Rod Sullivan is a Johnson County supervisor.
I searched the word “Medicaid” in my archive. I was shocked to find how much I have written on the topic—tens of thousands of words over the years.
Why have I written so much about Medicaid? For one, you write what you know. I used to work in the Iowa Medicaid program. Even though that was several years ago, I know Medicaid quite well. That is why the Republican scheme to cut the program upsets me so much.
The bigger reason is that people who use Medicaid are the very reason I ran for office in the first place. It was literally what made me choose this career. I wanted to—and still want to—help the poorest among us.
Before I go any further, let’s give a quick primer on Medicaid. Medicaid (often referred to as Title 19) is the federal program that provides government health insurance to our poorest residents. Medicaid was passed in 1965 as an addition to the Social Security Act, a key component in President Lyndon Johnson’s “War on Poverty.”
Medicaid is about to celebrate its 60th birthday. Medicaid and Medicare were among the greatest achievements in the history of our great nation. Health care for the poor… we have been called to provide this since before Jesus walked the earth. The U.S. finally got around to it in 1965.
While the vast majority of the funding for Medicaid is federal, each state pays a portion based upon the relative wealth of that state. Connecticut pays the most, Mississippi the least. Iowa is in the middle when it comes to relative wealth; in fact, our state match just went up because of the recent good years enjoyed by the agriculture industry. Iowa pays a 37 percent match for regular Medicaid, and a 10 percent match on the Medicaid expansion that began in 2013 under President Barack Obama.
Over time, states have argued for and received greater flexibility in designing state Medicaid programs. This is where the managed care concept began, and how it is spreading to states with Republican governors. Unfortunately, most of these state “experiments” with Medicaid do not improve outcomes. In fairness, over the years, Medicaid has become a bigger and bigger piece of each state’s budget.
While many conservatives will try to tell you Medicaid has “not worked,” the reality is a very different story. In fact, 80 million Americans received some type of Medicaid service last year, almost 1 in 4. These services were provided at an average cost lower than private insurance, and at an average administrative cost much lower than private insurance.
It is important to understand who is on Medicaid. The program serves the most vulnerable members of our society. First, you must be incredibly poor. Then you need to fit a second category of need. For example, most Medicaid recipients are children. The next biggest group is people living in nursing homes. The third largest group is people with significant disabilities. These are people whose health can easily be negatively affected.
Iowa’s state government has steadily made Medicaid worse for Iowans, especially the foray into “managed care” that Governor Terry Branstad began and Governor Kim Reynolds has continued. Managed care companies rarely root out waste or fraud. They take an easier route: they simply cap services, and let the rest of the health care system sort it out. The managed care companies make their millions, and patients and providers fight over what is left.
In my opinion, managed care is nothing more than a transfer of public tax dollars to private companies who are guaranteed to hurt the poor. Instead of encouraging these practices, states should make it illegal for private companies to manage care by Medicaid recipients. But that is not the environment in which we live.
Has managed care improved things? No, it has not—unless you own one of the firms that has sucked millions of our tax dollars from our poorest residents. If you own one of those, you did fine.
This “experiment” is not working, just as experts warned. The Republicans in the Iowa legislature not only put money ahead of people – they do that several times every day. But this time, they chose to pick on the weakest, poorest, least able to fight back. It is simply deplorable.
Medicaid really, truly serves our most vulnerable citizens. Without this help, these people die. That is not made up. It is real.
President Donald Trump and Republicans in Congress have voted to give millions of our tax dollars away in tax cuts for the wealthy while poor Iowans get sicker and die. You may call that hyperbole, but I disagree. The fact is, when Medicaid is cut, poor people get sicker and die more quickly. It is proven. Any ignorance here is willful ignorance. They voted to hurt poor people. Period. What they voted for was evil.
Evil is a strong word. But what word would you use to describe someone who took away nursing home care from a sick elderly woman? What word would you use to describe someone who kept a sick baby from getting tubes in her ears? What word would you use to describe someone who left a poor man with an IQ of 40 on the street to eat from the trashcans? If you knowingly voted to make this happen? I call it evil.
Republicans may not get their just desserts electorally. They may go on to win many more elections. But I am convinced that someday they will be judged harshly. And I imagine it will be harsher than anything handed down by voters.