Governor Kim Reynolds made a strategic error by not distinguishing herself from her predecessor in any meaningful way, judging by the new Iowa poll by Selzer & Co for the Des Moines Register and Mediacom.

Changing course on even one high-profile policy could have demonstrated strong critical thinking and leadership skills. Instead, Reynolds is in effect running for a seventh Terry Branstad term. Unfortunately for her, Iowans are inclined to think it’s “time for someone new” in the governor’s office.

The Selzer poll indicates that Reynolds is relatively well-liked. Some 44 percent of Iowa adults surveyed have a favorable opinion of her (33 percent unfavorable). Some 51 percent of respondents approve of the job she is doing; 30 percent disapprove and 19 percent are not sure.

Yet just 35 percent said they would vote for Reynolds if the gubernatorial election were held today, while 49 percent said “it’s time for someone new.”

That number should ring alarm bells at Terrace Hill. Brianne Pfannenstiel noted in her write-up of the findings,

Those who want a new occupant at Terrace Hill include 77 percent of Democrats, 51 percent of independents and 18 percent of Republicans.

Although Reynolds is the state’s first female governor, women are more likely than men to say they prefer someone new in office, 53 percent to 46 percent. And in each congressional district, more Iowans say it’s time for someone new than say they’d vote for Reynolds. […]

In comparison, an Iowa Poll in September 2009 asked respondents whether they would vote for then-Gov. Chet Culver or an alternative. Forty-eight percent said they would definitely vote for an alternative or consider doing so. In November 2010, Culver, a Democrat, lost his re-election bid to Branstad, previously a four-term governor, by nearly 10 percentage points.

Three missed opportunities for Reynolds come to mind.

MEDICAID

Branstad’s rush to privatize Medicaid was one of the worst decisions he made in more than two decades as governor. The state was supposed to save money and gain predictability on spending, but the Iowa Department of Human Resources has repeatedly agreed to transfer more funds to the private insurance companies–most recently, another $60 million from the state.

Medicaid recipients are not getting better health care–on the contrary, many people with disabilities have had managed-care providers refuse to cover in-home care or critical services they had received for years. Nor are they enjoying more choices. One of the three companies selected to manage Medicaid in Iowa quit the program this fall, and most of its covered patients had no choice but to switch to UnitedHealthcare.

Privatization has been terrible for service providers. Some companies have laid off staff or gone out of business because of untimely Medicaid reimbursements. Iowa hospitals are often not getting paid for services provided to people who walk into emergency rooms, because the managed-care companies classify those visits as “observation stays” rather than hospital admissions.

Some Republican lawmakers are rumored to be ready to pull the plug. GOP State Senator Thomas Greene, a retired pharmacist, said so out loud at a southeast Iowa legislative forum last weekend. Elizabeth Meyer reported for the Hawk Eye,

“When this was bought forward by (former) Gov. Branstad a year-and-a-half ago, I was cautiously optimistic that it would work,” said Greene. “It has not. I do not have one provider in southeast Iowa that has said this has been a positive measure.”

Greene said he has talked with Gov. Kim Reynolds and her health care advisers about the failed initiative and told them if improvements in Medicaid operations “were not dramatically moving forward” in two months, he would work toward moving the system back under state control.

Although more than a half-million Iowans are on Medicaid, Reynolds didn’t mention the program in her first speech after being sworn in as governor. Admitting that privatization hasn’t worked would have been good policy and smart politics. Reynolds could have proved she is not beholden to ideology and listens to feedback from patients and health care providers. Instead, she agreed to throw more good money after bad following months of secret negotiations with the private insurance companies.

Last month, the DHS hired the former director of Kansas Medicaid–where privatization was disastrous for thousands–to oversee the program here. What could go wrong?

When challenged about Medicaid privatization, Reynolds sounds defensive and inflexible. Rod Boshart reported on her November 28 press conference:

“It’s not perfect. I’ve never said it was perfect,” the GOP governor told reporters during her weekly news conference. “I’m willing to put the time and the effort into making sure that Iowans get the care that they deserve in a managed and coordinated and more modern delivery system. I’m not going back.”

Appearing on Iowa Public Television’s “Iowa Press” program December 1, Reynolds took umbrage at Kathie Obradovich’s suggestion that managed Medicaid is “imploding.”

