2016 RAGBRAI route announced: A short ride across southern Iowa

After two straight years of taking bicyclists across northern parts of the state, the Des Moines Register announced this evening that the Register’s Annual Great Bike Ride Across Iowa (RAGBRAI) will cross southern Iowa from July 24 to 30. The route starting in Glenwood and ending in Muscatine will take riders "419.9 miles (third-shortest in the event’s 44-year history), with a total climb of 18,488 feet (making it the 24th flattest)."

Full details on the 2016 route are on the official RAGBRAI website. After the jump I’ve listed the overnight stops, along with daily mileage totals and feet of climb and some political trivia about places riders will visit this summer.

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Feds say Iowa not ready, must delay Medicaid privatization until March 1

For months, Governor Terry Branstad has dismissed warnings from patients, advocates, doctors, hospitals, editorial boards, and lawmakers that the state’s rush to privatize Medicaid would disrupt health care for some 560,000 Iowans. Today the governor finally got the message in a form he can’t ignore. Director Vikki Wachino of the federal government’s Centers for Medicare and Medicaid Services wrote to Iowa Medicaid Director Mikki Stier,

Based on our review last week of Iowa’s progress, as well as the information you have provided, CMS expects that we will ultimately be able to approve Iowa’s managed care waivers. However, we do not believe that Iowa is ready to make this transition Jan. 1. CMS previously outlined the requirements to provide high quality, accessible care to Medicaid beneficiaries, and Iowa has not yet met those requirements, meaning that a transition on January 1 would risk serious disruptions in care for Medicaid beneficiaries. While you have made progress in some areas of readiness, our review also identified significant gaps that need to be addressed before CMS can authorize your waiver requests. For that reason, CMS will work with you toward approval of your request effective March 1, 2016, provided that the state demonstrates progress toward readiness consistent with the actions in the attachment to this letter.

Click through to read the full four-page letter and four-page attachment from Wachino to Stier, which the Des Moines Register posted online. CMS officials found that "significant areas of the state did not have many provider types within a reasonable distance," and that "Relying too heavily on out-of-network providers is likely to create confusion among beneficiaries and providers, result in access issues for beneficiaries, and disrupt continuity of care for beneficiaries." Many of the points raised echo concerns three Democratic state senators expressed during meetings with CMS officials in Washington last month.

The CMS readiness review also showed that nearly half of Medicaid recipients who tried to call the state’s call centers earlier this month could not get through. Many Iowans who did reach a staffer on the phone were not able to find out whether any of their current doctors had signed contracts with the four managed care providers approved to run Medicaid. The CMS findings are consistent with what I’ve been hearing from acquaintances: the enrollment packets sent to Medicaid recipients did not include basic details they would need to make an informed choice of managed care provider (such as where their family’s current doctors will be in-network).

I enclose below reaction to today’s news from Branstad, who struck an upbeat tone, and key Democratic lawmakers, who vowed to keep fighting to improve legislative oversight of the Medicaid privatization. The Democratic-controlled Iowa Senate approved such a bill during the 2015 session, but the Republican-controlled Iowa House declined to take it up. Oversight is the very least state lawmakers could do to prevent the transition to managed care from becoming a pretext for denying services to vulnerable Iowans.

David Pitt noted in his report for the Associated Press,

Two legal challenges continue including one from the Iowa Hospital Association, a trade group for the state’s hospitals. It sued the state claiming the privatization plan is illegal because it takes millions of dollars from a dedicated hospital trust fund and gives it to the four managed care companies.

Any relevant comments are welcome in this thread. I am grateful that so many Iowans took the time to contact federal officials about Branstad’s disastrous policy. Bleeding Heartland reader Rhonda Shouse has been one of the superstar organizers in that fight.

UPDATE: Added below reaction from Representative Dave Loebsack (D, IA-02). I expect that during next year’s re-election campaign, Loebsack will highlight his efforts to shield constituents from the negative consequences of shifting Medicaid to managed care. His only declared Republican opponent is State Senator Mark Chelgren, who like his GOP colleagues in the upper chamber has done nothing to slow down the privatization or strengthen legislative oversight of the process.

SECOND UPDATE: Added more news and commentary related to this issue.

