inney and Paulsen hosted a panel discussion on the issue today at the statehouse. Captain Curt Henderson of the Iowa Highway Patrol is involved in training troopers and others to recognize the signs of human trafficking.

“These are kids from our own communities and you hear their testimony and you look at their faces and you recognize this is a big problem,” Henderson said during the hearing. “And I’ll be the first to admit that law enforcement hasn’t been on board.”

Henderson said it’s important to not only go after the person trafficking young women and girls for sex, but to properly penalize the person who’s paying for it.

“This isn’t just a law enforcement problem. It really is a society problem,” Henderson said. “However, I have come to believe that law enforcement must take the lead in moving forward in our state on this issue.”

Iowa State University sociology professor Teresa Downing-Matibag is a volunteer with the Network Against Human Trafficking. She recommended a law that would force those arrested for paying for sex to notify their spouse or partner, so they can be tested for sexually transmitted diseases.

“I believe that we are at a tipping point in Iowa and our nation,” Downing-Matibag said, “wherein if we do not address this crime there will be no turning back.”

She said Islamic terrorists have been using prostitution to finance their operations in the Middle East and highly-organized crime syndicates are established in other countries where parents sell their own children into the sex trade. Iowa Public Safety Commissioner Roxanne Ryan said it’s important for state officials to ensure victims of human trafficking can be protected once they’re rescued.

“What we’re finding is that when we do training for everybody in the system, law enforcement and others, that there are signs that are pretty obvious that human trafficking is going on, but if you’re not familiar with what the signs are, you may not recognize it as a human trafficking case,” Ryan said.

Ryan is using the already existing Law Enforcement Intelligence Network to collect information about human trafficking. Some advocates recommend law changes to make it easier to prosecute those who use on-line forums to offer and solicit sex. Experts say $150 billion will be spent this year in the international sex trade.

Medicaid privatization subject of day-long statehouse hearing

A statehouse committee spent much of Tuesday hearing about what’s being called a massive change in how health care in Iowa is delivered to the poor and disabled.

On January 1, four private companies are scheduled to take over management of the state-federal health care program known as Medicaid which serves more than 565,000 Iowans. Iowa Medicaid director Mikki Steir is hearing not only from Medicaid patients, but from doctors, hospitals, clinics and mental health care providers who are trying to figure out the new system.

“We’re answering as many questions, no matter where they’re coming from, as quickly as we can,” Steir told legislators.

Under the current program rules, hospitals, doctors and other providers are paid for the services provided. Starting January 1, the state will pay a per-patient fee and some health care providers say they don’t yet know what that fee will be. Democrats on the committee tried to force a delay until July, but Republicans backed Republican Governor Terry Branstad’s plan to move ahead with the plan. Republican Representative Dave Heaton of Mount Pleasant accused Democrats of grandstanding.

“I think there’s politics in these positions through and through,” Heaton said.

Senator Joe Bolkcom, a Democrat from Iowa City, said this same committee will meet again to review progress on the policy shift.

“We going to continue to have a conversation about whether we’re ready or not and we’ll evaluate it then on whether we’re going to take another run at a delay,” Bolkcom said.

And Bolkcom said there’s also a lawsuit that could derail the plan. Companies that lost out in the bidding process are challenging how the state chose the four winning companies.

(Reporting by Iowa Public Radio’s Joyce Russell)

State tax collections down 2.9 percent in October

State tax revenues continue to lag. The state collected nearly three percent less in overall taxes in October compared to the same month a year ago.

“General fund revenues were a little bit disappointing in October and that’s kind of been a trend lately,” says Jeff Robinson, an analyst for the Legislative Services Agency.

Individual income tax payments to the state were up five percent last month, but corporate income tax refunds were pretty large.

“That provided quite a drag on revenue,” Robinson says.

Sales and use taxes account for a big chunk of tax collections, but sales and use tax payments to the state were down 1.3 percent in October.

“Sales and use tax has been weak for a number of months now,” Robinson says. “…That is a disappointment, particularly given the price of gasoline.”

According to the AAA, gasoline prices in Iowa are about 70 cents per gallon cheaper today than they were a year ago. Robinson says Iowans don’t appear to be spending the money they may be saving on energy costs, however. Experts had predicted overall state tax revenue would be growing at a four percent clip, but there’s been just a slim, 0.1 percent increase since July 1.

“The trend for the first four months of this cash fiscal year has not been positive other than personal income tax and, unfortunately, what we’re finding so far is that personal income tax can’t hold the revenue stream together if all the rest of them are declining,” Robinson says, “so hopefully what comes in the future months is that what is happening in personal income tax are just transient things that disappear.”

A three-member panel of financial experts will meet in December to review the data and set an official estimate of state tax collections. That estimate must be used by the governor and lawmakers as they draft next year’s state budget.