Latest news with #MikeKlimesh
Yahoo
14-05-2025
- Health
- Yahoo
Iowa Senate sends expanded Medicaid work requirements bill back to the House
Sen. Mike Klimesh, R-Spillville, spoke May 13, 2025 on the legislation to implement work requirements for Iowa's expanded Medicaid program. (Photo by Robin Opsahl/Iowa Capital Dispatch) The Iowa Senate on Tuesday sent back to the House a bill to implement work requirements for the Medicaid program, although the Iowa Department of Health and Human Services has already requested a waiver from the federal government to implement similar requirements. There are some differences between Senate File 615 and the waiver request announced by Gov. Kim Reynolds in April. The legislative proposal would require people who receive health coverage through Iowa Health and Wellness Plan (IHAWP), the Medicaid coverage available for low-income, able-bodied adults from ages 19 to 64, to work at least 80 hours each month to stay in the program. The HHS proposal sets a higher work requirement of 100 hours per month, and includes other means to retain IHAWP coverage, such as being enrolled in education or job skills programs, or earning the equivalent in wages to working 100 hours a month at $7.25 per hour. Both versions of the proposal contain exceptions for certain groups, including people with disabilities, individuals who are in a substance abuse treatment program for up to six months, and those with children under age 6. While the legislative proposal has a lower monthly work requirement, it also contains a provision that would end the IHAWP program entirely if work requirements are ever approved by the federal government and later revoked. Iowa HHS would be directed to discontinue the expanded Medicaid program if federal law or regulations are changed to exclude work requirements in the future — contingent on the federal government having previously approved Iowa's implementation of these restrictions. Ending IHAWP would be subject to federal approval. If ending the program is not allowed, the state department would be directed to implement an alternative plan. Both the Senate and House have approved this measure, but the House had sent the legislation back to the Senate with an amendment clarifying the language calling for the discontinuation of IHAWP if the federal government revokes work requirement approval, in addition to adding a requirement for HHS to conduct and submit a report to lawmakers on the Medicaid for Employed People with Disabilities (MEPD) program by Dec. 15, 2025 — before the 2026 legislative session. The Senate amended the House's change to remove the language calling for a MEPD report. Sen. Mike Klimesh, R-Spillville, said the report was unnecessary as conversations on this topic will occur 'on a voluntary basis' before the legislature reconvenes in 2026. Democrats criticized the measure, which they said will remove, due to reporting requirements, low-income people who are working and are in need of health coverage. Sen. Sarah Trone Garriott, D-West Des Moines, compared the feedback lawmakers received at the subcommittee meetings discussing IHAWP work requirements to the subcommittee held on the 'Work Without Worry' legislation that proposed removing Medicaid income and asset limits for Iowans with disabilities. While advocates and Iowans who attended at the 'Work Without Worry' bill subcommittee praised the measure for allowing them to return to the workforce without risking the loss of health coverage, people at the subcommittee meeting for the bill setting Medicaid work requirements overwhelmingly spoke against the proposal. 'Everyone who was a local Iowan showing up on behalf of folks with disabilities, children, pregnant mothers, just folks in the population who are low income and struggling — trying so hard to make ends meet — they said this bill will hurt Iowans,' Trone Garriott said. 'It will push people off of their health care. In other states where it's been implemented, legislation like this has just made it harder for people who do qualify to actually get the paperwork done and stay on.' While supporters have said work requirements will help reduce the costs of Medicaid, Trone Garriott said other states that have implemented similar work requirements have not seen significant savings, and that these requirements will raise overall health care costs in the state because it will cause more people to be uninsured. 'We have a growing number of people who are uninsured when measures like this are enacted, and those folks end up seeking charity care at emergency rooms and hospitals,' she said. 'Charity care is not free. A health care provider needs to spread out the cost, shift those costs on the other folks in order to keep paying the bills and keeping their doors open. It raises costs on everyone when folks are not insured.' Senate Minority Leader Janice Weiner also said the legislature is moving forward with this measure 'without having any firm idea what the fiscal impact will be.' The Legislative Services Agency fiscal notes on the bill stated the nonpartisan agency did not receive responses to multiple requests for information from HHS about the financial impact of implementing work requirements. Klimesh said HHS has included fiscal impact estimates in its waiver request over a demonstration period of five years that have found a cumulative savings of $50 million for the state, and held public hearings on the proposal, a part of the process of seeking approval from the federal Centers for Medicare and Medicaid Services. Klimesh also pointed to movement by the U.S. Congressional Committee on Energy and Commerce to make federal changes to Medicaid which includes requirements for able-bodied people between ages 19 to 65 to work, attend educational programs or participate in community service for at least 80 hours a month to stay eligible for coverage. 'Essentially, if you look at the blueprints the federal government is utilizing, it almost lines up specifically with what the state's requirements are,' Klimesh said. The bill was approved as amended in a 33-13 vote, and returns to the Iowa House.
