Never let it be said that the 2016 Iowa legislature accomplished nothing

In four months of work this year, Iowa lawmakers made no progress on improving water quality or expanding conservation programs, funded K-12 schools and higher education below levels needed to keep up with inflation, failed to increase the minimum wage or address wage theft, let most criminal justice reform proposals die in committee, didn’t approve adequate oversight for the newly-privatized Medicaid program, opted against making medical cannabis more available to sick and suffering Iowans, and left unaddressed several other issues that affect thousands of constituents.

But let the record reflect that bipartisan majorities in the Iowa House and Senate acted decisively to solve a non-existent problem. At a bill-signing ceremony yesterday, Governor Terry Branstad and supporters celebrated preventing something that probably never would have happened.

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Iowa Democrats trying to add autism insurance coverage to budget bill

Earlier this month, Claire Celsi informed Bleeding Heartland readers about the demise of an autism insurance bill after State Representative Peter Cownie refused to bring the measure up for a vote in the Iowa House Commerce Committee, which he chairs.

As both Autism Awareness Month and the 2016 legislative session wind down, Democrats in the Iowa House and Senate have been working to add the same requirements to a must-pass budget bill. Follow me after the jump for background and where things stand in this fight.

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Weekend open thread: Ted Cruz delegate domination edition

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

Newly-disclosed details about the sex abuse charges filed against former U.S. House Speaker Dennis Hastert caught my attention. As Talking Points Memo’s Josh Marshall explained here, "Without the unending hunt into Bill Clinton’s sex life, you never would have heard of Denny Hastert. It also seems highly unlikely he ever would have had to answer, even in this limited way, for his own past." While the Monica Lewinsky scandal unfolded, I was covering Russian politics and had many Russian colleagues. They were astounded by the Republican effort to remove Clinton from office. I remember some joking, if only our president (the rarely-seen-in-public Boris Yeltsin) were healthy enough to have an affair.

The big Iowa politics news of the weekend came out of the GOP district conventions on Saturday. Repeating a storyline that has played out elsewhere, Ted Cruz’s campaign destroyed the competition with superior organizing in every part of the state. Cruz didn’t entirely shut out other candidates here the way he did in Colorado, but his supporters took eleven of the twelve Republican National Convention delegate slots. Although Donald Trump has belatedly started to build a serious RNC delegate strategy, his campaign’s efforts leading up to this weekend in Iowa were remarkably incompetent. Cruz’s team have been preparing for a prolonged delegate battle since last summer and have executed the strategy well lately.

Trump still hits the magic number of 1,237 delegates (an overall majority) in most of the scenarios guest author fladem played out this week (most recently updated here). Sam Wang showed at the Princeton Election Consortium that current polling still indicates Trump could clinch the nomination on June 7—though Cruz has been over performing his poll numbers lately, which increases the chance of a brokered convention. The Cruz sweep of Colorado delegates and near-sweep of Iowa’s GOP district conventions are a reminder that the first ballot at the RNC in Cleveland may be Trump’s only chance for the nomination.

More links and commentary about the district conventions are after the jump.

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Medicaid oversight bill passes Iowa Senate with bipartisan support

Since Terry Branstad returned to the governor’s office, the overwhelming majority of Iowa Senate votes on contentious political issues have fallen along strict party lines: 26 Democrats one way and 24 Republicans the opposite. However, the Branstad administration’s rush to privatize Medicaid has created space for bipartisanship, as a growing number of Republicans acknowledge the dangers of shifting to managed care for a program through which one in six Iowans access health services.

Last month, three GOP senators joined their Democratic colleagues to vote for a bill that would have halted Iowa’s Medicaid privatization. That legislation is going nowhere in the Republican-controlled state House, and federal officials recently approved waivers to allow the Iowa Department of Human Services to implement the managed care policy as of April 1.

Yesterday a quarter of the GOP state senators voted with all 26 Democrats for a Medicaid oversight bill that had cleared the Senate Human Resources Committee unanimously. In her remarks to open floor debate on Senate File 2213, Human Resources Committee Chair Amanda Ragan said the bill was designed "to safeguard the interests of Medicaid members, encourage the participation of Medicaid providers, and protect Iowa taxpayers." She told colleagues, "we must require DHS and the managed care companies to protect consumers, preserve provider networks, address the unique needs of children and assure accountability."

I enclose below highlights from the debate on SF 2213, the roll call on final passage, and Ragan’s full remarks, along with a Democratic staff analysis summarizing the bill’s key points.

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Will any elected Iowa Republicans vow to #NeverTrump?

In an effort to halt Donald Trump’s momentum and also to preserve some self-respect, a growing number of Republicans are vowing never to vote for Trump, even if he becomes the GOP presidential nominee. As Megan McArdle reported for Bloomberg, the #NeverTrump faction represents "all segments of the party — urban professionals, yes, but also stalwart evangelicals, neoconservatives, libertarians, Tea Partiers, the whole patchwork of ideological groups of which the Republican coalition is made."

Former New Jersey Governor Christine Todd Whitman said she would consider voting for Hillary Clinton over Trump. At a funeral in Des Moines this past weekend, the daughter of the deceased (like Whitman a moderate Republican) struck a chord with some of the mourners when she joked during her eulogy that she was a little envious her mother would not have to vote in the presidential election now.

At the other end of the GOP ideological spectrum, staunch conservative U.S. Senator Ben Sasse of Nebraska became the first member of Congress to take the #NeverTrump pledge, laying out his reasoning in a long Facebook post.

So far, the most prominent Iowa Republican to join the #NeverTrump camp is right-wing talk radio host Steve Deace, who explained his stance in a column for the Conservative Review website. Deace worked hard to persuade fellow Iowans to caucus for Ted Cruz. Meanwhile, Marco Rubio endorser and former Waukee City Council member Isaiah McGee described himself to me as a "founding member" of #NeverTrump.

Early signs suggest that few, if any, elected GOP officials in Iowa will join the club.

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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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