As America’s heartland prepares for another frigid winter, low-income families in Iowa are also bracing for a significant change. That’s because private companies are scheduled to take over management of the state’s Medicaid program the first of the new year, a shift Iowa’s governor is calling “modernization.”

Governor Terry Branstad says that concerned Iowans “should not be afraid of change,” but private management could make it harder for almost 600,000 people—about 22 percent of the state’s population—to get the health care they need.

The Des Moines Register says the current state-run program “spends less per person than the majority of other states, while still providing comprehensive coverage.” Why jeopardize that? A chaotic transition, diminished services, or reduced coverage could threaten low-income families and people with disabilities.

But Iowans still have a say. The federal government has to sign off on the transition, and a top federal official just said he has “serious concerns” about the end-of-the-year deadline.

Privatization could make it harder for almost 600,000 people—about 22 percent of Iowa’s population—to get the health care they need.

A number of states have privatized Medicaid with the alleged values of efficiency and cost savings, but the results have been mixed at best. Less than a year into Florida’s experiment with statewide privatization, the companies hired to manage the program are already asking for hundreds of millions of dollars more from the state. In Tennessee, some patients have experienced inadequate physician networks, long waits for care, and denial of treatments using the state’s privatized program.

Adding private profit to the only source of health care available to our most fragile citizens is a recipe for problems, and Iowa is learning that lesson already. The Des Moines Register has investigated nepotism, unfair bidding practices, and hundreds of millions of dollars in past fines or settlements involving the four companies that will manage the state’s program if the federal government approves it. But Governor Branstad is shrugging those issues off: “I guess I challenge you to find any Medicaid provider of any magnitude that hasn’t had some issues in the past. That’s just kind of the nature of it.”

Iowans should contact the federal government’s Centers for Medicare and Medicaid Services (CMS) and tell it not to grant Iowa permission to privatize. A fifth of the state’s population and over $4 billion in public money are nothing to shrug about.

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