Three Republicans join Iowa Senate Democrats in vote to terminate Medicaid privatization

This morning the Iowa Senate passed Senate File 2125, which would terminate contracts the state has signed with insurance companies picked to manage care for Iowans on Medicaid. Governor Terry Branstad announced his administration’s "modernization" plans early last year and selected four managed care providers in August, with a view to fully privatizing Medicaid by January 1, 2016. The state later terminated a contract with one of those four companies, and the federal government refused to grant the necessary waivers, saying Iowa would not be ready to shift to managed care until March 1 at the earliest.

Iowa Senate leaders made clear on day one of this year’s legislative session that Medicaid privatization would be a pressing concern. Senate President Pam Jochum has been sounding the alarm since last year, worried about how privatization would affect her developmentally disabled adult daughter and other Iowans with special needs. Jochum gave the opening and closing remarks in support of Senate File 2125 today. She repeatedly warned that the Branstad administration has tried to do too much, too fast, without input from state lawmakers or other stakeholders with expertise in the area. Fellow Democrats Chris Brase, Liz Mathis, Mary Jo Wilhelm, Rich Taylor, and Amanda Ragan echoed many of those concerns in their speeches.

During the floor debate, Republican State Senator David Johnson explained why he would vote for the bill. He read e-mails from numerous constituents expressing concern about access to health services for their loved ones on Medicaid. He pointed out that Minnesota took 20 years to transition to managed care, while Iowa is trying to implement the same changes over just one year. "It’s moving too fast. That’s the issue here. We need to put a dagger in this."

Last week Johnson became the first GOP lawmaker to come out in favor of terminating the privatization program; I enclose below excerpts from Jason Clayworth’s report for the Des Moines Register. Johnson’s fears about "children at risk of losing services" stem from the failure of the managed care companies to sign contracts with thousands of providers who have been treating Iowans on Medicaid, including children on HAWK-I (Iowa’s version of the State Children’s Health Insurance Program). Scroll to the end of this post for more details on that access problem, based on data from the Iowa Department of Human Services.

Republicans who spoke against the bill today included Senators Jason Schultz and Mark Chelgren. Schultz claimed Democrats took "ownership" of managed care by putting assumptions about Medicaid savings into the health and human services budget for the current fiscal year. During her concluding remarks, Jochum pushed back hard against the idea that a vote for last year’s health and human services budget was a vote for managed care. Rarely do I ever agree with Schultz, but I think Senate Democrats walked into a trap there. The Branstad administration’s estimates on reduced Medicaid costs after privatization were never grounded in reality, but Democrats accepted those assumptions in the budget they passed—not because they supported the Branstad effort, but likely because doing so gave them an extra $51 million to spend on other health-related priorities.

Chelgren argued that lawmakers should keep their word after voting for a budget that assumed Medicaid would shift to managed care. He likened the situation to Congressional Republicans voting to repeal the 2010 Affordable Care Act without having a plan ready to replace "Obamacare." The analogy fails because terminating Medicaid privatization that hasn’t been fully implemented would not be like repealing Obamacare after several years of operation. The status quo is an available and less disruptive alternative to serving the 560,000 Iowans on Medicaid. Chelgren claimed that halting Medicaid privatization and starting the process over would "betray" those who signed up as providers under the new system. That argument made no sense; public comments from Iowans on Medicaid and health care stakeholders have overwhelmingly opposed the Branstad policy.

During her concluding remarks, Jochum refuted claims that 39 other states have put Medicaid in managed care. In reality, only four states have fully privatized the system, as the governor is doing.

Shortly after the floor debate, senators voted 29 to 19 to approve SF 2125. Republicans Jake Chapman and Tom Shipley joined Johnson and all 26 Senate Democrats. Notably, those three Republicans all represent strongly GOP districts, not marginal seats.

The bill now goes to the Iowa House, where Speaker Linda Upmeyer has indicated she does not plan to bring the measure up for debate. For a nurse practitioner by training, Upmeyer is remarkably insensitive to ordinary people’s health care needs—not only those on Medicaid, but also chronically ill Iowans who could benefit from medical cannabis. A post in progress will catch up on the state of play for medical marijuana in the Iowa legislature.

UPDATE: Added more links and comments on the Medicaid debate below. According to Erin Murphy, Upmeyer confirmed today that the House will not take up SF 2125, because the governor would certainly veto it. Given how unpopular Medicaid privatization is, the public would likely support a legislative override of that veto. But at least five more Republican senators would have to change their stands to override a veto in the upper chamber. In the House, at least 24 GOP state representatives would need to support an override, assuming all 43 House Democrats voted in favor.

