A plan to dramatically change the way poor and disabled Iowans are covered by government-paid health insurance is being constructed, and Senate President Mary Kramer is the chief architect of the transformation of Medicaid. Kramer says the state will have to get federal permission, or waivers, to make the reforms as “this is virtually like starting over.” One reform would provide a yearly stipend to poor families for medical care, and they’d get a partial refund at year’s end if they don’t use it all. Kramer believes it’d be an incentive to control costs and encourage folks not to wait ’til things get really bad to seek medical help — when it’s most expensive.Another idea would impose restrictions on prescriptions for common maladies like arthritis and high blood pressure similar to a system that’s been operating in Oregon for a year.She says Oregon shows two million dollars in savings in some months by the change in prescribing.Over 230-thousand Iowans are on Medicaid today, at a cost to state taxpayers this year of just over half a billion dollars. Kramer, a republican from Clive, is a retired insurance company executive.
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