Former State Representative Rod Roberts had no experience in staff management or regulation when Governor Terry Branstad picked him to head the Iowa Department of Inspections and Appeals. In fact, Roberts admitted that he hadn’t applied for the position Branstad offered him in early November.

It didn’t take long for Roberts to figure out how to please his boss, who had complained last year about nursing home inspectors’ “gotcha attitude.” The Des Moines Register’s Clark Kauffman reports today,

The Iowa Department of Inspections and Appeals will now have 28, rather than 38, inspectors to monitor the care received by 30,000 residents in the state’s 442 nursing homes.

The reduction comes five months after state officials warned the federal government that a shortage of inspectors had already put Iowa at risk of failing to meet minimum federal standards for overseeing nursing homes.

The cuts will result in annual savings of $125,000 in state salaries. The 10 inspectors were paid a total of about $500,000, but 75 percent of that was paid by the federal government.

“That just shows you that this isn’t about saving money,” said John Tapscott, a former state legislator who now advocates for the elderly.

“This has to do with the fact that the nursing home industry wants less oversight,” he said. “How much clearer can it be that the governor is a pawn of the industry?”

I encourage you to click through and read Kauffman’s whole story. Roberts was a natural pick to pursue the more “collaborative” approach Branstad desires, because he and his wife have direct ties to regulated nursing homes. Roberts also spent a decade serving in the Iowa legislature, where the assisted living industry usually gets what it wants.

Branstad’s record on nursing home regulations was dismal during his previous four terms as governor, and even in recent years inspectors have found it hard to enforce rules for care facilities.  A 2009 Government Accountability Office report described disturbing pressure on Iowa nursing home inspectors (see the references to “State A” on pages 40 through 42 of the GAO report). Reducing the number of inspectors will increase the chance for negligence or maltreatment of residents to go unnoticed and/or unpunished. I would hesitate to move a loved one to an Iowa assisted living facility unless I were able to visit frequently and keep a close eye on conditions.

Given our state’s aging population, Iowa politicians should be demanding more oversight of care facilities. Nearly 15 percent of Iowa residents (roughly 445,000 people) are over the age of 65.  

President Barack Obama presented his $3.73 trillion budget proposal for fiscal year 2012 yesterday. I had a post in progress highlighting some good ideas from the proposal, like more investments in high-speed rail and clean energy programs, and reducing taxpayer subsidies for the oil and gas industries. There are bad ideas too, such as a pathetically small “cut” of $78 billion for defense spending over 10 years. The word “cut” misleads here because we’re talking about a slightly smaller rate of growth for the defense budget. Our military spending skyrocketed during the last decade and should be reduced substantially if Washington officials are serious about reducing the deficit.

The moral failure of Obama’s budget becomes clear when you look at the $400 billion in cuts he proposes for non-defense discretionary spending (which is half as large a portion of the budget pie as the military). Many of those cuts will hurt the vulnerable: less money for the Low Income Home Energy Assistance Program and some student aid programs, to name a couple of egregious examples. Obama also wants a “bipartisan” conversation about “strengthening” Social Security, and Washington bipartisanship on Social Security is sure to harm working people and future retirees.

Since the Republican-controlled House of Representatives won’t enact the president’s spending plans, the budget document is important mainly as a sign of Obama’s priorities and political calculations going into this year’s negotiations with Congress.

Speaking of political calculations, I was struck by Representative Bruce Braley’s statement on the president’s draft budget document–so much that I shifted gears on this post. Braley’s comments were another sign of a noticeable change in tone since he won a third term in Iowa’s first Congressional district. During the last Congress, Braley’s policy statements often emphasized the importance of public investments. In the past two months, he has he put deficit hawkishness front and center. Several examples are after the jump, along with background putting Braley’s new rhetorical style in political context.

Iowa's county election officials (the county auditors) oppose a bill that has already passed the Iowa House. The bill would require voters to show a photo ID before voting. Absentee voters would have to photocopy their ID and mail it in with the ballot (Think for a moment how that would help the auditor know if the person in the photo matches the person who mailed the ballot).

Republicans dominate both the House and the auditors group. The sixty House Republicans voted unanimously for the bill three weeks ago. According to the Register, not a single auditor endorses it. Meeting last week, the Iowa auditors decided to register their group in opposition to the bill.  

Secretary Schultz said the bill, HF 95, should be passed to prevent people from impersonating someone else at the poll. Auditors said they had never heard of such a thing happening.

