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This time of year, politics are big in Iowa, but there's something even bigger happening. The way in which one-fifth of the state's population gets health care is about to change. The state's governor plans to hand over managing Medicaid to private insurance companies. Iowa Public Radio's Clay Masters reports.
CLAY MASTERS, BYLINE: It's a bedroom any 7-year-old girl would love. Stuffed bears and monkeys are on the shelves. A light-up frog shines images on the ceiling. A fan blows a mobile of butterflies. But the bed stands out.
BRENDA HUMMEL: The head raises, and the feet raise as well, elevating her. When she was throwing up all that time when she was in a regular bed, I hardly got any sleep because if I heard her coughing, I knew she was choking.
MASTERS: Brenda Hummel is talking about her 7-year-old daughter Andrea who was born with severe epilepsy. She has this bed thanks to Medicaid, as well as her wheelchair and nurses, like Nate Lair, who's been with the family for years. When Brenda gets home from work, Lair says Andrea's personality changes.
NATE LAIR: And that's when she turns on the diva attitude.
MASTERS: That diva attitude is significant progress. For years, Hummel says her daughter showed very little personality. Seizures interrupted her development. Now her daughter is like any other 7 year old who goes to school and does normal activities. She worked for years to fine tune just the right doctors and care for her daughter.
So when she heard the state would be moving to private companies managing that care, she became anxious. Her concern is private business will put company profit ahead of care for her daughter.
HUMMEL: She hasn't been in the hospital for, gosh, two and a half years, I think. And so when they look at that, they may think she doesn't need these services that are costing money, but in my eyes, she can fall back to having seizures at any time. We're not out of the woods at all.
MASTERS: Hummel says maybe it'll be OK, but she just doesn't know enough. The state Department of Health insists patients will continue to receive the same care. Amy McCoy with the Department of Health says these changes will save money and streamline care.
AMY MCCOY: Some people might have five doctors, and through this care coordination effort, they can make sure that everybody's on the same page with their treatment.
MASTERS: McCoy says having private insurers manage Medicaid is nothing new.
MCCOY: Thirty-nine states are using some kinds of managed care, so other people have done this. We have models to look after, and we have companies who have experience.
MASTERS: But a lot of states have not done so great, like Kansas or Kentucky, says Democratic State Senate president Pam Jochum.
PAM JOCHUM: When I was a kid growing up, my mother would say, so if everybody jumps off the bridge, are you going to too? Of course not. Just because everybody else is doing it doesn't mean that it makes the system better.
MASTERS: Families like Brenda Hummel's have a natural ally in Jochum. She has a daughter with special needs who has been on Medicaid all of her life. She's against the changes to Medicaid, but the process is moving forward no matter what. Iowa's Republican Governor Terry Branstad did not need legislative approval when he announced it in January. So lawmakers, including Jochum, insisted on a committee to oversee the transition and make sure consumers are treated fairly.
JOCHUM: There is no way you can put that many people into a system all at once with varying degrees of disabilities and needs and think somehow anyone can manage that, manage it well and meet all the needs of the people.
MASTERS: Eleven companies have submitted bids. None of the companies can comment on how exactly they plan to run the system during the bidding process. Brad Wright studies health policy at the University of Iowa. He says a lot of states have experimented with this idea but on a smaller scale.
BRAD WRIGHT: Most of them have not done what Iowa is proposing to do, which is to put everyone into it.
MASTERS: Wright says the only hurdle that stands in the way of approval is an OK from the federal government.
WRIGHT: If that happens, then starting in January, that's a full steam ahead.
MASTERS: Iowa plans to announce which insurers will win the bid this month to manage most of the $4 billion program. For NPR News, I'm Clay Masters in Des Moines.
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CORNISH: This story is part of a reporting partnership between NPR, local member stations and Kaiser Health News.
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