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Loebsack, King cross party lines on bill halting refugees from Syria, Iraq

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Today the U.S. House approved a bill that "would prevent any refugees from Syria or Iraq from entering the United States until the FBI, Department of Homeland Security and Director of National Intelligence certify that none of them are dangerous," Cristina Marcos reported for The Hill. Representative Dave Loebsack (IA-02) was among 47 Democrats who joined 242 Republicans to pass the bill (roll call). Representatives Rod Blum (IA-01) and David Young (IA-03) also voted yes, but Representative Steve King (IA-04) was one of only two House Republicans to vote no. His office has not yet responded to my request for comment or issued a statement explaining that vote.

President Barack Obama has threatened to veto the American Security Against Foreign Enemies Act, which according to White House would "’provide no meaningful additional security for the American people’ and impose new certification requirements that effectively end the refugee program" to assist those fleeing Syria or Iraq. Marcos reported, "GOP aides noted that because of absences, the vote would have met the two-thirds requirement to override a presidential veto if that vote had been held Thursday. Still, there’s no guarantee that Democrats would vote to override the president if the bill comes back to the floor." Senate Minority Leader Harry Reid sounds confident the bill will not clear the upper chamber.

I will update this post as needed with comments from Iowa’s Congressional delegation or other reaction to today’s vote. The epic fail of the day goes to the Republican Party of Iowa for sending out the press release enclosed below. In that statement, Iowa GOP chair Jeff Kaufmann "applauds King, Blum, Young on Refugee Vote." Check the roll call first, guys.

Note: most of the perpetrators of last week’s horrific terrorist attacks in Paris were French citizens.

UPDATE: King’s office provided the following statement: "I voted against the American SAFE Act because it fails to restore Congress’ Article 1 authority over admissions of migrants to the United States. How can we trust this Obama Administration who will not utter the words ‘radical Islamic jihad’ to accurately screen Syrian and Iraqi refugees as required in this bill? For that reason, I submitted an amendment to rules, which was ultimately not adopted, that would create international safe zones for refugees in their homeland. The safety and security of the American people is paramount. I respect the House trying to find a solution but I do not believe this was the right or strong enough one."

The Iowa GOP issued a corrected press release, blaming "incorrect press reports of a unanimous Republican vote" for their error. Always wait for the official roll call. I’ve added the new statement below, along with a screen shot of a tweet (since deleted) from state party co-chair Cody Hoefert thanking all three Iowa Republicans "for voting to strengthen our national security."

SECOND UPDATE: Blum’s statement is below as well.

THIRD UPDATE: Added Loebsack’s official comment on the vote. When I asked whether Loebsack would vote to override a presidential veto of this bill, his communications director Joe Hand responded, "Will have to see what happens in the Senate before we talk overriding any possible veto."

FOURTH UPDATE: I’ve seen lots of progressives criticize Loebsack’s vote on social media, and some of that feedback must be getting through. On Friday afternoon, Loebsack for Congress sent out an e-mail blast with the subject line "my vote." Scroll to the end of this post to read the full text. Most of the commenters on Loebsack’s Facebook status update about this vote criticized his stance. As of November 21, neither Loebsack nor his staff had responded publicly to the comments.

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Thoughts on the Iowa Democratic Party's final Jefferson-Jackson dinner

The Iowa Democratic Party held its final Jefferson-Jackson dinner Saturday night, drawing some 6,000 activists to hear three presidential candidates speak in Des Moines. Last night’s spectacle won’t loom as large over the Iowa caucus campaign as the JJ did in 2007, when it took place in November and the caucuses were scheduled for early January, rather than February. But some new tactics emerged during the speeches by presidential candidates Bernie Sanders, Martin O’Malley, and Hillary Clinton. My thoughts on the evening’s highlights are after the jump.

I am a sucker for hand-made political signs, so I also enclose below my favorite pictures from the crowds in the bleachers. I put "Feel the Bern" in lights up top because I’ve never seen electrified signs at the JJ before.

While I see the value in supporters waving signs (or glow sticks, as many did last night) at a big rally, the "sign wars" some campaigns stage before multi-candidate events have always struck me as pointless. How does it demonstrate "organizational strength" to send a few staffers to put up printed materials in windows or along a road? Why would anyone want their volunteers to stand around yelling for hours before the dinner, rather than saving their energy and voices to show that enthusiasm inside the hall? For those who disagree with me and love the show, Pat Rynard chronicled the morning and afternoon activities by all three campaigns at Iowa Starting Line.

As for why I called it the "final" JJ, the Iowa Democratic Party’s annual fall fundraiser will continue under a to-be-determined name honoring icons considered more inclusive. You can send your suggestion to the state party using this form through February 15, 2016.

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