Advocacy from Your Couch

Iowa Can do better on Medicaid

Re-establish an efficient state-run system

The 20 Democrats and one Independent in the Iowa Senate have introduced a bill (SF 2058) to end privatized Medicaid. We want to put Iowans back in control of a state-run system that provides affordable health care to 600,000 citizens.

Since April 2016, when Medicaid was turned over to out-of-state companies, Iowans have complained about the obstacles they face getting care and services.

Hospitals, nursing homes and other health care providers – especially in Iowa’s small towns and rural areas – agree that the privatized system is not working. They aren’t being properly reimbursed for the care they provide. They face red tape and bureaucratic nightmares. Many are in financial jeopardy, and some have even been forced to close their doors.

Things continue to get worse. Yet the state keeps giving private, out-of-state companies more of your tax dollars to run Medicaid. In fact, Governor Reynolds just agreed to give them another $130 million.

This is not how health care should work for Iowans who are gravely ill or live with a disability. Even the Reynolds Administration now admits privatized Medicaid has many shortcomings, but refuses to return to a system that once worked so well for Iowa.

Our families are all just one tragic mishap away from being entangled in Iowa’s Medicaid mess. That’s what happened to Michelle Meadors when an auto accident on her way home from work left her paralyzed. She is now one of many Iowans fighting for decent health care for all of us. During a recent visit to the Statehouse, she shared her story with Senator Kevin Kinney of Oxford and Senator Rich Taylor of Mount Pleasant. Here’s a video of her testimony at a legislative meeting in 2016: http://bit.ly/Michelle-Meadors. Many of the concerns Michelle raised then are still problems today.

Ensure our most vulnerable get the care they need

To help Iowans with especially complex health care needs, Senators Amanda Ragan and Liz Mathis have co-sponsored a second Medicaid bill.

SF 2013 would return Medicaid patients with complex health care needs to the state-run system that worked well for them prior to Medicaid privatization. These folks could be your next door neighbor who is a quadriplegic, a student in a special classroom for severe developmental disabilities, or a senior with a serious illness that cannot be addressed through typical health care.

In 2016, all Medicaid patients were thrown into the new system with only a few months to plan. Not a wise move. Iowans have died because of cuts to services under managed care. 

Many other states have “layered-in” citizens with more complex needs over time. With SF2013, Iowa could work to get managed care right for the larger population.  

Let’s listen to Iowans

Between SF2013 and SF2058, we are answering the concerns of 600,000 Medicaid patients, as well as thousands of Iowa health care providers, advocates and families. 

We can and should redesign Medicaid our own way—the Iowa way. We have many experts across the state with innovative ideas for delivering great service AND saving money.

Governor Reynolds could end the chaos created by the Administration’s unilateral decision to privatize Medicaid by working with us on these solutions.

Senate Democratic Leader Janet Petersen meets with parents advocating for their adult children with disabilities. They rely on Medicaid assistance for many aspects of their daily living. The privatized Medicaid system has failed them. They, like thousands of other Iowans, believe our citizens would be better served under an Iowa-run system that doesn’t give out-of-state companies the chance to earn a profit by cutting care and providers’ payments.

Why Iowa needs to pass Copay Choice in Legislation

  • The average deductible for employer based plans in Iowa increased 188% for individuals and 185% for families since 2004.
  • Payments for cost-sharing have risen exponentially across the U.S. since 2004 and have rapidly outpaced wages.
  • Use of drug (Rx) deductibles across the U.S. increased 100% between 2012 and 2015 (23% to 46%) in commercial health plans.
  • The average annual deductible for health exchange individual policies in 2017 across the country was $4,328.
  • Nationally, 1 in 5 prescriptions is abandoned while a patient is still paying a deductible. Non-adherence to medication regimens adds an additional $100 billion in costs to the US healthcare system. Indirect costs exceed $1.5 billion annually in lost patient earnings and $50 billion in lost productivity.

Co-Insurance vs. Co-Pay: What’s The Difference?