This is the second time the group has rebuked the new Secretary of State. Last summer a large faction of the auditors endorsed Schultz's opponent, an unusual step for these generally tight-lipped officials. Even Schultz's home county auditor, Republican Marilyn Jo Drake, endorsed the incumbent Mike Mauro.

Other groups that have registered against the bill include the ACLU, AARP, the Governor's Developmental Disabilities Council, the Methodist Church, and Iowa Citizens for Community Improvement. Backing the bill are the Farm Bureau, the Iowa Minutemen, and the Iowa Faith and Freedom Coalition.

 cross posted from IowaVoters.org

The House of Representatives passed an extension of three PATRIOT Act provisions yesterday by a vote of 275 to 144. The roll call shows that Republicans Tom Latham (IA-04) and Steve King (IA-05) voted for the bill, as did all but 27 members of their caucus. Leonard Boswell (IA-03) was among 65 Democrats voting for the extensions, while Bruce Braley (IA-01) and Dave Loebsack (IA-02) voted with the majority of the Democratic caucus against the bill.

Iowa’s representatives voted the same way last week when a similar measure failed to win the two-thirds majority needed for passage under special House rules.

Open Congress summarized the bill as follows:

Extends three provisions of the USA PATRIOT Act that are set to expire on February, 28, 2011. They include the authority for “roving” wiretaps that allows the government to monitor computers that may occasionally be used by suspected terrorists, the “tangible records provision” that requires banks, telecoms and libraries to hand over any customer information the government requests without informing the customer, and the “lone wolf” provision allowing the government to track international terrorist groups. These would be extended straight up — i.e. no reforms — and would expire again under the bill on December 8, 2011.

According to the Washington Post, senators “are debating three competing proposals that would either permanently extend the [PATRIOT Act] provisions or extend them through 2013.”

UPDATE: The U.S. Senate approved a three-month extension for controversial PATRIOT Act provisions on February 15 by a vote of 86 to 12. Senator Chuck Grassley voted yes, as did all but two of his Republican colleagues. Senator Tom Harkin was among ten members of the Democratic caucus to vote no (roll call). Harkin’s office did not issue a statement on this vote and did not respond to my request for comment, so I don’t know whether he is against all efforts to extend those controversial PATRIOT Act provisions, or whether he would support Senator Pat Leahy’s bill to extend the provisions through 2013with “additional safeguards to the act which would provide for increased oversight of U.S. Intelligence gathering tools.” Grassley has introduced a rival Senate bill that would permanently extend the government surveillance powers.  

I’m late getting my calendar up this week. As always, please post a comment or send me an e-mail if you know of a public event worth mentioning here.

Various advocacy organizations continue to hold lobby days at the state capitol as the first “funnel” deadline for legislation approaches. The Department of Natural Resources is holding public meetings around the state this month to discuss air and water quality issues. Also, the sixth annual Iowa Governors Conference on LGBTQ Youth takes place on February 24. Details on those events and more are after the jump.

I drew this map upon release of the new Census data for Iowa.  I paid no attention to partisanship and tried to correlate each district with a geographical area of the state.  Starting with Des Moines, I drew a district around it, then drew a district for the southeast, northeast and western Iowa.  My goal was to have each district within 1,000 persons of the ideal district population.  Amazingly, my configuration worked out on my very first try (which means there’s probably many possible combinations to how the state can be drawn).  Nevertheless, I kind of like the map here because I think it does a good job in keeping the different regions of the state together (in that respect, I think it’s better than, for example, the 1990’s Iowa map which had one district run from Des Moines to  the western border).

County-level population numbers from the 2010 Census came out a couple days ago, and I've been trying to draw a map aimed at getting the population of each district as close to the ideal of 761,589 as possible while still retaining some degree of compactness. (Obviously, more compact districts could be drawn if one is willing to have a greater degree of variance in population.)  Here's the best I've done so far:

Putting up the weekend open thread early in case Bleeding Heartland readers want to talk about the momentous news out of Egypt. After Egyptian President Hosni Mubarak didn’t step down as anticipated yesterday, I thought he was heading for a Ceausescu endgame. However, today Mubarak handed power over to the military, ending 30 years in control of Egypt. On paper, Mubarak is one of the richest men in the world, but it’s not clear how much of that wealth is accessible to him; Switzerland has already frozen his accounts.

