sort through the issues. the democratitic presidential front runner returns to siouxland and hillary clinton picks up a major endorsement while in oux c city. we'll hit the campaign with clinton and a gop home hope frl this week's latest polls. and it all starts right now. >> from the abc studios in sioux city, iowa, j join us as we discuss the hot topics in sueland. >> we're glad you're withs this sunday. iowa is making major changes in its medicaid program. spearheaded by iowa governor terry branstad, the pn involves changing the state-run program to a contracted service with manag care organizations. the governor said the change will save the state no less than 50 million-dollars. some lawmakers disagree and many hospital administrators and patients say next month's move

less effective care, a in some cases none at lent. that b brings me to our first guest this week. two men w find themselves smack dab in t theiddle of this mid medicaid debate. across from metate representative chris hall from sioux city, and next to mim the president and ceo of mercy medical center jim fits pt rblg. thanks for taking time to talk to us about this issue, which is certainly in the spot light these days. we'll geget into the details o of what's going on and how people are being impacteted but let's just start by saying is there any way this doesn't happen come next month? >> right now that seems to be in the hands of the federal, uh, centers for medicaid. they're looking into whether this needs to be delayed which is what democrats are asking for, uh, or whether it will actually go into effect and be implemented on january 1. >> medicaid costs inside of iowa have raised a ball pack park of 70 percent. is that an indication that maybe something should be done in.

number i've got according to the state. is that indication there should be some kind of change? >> the interesting thing about that is that medicaid costs have actually incased at a lesser rate tn what private insurance costs have over the last 10 years. the other key poioint in there is that medicaid has an incredibly low administrative cost. it's 4 percent which means the cost of medicaid goes almost directly to health care services. very little is taken up by over head expense and very little of it, um, reall goes s to waste. >> jim, jump in here. medicaid recipients will be able to continue to have their current providers through june of 2016.we really do have a 6-month window tha at least according to the paperwork, written in.n. is that enough time for your patients and your physicians as well as medical facility across the state to digest all of this? >> i don't, um, i thi that our progressing with the plan that

2015 and expected that we are going to be able to do this well from the people who are some of the sickest of patnts and in some of the most difficult of situations andxpected to implement that well in a 10-month time frame, uh, tim il-cononceived. he are two states recently; pennsylvania, which announced that it going to be transforming to a medicaid managed care program that is going to be impmplementin in 2019 oklama oklahoma, uh, through four years oklahoma is going to be taking two to three years to get that done. there's ten months of preparation, little to no involvement of physicians or hospits in discussing what's working right. and the problblem we're trying to fix. there's a lot of good things thatave happened in iowa. we've got, uh, the first state in the country that has had physicians and hospitals, former collaborative pact called the iowa healthcare c collaborave

health indicators across the country - - first to do this, first to do a lot of different things. as a result of that, receiving a lot of federal grants. the federal government wanted us to be leaders and continue to improve care. i know there'sot of waste in the healthcare system, no dououbtabout it. we've gone from 0 to 14 health coaches in our organization. that is one help hospital facilityn the state that are trng to catch people up stream before they fall into and working on ways to keep them well. the wasn't any discussion about how we leverage what is going well with the health care system. instead we've made an advance spending a l of money, uh, to, uh several consultants, managed care organizations that have dircht paths and try and make something better.

slowing down or thrawtsling the brake to make sure we do this well if we're going to do it. if we're going to advance healthh care reform, we've been working on reforming and managing care as hospitals and providers in this state for aong time f. much of the increase you - - the other big portion of that increase is we extended the program last year. over 150,000 additional people in the state who are not using emergency room as their family care provider, which is a good thing in all respects. >> let's stop for just a second basically a person who has been a recipient of medicaid for years since the program has started in iowa has had a represent, a health provider. under the governor's plan that program's being replaced with four private companies those recipients will now have to go to and decide wh which one they want to have provide their care at in itsel seems confusing when you break down - - in your

question for you i have is okay let's take four people they each have the same heart ailment. >> in the same family. >> go one step further. they each have different mc o's providing their health care. what kind of snake ps nest sthalt for hospital across the state to have to dive into? >> we don't know yet and because of the lack of attention to detail in getti r ready to do this, we don't know the implications. >> you heard from people this week you had a town hall meeting, a listening session, and is that what you heard fm those folks? they don't kw what to do? >> that's the main concern is that this whole process isunfolding so quickly and with so little attention given to the details that health care providers and medicaid sun seumers are having a very difficult time navigating what direction to go. hadd interesng thing about that listening post i thoug we had concern coming from tax payers.

