A move that Minnesota made three decades ago — privatizing much of its medical-assistance program for the poor — became one of the biggest controversies of 2016 just south of the state border.

Iowa's longtime Republican Gov. Terry Branstad spent much of the year under fire from patients, providers and Democratic lawmakers for contracting out his state's Medicaid program to three for-profit private insurers. Branstad claimed that switching from state administration to managed care would result in big savings. But just months into the move, Iowa officials agreed to provide an additional $127 million in state and federal funding to cover insurers' unexpected costs, setting off angry new questions about the benefits.

Minnesota faced a similar and similarly outrageous demand late this year from a private insurer after big savings were promised for privately administering medical assistance here. Unlike Iowa, Gov. Mark Dayton's administration admirably pushed back. The move will not be without consequences for enrollees, who will have to switch insurers next spring, but it shows that state officials are serious about wringing savings from outsourcing the taxpayer-funded programs. For too long, these contracts, which pay a monthly sum for each enrollee's care, have been one of state insurers' most reliably profitable lines of businesses.

The request for more public dollars came from Minnetonka-based Medica, which claimed in late November that it had lost $150 million managing the program. It sought higher payment rates or other financial protections. A key point to know is that Medica had expanded its public program contracts by bidding aggressively under the state's new competitive bidding system. The shift to competitive bidding was a positive step forward in response to criticism in 2011 and 2012 about the amount of money insurers made from managing medical assistance and MinnesotaCare. The competitive system started small but was expanded to include the entire state in 2016.

State officials have claimed about $450 million in 2016 savings from the expanded bidding. But UCare, a widely respected insurer specializing in public programs and high-need patients, was virtually shut out.

State Human Services Commissioner Emily Johnson Piper admirably didn't cave to Medica's request, responding with hard questions of her own in December. A competitive bid situation shouldn't allow for lowball bidders to come back once a competitor is weakened and ask for more money. Blaming the state for unsound rates, as Medica has, also isn't reasonable given that the insurer has its own experts to calculate coverage costs. It also has significant experience dealing with the state's medical-assistance program enrollees.

The problem resulting from this standoff is that 311,000 Minnesotans served by these programs will have to switch insurers this spring because of Medica's looming exit. Many of them already had to switch from UCare to Medica or other insurers last spring after the bidding process results were announced.

There are understandable questions about the bidding criteria. Legislators should delve into this. But they should also leverage the opportunity to ask higher-level questions about the state's long reliance on the managed-care model for medical assistance.

Insurer demands in Minnesota and Iowa raise fair questions about whether promised savings and value for taxpayers and enrollees are being realized. The coming year will be one of significant health care changes with the expected repeal of the Affordable Care Act. This is a good time to evaluate fresher options for efficiently serving enrollees and taxpayers.