President Barack Obama sent Mubarak a fairly clear signal yesterday that it was time to go. I posted the full text of Obama’s speech today after the jump. I expect that for now Egypt will remain one of the top U.S. foreign aid recipients.

This is an open thread–all topics welcome.

The U.S. Census Bureau released a ton of new Iowa demographic information yesterday.

Data for Iowa show that the five most populous incorporated places and their 2010 Census counts are Des Moines, 203,433; Cedar Rapids, 126,326; Davenport, 99,685; Sioux City, 82,684; and Waterloo, 68,406. Des Moines grew by 2.4 percent since the 2000 Census. Cedar Rapids grew by 4.6 percent, Davenport grew by 1.3 percent, Sioux City decreased by 2.7 percent and Waterloo decreased by 0.5 percent.

The largest county is Polk with a population of 430,640. Its population grew by 15.0 percent since 2000. The other counties in the top five include Linn, with a population of 211,226 (increase of 10.2 percent); Scott, 165,224 (increase of 4.1 percent); Black Hawk, 131,090 (increase of 2.4 percent); and Johnson, 130,882 (increase of 17.9 percent).

Click here to find the Iowa numbers and charts. I haven’t had as much time as I’d like to look through the data, but I’m posting a few starting points for discussion here.

Rick Smith’s piece on growth in the Cedar Rapids-Iowa City corridor is worth a read. I’m not surprised Linn County grew substantially during the decade, especially in the suburbs, but the population growth in Cedar Rapids itself is impressive. I didn’t expect to see that after the 2008 floods destroyed whole neighborhoods in the city.

After the jump I’ve posted official 2010 population numbers for all 99 Iowa counties, along with a map putting the counties in different population categories and a map grouping counties by population gain or loss (percentage). Ten Iowa counties have populations larger than 65,000 people. Another 14 counties have populations between 25,000 and 64,999; 29 counties have populations between 15,000 and 24,999; and 46 counties have populations between 4,029 (Adams) and 14,999. Dallas led the 33 Iowa counties that gained population between 2000 and 2010.

Although I wasn’t able to reproduce this chart showing the racial and ethnic breakdown of the Iowa population by Congressional district, I did include those numbers at the end of this post. I was surprised to see that even though Polk County has the largest Latino/Hispanic population in Iowa, there are more Latino/Hispanic residents in IA-05 than in IA-03, with IA-02 and IA-04 not far behind. Meanwhile, IA-01 has the smallest Latino/Hispanic population but the largest African-American population. The largest Asian population is in IA-03 with IA-02 not far behind. View the chart here or scroll down for more details.

Share any thoughts about the census data or details that caught your eye in this thread. For example, the Newton Independent posted 2000 and 2010 numbers for Jasper County and area cities.

UPDATE: The Des Moines Register has lots of census coverage here. Statewide, Iowa’s population grew by 4.1 percent from 2000 to 2010. The Latino population was up by 83.8 percent, the Asian population was up by 44.9 percent, and the African-American population was up by 44.1 percent.

Steve Deace has resigned from WHO-AM radio, and February 11 will be his last broadcast of “Deace in the Afternoon,” station manager Van Harden informed employees today.

Harden told employees of WHO-AM in Des Moines that Deace said he and his family had been talking about resigning for some time, and “finally felt lead to make a change.”

“While he does not have another position to which he is going, he has had the ear and interest of many politicians and political campaigns seeking his strategic advice, and he says there is a possibility he may be doing some consulting,” the e-mail said. “While this came as a surprise to us, we at WHO, and Steve, want all to know this is a very friendly parting, so much so that Steve says he may be  able to make himself available occasionally to do some fill-in work for us if needed.”

Des Moines Cityview weekly published a good feature on Deace last year, chronicling his competitive nature, the evolution of his Christian faith and his path from sports reporting to hosting a political talk show. Craig Robinson of The Iowa Republican blog credits Deace with helping Mike Huckabee “crush” Mitt Romney in counties that make up the WHO listening area. Similarly, Deace’s loud and frequent support for Bob Vander Plaats boosted the candidate’s showing against Terry Branstad in central Iowa during last year’s GOP gubernatorial primary. (I have to believe Branstad will be relieved to hear Deace is going off the air.)