democrat or a republican issue, but it's become one. the concern as a tax payer is this is the largest contract ever awarded in state history, 4 billion-dollars annually. and what is being done is that 4 billion-dollaris being divvied up and sent to companies in tampa, virginia beach, philadelphia, and minneapolis, when the state has a various active track record of implemting and delivering these services within our statate's bords already. >>re you comfortable with the four companies that have been slekded? an administrative law judge said days ago one of them should be thrown out completely. >> a judge said one of the contracts should be thrown out for 2 reasons. first, there's improper contact between the company, officials and governor's chief of staff among other peoe during a blackout period when no communication was to have occurred. and second, within that company's application, they failed toisclose the fact that

fraud had been committed in other states, resulting in criminal conviction of some of their executive officers. that is a huge red flag that needs to be raised a and it also speaks to the rushed process that a lot of the really issues that have come forth. >> has govnor branstad increased his communication with lawmakers or hlth providers as these issues have raised or is there still a gap? i'm not saying there is one, but that's one of the criticisms that the governor sped superthis through. are yohearing more from h h mao? not souch. the reason so many of us in the legislature are holding our own listening postsis because when the department of human services came in october, they had suchh lack of detail for some of the real legitimate questions that were asked by consumersnd health car providers. they were asked questions, they coul't givan answer, they said just give us time. there's not much time left. there's less than a month uil

tr are trying to find out what details people need to have i their hands. because we're not getting from the governor. >> you both know, the county's already made moveses considering staff and operations so it's almost unable to turn around and go back and hold the flood gates from opening at some point. >> even if you disagreed with theremise of what is going forward, which i do. now you have the question of it is moving forward, how do we actually make it happen in the best possible circutances? and what we'e're saying is we need to d delay. we need to at least hold off for a period of several months, help health care providers know what they're getting into and signing these contractcts and also making sure that consumers know who their doctor's going to be. >> guys, we'e're runnining out o time here quickly already. the are some reports that some of these managed care companies have threatened a 10 percent penalty to the providers if they're not signed up by january.

mercy medical or anything you've heard? >> that's exactly accurate. that isritten into, um, the sign up guidelines that there will be a reduction, uh, in payment for those who don't. and how that gets - - how that gets passed on ultimately will enend up getting, um, absorbed by the hospitals, uh, and, um, andthen we end up having to make tough choices >> what does that mean for the patient when t the hospital has to make those kind of decision. >> right,, yeah. >> tough decisions to be made down the road. chris, what do you say, both of you in closing, what do you say to people that are listening this morning that want to see a delay and do whatever it takes toet this slowed down or at least delayed? >> i think our best hope right now is to ask for thatt delay, try to slow the process down, and i would encourage, uh, citizens who are concerned either as tax payers or medicaid sun seumers they should contact their local legislatures and that they should also be coactinghe governor's

timately the governor has circumvented the legislature, and he's moving forward with allll these changes and doing so of s own choice. >> he was able to do that under state law; correct? >> the execuve branch and their contracting process they were able to move forward without legislative input yes. >> jim, a final word from y. >> i wou say also that representative paul and others took a proactive step in trying to get the voice of the customer, the patients who are being served who would probabl be most impactedy this change when the train wreck occurs. establishing o website that some people can get on and share some of their thoughts and feelings. three people have heart conditioions or examples of a family one that wrote in said i've got four chiren, received four different letters from four dierent vendors whare going to be all my kids have a different managed care and representing them. one of them, i understand, is

shouldn't be allowed to bid, what to i do? we're leaving people in a lurch. i'm not asking for stopping. but i really feel badly about what we are walking into without haviving about it. >> i see you have one more thing. >> just quickly i would say go to iansforqualitymedicaid.com, that a place they can sign a petition and get more information. >> gentlemen, thanks both for being with us. this is coming at us in aurry and we appreciate your ti this morning to try to clear the smsmoke a bit. when w we come back, the state's most out spoken critics of the governor's plan joins me here in the studio to continueur discussion. presidential hopefuls return to iowa. we'll check out what they had to say this week right here in sioux citity. so stay th us.

