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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Who's who in the Iowa Senate for 2016

The Iowa legislature’s 2016 session began on Monday. For the sixth year in a row, the 50 state senators include 26 Democrats and 24 Republicans. Just seven senators are women (six Democrats and a Republican), down from a high of ten women serving in the chamber during 2013 and 2014. All current senators are white. To my knowledge, the only African-American ever to serve in the Iowa Senate was Tom Mann, elected to two terms during the 1980s. No Latino has ever served in the Iowa House or Senate; Nathan Blake fell 18 votes short of becoming the first in 2014. No Asian-American has served in the state Senate since Swati Dandekar resigned in 2011.

I enclose below details on the Iowa Senate majority and minority leadership teams, along with all chairs, vice chairs, and members of standing Senate committees. Little has changed since last year, in contrast to the Iowa House, which saw some big changes in the majority Republican caucus since the legislature adjourned in June.

Term limits are a terrible idea generally but would be especially awful if applied to the Iowa Senate, as the longest-serving current senator bizarrely advocated last year. The experience gap between Democrats and Republicans is striking. As detailed below, only four of the 24 Senate Republicans have ten or more years of experience in the Iowa legislature, compared to seventeen of the 26 Democrats. No current Iowa Senate Republican has more than 20 years legislative experience, whereas six Democrats do.

Some non-political trivia: the 50 Iowa Senate members include three Marks, three Bills, three Richards (who go by Rich, Rick, and Dick), two Mikes, two Toms, two Joes, and two men named Charles (one goes by Chaz).

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Iowa Senate district 26 preview: Mary Jo Wilhelm vs. Waylon Brown

After several months of recruiting efforts, Republicans finally have a candidate willing to run against two-term State Senator Mary Jo Wilhelm in Iowa Senate district 26. This race is among a half-dozen or so contests that will determine control of the upper chamber after the 2016 elections. Since Iowans elected Governor Terry Branstad and a GOP-controlled state House in 2010, the 26 to 24 Democratic majority in the state Senate has spared Iowa from various disastrous policies adopted in states like Kansas, Wisconsin, Michigan, Ohio, and Pennsylvania. Of the senators who make up that one-seat majority caucus, Wilhelm was re-elected by the narrowest margin: 126 votes out of nearly 31,000 cast in 2012.

I enclose below a map of Senate district 26, a review of its voter registration numbers and recent voting history, and background on Wilhelm and challenger Waylon Brown. Cautionary note: although Brown is the establishment’s pick here, he is not guaranteed to win the nomination. "Tea party" candidates won some upset victories in the 2012 Iowa Senate Republican primaries, notably Jane Jech against former State Senator Larry McKibben in Senate district 36 and Dennis Guth against former State Senator James Black in Senate district 4.

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GOP State Representative Josh Byrnes will not run for Iowa Senate district 26

Republican State Representative Josh Byrnes will not run against Democratic State Senator Mary Jo Wilhelm in Iowa Senate district 26 next year. The Iowa House Transportation Committee chair has thrown his hat in the ring to replace Kraig Paulsen as House speaker. Regardless of how the speaker contest goes, Byrnes confirmed to Bleeding Heartland, "I am not running for Senate."

The news will lift Democratic spirits, as Byrnes would have been the obvious GOP recruit for this competitive Senate district. Democrats hold a 26 to 24 majority in the upper chamber, and Republicans will almost certainly target Wilhelm next year.

First elected to the upper chamber in 2008, the former Howard County supervisor was the Iowa Senate incumbent re-elected by the narrowest margin in 2012. Redistricting pitted Wilhelm against GOP State Senator Merlin “Build my fence” Bartz, whom she defeated by just 126 votes in a district where Barack Obama carried 55.6 percent of the vote.

Meanwhile, Byrnes was re-elected to the Iowa House by more than 4,000 votes in 2012, even as Obama carried 55.2 percent of the vote in House district 51. Only two other Republican-held House seats went to Obama by a larger margin: House district 91 (Muscatine area) and House district 58 (Maquoketa). Byrnes easily won re-election in 2014 as well. He disagrees with his more conservative House colleagues on some high-profile issues, giving him potentially strong crossover appeal.

I haven’t heard of any other Republicans taking a close look at Senate district 26. I encourage Bleeding Heartland readers who know differently to contact me. Since December 2012, Bartz has run Representative Steve King’s district office in Mason City. I will be surprised if he runs for the Iowa Senate again.

Senate district 26 includes all of Worth, Mitchell, Floyd, Howard and Chickasaw counties, part of Cerro Gordo County (but not Mason City or Clear Lake) and part of Winneshiek County (but not Decorah). A detailed map is after the jump. According to the latest figures from the Iowa Secretary of State’s office, Senate district 26 contains 11,202 active registered Democrats, 11,101 Republicans, and 16,899 no-party voters.

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Iowa Senate, House approve gas tax increase

A bill that would raise Iowa’s gasoline tax by 10 cents a gallon is on its way to Governor Terry Branstad’s desk after approval today by both chambers in the Iowa legislature. The Iowa Senate passed Senate File 257 this morning by 28 votes to 21. Sixteen Democrats and twelve Republicans voted for the bill, while ten Democrats and eleven Republicans opposed it. Senate Majority Leader Mike Gronstal had reportedly insisted on at least half the GOP caucus supporting a gas tax increase as a condition for bringing the bill to the floor.

