With the release of the FY 2011 Health and Human Services appropriations bill this week, Iowans are finally seeing the ugly picture forced by a $172 million cut in state spending forced by legislative Democrats. While the press will focus on the pain being felt this year, they will be missing the real problem with this budget – what happens to Medicaid next year.

Since taking over control of the Legislature in 2007, legislative Democrats have had an interesting relationship with Medicaid. For many years while in the minority, Democrats attempted to portray themselves as the defenders of the program. But once they took control, the way they approached Medicaid changed. In four years, the waiting lists for the HCBS waiver programs – which keep people in their homes and out of nursing facilities – has yet to be cleared.

And while overall state spending grew by 19 percent, Governor Culver and legislative Democrats were only able to find money to give Medicaid providers a one percent increase in reimbursement rates. Instead of properly funding the program, Medicaid has been transformed into a easily accessed bank account to fund other programs and new ideas.

As Medicaid has grown, the use of General Fund resources to pay for it has dropped.

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Health care reform solutions need not come from Washington, DC. In fact, the best reforms are often those developed closest to the people. Iowans do not need to wait for national politicians to act. Instead, they can join with Iowa Republicans in pursuit of a set of common sense Iowa Health Care Initiatives and solve Iowa problems with Iowa solutions.

Here is what Republicans will do if Iowa voters give us the opportunity.

Paitent’s Right to Know Act
Iowa Republicans propose legislation to establish a statewide information hub that brings together both cost and outcome quality data in a searchable format for online consumers. Cost and quality transparency will empower consumers to make better health care decisions in a way that maximizes quality while minimizing cost.

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On Thursday, the House and Senate Commerce Committees will hold a rare joint meeting to discuss one of the bigger issues facing Iowans today – health insurance premiums. It was learned last week that 80,000 Iowans were receiving double-digit premium hikes for their state regulated insurance plans. Legislators will have the chance to ask Wellmark why this is happening and what can be done to lower the cost of health insurance for Iowans.

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After a number of closed-door meetings, Iowa Democrats came forward Tuesday to introduce a new health care proposal. Elected officials hailed ideas having the government become a player in the insurance business and implementing direct competition with Main Street insurance agents. And to top it off, a promise to spend hundreds of millions of dollars on subsidies for insurance coverage. Iowans may be surprised to learn that this ceremony did not happen in the Rose Garden of the White House. It occurred within in the Iowa State Capitol.

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• The Senate clock has started:  link
• The Senate rules will make sure the debate is much more in-depth, to the chagrin of those on the left:  link
• Former President Clinton can’t stay away from the debate:  link
• No bill has passed, and states are already looking to opt out:  link
• Apparently there are still some hard feelings in the House, after Saturday.  And that’s just amongst Democrats:  link and link
• St. Petersburg Times’ fact checks some of the claims by pro-choice representatives about the Stupak amendment:  link

• Now that the Pelosi Plan has passed the House, what is its prognosis in the Senate?  link
• The battle over abortion coverage now moves to the Senate:  link
• Pro-choice representatives have sent the message - not again:  link
• President Obama not thrilled with House language on abortion:  link
• Economists, Senate moderates now concerned cost:  link
• Virginia Senator Mark Warner says President Obama is focusing on the wrong thing:  link
• Small businesses looking at bill’s impact:  link
• Young adults could end up paying a lot more so seniors pay less:  link
• Gallup poll flips – majority now opposed to health care reform:  link

Administrative rules being proposed by the Department of Human Services threaten to usurp legislative authority over what Iowa pays its health care providers who serve Iowans on the Medicaid program.

As part of the Department’s plan to achieve the ten percent reduction in funding, DHS proposed that almost all Medicaid providers have their payment rates reduced. Provider groups like the hospitals, doctors, and nursing homes were among those who would have their rates reduced by 5 percent. Another group of providers including dentists, in-home providers of waiver services, and community mental health centers would have their payments cut by 2.5 percent. The changes would reduce General Fund spending on the program by $16,845,648.

The proposed reductions are scheduled to go into effect on December 1. In order to implement these changes, DHS is asking the Council on Human Services to adopt a package of emergency rules on November 10. Once those are approved, the Department will seek quick approval of the changes to Iowa’s Medicaid plan from the Centers for Medicare and Medicaid Services (CMS).

There is just one problem with the Department’s plan. Iowa law does not give DHS the authority to cut Medicaid rates.

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• Saturday may be the day in the House, maybe:  link
• Changing 1/6 of the nation’s economy merits just 5 hours of debate in the People’s House:  link
• House Democrats still fighting it out over abortion, immigration provisions:  link
• President Obama will endorse the Pelosi Plan:  link
• The American Medical Association will have a lively meeting this weekend, after their President went ahead and endorsed the Pelosi Plan:  link
• In the Senate, the moderates still hold all the cards:  link
• Speaker Pelosi has left some leftover tricks in her plan for American taxpayers, according to the Wall Street Journal:  link
• Former Speaker Newt Gingrich and Texas Governor Rick Perry discuss the impact of the Senate’s Medicaid proposals on states:  link

• Health Care Reform bills do not do enough to control costs, says Washington Post:  link
• New York Times review of House Republican plan:  link
• Does Yesterday impact the health care debate?  Speaker Pelosi says no:  link
• House Democrats pushing for less than a day of debate, Saturday vote:  link
• As they show their cards with the Manager’s amendment:  link
• Surprise!  AARP to endorse Pelosi Plan:  link
• Immigration remains an issue:  link
• White House not worried if it takes until 2010 to pass Obamacare:  link
• Senate Moderates keep exerting influence on process:  link
• WSJ op-ed:  Women don’t like health care reform:  link

• The people go to Washington, say no to the Pelosi Plan:  link
• Leadership of AARP, AMA endorse Pelosi Plan:  link
• Senator Snowe, only Republican to support Senate Finance bill, no fan of the Pelosi Plan:  link
• More interesting abortion provisions found:  link
• SURPRISE!  Those without insurance will have to wait 6 months to get coverage under Pelosi Plan:  link
• Millions of Americans would pay Pelosi Plan fines:  link