When we visit a doctor, or other healthcare provider, most of us assume that after we pay our deductible and co-pay, our insurance will pay the rest.  Wrong!  Not only do we not know what the insurance company will pay our doctors, neither do the providers.   Sound crazy….it is.  Insurance companies present themselves as guardians of our health care dollars.  Wrong again! Their role can better be described as middleman between provider and patient which obscures their part in the high cost of healthcare, as well as in the disparity of access to medical care, which makes it easy to point a finger at doctors and other healthcare providers. Healthcare reimbursement in the United States is mind-numbingly complex.  There are private for-profit insurers, private not-for-profit insurers, state and federal fee-for-service payers, and true middlemen called Managed Care Organizations (MCOs) that manage Medicaid reimbursement for some states.  MCOs make decisions about how much medical care, if any, a person may receive, how much providers should be reimbursed, and if payment for services should be delayed or denied, without ever seeing a patient.  And, since their earnings are based on reducing medical expenditures for their employer (the state) they focus on the bottom line, as do for-profit insurance companies. 

Kudos to Sens. Liz Mathis of Hiawatha and Amanda Ragan of Mason City for introducing Senate File 156. This bill is meant to mitigate some of the most egregious problems created by the Republican-led privatization of Iowa’s $6 billion Medicaid program. The Senators, like so many Iowans, understand privatization has been a horrendous failure. Iowa’s 600,000 poor and/or disabled citizens can no longer assume they will receive medical care when it is needed. As recently as May 8, 2019 the Des Moines Register published an article by Tony Leys, titled: “Medicaid director meets with Iowans worried about United Healthcare’s exit. ‘You can’t calm our fears,’ one Iowan says.” With the loss of United Health Care of River Valley, House Democrats attached amendments to end Medicaid privatization to every bill eligible for debate on the final Monday and Tuesday of this year’s legislative session. Although it was a given that no amendments passed, nor were bills debated on Tuesday, we need to push for corrective legislation. The Daily Iowan, Emily Wangen, Politics Reporter April 4, 2019