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Sally Stutsman retiring, Amy Nielsen running in Iowa House district 77

Two-term State Representative Sally Stutsman will not seek re-election to Iowa House district 77, the Iowa House Democrats announced this morning. A separate press release sent less than two hours later announced that North Liberty Mayor Amy Nielsen will seek the Democratic nomination in the district Stutsman is vacating. I enclose both statements below, along with a map of the district covering a large area in Johnson County (but not Iowa City or Coralville).

To her credit, Stutsman announced her retirement more than a month before the filing deadline for statehouse candidates (on March 18 this year). Too often, Iowa legislative incumbents in both parties have kept their plans secret from all but a few insiders until a day or two before nominating petitions must be submitted to the Iowa Secretary of State’s office. Fairness calls for giving everyone in the district a chance to weigh the pros and cons of running for the legislature. Lots of people who would not challenge an incumbent would seriously consider competing for an open seat.

Nielsen’s quick announcement indicates some insider support, and her base in the rapidly-growing North Liberty area should boost her candidacy. Nevertheless, I would not be surprised to see another Democrat or two seek the nomination. Both Stutsman and Nielsen endorsed Hillary Clinton for president, while Johnson County was among the strongest for Bernie Sanders on February 1.

For reasons I don’t fully understand, many Iowa Democrats have an allergic reaction to primaries. I see no harm in a good, clean competition between two or more people who are focused on the issues. Johnson County has seen some bitterly contested Democratic primaries, though; I hope that dynamic doesn’t develop here.

Incidentally, Zach Wahls told me today that he has no plans to run for Stutsman’s seat. He lives in Johnson County but not in House district 77.

I am not aware of a declared Republican candidate in the district. Stutsman easily defeated a GOP opponent in 2012. Republicans did not field a candidate here in 2014 but will surely compete for the open seat. According to the latest figures from the Iowa Secretary of State’s office, House district 77 contains 7,043 active registered Democrats, 5,213 Republicans, and 7,727 no-party voters. President Barack Obama won more than 58 percent of the vote in the district in 2012, and Bruce Braley outpolled Joni Ernst by 9 points here in the 2014 U.S. Senate race. The winner of the Democratic primary will be favored to replace Stutsman in the legislature.

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Weekend open thread: Post Iowa caucus plans edition

What’s on your mind this weekend, Bleeding Heartland readers? This is an open thread: all topics welcome.

Many politically active Iowans have been decompressing from the build up to the Iowa caucuses and their aftermath. A few posts on the presidential race are still in my head, waiting to be written soon, and I am not done advocating for reforms to make the caucuses more inclusive and representative. But whereas fellow blogger Pat Rynard will continue to focus substantial energy on national politics in the coming months, I am eager to bring this site back to the state-level news I am most passionate about covering. So much has happened that I didn’t manage to write during the last couple of months, and new stories are breaking all the time. My writing plans include:

• Iowa campaigns and elections. Thanks to our non-partisan redistricting process, our state is blessed with an unusual number of potentially competitive state legislative districts. Many more close looks at Iowa House and Iowa Senate races are in the works, as well as posts about the Congressional races.

• Legislative and state government news. GOP State Senator David Johnson has just become the first statehouse Republican on record for lawmakers reversing the Branstad administration’s Medicaid privatization. (Johnson knows the policy put "children at risk of losing services" because so few providers have signed contracts with the private insurance companies picked to manage Medicaid.) Criminal justice reform, education funding, and water quality programs are other areas I’ll be following as the legislature continues its work.

• Iowa Congressional voting. Unfortunately, very few votes in the U.S. House or Senate receive any attention in the mainstream media. As I’ve said before, if a member of Congress didn’t brag about it in a press release, conference call, or social media post, Iowans are not likely ever to learn that it happened. Catching up on important votes by our four U.S. representatives and two senators is on my to-do list.

• Significant Iowa court rulings. A post in progress will highly key points from a federal court ruling David Pitt covered for the Associated Press, which determined "Iowa State University administrators violated the constitutional free speech rights of student members of a pro-marijuana group by barring them from using the university logos on T-shirts."

• Throwback Thursday. These looks back at Iowa political history have been so much fun, I wish I’d started writing them years ago. Several more are in the works, including one relating to a 2010 law on access to firearms by people subject to protective orders. Ryan Foley reported yesterday for the Associated Press, "More than a dozen states have strengthened laws over the past two years to keep firearms out of the hands of domestic abusers, a rare area of consensus in the nation’s highly polarized debate over guns." Iowa lawmakers adopted and Governor Chet Culver signed our state’s version of this legislation in 2010—but getting it through the state House and Senate took some heavy lifting.