Two weeks ago, Deace decided at the last minute to seek the position of Polk County Republican chair. According to Robinson, Deace posted on Facebook yesterday “that his next campaign might be for Republican National Committeeman or the State Senate.” The talk show host has been and remains a vocal critic of Iowa Senate Minority leader Paul McKinley (for instance: “Introducing the Paul McKinley Award for gutless, dishonest, and ineffective leadership!”). Iowa’s current elected Republican National Committeeman is Steve Scheffler, the head of the Iowa Christian Alliance whom Deace has called the “least trustworthy & most gutless person in Iowa politics.”

I wonder whom WHO will put in the drive-time slot and whether the new host will rival morning host Jan Mickelson in the outrageous comments department. One thing is certain: whoever gets the job will be wooed relentlessly by Republican presidential hopefuls. WHO has a large conservative listening audience.

UPDATE: A press release announcing Deace’s departure is after the jump. He says he hopes to publish a book this year, and he isn’t ruling out politics or a return to broadcasting someday. He and his wife plan to stay in Iowa: “We look forward to seeing how we will have the privilege to fear God, tell the truth and make money in the future.”

The news release says Deace lives in West Des Moines, so if he runs for the state Senate he presumably would face Pat Ward in a GOP primary, depending on what the new map looks like.

SECOND UPDATE: Deace on Twitter: “Just in case you were wondering, almost nothing in the Iowa Republican.com piece about my departure is true, except the spelling of my name.”

THIRD UPDATE: In this video, Deace talks about his reasons for leaving WHO and emphasizes that his split with the radio station was amicable. He also says that although it wasn’t an easy decision, he knows it was the right one, and he has “slept like a Calvinist at night” since he and his wife decided to pursue new challenges. After saying he felt he needed to take a chance and try something different at this point in his life, Deace added (around the 5:45 mark of the video), “I think a lot of guys, regardless of whether or not you agree with my belief system, you know, if you pee standing up like I do, I think you probably understand what I’m talking about.”

The Iowa Fiscal Partnership released a must-read report yesterday by economist Peter Fisher. Facts don’t support political rhetoric about a supposedly unfriendly tax environment for Iowa business, Fisher demonstrates:

Whether one focuses only on the corporate income tax, or the whole range of taxes falling on business, Iowa’s state and local taxes are well below average, and have been for some time.

Iowa’s corporate income tax in recent years has been considerably lower than the national average level of taxation and lower than all but 11 states. How can this be when the top tax rate – 12 percent – is the highest in the nation? The answer is simple: That 12 percent tax rate is applied to only a small portion of a company’s profits in Iowa. Iowa is one of only four states that allows a portion of federal corporate income taxes to be deducted from income. On top of this, Iowa determines how much of a multi-state firm’s profits are taxable in Iowa solely on the basis of sales in Iowa. The majority of states take into account a firm’s payroll and property in the state as well as sales. As a result, many large corporations selling nationally and worldwide earn substantial profits on Iowa operations but pay taxes on only a small fraction of those profits. Finally, Iowa offers a range of generous tax credits that further reduce corporate tax liability.

I recommend reading the full report, Corporate Taxes and State Economic Growth (pdf file) or at least the two-page backgrounder. While you’re on the Iowa Fiscal Partnership’s site, check out the many other valuable reports they have published in recent years. For instance, last month’s report showed why “additional cuts to essential public services are not needed to balance the 2011-12 [Iowa] budget.” The Iowa Policy Project, which is part of the Iowa Fiscal Partnership, is on Twitter here.

After the jump I’ve posted a few excerpts highlighting key conclusions from Fisher’s latest research. Keep these facts in mind next time you hear Iowa Republicans claim that we “can’t afford” a modest raise for state employees, continued investment in preschool or any growth in K-12 education budgets.

UPDATE: Agree 100 percent with what Fisher told Iowa Independent:

“Revenues are improving, in spite of the drain already in place by business breaks. A responsible budget does not include new breaks, especially when we know that the services provided by state and local government are important to a thriving business climate,” Fisher said. “We should be looking for ways to avoid cuts in services that will actually hurt Iowa jobs and the Iowa economy.”

An estimated 29,183 long-term unemployed Iowans could qualify for some $116.3 million in additional benefits, but only if state legislators act quickly, according to a new report by the National Employment Law Project. Federal dollars could cover an extra 13 weeks of benefits for those Iowans. Follow me after the jump for details and background on the federal stimulus money we may leave on the table.

