SULLIVAN'S SALVOS
February 16, 2017
Sullivan’s
Salvos 2/21/17
In this edition:
*Congratulations, Andy Chappell!
*MH/DS Targeted Case Managers
*Did You Know?
*Congratulations, Andy Chappell!
I have good news and bad news…
Governor Branstad has appointed Assistant Johnson County Attorney Andrew
Chappell to be a judge in Iowa's Sixth Judicial District. (The Sixth Judicial
District includes Johnson, Benton, Iowa, Jones, Linn and Tama counties.)
This is good news for Andy – he is a
brilliant, wise, ethical, outstanding attorney. He will make a fantastic judge!
The bad news is for those of us who Andy work with him all the time. He will be
incredibly difficult to replace!
Congratulations,
Judge Chappell! I will miss you tremendously, both personally and
professionally!
*MH/DS Targeted Case Managers
Friday,
February 9, 2017 was a rotten day. The Board of Supervisors sat down with a
room full of MH/DS Targeted Case Managers and told them most of them will be
losing their jobs. I have been a Supervisor for 12 years, and this was the
single worst thing I have ever had to do. And trust me – it was much worse for
the folks getting the news than for the people delivering it!
First,
some background: Johnson County has employed social workers for decades. In the
old days, these social workers were generalists. As Medicaid expanded over the
years, most people with disabilities became eligible for Medicaid programs. These
Medicaid programs required a service they called, “Targeted Case Management.”
The idea is that Case Managers would assist people in accessing resources, and
ensure that Medicaid dollars were being spent wisely. For 20+ years, that is
exactly what happened. About 20 of the 25 social workers employed by Johnson
County were Targeted Case Managers, funded 100% by Medicaid. 5 or so social
workers are funded through our Mental Health Region.
The
system was working fine – until Governor Branstad decided to privatize Medicaid
by going to a system of Managed Care Organizations, or MCOs.
The
role of an MCO in a health care system is very simple: reduce the amount of
money being spent on services, and keep some for yourself. I wrote the
following in Salvos in August of 2015:
Medicaid just celebrated its’ 50th
birthday. Medicaid and Medicare were among the greatest achievements in the
history of our great nation. Health care for the poor… we have been called to
provide this at least since Jesus walked the earth. The US finally got around
to it in 1965.
Iowa will soon be embarking upon a
system of “managed care” for folks enrolled in Iowa’s Medicaid program. I do
NOT believe this will be a good thing for our poorest residents.
Managed
care is a pretty simple notion. The idea is that healthcare is full of waste
and fraud, and managed care companies will root that out. Without all this
waste and fraud, the costs will go down.
The
problem is, managed care companies rarely root out waste or fraud. They take an
easier route. They simply cap services, and let the rest of the healthcare system
sort it out. The managed care companies make their millions, and patients and
providers fight over what is left. In my opinion, managed care is nothing more
than a transfer of public tax dollars to private companies who are GUARANTEED
to hurt the poor. Rather than being encouraged, managed care by private
companies should be illegal. But that is not the environment in which we live.
Allow
me to back up a moment. Medicaid (often referred to as Title 19) is the federal
program that provides government health insurance to our poorest residents.
Medicaid was passed in 1965 as an addition to the Social Security Act, a key
component in President Lyndon Johnson’s “War on Poverty”.
While the vast majority of the funding
for Medicaid is federal, each state pays a portion based upon the relative
wealth of that state. Connecticut pays the most, Mississippi the least. Iowa is
in the top half when it comes to relative wealth; in fact, our state match just
went up because of the recent good years enjoyed by the ag industry.
Over time, states have argued for and
received greater flexibility in designing state Medicaid programs. This is
where the managed care concept began, and how it is spreading to states with
Republican governors. In fairness, over the years, Medicaid has become a bigger
and bigger piece of each state’s budget.
While many conservatives will try to
tell you Medicaid has “not worked,” the reality is a very different story. In
fact, 72 million Americans received some type of Medicaid service last year,
almost 1 in 4. These services were provided at an average cost lower than
private insurance, and at an average administrative cost MUCH lower than
private insurance.
Will
managed care improve things? No, it will not. Unless you own one of the firms
that is about to suck millions of our tax dollars from our poorest residents.
If you own one of those, you’ll be fine.
Unfortunately,
I was correct. The chickens are coming home to roost. One of the three MCOs –
Amerihealth Caritas – has pulled a bait and switch. Amerihealth guaranteed
people they could keep their case managers, so folks signed on with them. A
year later, after lining up most of the business, Amerihealth tells us they
will begin doing case management themselves. That means the Medicaid money that
used to pay for Johnson County staff will now flow to them.
Obviously,
this gives Johnson County few options. We cannot continue to pay 20 salaries
with no source of income. The writing is on the wall.
It
should be noted, however, that no one has lost her/his job yet. Amerihealth
will slowly bleed away clients until Johnson County is forced to make layoffs;
after a while, there won’t be enough income to keep anyone on. Johnson County
will gladly retain our workers so long as their services are being reimbursed.
This process may be quick, or it may take several months. We simply do not
know.
The 5 positions funded by the Mental Health Region should be safe.
Since these are all union (AFSCME) positions, this creates a “bumping”
scenario. The most senior person in the unit is asked if she wants a job. If
not, they move to the second most senior. The process continues, based upon
seniority, until all available jobs are filled. Once all the jobs are filled, the
rest of the employees are laid off.
And let’s not forget the people who use Medicaid services. About
500 of our poorest people with disabilities – the most vulnerable among us –
are left hanging. These are but the first cuts they will suffer.
So,
Terry Branstad gets to enjoy his finest moment: services are cut for poor
people with disabilities, and 20 AFSCME workers in Johnson County get laid off.
I’m sure he is upstairs at Terrace Hill masturbating with joy! I also believe
that some day he will be judged by a much higher power than the people of Iowa…
and I don’t think he will fare very well.
Meanwhile,
if you have an opening and a Johnson County Case Manager applies, hire her/him!
This group is smart, hardworking, detail oriented, compassionate, and has done
tremendous work. I will personally vouch for any and all of them!
Seriously
– I am a social worker by trade. I worked for the Iowa Medicaid program. I have
known some of these folks since the late 1980s. They deserve better. Clients
deserve better. This is a sad, sad, sad day.
And
remember this whole fiasco the next time you vote!
*DID YOU KNOW?
More than 500,000 Iowans – one in every six – is on Medicaid.
Anyone
interested in learning more about County government should take a look at the
County website-
"Sullivan’s
Salvos" is sent once per week to any interested party. It will give a brief
update on issues of interest to Johnson County residents.
These messages
come solely from Rod Sullivan, and neither represents the viewpoints of the
whole Board of Supervisors nor those of groups or individuals otherwise
mentioned.
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feel free to contact me at 354-7199 or rodsullivan@mchsi.com. I look forward to
serving you!
---Rod
posted by Rod Sullivan @ 3:41 PM
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