siouxland with seaman. >> we're back with more this week in siouxland with tim seaman. >> and thanksor staying withus this morning as we ctinue our discussion about the change in iowa, the medicaid program going from a state-run program to a privatized program,nd joining me now to continue our discussion is one of the most out spoken critics of the

iowa, he's state. >> he was here taking a quetionz program dealing with the state of iowa. senator, thanks for being with us. >> good to be with you. >> you've been on the beat as far as the change in medicicaid here in the state o of iowa for more than a year now, um, initially ii know your first concern was thathere was the governor talked about a 50 some milln dollar savings if the program were privatized. have you yet to see numbers tt show the state will save that kind of money? >> no, we have not seen those numbers. and here hfs the concern about that, tim. is tt if we don't see the numbers up front, then we have a suspicion of how the moneyill be saved on the back end, which will be reducing service or reducing reimbursements to provers. providers may be still providing services but not getting the

in the long run that reduces access to health care for people. we're very concernd for not having the numbers. - - . who you are, how wealthy you are, how well off you are, it gets down to everybody is one disability or one accent uway from needing medicaid. it is our safety net, and all of us have an interest in making sure this is a well-managed program. >> that being said ether you agree or disagree with the privatization n of theedicaid program, uh, is this just being done simply too qckly? >> i don't think there's any question that this iss t quickly. uh, we're sitting here in early december, uh, and there are people who don't knoww who their case managers will be, staing january one. they don't know who their providers will be january 1. um, and, this is a big program.

servicices. i mean,hese are critical services for many iowans, healthcare services, disability serves. the danger is beerer growing to have we're - going to have things fall through the cracks. we had a well-run micaid system in our state. it was efficient, low bureaucratic costs. a low adminisative cost. so there was the first queion done - it. even if you're going to do it, it needs to be done right. >> i know folks round siouxland have hadad many questions as well, how the program works, why are we making the change, how do i benefit. why do you think the governor took this step? i mean the initial diskush kugz was it's going to save aot of money. other than tt, have you been able to answer that question when folks ask you? >> well, and of course on the ney side we don't know. hasn't been able to show anynumbers and it turns out that

guess, and nats not really good enough. but i think it's partltly, uh, aphilosophy where there's this beli that the private sector just does everything better. and the privateector does do many thicks very well. but this is a public program, umum, we had a well-administered public program, anand now th concern is we're going to have four out of state companies, very large corporations, and will they be as responsive to the public? i have my doubts that they will be. one of the thing that i am now thinking about doing, especially after the list ning post earlier this week, is how do we come up with legislation that makes sure that medicaid recipients have their rights protected? because if t mamged care organizations decide to make their money by just denying services, that's not right. and people need a recourse if th starts to happen. we're e going toave to watch this very, very carefully.

it may be too late to stop. but let's at least make sure that we're providing, uh, the people who are supposed to be receiving the benefits from it to make sure they're actuall getting those benefits. >> along that exactvenue, several days ago an administrative law judge requests one of those four companies beaken out of thatprocedure because it wasn'tcomfortable with their past histstory. the have bn questions raised about all four of the companies that will be taking over the privatization of the program. are you satisfi those companies will provide the service iowan need? >> i'm not satisfied. the bottom line is we want to make sure that people are getting the services they need and are entitled to and we want to make sure our providers are being treated fairly. our hospitals and doctors or other medical providers, we want to make sure they're being treated fairly. because if they're not, they may not be ableo provide their services. there's some talk