Rather than paying a fixed and predictable co-pay, insurers are requiring more enrollees to pay a percentage of their medicine’s list price -- this is co-insurance. Co-insurance tends to shift cost to the sickest patients, and it prevents patients from knowing how much their medicines will cost until they arrive at the pharmacy.

Did you know?

Co-insurance is unaffordable for most Americans, as the monthly cost of cutting edge biologic drugs necessary to treat many serious and chronic illnesses can be in the tens of thousands of dollars.

Nationally, use of co-pays for drugs dropped nearly 60 percent between 2004 and 2014 among commercial insurance plans.

Although most people taking prescription medication say they can afford their treatment, about 1 in 4 have a difficult time affording it.

THE SOLUTION

What will the Co-Pay Choice Legislation do?

  • 25% of individual or group plans within state regulated insurance carriers, will offer pre-deductible, flat dollar co-payment structure.
  • If a carrier only provides one plan in a given insurance level, that plan shall comply with the requirements of the 25% individual and group plans.
  • Flat-dollar co-payment includes all specialty tier medication.
  • Co-payment must be reasonably graduated and proportionate to drug formulary tier levels.
  • High deductible or catastrophic plans are exempt from these requirements.

What does the bill do?

  • Expands insurance options.
  • Gives patients insurance options without high-upfront prescription costs.
  • Gives patients insurance options with predictable co-pays.
  • Mirrors successful policies from other states (CO, MT).

What doesn’t the bill do?

  • Create a mandate.
  • Require insurers to raise premiums.
  • Prevent insurers from using deductible or co-insurance.
  • Require caps or limits.
  • Prevent insurers from offering HDHPs.

What the Government Shutdown has to do with the BD Community

Healthcare

Though Medicare or Medicaid will continue to operate, the biggest concern is how the shutdown might affect the Children’s Health Insurance Program (CHIP), which provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid.

Funding for the program ran out in October, and though Congress provided $2.85 billion in December, that money is running out, says Don Taylor, a professor at Duke University’s Sanford School of Public Policy. The government shutdown now makes it unlikely that states would be able to get their share of any funding, according to the Centers for Medicare & Medicaid Services.

There are currently two live bills that relate to non-medical switching at the Iowa Legislature

These bills are about non-medical switching which will discuss "coverage exemption determination" and other topics that will affect the community.

Hemophilia of Iowa Advocacy from Your Couch Member Spotlight! 

mark and family 2017 legislative day

Mark Castenson and family attended Hemophilia of Iowa's Legislative Day in 2017. They had the chance to meet with State Representative Art Staed.

"The Castensons spoke to me about HF233/SSB 1072. This is a bill aimed at revising “fail first” protocols among Iowa’s health plans. “Fail first” protocols control the order and use of prescription drugs that a patient may use. Often, patients must try, and then fail on lower-cost or older drugs selected by their health plan before coverage is granted for the drug prescribed by the patient’s health care provider."

"HOI would like to ensure that appropriate medicine - not just cost - dictates patient treatment. This will not prevent insurers from requiring generic version equivalents when they are available, but it will require that the “fail first” exceptions process be transparent and accessible to patients and health care providers."

Thank you to the Castenson's for bringing this to the states attention!

How to maintain protection for current plans

Stay up to date and make action!

How to contact your representatives

Use these sample letters for you to reach out to your representative! 

Sample letter one
Sample Letter two
 

What's happening

Medicaid 

Medicaid is currently one of the few providers available for individuals with bleeding disorders. Medicaid is a medical assistance program administered by the state and funded through a state-federal partnership.

Step Therapy

Step therapy is a coverage restriction placed on drug coverage by private health plans and Medicare private drug plans 

How you can help

Call and write your representatives today! 

A simple phone call, letter or email goes a long ways. Stand up for your community today!

Why it matters

It has been extremely difficult to find coverage for the bleeding disorder community. The current live bills can play a huge role in non-medical switching and if your family remains covered or not. Keep up to date and make an impact today!