Reynolds: Well, no it’s not imploding. We’re just into our second year. This is a big shift from what we did before. We need to modernize the way that we deliver quality care to some of the most vulnerable Iowans in our state. And the problem with fee for service is it wasn’t sustainable. We had seen growth on an average of 10.7% over the last ten years, that’s not sustainable. 39 other states are providing managed care, over 52 million Iowans across this nation are receiving or are participating in managed care.

Obradovich: But one of the big selling points was people would have a choice, they would have a choice of providers and they don’t have a choice now.

Reynolds: Well, it’s temporary. They will have a choice and we have indicated that. I’m really proud of the work that Director Foxhoven with the Department of Human Services has done in putting together him and his team, putting together a transition plan, they’re monitoring it very, very closely, they’re working with our managed care providers. United has done a really good job of really stepping up. I’m very appreciative of that. AmericGroup has indicated right now they don’t have the capacity but they’re working to get the capacity so this is a temporary shift. It’s not unusual, we’re not the only state that has had providers step out, Kentucky, Minnesota have had that happen. It’s kind of part of the process. But we’re focused on really providing continuity of care, to really minimizing the disruption that some of our most vulnerable Iowans are experiencing and that’s what we’re focused on and that’s what we’re going to do. […]

Reality check from a Republican state senator: “I do not have one provider in southeast Iowa that has said this has been a positive measure.”

MENTAL HEALTH CARE

Iowa “ranks among the worst states in the nation” for treatment of mental illnesses: “47th in psychiatrists, 44th in mental health workforce availability and 51st (including the District of Columbia) in the ratio of state psychiatric beds to residents.” Several Democratic candidates for governor routinely bring up this problem in their stump speeches. It was a recurring theme at the Iowa Democratic Party’s big event last month. Branstad closed two of Iowa’s in-patient mental health care facilities, over the objections of state lawmakers.

Reynolds didn’t mention mental health care in her first speech as governor and hasn’t done anything concrete to show this issue will be a priority for her. A nationally-recognized community care facility closed in Centerville this fall because the DHS couldn’t get its act together to issue rules that would have allowed mental crisis centers to bill Medicaid. (The agency finally set up a billing arrangement a few weeks too late.)

During her “Iowa Press” appearance on December 1, Reynolds put a positive spin on recent developments.

Obradovich: There is a growing conversation in Iowa, especially this fall, around the issue of mental health in Iowa and especially major gaps in Iowa’s services. The state went through the redesign. But there are services that just really aren’t available in Iowa and the Register is going to be having a forum next week, unfortunately you aren’t able to be there. But what is your plan? What is your priority when it comes to mental health?

Reynolds: Well, first of all, I think we have made progress over the last several years. If you look at, we did have 99 counties, it was a very disparate service, it really depended on where you lived, what kind of access you had to even core services. So to change that from 99 counties to 14 was a step in the right direction. Now, every single Iowan no matter where they live have access to the same core services. The other thing that we’ve seen happening is that not only do they have the core services but they’re really implementing core plus services, jail diversion programs, a 24/7 hotline and we’ve seen it has tripled and quadrupled the number of counties that offer that and we want to continue to build on that. We have 150,000 Iowans today that have coverage that didn’t have it before. So they have access to mental health care. There’s still areas and gaps and working with Director Foxhoven —

Obradovich: So what is the priority for those gaps?

Reynolds: So we’re working, there is a task force that is going to report to us in December, especially with child mental health issues. I think coordinating the system better. We still need to move in that direction. We are dead last in psychiatrists. We put funding, $4 million, into a psychiatrist residency program. We’re actually going to have three of the hospitals start that next year and that will be an average of ten residency programs —

That’s master-class chutzpah for Reynolds to take credit for 150,000 Iowans who “have coverage that didn’t have it before.” They got their newfound “access to mental health care” thanks to the Affordable Care Act’s Medicaid expansion. Meanwhile, the governor has repeatedly called on Congress to repeal the 2010 federal health care reform law, saying “Obamacare is unsustainable, unworkable, unaffordable.”

Due to a previously planned vacation, Reynolds was a no-show at the Des Moines Register’s December 5 forum for gubernatorial candidates to talk about mental health. Her prepared statement was strangely upbeat.

In a video statement, Reynolds highlighted the state’s efforts to expand access to jail diversion programs as well as its efforts to provide a regional approach to mental health services.

