Bleeding Heartland is a community blog about Iowa politics: campaigns and elections, state government, social and environmental issues. Bleeding Heartland also weighs in on presidential policies and campaigns, federal legislation and what the Iowans in Congress are up to. Join our community, post your thoughts as comments or diaries, help keep our leaders honest and hold them accountable.
Iowa received the overall top ranking in a new report on the health care system in all 50 states and the District of Columbia. The Commonwealth Fund is a private foundation supporting research on health care issues and policies to achieve "better access, improved quality, and greater efficiency, particularly for society's most vulnerable." Researchers who compiled the 2011 state scorecard uncovered huge disparities in terms of access to care, health care quality, and health outcomes:
There is a twofold or greater spread between the best and worst states across important indicators of access and affordability, prevention and treatment, and potential to lead healthy lives (Exhibit 1). The performance gaps are particularly wide on indicators assessing developmental screening rates, provision of mental health care, hospitalizations because of asthma, prevalence of teen smoking, and mortality rates among infants and children. Lagging states would need to improve their performance by 60 percent on average to achieve benchmarks set by leading states.
If all states were to improve their performance to levels achieved by the best states, the cumulative effect would translate to thousands of children's lives saved because of more accessible and improved delivery of high-quality care. In fact, improving performance to benchmark levels across the nation would mean: 5 million more children would have health insurance coverage, nearly 9 million children would have a medical home to help coordinate care, and some 600,000 more children would receive recommended vaccines by the age of 3 years.
Leading states-those in the top quartile-often do well on multiple indicators across dimensions of performance; public policies and state/local health systems make a difference. The 14 states at the top quartile of the overall performance rankings generally ranked high on multiple indicators and dimensions (Exhibit 2). In fact, the five top-ranked states-Iowa, Massachusetts, Vermont, Maine, and New Hampshire-performed in the top quartile on each of the four dimensions of performance. Many have been leaders in improving their health systems by taking steps to cover children or families, promote public health, and improve care delivery systems.
The Scorecard's findings on children's health insurance attest to the pivotal role of federal and state partnerships. Until the start of this decade, the number of uninsured children had been rising rapidly as the levels of employer-sponsored family coverage eroded for low- and middle-income families. This trend was reversed across the nation as a result of state-initiated Medicaid expansions and enactment and renewal of the Children's Health Insurance Program (CHIP). Currently, Medicaid, CHIP, and other public programs fund health care for more than one-third of all children nationally. Children's coverage has expanded in 35 states since the start of the last decade and held steady even in the middle of a severe recession. At the same time, coverage for parents-lacking similar protection-deteriorated in 41 states.
After the jump I've posted a sidebar from the general summary of the Commonwealth Fund's report, called "Iowa's Comprehensive Public Policies Make a Difference for Children's Health." I also included some methodological notes and listed the 20 indicators measured by researchers.
The Oklahoma Legislature voted Tuesday to override the governor's vetoes of two abortion measures, one of which requires women to undergo an ultrasound and listen to a detailed description of the fetus before getting an abortion.
Though other states have passed similar measures requiring women to have ultrasounds, Oklahoma's law goes further, mandating that a doctor or technician set up the monitor so the woman can see it and describe the heart, limbs and organs of the fetus. No exceptions are made for rape and incest victims.
A second measure passed into law on Tuesday prevents women who have had a disabled baby from suing a doctor for withholding information about birth defects while the child was in the womb.
To clarify: Republicans passed a law dictating the way doctors communicate with patients and how they must proceed with every woman seeking an abortion, regardless of her individual circumstances. According to the New York Times, the Center for Reproductive Rights has already filed suit to challenge the constitutionality of the ultrasound law, claiming it "violates the doctor's freedom of speech, the woman's right to equal protection and the woman's right to privacy."
The second law is in some ways more offensive, because the government is shielding doctors who deliberately do not level with their patients. I have close friends who have learned while pregnant that their future child has serious medical problems. To give doctors license to deceive women in that situation is unconscionable. Pregnant women must be able to make informed decisions regarding all medical care. Who's to say that doctors will stop at "merely" hiding birth defects? Maybe some will decide it's better not to tell women they have cancer or some other disease that might prompt them to terminate a pregnancy.
The memorandum from Obama to HHS Secretary Kathleen Sebelius, made public late Thursday night, orders new rules that would ensure hospitals "respect the rights of patients to designate visitors."
Obama says the new rules should require that hospitals not deny visitation privileges on the basis of sexual orientation or gender identity.
"Every day, all across America, patients are denied the kindnesses and caring of a loved one at their sides whether in a sudden medical emergency or a prolonged hospital stay," Obama says in the memo.
Affected, he said, are "gay and lesbian American who are often barred from the bedsides of the partners with whom they may have spent decades of their lives -- unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated."
