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A preview of issues facing the 2018 Iowa Legislature.

DES MOINES — Iowans could see more of the same during the upcoming session in terms of health care legislation — debate over Iowa’s Medicaid program and abortion — as well as new proposals such as limiting opiate prescriptions and doing more to aid those with mental health issues.

Lawmakers begin the 2018 session Monday.

Managed care

The state made the switch to a privatized Medicaid system in April 2016, handing the majority of Iowa’s Medicaid beneficiaries over to three managed-care organization. Two of them, Amerigroup Iowa and UnitedHealthcare of the River Valley, remain, while AmeriHealth Caritas dropped out in November.

The handling of Medicaid in Iowa has continued to receive criticism from enrollees and health care providers alike, and political leaders on both sides of the aisle seem to agree the system needs some change, said Sen. Liz Mathis, D-Hiawatha.

Senate Majority Leader Bill Dix, R-Shell Rock, said the solution may lie in strengthening state partnerships with health care providers across Iowa, such as hospitals and not-for-profit agencies.

“We need to look at where the opportunities lie, and how to improve the process” Dix said.

But Senate Minority Leader Janet Petersen, D-Des Moines, said the system should be switched back to state control, which Medicaid previously operated under before managed care. She said under the current system it’s difficult for Iowans to get affordable health care coverage.

Opioid crisis

Over the past decade, the state has seen a rapid increase in opioid-related deaths. According to Iowa Department of Public Health, there were 67 overdose deaths in 2016. In 2005, there were 28.

A bill to expand reporting requirements to reduce overdose-related deaths already has been filed for this session. The legislation would look at the state’s Prescription Monitoring Program, a mandated system that tracks patients’ use of controlled substances through information uploaded by prescribers and pharmacists.

Rep. Dave Heaton, R-Mount Pleasant, said legislators also want to look at bills that limit opiate prescriptions and expand medication-assisted treatment programs, most likely modeled after other states that have been more successful in dealing with the issue. Heaton pointed to Wisconsin, which is using injections coupled with counseling to help those in recovery.

Mental health

To improve mental health treatment in Iowa, Heaton said legislators need to consider developing adequate Medicaid reimbursements for regional crisis-intervention facilities.

He said lawmakers need to expand the concept of Assertive Community Treatment, a program that offers community-based services for people with serious mental health issues, according to the Department of Human Services.

“The problem is that in many areas in the state, there are no services in the community to support their needs,” Heaton said. “There’s no housing, there’s no community services available.”

However, Rep. Mark Smith, D-Marshalltown, is pessimistic, adding he doesn’t expect “this Legislature will take much action to resolve the problems with mental health.”

Abortion

Last session, the Legislature passed a new law mandating a three-day waiting period before abortions, as well as a shift in family planning funding that cut money from abortion providers such as Planned Parenthood of the Heartland.

But in late October the state Supreme Court extended a temporary injunction against enforcement of the three-day waiting period.

With Republicans holding the majority in the Senate 28-20-1 and 59-51 in the House, Dix said they will continue those discussions.

“Senate Republicans have been, as we demonstrated this year, very much want to lead on promoting a culture of life in our state, protecting the life of the unborn,” Dix said. “I suspect that will be something we will have conversations about.”

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