A bill to extend parts of the PATRIOT Act fell seven votes short of passage in the House of Representatives yesterday. A summary at OpenCongress.org explains that this bill

Extends three provisions of the USA PATRIOT Act that are set to expire on February, 28, 2011. They include the authority for “roving” wiretaps that allows the government to monitor computers that may occasionally be used by suspected terrorists, the “tangible records provision” that requires banks, telecoms and libraries to hand over any customer information the government requests without informing the customer, and the “lone wolf” provision allowing the government to track international terrorist groups. These would be extended straight up — i.e. no reforms — and would expire again under the bill on December 8, 2011.

Although 277 House members voted for the bill and only 148 opposed it, the measure failed because it had been brought to the floor under special rules that limit debate but require a two-thirds majority. The roll call shows that 67 Democrats voted with the majority of the Republican caucus in favor of the PATRIOT Act extension, but 26 Republicans voted with most of the Democratic caucus against the bill.

Iowa Democrats Bruce Braley (IA-01) and Dave Loebsack (IA-02) voted no yesterday, while Democrat Leonard Boswell (IA-03) and Republicans Tom Latham (IA-04) and Steve King (IA-05) voted yes. In all likelihood this bill will pass later this month when House leaders bring it to the floor under normal rules, requiring only 218 yes votes to pass.

Boswell’s vote yesterday is consistent with his record in this area. He voted for the PATRIOT Act in 2001 and its extension in 2005. He also voted with most House Republicans on the controversial Foreign Intelligence Surveillance Act in 2008. Last year, Boswell voted for another PATRIOT Act extension bill that Loebsack and Braley opposed.

If Boswell faces a Democratic primary challenge in the new third Congressional district in 2012, his voting record on government surveillance may become a campaign issue. During his 2008 primary race against Ed Fallon, Boswell temporarily changed his stand on the FISA Act. He reverted to his original position after winning the primary.

The Iowa Environmental Council, Sierra Club and the Chicago-based Environmental Law and Policy Center are intervening in a lawsuit seeking to throw out new water quality rules for Iowa. The State Environmental Protection Commission approved the “antidegradation” rules in December 2009, and the Iowa Department of Natural Resources adopted the rules last year. Immediately following the U.S. Environmental Protection Agency’s approval of the rules, the Iowa Farm Bureau Federation, Iowa Renewable Fuels Association and Iowa Water Environment Association sued, claiming two EPC members should not have been able to vote on the rules, and that the rules violate an Iowa ban on environmental regulations that are stricter than federal standards. The Iowa Attorney General’s Office is representing the Department of Natural Resources and the Environmental Protection Commission in the lawsuit.

The Iowa Environmental Council, Sierra Club and Environmental Law and Policy Center sought to intervene to ensure that the antidegradation standards will not be relaxed. On February 3, a Polk County district judge approved the groups’ request, saying “the applicants for intervention are environmental groups that have been active in the administrative process and it would be more than beneficial to have their input as intervenors in this case.” After the jump I’ve posted an IEC press release containing more background information.

UPDATE: From an IEC action alert on February 8:

Once again, groups that represent wastewater dischargers are urging legislators to take action to eliminate or weaken Iowa rules that protect water quality.

The Iowa League of Cities and the Rural Water Association are asking lawmakers, who serve on the Senate Natural Resources and Environment Committee, to repeal Iowa’s anti-degradation rules. Anti-degradation rules are required by the federal Clean Water Act and are designed to stop further degradation of the rivers, streams and lakes.

Please contact the Legislators who serve on this committee to let them know how important these rules are to protect Iowa’s waters.

Click here for a list of committee members and here for background information and a link to send a letter to lawmakers.

Civic Skinny’s latest column at the Des Moines weekly Cityview leads with a warning for Iowa Senate Minority Leader Paul McKinley. Citing “top people in both parties,” Skinny speculates that “powerful party forces – and that’s code for Ed Failor Jr.’s Iowans for Tax Relief” want to replace McKinley with “one of their own – and that probably means Bill Dix […]”

Follow me after the jump for Skinny’s case as well as some additional supporting evidence and background on Dix, Iowans for Tax Relief, and longstanding Republican discontent with McKinley.

Someone I follow on Twitter posted this during the Superbowl:

Two y/o mistook me yelling at the interception as telling her to “get out of here” still crying.

A helpful reminder that young children are often more tuned in to our tone of voice than to what we say to them–or not even to them, but what we say out loud while they happen to be in the room.

My younger son is particularly sensitive to tone and has been known to say “Stop shouting at me” when I wasn’t yelling, just speaking in an irritated or exasperated voice.

