Iowans should consider sending thank-you notes to U.S. Sen. Robert Casey. The Pennsylvania Democrat is doing what Iowa's senators have failed to do: Request a federal investigation into privatized Medicaid health insurance.
Former Gov. Terry Branstad turned over Iowa's program to for-profit companies three years ago. Despite life-threatening and costly problems, Gov. Kim Reynolds has refused to return control to the state.
Now a senator who doesn't directly represent Iowans is getting involved. Casey requested an investigation by the U.S. Department of Health and Human Services (HHS). He cited media reports about for-profit insurers refusing to cover health care for vulnerable people and referenced a Des Moines Register investigation about care denials and endless appeals.
"Due to concerns that some MCOs are putting their bottom line ahead of patient health and safety, I am requesting that you open an investigation into this industry to shed light on whether all patients enrolled in Medicaid managed care can successfully access the services to which they are entitled," wrote Casey.
Among the specific questions he wants the investigation to address: Have private insurers knowingly denied care that should have been covered? Are children, people with disabilities, older adults and others facing hurdles? What type of data should the federal government require states to collect to ensure patients are not inappropriately denied care?
The HHS Office of Inspector General agreed to conduct an investigation, and findings are expected in 2020. The federal agency, which largely funds Medicaid for more than 70 million Americans, certainly should be interested in this issue.
So are Iowans.
Also noteworthy is Casey's mention of a subsidiary of the health insurer Centene, which Iowa recently contracted with after the abrupt departure of another Medicaid insurer.
Centene denied round-the-clock nursing care to a child who needed a tracheotomy tube to help him breathe. The toddler needed continual supervision to prevent him from removing the tube. After the insurer refused to pay, the boy pulled it out, was deprived of oxygen and was left with limited brain function.
Let's hope such reprehensible care denials are not on the horizon for Iowa children.
Casey's request for an investigation raises an obvious question: Why didn't Iowa's members of Congress make it?
Sen. Chuck Grassley regularly expresses interest in potential Medicaid misspending and he hasn't been shy about investigating misuses of public money.
He must know hundreds of millions of Iowa's Medicaid dollars are being funneled to for-profit companies for "administration" instead of paying for Iowans' health care.
He must have heard at least some of the many complaints from Iowa patients, doctors, and hospitals.
His staff, which closely follows news in Iowa, must know per-patient costs have tripled under privatization.
A Register editorial writer asked Grassley's office for a comment from the senator.
"It's always worthwhile to conduct an independent review to make sure taxpayer dollars are being well-spent and government programs are achieving their intended effect," said Grassley. He expressed support for Reynolds and hopes a review can help inform policymakers on ways to improve Medicaid "even further."
There is no evidence Medicaid has been improved at all by privatization. Just the opposite.
It will, however, be interesting to see what, if anything, Grassley has to say if the inspector general finds problems. For three years, he has largely ignored the hurtful impact of privatization in Iowa.
Fortunately, a senator from Pennsylvania didn't.