our hospital providers. that's really, really bad if we go down that route because we need more access to health care, not less. i have a very high level of concern about this. whether it should have happened in the first place t is not being handled well. >> how does the fact that the in the last session the governor came out with his proposals to privatize mental health care in the state of iowa.how does that ro inthis decion? >> obviously these arere very related issues because a a lot of the provider whose a ghow going to be dealing with these four different managed sre organization - - by the way, whether it's three or four, all providers are saying they have three separate billing syste, three separate electronic interfaces, three separate contracts.so there's a large increase in bureaucratic cost not just for the state with these providers coming in and replacing the public program, it's also for the providers who are going to

mental health is a ex point of this. 'vee actuallyad - - manage mental health has been under a managed care organization. m a rks gellan, which is being replaced in this process, so that adds to the level of complication. we badly need more mental health service, not less. if this tnsition resul in fewer mental health service that's going to be a big blow to our state. >> lastly, what can someone do fromom thehe sta of iowa as a tax payer, if th have a concern they have a question f they want to see it delayed, whatould you recommend? >> there are a couple of things mple. first of all, contacting the center for medicare and medicaid services,ms, that stuff i is out on the internet. contacngng the governor's office and elected officials, both at the state and federal level. we need our federal delegation to speak up and help slow this down at a minimum. and then third, be in contact with people. if youreing personally affected by it, be in contact

state legislatures, so that we know what kind of legislation we need to pas to make sure, um, to make sure this system ctinues to work even if we end up - - even if this transition goes through. i'd like to be able to say we could stop this. that deadline's coming up. a lot of it, as you know, woodbury county already decided to terminate their program. we may - - the best weay be able to do is to provide some oversight and some rites to safe guard some people in the new system, but his is a total mes >> we're a few weeks away. we'll hope for a smooth as possible transition. but it lks like it could be a bumpride. >> i think it's going to be very bumpy ride. >> senator, we appreciate your time this morning. we'll continue to follow this and the state session is just rouound the corner as well. good luck as you return to des moines. >> thanks, tim. >> mean while in local politics, gop contender mike huckabee made stops in siouxland.

veterans at the veterans memorial museum. >> when unions succeed, , america succeeds. when collecte bargaining thrives, then communities succeed, workers, succeed, businesses succeed. they've seen she is fighng for them and that's why she's getting so much union support. >> mean while the latest poll out, let's check the democratic numbers with clilinton now doubling bernie sanders w with the rest of the field in single digits, it's's clearly a 2-person ce. on the republican side, donald trump still leading by 10 percent, but marco rubio is now listed second. cruz, carson, and bush are listed behind those two. stay with us, whether we come

>> stay tuned, more this week in >> n we're back withth more this week isiouxland. >> and before we let you go, let's check out this week's nine things to know, starting with

clark will be at ahem inside hard rock friday. a ymca blblood dve on friday 3:00 p.m., a good way to give during the holiday season. fourth annual gospel mission christmas comes up monday. three years ago this w week,k, colorado john hickenlooper declares marijuana legal for recreational use. youngstown visits friday. the hinton toy show comes up next saturday beginning at 9. farm toys, hot wheel, race cars, lots of stuff including dolls. the crittenton cenr toy drive is today at noon at the railrd museum. admission is fe. toppining our list of nine things to know, christmas spectacular comes up saturday, december 12,7:30 p.m. at the orpheum, recognized as onef the city's

think abt stopping by fort f that. that's it for this week's show. make sure to circle it on the calendar, come back to join us next sunday for this week in siouxland. captioni provided by: caption solutions, llc. www.captionsolutions.com (music) >>amanda: coming up, governor terry branstad is in studio with us. will he ever endorse a presidential candidate? then we ask him why cut education funding when it's a top priority? and will he ever release his medical records? it's all coming up on this week in iowa. (music) >>amanda: and thank you so much for joining us on this special edition of this week in iowa. iowa governor terry branstad joins us for the entire half hour. welcome. thanks for being here. >>mr. branstad: thank you. good to be with ya. >>amanda: now the reason he's here is to talk about a big milestone. it's right around the corner. on monday, december 14th the governor becomes the longest serving governor in the history of the united states. it will officially be his 7,640th day of service to the state of

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