“My administration has taken a number of steps to address the critical mental health needs in our state,” she said. “Today, Iowa’s mental health system is serving more Iowans in more modern ways with better services and more local home and community settings than ever before.”

Who does Reynolds think she is fooling here? Iowans know the system isn’t working.

CORPORATE TAX GIVEAWAYS

Reynolds is continuing the hallmark of Branstad’s economic development strategy: generous handouts for companies promising to create a small number of permanent jobs. In August, she touted $20 million in state tax incentives for the Apple corporation to build data centers in Waukee, bragging at press conference with with Apple’s CEO,

“This puts Iowa on the world stage,” Reynolds said. “This gives us an opportunity with a global company like Apple to say ‘we are the place to be, this is where your business should locate.'”

Asked if cash-strapped Iowa could afford to hand over that much in new tax breaks, Reynolds pointed to the optics of landing one of the world’s most ubiquitous companies.

“This is Apple,” she told reporters. “They chose Iowa.”

Even some Republicans questioned whether the state was getting good value for its money. Every Democrat running for governor criticized the Apple deal in some way, and the re-tread Reynolds policy is the theme of Fred Hubbell’s third statewide television commercial, “Show.”

My transcript:

Clip from KCCI-TV report by Hannah Hilyard: The state of Iowa is offering Apple 20 million dollars in tax credits. Not everyone is buying it. [Viewer sees footage of tv reporter, then words on screen from an August 30 Des Moines Register editorial, “APPLE PLAYED IOWA FOR SUCKERS,” then Reynolds and acting Lieutenant Governor Adam Gregg walking with Apple’s CEO]

Hubbell speaks to the camera: We’ve seen this show before, giveaways to out-of-state companies that don’t need them. [words near bottom of screen: Fred Hubbell Democrat for Governor]

Hubbell’s voice continues: I came in and helped clean up the film tax credit scandal. [footage of Hubbell as interim head of the Iowa Department of Economic Development during the Culver administration, words from a Quad-City Times report on February 2010, “Charges filed in Iowa film tax credit scandal”]

Now this governor is taking money we don’t have [viewer sees footage of Reynolds smiling and speaking at the August press conference, while Gregg and Apple’s CEO look on]

and giving it to one of the world’s richest companies that doesn’t need it. [viewer sees a quote from an August 25 WHO-TV story on screen: “Hubbell says Apple deal was bad negotiating by Reynolds administration“]

Hubbell speaks to camera again: I helped put an end to these taxpayer giveaways once, and I’ll do it again. It’s time we start growing Iowa the right way. [Fred Hubbell’s name and campaign logo appear on screen]

I expect this ad to resonate. The communities where most Iowans live are not nearly as prosperous as the booming Des Moines suburb that will benefit from Apple’s huge construction project. Hubbell has framed a proud moment for Reynolds as a foolish one (“played Iowa for suckers,” “taking money we don’t have and giving it to one of the world’s richest companies”).

FINAL THOUGHTS

The Selzer survey of 802 Iowans between December 3 and December 6 (margin of error plus or minus 3.5 percent) had some good news for the governor. Her job approval and favorability numbers are in positive territory. She has far higher name recognition than any of her opponents. Only 23 percent of Iowans aren’t sure what they think of Reynolds, while 59 percent are unsure about her main Republican challenger Ron Corbett.

Republican consultant David Kochel, whose firm has done work for the Reynolds campaign, tweeted Saturday night, “This is a very solid poll for @KimReynoldsIA and anyone without a campaign agenda knows it. Dems in deep trouble with basically no candidate with any real definition.” Five Democratic candidates had favorability ratings from 18 percent for Cathy Glasson and John Norris to 21 percent for Nate Boulton to 26 percent for Andy McGuire and 27 percent for Hubbell. Some 57 percent of respondents were unsure about Hubbell after six weeks of statewide television commercials. The other Democratic candidates had “unsure” numbers from 63 percent for McGuire to 70 percent for Glasson. (The poll does not appear to have asked Iowans about Jon Neiderbach or Ross Wilburn.)

Still, Reynolds supporters must have hoped more than 35 percent would be willing to vote for the governor if the election were held today. For half of respondents to say “time for someone new,” knowing little about the other options, suggests that Reynolds should have found a way by now to be more than Branstad redux.