A few hours later, the Iowa House took up the Senate bill (rather than the bill that cleared two House committees last week). Thirty Republicans and 23 Democrats voted yes, while 26 Republicans and 20 Democrats voted no.

Only two state legislators missed today’s votes: Republican State Senator Mark Chelgren and Republican State Representative Chip Baltimore. Baltimore voted against the House version of this bill in committee last week, while Chelgren doesn’t serve on the committees that approved the bill in the Senate. Chelgren appears to have been absent for all of today’s votes, while Baltimore was at the Capitol but left the chamber when the gas tax bill came up. Speaking to reporters later, he tried to make a virtue out of his absence: “I refuse to legitimize either the bill or the process with a vote.” Weak sauce from a guy who is widely expected to seek higher office someday.

Conservative groups are urging Branstad to veto Senate File 257, but that seems unlikely, given the governor’s recent comments on road funding. Branstad’s spokesman said today that the governor will carefully review the final bill before deciding whether to sign it.  

After the jump I’ve enclosed the roll call votes in both chambers, as well as Senate Transportation Committee Chair Tod Bowman’s opening remarks this morning, which summarize key points in Senate File 257.

Final note: several of the “no” votes came from lawmakers who may face competitive re-election campaigns in 2016. Those include Democrats Chris Brase (Senate district 46), Steve Sodders (Senate district 36), and Mary Jo Wilhelm (Senate district 26), and Republicans Dennis Guth (Senate district 4) and Amy Sinclair (Senate district 14).

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IA-01 Democratic candidate news roundup

Another Democrat is moving closer to a Congressional bid in Iowa’s first district. The Daily Iowan reported several days ago that Ravi Patel "is assembling campaign operatives and meeting with influential donors in Eastern Iowa in preparation for the run." He is best known as principal and president of Hawkeye Hotels, a fast-growing company his parents established. Pat Rynard wrote on the Iowa Starting Line blog that Patel "has built connections from holding many fundraisers for Democratic candidates" and is "an entrepreneur involved in many startup businesses."

If he runs for Congress, Patel told the Daily Iowan that his campaign “would be data-driven and heavy on social media.” His biggest potential weakness would probably be his youth (current age: 29). Iowans have nominated some young candidates who faced competitive primaries against more experienced rivals, most recently Ben Lange, the GOP’s 2012 nominee in IA-01. But despite a lot of excitement on social media, State Representative Anesa Kajtazovic didn’t make much headway with IA-01 Democratic voters, finishing fourth in the 2014 primary. Anecdotally, many Democrats liked Kajtazovic but questioned whether she had enough experience for the job she was seeking. Patel would also be competing against others who have more longstanding ties to the district. Although he owns a home in Cedar Rapids now, he has spent most of his life in either Burlington or Iowa City, which are located in the second Congressional district.

The front-runner in the Democratic primary remains Cedar Rapids City Council member Monica Vernon, who last week added her first labor union endorsement to the long list of sate legislators backing her second bid for Congress. After the jump I’ve posted the press release announcing the Teamsters Local 238 endorsement of Vernon. That local did not endorse in the 2014 primary to represent IA-01, but two other Teamsters locals backed the eventual winner Pat Murphy. Note: the press release mentions that Teamsters Local 238 has approximately 6,000 members. A representative for the union told me that between 2,000 and 2,500 of those members live in the IA-01 counties.

Other Democrats considering a bid in IA-01 include former Governor Chet Culver, former State Senator Swati Dandekar (who placed third in the 2014 primary), and former Saturday Night Live actor Gary Kroeger. His most recent blog post, which I’ve excerpted below, takes a quick look at the history of America’s major political parties with a view to reducing the “vitriol in our disagreements.” Kroeger posted today on Facebook that if elected to Congress, he would push for creating a national jobs program inspired by a non-profit foundation he profiled at his blog a couple of years ago.

Any comments about the IA-01 race are welcome in this thread. Republican blogger Craig Robinson pointed out recently that GOP incumbent Rod Blum will benefit tremendously from having U.S. Senator Chuck Grassley on the ballot in 2016.

It’s also worth noting that at least three and perhaps as many as six battleground Iowa Senate races will be located within IA-01 next year. State Senator Jeff Danielson will seek a fourth term in Senate district 30, covering parts of Waterloo and Cedar Falls; he faced well-funded challengers in his last two re-election campaigns. State Senator Mary Jo Wilhelm won by just 126 votes in Senate district 26 in 2012. I expect the GOP to target that district, half of which is in IA-01 and half in IA-04. Republicans are less likely to mount a serious challenge against either State Senator Liz Mathis in Senate district 34 or State Senator Brian Schoenjahn in Senate district 32, but a surprise retirement would instantly make either of those races competitive. Meanwhile, Democrats are likely to target Senate district 28, where GOP State Senator Mike Breitbach won by only 17 votes in 2012. First-term Senator Dan Zumbach could also face a serious challenger in Senate district 48. After the jump I’ve posted a map showing all the Iowa Senate district lines. UPDATE: Perhaps I should also have mentioned Democratic State Senator Steve Sodders (SD-36) and Republican Tim Kapucian (SD-38), who will be up for re-election in 2016 as well in counties that are part of IA-01. I haven’t heard of potentially strong challengers in either Iowa Senate district, but that could change before next spring.

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