Dr. Traci Acklin, a pediatrician in Montgomery, W.V., peers into Connor Prather's ear. The one-year-old boy, who has Medicaid coverage, has had persistent ear infections, which will require surgery. (Noam N. Levey/Los Angeles Times/TNS)

Prall: Medicaid is privatized and problematic


Iowa’s privatized Medicaid is supposed to save the state cash — but at what cost?

By Jacob Prall


In 2015, Iowa Gov. Terry Branstad pushed through legislation that privatized Iowa’s Medicaid system. Proponents lauded the move for its promised cost-saving potential, but many critics warned about the potential flip side to cost-cutting measures. The free market has proven unsuitable for health-care distribution, especially for the economically disadvantaged. Two years later, many of the fears held by me and other critics of privatized Medicaid have become a reality.

Last week, The Des Moines Register released a special investigative report into the private managed-care companies handling Iowa’s Medicaid. The reports are disturbing. Take Ann Carrigan, a 70-year-old from Spencer, Iowa, who suffers from advanced cerebral palsy and a brain injury. She is in need of a specialized wheelchair to prevent muscular atrophy that would cause her to suffocate. Medical officials, an administrative judge, and even the Iowa Department of Human Services director all agreed she needs this wheelchair. Despite the unanimity, UnitedHealthcare, one of the three private managed-health-care companies in Iowa, refuses to pay for the wheelchair. Instead, it is taking her to district court.

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Carrigan’s case is not an anomaly. There are more than 200 cases being appealed by UnitedHealthcare in Iowa’s district courts. Each appeal represents a case of the company seeking to deprive a patient of health-care needs. Not only are sick, poor and elderly patients being denied treatment, they’re being forced through a nearly endless legal process. The failures by UnitedHealthcare continue — the Register found UnitedHealthcare engages in due-process violations, routinely denies in-home care, and creates endless appeals to sap the will and financial resources of Medicaid recipients. This is the problem with entrusting a social service such as Medicaid to a private entity. The goal of Medicaid should be to provide health care to disadvantaged communities, not to turn a profit.

There seems to be no solution in sight. There is a need for the three managed-care providers in Iowa to improve their appeals process, but the incentives are not there. Each group is competing to win cost-cutting awards at the expense of quality care for the 600,000 Iowans on Medicaid. More public oversight of the private companies is necessary to ensure Iowans receive the care they need and deserve.

Originally, officials estimated that 174 public servants would be required to investigate Medicaid claims and oversee the private companies. To date, there are four. The priorities of Iowa’s GOP, responsible for the privatization of Medicaid, are all wrong. We should fight for lower health-care costs, but not through denied or subpar service.

Across the globe, countries have balanced health-care costs with providing superior health care. The U.S. will not be able to control costs through denying health care to those who need it. Our country must address systemic problems in medical expenditures, medication costs, and excessive moral hazard.

RELATED: Guest opinion: ACA needs work, but privatized Medicaid is not the fix

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