Cue conservatives to start whining about "special rights for homosexuals," as if there is something extraordinary about visiting a loved one in the hospital or granting your life partner power of medical attorney. I'm glad the president took a stand on this issue.
I'm curious to see how the U.S. Conference of Catholic Bishops reacts to this executive order. I don't know whether Catholic hospitals are more likely to have rules in place preventing visitation by gay or lesbian partners, but I would expect religious conservatives to complain about the government nullifying such rules. I wonder whether there is even grounds to challenge Obama's order in court, if hospitals could demonstrate that their visitation bans are grounded in religious principles.
The Iowa Legislature has been moving at an unusually fast pace during the shortened 2010 session. It's time to catch up on what's happened at the statehouse over the past three weeks. From here on out I will try to post a legislative roundup at the end of every week.
February 12 was the first "funnel" deadline. In order to have a chance of moving forward in 2010, all legislation except for tax and appropriations bills must have cleared at least one Iowa House or Senate committee by the end of last Friday.
After the jump I've included links on lots of bills that have passed or are still under consideration, as well as bills I took an interest in that failed to clear the funnel. I have grouped bills by subject area. This post is not an exhaustive list; way too many bills are under consideration for me to discuss them all. I recommend this funnel day roundup by Rod Boshart for the Mason City Globe-Gazette.
Note: the Iowa legislature's second funnel deadline is coming up on March 5. To remain alive after that point, all bills except tax and appropriations bills must have been approved by either the full House or Senate and by a committee in the opposite chamber. Many bills that cleared the first funnel week will die in the second.
I was going to comment on desmoinesdem's snow link story, but I decided to write my first diary instead...here she is:
Many on the left might be feeling depressed right now. After all, this filibuster proof majority in the Senate is not really helping that much, and health care is seemingly being excessively watered down.
However, Democrats should not be overly depressed. They have effectively shut down the voices of the Republican Party in Washington, save Olympia Snowe. Isn't that what the supermajorities were all about?
Furthermore, according to President Obama, the public option is not everything. I know many folks believe that it is, but there are many reforms in this bill that, if voted on by themselves, would easily receive over 80 votes in the Senate (i.e. they're popular and good policy). Plus, if a bill does pass before the State of the Union address, even a sub-par one, President Obama can use that platform to boast, and tell us all about the wondrous portions of the health care reform that the Democrats alone passed through Congress.
I'm sure it'll be quite a speech.
As for the public option, moderate Democrats are quite the thorn in the side of the Democratic leadership. It's kind of a Catch-22, though, as we can see in the following conversation:
Senator Lieberman: "The public option is a huge deal!"
President Obama: "Look, Joe, the public option is only a small part of reform. As such, if it's such a small portion of reform, why would you sink all of health care just to stop the public option?"
Lieberman: "Oh...it's only a small part of reform?"
Obama: "Yes...didn't you hear my speeches over the last 3 months?"
Lieberman: "Great...so if we get rid of the public option, it really won't harm reform that much...after all, it's only a small part of reform."
Moderate Dems are probably thinking one of two things.
1. If this PO is huge, then I’m justified in opposing it…more govt, more spending, my constituents don’t like it, yada yada yada
2. If this PO is not huge, then I’m justified in opposing it…why are we fighting over something so small?
Some may disagree with their logic and/or facts, but the situation remains.
I'm willing to declare that the "public option" will be one of the following four options:
1. The idea that was floated yesterday was of Medicare 55-65. Although it could be problematic, politically. thereisnospoon had a diary that speaks to that yesterday. Interesting points.
2. The good ole' Snowe trigger. Many on the left believe that this is actually designed never to trigger.
3. This OPM buy-in, so people can purchase federal insurance...although, many people are saying that it's not a real public option.
4. Some sort of Opt-In public option...which probably would not be as robust as an Opt-Out, considering the nature of it.
Another big question is, if the final PO is one of these four options, is an individual mandate a political winner for the Democrats? I’d have to say no. desmoinesdem seemed concerned about it today too. Why alienate younger voters?
The political play-out of this has been fascinating, and rarely do we have a time in American politics where we truly do NOT know the outcome. We’ll see how it plays out. Of these four options, or a fifth that I may have overlooked, what would be the best from a policy standpoint? A political standpoint?
Something I just realized, from reading about the tightening results in NY-23 - prior to the two special elections, Pelosi had literally a one vote margin on the health care. From the article:
Before Owens was sworn in Friday, Rep. John Garamendi, a Democrat who won a special election in California, was sworn in Thursday. The two gave Pelosi the votes she needed to reach a majority of 218 and pass the historic health care reform legislation in the House.
