Sand says he’d undo Iowa’s private Medicaid management on Day 1

DES MOINES — Rob Sand would end the private management of Iowa's Medicaid program via executive order on his first day in office, the Democratic candidate for governor said Saturday.

Sand has in the past pledged to end private management of Iowa Medicaid, which has been in place since an executive order by then-Republican Gov. Terry Branstad in 2015 and maintained through Republican Gov. Kim Reynolds' tenure.

Sand, speaking to reporters at the Iowa State Fair on Saturday, said undoing private Medicaid management would be one of two executive actions he would take on Day 1 in office.

The other, Sand said, would be an executive order stating state government workers would be free to live and work from any community in the state.

Sand, the state auditor who lives in Des Moines and is originally from Decorah, is running for governor against Republican Zach Lahn, a venture firm business owner from Belle Plaine.

Sand on Saturday at the State Fair spoke on the Des Moines Register Political Soapbox and served lunches at the Cattlemen's Beef Quarters.

"Two Day 1 executive orders: one to kind of echo what we did in the auditor's office, statewide work, statewide jobs," Sand told reporters after his shift serving lunches. "If you have a state job and you can do it from anywhere within the state of Iowa just as well, we want to let you do that because that's how we can move some of our state jobs out into smaller counties and rural communities where they'd love to have one more family.

"And then starting to reverse the privatization of Medicaid."

Per Branstad's 2015 order, the state contracts with private insurers who manage services for most Medicaid members. The Iowa Department of Health and Human Services currently contracts with three managed care organizations; a smaller number of members remain in a traditional fee-for-service system, where providers are paid directly by the state.

Republicans have pushed back on Sand's proposal, arguing Iowa's privatized Medicaid system is necessary to control costs. Iowa Rep. Ann Meyer, a Republican from Fort Dodge, has said repealing Medicaid managed care would cost hospitals more than $1 billion annually by eliminating federal hospital payments tied to managed care. As such, GOP officials warn Sand's proposal could lead to reduced services and financial strain for rural hospitals.

Republicans have long defended the state's managed care model, arguing the previous fee-for-service system was financially unsustainable.

At the same time, lawmakers have faced mounting pressure from families and patient advocates frustrated with care denials and service reductions under Medicaid managed care.

Sand's health policy information includes a claim that Iowa's private Medicaid management "has been one of the most disastrous decisions in Iowa over the last decade," that, the policy says, prioritizes profits over Iowans' health, reduces care, and "has been an administrative nightmare." Sand's reviews of the program, as auditor, claim illegal coverage denials have increased 900% under private Medicaid management; Republicans and supporters of the program dispute Sand's data.

Nonpartisan claims

Sand, responding to a reporter's question on Saturday, addressed claims made a day earlier at the State Fair, by Lahn and Republican Party of Iowa Chairman Jeff Kaufmann.

During a press conference Friday, Lahn and Kaufmann reiterated their belief that Sand is not a nonpartisan elected official, but a classic "liberal" Democrat. They cite the donations Sand has received from prominent Democrats, both in Iowa and nationally, and the donations Sand has made to the Iowa Democratic Party.

Sand presented all the arguments he has been making throughout his campaign during his 20 minutes of remarks Saturday on the Register Soapbox — which was attended by a large crowd that spilled onto the main State Fair concourse. Among others, he talked about his opposition to a political system dominated by two major parties, Democrats and Republicans; and his push for the state to force state workers found guilty of harassment to pay any settlements rather than the state.

Sand on the Soapbox claimed his work has upset officials of both major parties.

"When all those folks in both political parties got mad at me, do you know what? I didn't care," Sand said. "I've been pissing off powerful people in both parties on your behalf as your state auditor. I'd like to keep doing it as your governor."

During Friday's press conference at the Republican Party of Iowa's State Fair booth, Lahn and Kaufmann questioned Sand's nonpartisan claims.

"Rob Sand is not being honest about who he is and what his positions are," Lahn said during the press conference. "As Chairman Kaufmann said, 'Rob Sand has a history of being a far-left Democrat.' And look, that's OK. He can be that. He just needs to be honest about who he is."

Asked for any additional examples outside of the arguments Sand lays out in his typical campaign speech, Sand said the auditor's office rejected a public records request from the Democratic National Committee for "allegations of wrongdoing by (Gov.) Kim Reynolds." Sand said the national Democratic Party made the request twice, and his office rejected it both times.

"We gave them absolutely nothing because we believe that our job under Iowa law was to give them nothing," Sand said. "And at the end of the day, we're here to follow Iowa law and not do what some private club asks us to do."

The general election is Nov. 3.

Tom Barton of the Lee-Gazette Des Moines Bureau contributed to this story.