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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Iowa Senate district 16: Nate Boulton raised more money in four months than Dick Dearden did in seven years

When Nate Boulton announced his Iowa Senate campaign in September, he subtly indicated he would be a different kind of legislator than State Senator Dick Dearden, the longtime Democratic incumbent who is retiring this year. Boulton promised to "be an active and engaged representative of district interests" and to "bring bold progressive ideas and a fresh, energetic style of leadership to the Iowa Senate."

Just a few months into his primary race against Pam Dearden Conner, the retiring senator’s daughter, Boulton sent a strong signal that he will be a more "active and engaged" candidate as well. Campaign finance disclosure forms show that Boulton raised $75,383 during the last four months of the year, a phenomenal total for a non-incumbent, first-time state legislative candidate in Iowa. Not only did Boulton out-raise his primary rival, he raised more than Dearden (a 22-year incumbent) has brought in cumulatively since 2008.

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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.

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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Weekend open thread: "Making a Murderer" edition

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

The more I hear about "Making a Murderer," the more tempted I am to become a Netflix subscriber so I can watch the ten-part documentary myself. The series follows the case of Steven Avery, released from prison after 18 years when DNA evidence showed he was innocent of the rape for which he had been convicted. A few years later, Avery and his teenage nephew Brendan Dassey were charged and convicted of murdering Teresa Halbach. The documentary suggests that Avery and Dassey, who are both serving life sentences, did not kill Halbach and did not receive fair trials.

Lee Rood has a front-page feature in today’s Des Moines Register about how problems highlighted in "Making a Murderer" point to the need for criminal justice reforms in Iowa, such as "uniform best practices for eyewitnesses and the mandatory recording of law enforcement interrogations." I’ve enclosed excerpts after the jump, but I strongly recommend clicking through to read her whole story.

Avery’s wrongful conviction for rape rested primarily on eyewitness testimony. The latest edition of the New Yorker contains an excellent piece by Paul Kix on how a similar "travesty led to criminal-justice innovation in Texas." Passages enclosed below cite Iowa State University Psychology Professor Gary Wells, who "has spent decades researching ways in which police lineups can be made more accurate." Wells testified at a hearing seeking to exonerate a man who had died in prison, serving time for a rape he did not commit. Some of Wells’ recommendations for improving police identification practices were incorporated into a Texas law.

Those measures are different from the reforms an Iowa working group proposed and Governor Terry Branstad endorsed in his speech to state lawmakers this week. But with statehouse Republicans and Democrats deeply divided over education spending, Medicaid privatization, and Planned Parenthood funding, criminal justice reform may provide a rare opportunity for bipartisan cooperation this year. I hope members of the Iowa House and Senate who applauded Branstad’s call to reduce racial disparities will also consider some of the steps Texas has taken to prevent wrongful convictions.

Speaking recently to the Marshall Project, the rape survivor whose mistaken eyewitness testimony sent Avery to prison during the 1980s recounted how seeing a picture of her real attacker doesn’t stir up any emotion for her. In contrast, she says, "I still see Steven Avery as my assailant even though I understand he wasn’t." I have read other accounts of traumatic memories being altered so that misremembered details evoke panic and terror. The way trauma affects the mind and body and the malleability of traumatic memories are major themes in Dr. Peter Levine’s latest book Trauma and Memory. I hadn’t heard of the book until I received a copy from a friend who found Levine’s approach to healing trauma life-changing.

A videotaped confession by Avery’s "low-functioning" nephew became a key part of the prosecution’s case in the trial that is the focus of "Making a Murderer." Des Moines defense attorney Gary Dickey told Rood, "Set aside Avery’s innocence or guilt, the most striking thing of the whole series is the clearly coerced confession of Brendan Dassey." It is surprisingly easy to manipulate a person to admit doing things that never happened, as shown by the New York Police Department’s ability to obtain false confessions from five teenagers accused of assaulting the "Central Park jogger" during the 1980s. Discussing that notorious crime, Saul Kassin, Psychology Professor at the John Jay College of Criminal Justice and Williams College, pointed out that "in some cases people accused of crimes, particularly kids and others who are limited intellectually, become so confused by the lies that they actually come to believe they have committed this crime they did not commit."

A chapter in Trauma and Memory focuses on "the pitfall of false memory," such as when therapists (either unscrupulous or well-meaning) induce patients to believe wrongly that they suffered ritual or sexual abuse as children. At the end of this post, I enclose a passage from Levine’s book addressing "malevolent police interrogation methods" used to implant inaccurate memories and thereby obtain false confessions or wrongful convictions.

Among other things, the final installment of "Making a Murderer" covers a post-script to the Avery case: the downfall of District Attorney Ken Kratz, who prosecuted Avery and Dassey. Ryan Foley, an Associated Press correspondent in Iowa, was working for the AP in Wisconsin when he reported that Kratz "sent repeated text messages trying to spark an affair with a domestic abuse victim while he was prosecuting her ex-boyfriend." Kratz lost his job over that despicable abuse of power, which he later blamed on mental health conditions and prescription drug dependence. All journalism students should listen to Foley’s interview with Kratz before the story appeared, a fascinating example of a newsmaker trying to intimidate a reporter. In quite a show of interrogation techniques, the DA warned that a "hatchet story" on his inappropriate behavior would reveal the journalist to be a "tool" for someone else’s political agenda. Kratz modulated his voice frequently—lecturing, mocking, shouting, even whispering—hoping to throw Foley off balance and trick him into revealing his sources.

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