• Iowa political journalism. Media issues are close to my heart, having been one of my main beats as during my decade as an analyst of Russian politics. How the Iowa media are covering (or not covering) important political news will continue to be an occasional focus at Bleeding Heartland. Some posts will be short, others long.

As always, guest pieces about any subject related to Iowa politics are welcome here. There is no need to clear ideas or content with me ahead of time. Anyone can register for an account, and I approve all non-spam, substantive posts. Bleeding Heartland has no minimum or maximum word length or restrictions on format. Looking through the posts by all guest authors in 2015, you will find a wide variety of topics and writing styles.

I also appreciate tips and story ideas. Readers can contact me at the e-mail address near the lower right corner of this page or through Twitter.

Josh Byrnes not running for re-election in Iowa House district 51

Three-term GOP State Representative Josh Byrnes announced today that he will not seek re-election to the Iowa House. I enclose below the full statement he posted on Facebook, which expressed his "hope that the voters of House District 51 will continue to elect moderate candidates to represent them in Des Moines. The constituents of a district lose when we elect those who are hard line party people."

Byrnes was occasionally out of step with his caucus, having supported marriage equality and voted with Democrats for expanding Medicaid. Rumors of his impending retirement proved wrong during the last election cycle but flared up again in recent months, following his unsuccessful bid to be House speaker and subsequent criticism of excessive partisanship and failure to approve school funding levels on time.

House GOP leaders have resisted compromise on education funding during the past several years, which likely contributed to decisions by three other Republicans not to run for re-election in 2016. Like Byrnes, State Representatives Brian Moore, Quentin Stanerson, and Ron Jorgensen all have worked in the education field.

With Byrnes retiring, House district 51 immediately moves to the top tier of Democratic pickup opportunities in the lower chamber, which the GOP controls with a 57 to 43 majority. President Barack Obama received 55.19 percent of the vote among its residents in 2012. Only two Iowa House districts currently held by Republicans voted to re-elect the president by a larger margin; one of them was House district 58, which Moore is vacating. According to the latest figures from the Iowa Secretary of State’s office, House district 51 contains 5,119 active registered Democrats, 6,074 Republicans, and 8,247 no-party voters. I enclose below a district map.

UPDATE: Tony Krebsbach announced on Facebook today that he will seek the GOP nomination in House district 51. He has served on the Republican Party of Iowa’s State Central Committee and chaired the Mitchell County GOP and is part of the "Liberty" faction, which supported Ron Paul for president.

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Reflection on a Five Year Anniversary

The video of Zach Wahls speaking at that 2011 public hearing went viral and inspired thousands of Iowans who supported equality. Although Zach did not dissuade Iowa House Republicans from approving a state constitutional amendment on marriage the following day, Democrats in control of the Iowa Senate held the line. -promoted by desmoinesdem

Yesterday (January 31) marked the fifth anniversary of a three-minute speech that I delivered to the Iowa Legislature about growing up with gay parents. It was the first time I’ve celebrated an anniversary of this speech knowing that no speech like it will ever have to be given again in this state or country, following the Supreme Court’s 2015 ruling.

I had no idea when I stepped up to that microphone just how much the world would change in the next five years.

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How Iowa political leaders could honor the legacy of Rev. Dr. Martin Luther King, Jr.

When Congress finally passed a bill establishing a federal holiday named after the Rev. Dr. Martin Luther King, Jr. in 1983, national public opinion was split down the middle on whether the civil rights leader should be honored in this way. The holiday is no longer controversial, and members of Congress who voted against it, such as Senator Chuck Grassley, are quick to explain that they admire King’s work. Bleeding Heartland has compiled links related to Dr. King’s legacy and the long slog to establish this national holiday here, here, here, here, here.

I’ve been predicting for months that this year’s legislative session would mostly be a giant waste of many people’s time. I hope Iowa lawmakers and Governor Terry Branstad will prove me wrong by enacting not only the criminal justice reforms Branstad advocated in his Condition of the State speech last week, but also legislation to reduce mandatory minimum sentences, and improve police identification and interrogation procedures as well as police use of body cameras. The NAACP is pushing for a bill to ban racial profiling by law enforcement, which should not be controversial but probably will be a very heavy lift at the Capitol.

Branstad could act unilaterally to reduce one of Iowa’s massive racial disparities by revoking his 2011 executive order that has disenfranchised thousands of people, disproportionately racial minorities. (The procedure the governor established for regaining voting rights is "just about impossible" for felons to navigate.)

Any relevant comments are welcome in this thread. All three Democratic presidential candidates mentioned Dr. King during their opening statements during last night’s debate in South Carolina, and I’ve enclosed the videos and transcript below. I also included the part of the transcript containing Hillary Clinton’s and Bernie Sanders’ remarks on criminal justice reform.

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