Yahoo
29-04-2025
- Business
- Yahoo
PBM reform bill amended, advanced through Iowa Senate
DES MOINES, Iowa — After multiple attempts over a span of several general assemblies, the bill to add regulations in the state's pharmaceutical industry passed through the Iowa Senate on Monday afternoon. The bill passed through the chamber by a vote of 36 to 14, with an amendment to the bill added that sends it back to the Iowa House. The bill adds regulations to pharmacy benefit managers, or PBMs, requiring them to reimburse pharmacies based off of the National Average Drug Average Cost. The bill also requires PBMs to reimburse pharmacies a dispensing fee and more. Advocates for the bill have explained that PBMs have been following a model where pharmacies are not fully reimbursed when filling a prescription for a patient. This leaves the pharmacy at a net loss on the cost to fill the prescription and what costs were reimbursed by PBMs. This in turn has seen an increased closure rate of both rural and urban pharmacies. Italian manufacturer to build new facility in Perry, creating jobs and boosting economy by millions 'If we do not pass this bill today, we are setting them up for having no access to a pharmacy. Thirty-two of them closed last year. I lost four alone in my district and once they close, they're not going to reopen. So, this bill is a great step in the right direction to provide transparency in what's an opaque system,' said State Senator Mike Klimesh (R), District 32 from Spillville. Those 32 pharmacies that have closed over the last year reflects concerns from owners about PBMs not reimbursing at fair rates. The majority of Senate Democrats voted against the bill, because insurance companies have indicated if there is any change to the PBM system, the costs will be passed on to the consumer. 'We have to take seriously that the PBMs have promised they're going to pass the costs along to the consumers, and we want to shield the people of Iowa from increased costs while protecting our small town and rural pharmacies,' said State Senator Sarah Trone Garriott (D), District 14 from Waukee. According to the Iowa Pharmacy Association, out of all the states that have passed PBM reform there has not been an increase of insurance premium prices for patients. Iowa News: PBM reform bill amended, advanced through Iowa Senate Des Moines Afghan military refugees fear for lives after apparent deportation notices What's ahead for Monday's severe weather Scholastic Spotlight: Norwalk fashion & National Decathlon in Des Moines Hundreds of students honored as part of Governor's Scholar Program Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
29-04-2025
- Business
- Yahoo
Bill regulating pharmacy benefit managers passes Iowa Senate
The Iowa Senate passed legislation Monday increasing regulation on pharmacy benefit managers. (Photo by Getty Images) The Iowa Senate passed a bill setting new standards for pharmacy benefit managers that lawmakers said will help keep rural pharmacies in business and lower the cost of prescription drugs. Senate File 383, passed 36-14, is the legislation passed through the committee process earlier this year limiting certain PBM business practices. Pharmacy benefit managers are companies that serve as the negotiator between drug manufacturers, pharmacies and health insurance companies for setting prescription drug costs. The legislation would set new regulations for PBMs, including requiring pharmacies to be reimbursed for the national or state average acquisition cost of a drug — a higher reimbursement rate than many pharmacies are currently receiving, according to several workers and owners of current rural pharmacies. Many components of the bill deal with PBM practices to pressure or force consumers to use certain pharmacies to fill a prescription. The bill specifically prohibits PBM strategies like setting different cost-sharing rates or implementing financial advantages or penalties for the use of certain pharmacies to fill a prescription. It also restricts other methods of PBMs limiting the use of certain pharmacies if that provider has agreed to participate in a person's health benefit plan. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX Earlier in the legislative session, pharmacists and supporters told lawmakers the bill would help Iowa pharmacies stay in business, linking the closure of many locally owned, rural pharmacies in recent years to PBM practices that favor mail-order prescription refills and certain pharmacy chains. The bill was amended by the Senate Monday to define 'retail pharmacies' and 'pharmacy chains.' The Senate amendment also makes some changes to the language about how rebates received by a PBM on drugs are returned to a health benefit plan to reduce insurance premiums. The bill's floor manager Sen. Mike Klimesh, R-Spillville, said the legislation was important to him because of his own experience having medicine for his father, which could only be filled by a mail-order pharmacy, get lost in the mail. He said ensuring rural pharmacies in Iowa stay in business is necessary to help keep Iowans healthy, saying local pharmacies can help address problems and adjust to the medical needs of people in their community in real time. 'We need to have a conversation about what rural health care looks like in Iowa,' Klimesh said. 