The bill passed 220-215 late Saturday with the support of only one Republican. The Republican, Rep. Anh "Joseph" Cao of Louisiana, said he voted for the legislation only after seeing that Democrats had the 218 votes needed for passage.
This isn't quite right; with both special election seats vacant, 217 would have provided a majority. If both seats had been claimed by opponents of health care, Pelosi could have held the vote before seating the new representatives. Without their two votes and without counting Cao, this would have left her with exactly 217 votes. Wow.
I may change my mind later, but tonight that speech hurt really bad. Sure, it was full of the erudition and grand language the President is so good at, and it sure energized the base - which I don't understand!
From the very beginning of the Obama caucus campaign continuing through the general election, I gave more money, more time, and stuck my neck out further than I ever had before for a Presidential candidate, and I've worked hard for quite a few.
I will not invest my energy in a cause that has no bottom line, no goals which the president will not compromise, nor any clear cut progress toward true reform.
I respect Barack Obama for the great things he HAS done, but I refuse to work for his version of health care reform when he has no clear goal other than to pass something - anything - that may get through Congress, regardless of content.
Last Wednesday, I attended a health care forum in Iowa hosted by Senator Tom Harkin. Following it, I wrote a diary, "Now I understand why war happens (a health care forum story)." In it, I asked the question, how can you defeat the bullies who are overrunning most of these meetings?
The problem in dealing with the teabaggers, deathers, birthers, racists, anarchists and radical libertarians who are overrunning health care forums nationwide is simple to describe.
They. Don't. Listen. Ever.
So, you can't really talk to them. When they have stacked the room, the intimidation is palpable. That's how they win.
I couldn't for the life of me think of how to beat these people, short of overpowering them somehow - hence the title of the diary. But, even as I wrote it, I knew that overpowering them just feeds into their fear and paranoia, and realistically, it's impossible anyway.
Today, after a little sleep and some reflection, I realized that the effect of the teabaggers' aggressive intimidation made me stupid for about eight hours. Anger is an amnesic agent. It makes you forget what you know. I was angry, depressed, agitated, and clueless all at once.
Yesterday, I saw our problem first hand. We are in a world of trouble, people.
Mobs are powerful and wholy beyond reason. Yet, they must be stopped, because they are extremely dangerous. There are a lot of very angry, very frightened people out there, and about 150 of them turned out on a Wednesday afternoon to harass Senator Tom Harkin, shout incoherent political slogans (the same ones that have been diaried to death here in the last week), and to let him know that they are very angry about the idea of government in general and government health care in particular. The total crowd was limited to about 210 by the fire code.
LATE UPDATE: I was wrong to criticize Boswell for not scheduling a health care event in the Des Moines area this month. On August 13 his office announced a town-hall on health care to be held on August 23 from 3 pm to 4 pm at the AIB College of Business Activities Center, 2280 Bell Avenue in Des Moines. RSVP by calling Congressman Boswell's Des Moines office at 515-282-1909, or emailing email@example.com.
Iowa CCI's statewide annual convention will feature workshops and plenary sessions on factory farming, campaign finance reform, immigration reform, and predatory lending. The convention will conclude with an exciting direct action targeting an undisclosed payday lender in a low-income community in Des Moines.
More details on that and other events coming up soon are after the jump.
As always, please post a comment or send me an e-mail (desmoinesdem AT yahoo.com) if you know of another event I've left out.
To Bleeding Heartland readers who plan to do RAGBRAI next week: consider posting a diary about your experience or any candidates you encounter during the ride. I saw this at Bob Krause's campaign site:
Eric Rysdam of Fairfield, Iowa has agreed to ride across the state in RAGBRAI, The Register's Annual Great Bicycle Ride Across Iowa with a big Krause banner and shirt. Eric will be the core of an amorphous group participating and getting the word out about for us! Please wish Eric well with his training in anticipation of the July 19-25 event! Eric's number is 319-293-6306 if you want to wish him well, or if you want to be on the ride with him.
There has been a lot of talk this week about the surprising move by Walmart to publically support President Obama’s health care reform plan, supposedly positioning themselves as a
leader in the fight to bring health care to all Americans. As we mentioned in a post on our blog
yesterday, this might be easier to swallow if Walmart had any history of leading by example. Instead, they usually do just the opposite.
Walmart’s long record of trying to build a positive
reputation on ineffective work-arounds to health care coverage
for employee, the recent revelations about sacrificing quality for cheap perescription drugs, and their deceptive PR campaign that severely overstated their workers’ health
care coverage, it’s not hard to understand our skepticism. [get the details in the extended entry]
Most of the new laws are steps in the right direction for Iowa: increased foreclosure protections; $30 million in historic tax credits; expanded health care for children, low-income pregnant women and adult children under 25; broader eligibility for wind energy tax credits; more job protection for volunteer emergency providers, electronic logbooks to track pseudoephedrine sales. A few of the highlights on the House Democrats' list deserve additional comment.
