This week Republican Gov. Kim Reynolds says she’s not backing down from yet another big change to Iowa’s privatized Medicaid.

“I’ve never said it was perfect," Gov. Reynolds said on Tuesday. "I’m willing to put the time and the effort into making sure that Iowans get the care that they deserve in a managed and coordinated and more modern delivery system.”

She says she’s “not going back” on how Iowa’s Medicaid is managed.

Former Iowa Republican Gov. Terry Branstad privatized Medicaid in 2016 without approval from the legislature. Privatization turned management of the healthcare program for around 600,000 poor and disabled Iowans over to three for-profit companies: AmeriHealth Caritas, United Healthcare and Amerigroup.

There have been a lot of developments the last couple of weeks. Here are four worth noting, as IPR’s Clay Masters discussed Friday with Des Moines Register Healthcare Reporter Tony Leys.

- AmeriHealth Caritas dropped out in October but the state says patients will continue to get coverage. “All three companies said they were losing hundreds of millions of dollars,” Leys says. Department of Human Services said they were going to auto enroll the 215,000 former AmeriHealth patients into United Healthcare and that patients could choose.

- Amerigroup told the state they couldn’t take any more patients. “Some of these folks had gone ahead and gotten Amerigroup cards,” Leys says. Now the state is temporarily taking 10,000 patients in under the old fee-for-service model but haven’t specified what temporary means.

- A fundamental part of private Medicaid management is about competition. Private Medicaid Managed Care is supposed make companies compete with each other. “If you’re on Medicaid and you’ve signed up with one of these companies and you don’t like [it] you could once a year choose to switch,” Leys says. Right now, that only option is going to be United Healthcare unless something changes.

- Medicaid will be a big part of the governor’s race. Republicans control both chambers of the legislature and Democrats want to “pull the plug” on privatized Medicaid management. Democrats running for the governor’s office are talking about it on the campaign trail, and it will only heat up in 2018.

The 2018 legislative session starts on January 8th.