'And one of those main talking points about rural health care in Iowa is not only just a clinic you go to to get your check up, or the hospital you see, but the next step in that in that phase — which is the pharmacy, the pharmacy to fill your prescription.' Many local pharmacies have closed in recent years, which Klimesh said was largely due to unfair business practices by PBMs. More than 150 Iowa pharmacies have closed in the past 10 years, and 31 closed in 2024, according to the Iowa Pharmacy Association. Klimesh said if the Legislature does not pass a bill regulating and PBM practices and improving transparency, 'we are setting (Iowans) up for having no access to a pharmacy.' 'I lost four alone in my district, and once they close, they're not going to reopen,' Klimesh said. 'So this bill is a great step in the right direction to provide transparency.' Sen. Sarah Trone Garriott, D-West Des Moines, said she supported a measure to restrict PBM business practices, but said Senate Republicans' amended legislation would lead to consumer cost increases. She introduced an amendment that would require negotiated drug manufacture rebates exclusively go to reducing health care plan premiums. Her proposal also would require pharmacies with five or less organizations and pharmacies that are the only entity able to fill a prescription in their community receive a $10.68 dispensing fee for every prescription they fill. Trone Garriott said she believed Klimesh's amended bill would lead to significantly increased health insurance costs for Iowans, while her amendment would ensure Iowans do not lose access to health coverage because of efforts to regulate PBMs. '(The amendment) does increase prices on consumers, it does increase prices on Iowa,' Trone Garriott said. 'The amendment that I am presenting today has a much smaller increase. When we compare $160 increase to $6 increase, that's a pretty big difference when it comes to folks who are working so hard to make ends meet. We have to take seriously that the PBMs have promised they're going to pass the cost along to the consumers, and we want to shield the people of Iowa from increased costs, while protecting our small town and rural pharmacies.' Klimesh called Trone Garriott's amendment 'PBM reform light.' He said the issues she brought up with rebates were already addressed in his amendment, stating a transparency provision in the bill 'forces all rebates to flow back to the plan payer,' and said the Democratic senator's amendment did not address issues with spread price manipulation, where PBMs charge payers like Medicaid more than a pharmacy is paid for a medication. Trone Garriott's amendment failed, while Klimesh's amendment was adopted. The amended legislation heads to the House for further consideration. The House passed a companion version of the legislation through the committee process in March, but has not yet had floor debate on the measure. SUPPORT: YOU MAKE OUR WORK POSSIBLE
Yahoo
26-03-2025
- Health
- Yahoo
Work requirements for Medicaid, public assistance programs passes through Iowa Senate
DES MOINES, Iowa — The Iowa Senate Republican majority pushed through a bill that would add minimum work requirements for Iowans who are receiving healthcare benefits and help from public assistance programs. The bill advanced by a vote of 33-15, stating that people must work for 80 hours each month to continue receiving health coverage. The Iowa Health and Wellness plan is the expanded Medicaid coverage for Iowans with incomes near the poverty level, giving them low or no cost benefits. The Legislative Services Agency projects that around 32,000 Iowans will lose coverage in the wellness plan due to the lack of ability to work. Republican Senators argued that the bill would help turn people's lives in the right direction instead of relying on government benefits. 'This bill ensures that individuals receiving Medicaid expansion benefits are given the opportunity to experience this dignity. By requiring work we are providing an important stepping stone to help Iowans develop life skills, build responsibility and regain a sense of purpose,' said State Senator Mike Klimesh, (R) District 32 from Spillville. Iowa bill prohibiting diversity, equity and inclusion advanced by Senate Republican majority Senate Democrats argued that this will gut those who rely on these benefits and will slow down early screening and prevention opportunities for low income Iowans on the program. One argued that this bill is one step to repeal Medicaid by the majority party. 'This is a Medicaid repeal bill in sheep's clothing,' said State Senator Janet Peterson (D), District 18 from Des Moines. 'This bill requires the department to discontinue the Iowa Health and Wellness plan. Kicking all 181,000 Iowans off of their healthcare insurance.' The bill requires the state department of health and human services to request federal approval necessary to include work requirements as a condition of a member maintaining eligibility. It also states that if federal law or regulations affecting work requirements for the wellness plan are modified to exclude work requirements for the basis of maintaining eligibility, the department shall discontinue the Iowa Health and Wellness plan. There is a list of people who are exempt from having these work requirements imposed on them, as stated in the bill. The policy now heads over to the Iowa House where a bill already exists with similar parameters. Iowa News: New Iowa Head Coach McCollum already has ties with new fans Work requirements for Medicaid, public assistance programs passes through Iowa Senate Webster City lineman injured by live wire during blizzard recovery; fundraisers created Iowa bill prohibiting diversity, equity and inclusion advanced by Senate Republican majority Iowa law banning school library books that depict sex acts on hold again after a new federal ruling Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