Manure application during winter: On principle I think it's a bad idea for legislators to interfere with the rulemaking process at the Department of Natural Resources. However, amendments greatly improved this bill from the version that passed the Iowa Senate. In fact, the new law includes tougher restrictions on liquid manure application than the rules that the DNR would have eventually produced. It's important to note that these restrictions only apply to manure from hogs. Cattle farmers face no new limits on what to do with solid manure during winter.
Consumer fraud protections: Iowans rightly no longer need permission from the Attorney General's Office to sue some types of businesses for fraud. Unfortunately, this law contains an embarrassingly long list of exemptions.
Let's end this post on a positive note. The septic tank inspection law approved during the 2008 session also takes effect today. Over time these inspections will reduce water pollution produced by unsewered communities in Iowa. Credit goes to the legislators who approved this bill last year and to Governor Chet Culver. He wisely used his line-item veto to block State Senator Joe Seng's attempt to sneak a one-year delay of the septic tank inspections into an appropriations bill.
This thread is for any thoughts about Iowa's brand-new laws. Probably none of them will be as controversial as the public smoking ban that took effect on July 1, 2008.
Walmart, in one of their worst ways of prioritizing prices above qualities to date, turns to a foreign drug supplier, Ranbaxy Laboratories, LTD, who has repeatedly been investigated by the FDA and the DoJ for "inadequate" safeguards against contamination, falsification of records and submitting false information to the FDA.
On top of that, just eight months before the FDA inspected Ranbaxy's Paonta Sahib plant and found significant violations, Walmart awarded the company a "Supplier Award" for improving shipping times and performance.
In a new report on our website, we detail their multi-year spanning violations, DoJ investigation, Congressional Investigation, and list out all of the drugs made at the facility in questions. Additionally, we detail their recent violations below.
Following up on yesterday's post, I see that a brand-new New York Times/CBS nationwide poll shows widespread support for a real public health insurance option. The wording of the question was clear: "Would you favor or oppose the government's offering everyone a government administered health insurance plan like Medicare that would compete with private insurance plans?"
Results: 72 percent of respondents favored the public option, including 87 percent of Democrats, 73 percent of independents, and 50 percent of Republicans.
Senator Chuck Grassley works overtime to snuff out a public option, urging President Obama to support a bipartisan bill in the Senate. But in the real world, a strong public option has bipartisan support. Even half of Republicans favor making a "government administered health insurance plan like Medicare" available to all Americans.
A public option would increase competition and give Americans more choices while driving down costs. A recent report found that one or two companies dominate the health insurance market in most parts of the country.
Sotomayor has managed to disarm even senators who came prepared not to like her. Sen. Charles E. Grassley, an Iowa Republican, went in thinking "she would be aggressive and maybe even a little obnoxious."
"I would classify her as kind of much friendlier ... more reserved, less aggressive," than he expected, Grassley told reporters later.
Pres Obama you got nerve while u sightseeing in Paris to tell us"time to deliver" on health care. We still on skedul/even workinWKEND.
A little later, the senator Tweeted,
Pres Obama while u sightseeing in Paris u said 'time to delivr on healthcare' When you are a "hammer" u think evrything is NAIL I'm no NAIL
First of all, Obama recorded the weekly address before leaving for France. Second, it's bizarre for Grassley to mock Obama's "sightseeing in Paris," as if that were the main purpose of his foreign visit. You can be sure that if Obama had not gone to France to commemorate the D-Day invasion, Republicans would be howling in protest.
In the Register's Your 2 Cents' Worth feature May 4, "Disgusted 50010 Woman" said I pay $40 a month for health insurance. In fact, I pay $356 a month for Blue Cross insurance coverage, a plan that is available to federal employees. This differs from health plans for state government employees in Iowa, where no portion of the premium is paid by the employee. There's no basis for the assertion in her comments.
Fair enough, senator. But you have to admit, you've got a pretty good deal going. A couple half your age who purchase their own Blue Cross insurance plan could easily pay two or three times as much in premiums for comprehensive coverage. Even a bare-bones policy covering primarily catastrophic care could cost individuals more than $356 a month, and they'd have to pay out of pocket for most routine medical expenses and prescription drugs.
Natasha Chart recently looked into her health insurance options as a single 34-year-old woman. If she can afford it, she'll pay $200 to $300 a month for less coverage than what members of Congress receive. I encourage Senator Grassley to read her post.
Senator Grassley has been urging the President to let the legislative process work so that health care reform legislation restructuring 17 percent of America's economy will reflect broad consensus and garner bipartisan support from as many as 80 senators.