Update, 1/9/20: Although he campaigned heavily on the failures of Medicaid’s privatization, Democrat Fred Hubbell, of course, did not ultimately defeat Gov. Kim Reynolds in November 2018. But one Democrat did manage to defeat an incumbent Republican holding a statewide office: now-State Auditor Rob Sand, who on Thursday held a press conference about the results of a promised audit of Iowa’s Medicaid program. The quality of its in-home health services, Sand said, was impossible to measure because of the inadequacy of the data that the private companies now in charge of the program submitted to the state. “If we can’t assess the quality of care because the data are not reliable, that certainly calls into question the quality of that care,” he said.

The problem should be a familiar one to Reynolds, who hired the former director of Kansas’ broken Medicaid program to oversee Iowa’s. As the Iowa Capital Dispatch‘s Clark Kauffman reported today, “After a year of investigations, auditors working for the Kansas legislature issued a report in 2018 that said data maintained on KanCare, the state’s privatized Medicaid system, was so unreliable it ‘prevented us from evaluating KanCare’s effect on beneficiaries’ health outcomes.'”

At the Thursday press conference, Sand reportedly warned that his office was “probably more patient in this audit than we will be in future audits.”

Original post: From the start, when then-Gov. Terry Branstad revealed his plan in 2015 to privatize the state’s Medicaid program, it should have been clear that the shift would be disastrous for many of the roughly 600,000 poor and disabled Iowans enrolled in it. Now, it could prove disastrous for his successor Kim Reynolds’ electoral chances as well, with Democratic rival Fred Hubbell vowing to return the program to the state’s hands as a key campaign plank and a poll out last month showing that just 28 percent of Iowans want to keep it privatized.

He can’t say he wasn’t warned: Advocates for the disabled immediately cried foul, demanding strong oversight through the transition and pointing to Kansas, where vulnerable residents soon saw services cut and care denied after Gov. Sam Brownback enacted his privatized KanCare in 2013, as a cautionary tale. A poll showed that Iowans were overwhelmingly opposed to it then, too. Hospitals protested that the Jan. 1 implementation date was too rushed and the feds agreed after receiving hundreds of complaints from residents who said they had been kept in the dark about their options under the new for-profit providers, forcing the state to push the transition back to April 2016.

Ignoring one red flag after another, Branstad — and now Reynolds — continued to push ahead, assuring Iowans all the while that the transition was necessary for Medicaid’s long-term sustainability and would result in better care despite the occasional hiccup. Rather than taking KanCare as a warning sign, they learned from the lessons of Brownback’s secrecy and spin in the face of ever-mounting evidence that privatized care was contrary to the well-being of those who needed it most.

In fact, two of the four companies selected to take over the program were already notorious in Kansas for systematically and arbitrarily denying claims. In 2017, as evidence of privatization’s shortcomings was becoming increasingly clear, Iowa tapped the Sunflower State’s former Medicaid director, Mike Randol, to take over after he jumped ship on KanCare. In February, the Iowa Department of Human Services introduced legislation that would have reduced Medicaid’s already lax oversight even further by eliminating statistical reporting requirements. Three months later, independent auditors in Kansas concluded that the state’s record-keeping on KanCare was so poor that it was impossible to determine whether the program was working.

When Reynolds took over as Iowa governor in May 2017, she had a chance to distinguish herself from her former mentor by acknowledging the many failings of privatized Medicaid and reversing course. Instead, she dug in her heels. The decision could be the determining factor in costing her the opportunity to govern for a full term.

But the true victims of her decision are the tens of thousands of at-risk Iowans whose Medicaid services have been slashed. The hundreds who have been denied medical equipment their doctors say they need. Countless others forced from their homes into care facilities. People like Todd Mouw, a quadriplegic who died three months after the coverage he’d relied on for 20 years was suddenly denied.

Here’s a look at how it’s all unfolded.

Featured image: Phil Roeder/Flickr (photoillustration by the Iowa Informer). Timeline created using Northwestern University’s Knight Lab TimelineJS tool.

Gavin Aronsen
Gavin Aronsen is an editor and reporter for and founding member of the Iowa Informer. He previously worked as a city reporter for the Ames Tribune, research assistant to investigative journalist Wayne Barrett at the Village Voice, and in various roles at Mother Jones, where his work contributed to a National Magazine Award nomination for the magazine's digital media coverage of the Occupy Wall Street movement. Email: garonsen [at] iowainformer [dot] com.