Speaking more gently and patiently around my kids is my perennial new year’s resolution. Any helpful tips along these lines are welcome in this thread.

Last week the non-profit organization Smart Growth America released a report on “how successful states have been in creating jobs with their flexible $26.6 billion of transportation funds from the American Reinvestment and Recovery Act (ARRA).” The report demonstrates that “the states that created the most jobs were the ones that invested [stimulus funds] in public transportation projects and projects that maintained and repaired existing roads and bridges. The states that spent their [stimulus] funds predominantly building new roads and bridges created fewer jobs.”

Table 2 of the full report (pdf file) ranks the states in terms of percentage of road spending allocated to “system preservation” (road and bridge repair) versus building new capacity. Here Iowa did well, spending 93 percent of the stimulus road money on repair work. Iowa ranked 12th in this category; seven states and Washington, DC spent 100 percent of their ARRA road funds on repair.

Iowa didn’t score as well (30th place) on Smart Growth America’s list of states by the percent of stimulus transportation funding spent on public transit or non-motorized projects. Just 3.5 percent of Iowa’s transportation stimulus money went to such projects. That’s not surprising; it has long been difficult to persuade Iowa policy-makers to invest more in passenger transit, even though we have an aging population, and many older Americans want alternatives to driving. A long-range transportation funding plan adopted in 2008 didn’t require a single extra dollar to be spent on public transit in Iowa. The Republican-controlled Iowa House has already voted to scrap funding that would help bring passenger rail service to Iowa City, and Governor Terry Branstad didn’t include passenger rail funding in his draft budget for the next two years.

After the jump I’ve posted excerpts from the full report, which explain why repair and transit projects create more jobs per dollar spent. A memo about the recent opinion poll findings references below can be downloaded here (pdf).

Smart Growth America’s latest study didn’t assess the rate at which states turned around their stimulus transportation funding to create jobs. A 2009 study by the U.S. House Transportation and Infrastructure Committee showed that Iowa was the second-best state in terms of allocating stimulus road funds quickly. At the end of July 2009, 85.1 percent of the $358 million Iowa received for highway and bridge projects was under contract, and 74.9 percent was for projects already underway. Those percentages were more than double the national average.  

Sunday, February 6 would have been Ronald Reagan’s 100th birthday, and the occasion will be marked by a graveside ceremony in California and a tribute video to be aired during the Superbowl. I try not to speak ill of the dead, but I honestly struggle to think of anything Reagan did that benefited the country, besides signing the arms control treaty with the USSR. Not only was he nowhere near one of the great presidents, his main legacy was massive income inequality. He cut programs aimed at helping the poor and demonized welfare recipients successfully, paving the way for the welfare reforms of the 1990s. I disliked Reagan’s politics so much that Barack Obama’s rhetorical similarity to the Gipper was a big reason I never could warm up to Obama’s “inspiring” speeches.

The Reagan-worship in today’s Republican Party is comical. If Reagan were a candidate today, he’d be assailed as a “RINO” for his tax-raising, big-spending policies. Yes, Reagan raised many taxes as governor and as president, not that many Republicans would admit that today. At Think Progress, Alex Seitz-Wald published “10 Things Conservatives Don’t Want You To Know About Ronald Reagan,” and one of them was news to me, even though I remember the 1980s well: “Reagan signed into law a bill that made any immigrant who had entered the country before 1982 eligible for amnesty. […] The bill helped 3 million people and millions more family members gain American residency.”

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

UPDATE: I like Robert Borosage’s post on “The Reagan Ruins.”

SECOND UPDATE: Daily Kos user Clarknt67 on Reagan’s years-long non-response to the AIDS epidemic.

Excerpt from the post.culture.shock blog

When I was in middle school, I earned spare money by babysitting for a lot of the neighborhood kids. One of the parents I was employed by was Kim Pearson, one of the sponsors of the bill in the Iowa House to amend the Constitution to ban not only gay marriage, but also civil unions and domestic partnerships. This is my letter to her. (edited somewhat with the recognition that this is now going to a lot of folks who don’t know me as well as Kim did, and who likely don’t care what I’ve been up to since I spent a summer taking care of her kids)

Iowa received the overall top ranking in a new report on the health care system in all 50 states and the District of Columbia. The Commonwealth Fund is a private foundation supporting research on health care issues and policies to achieve “better access, improved quality, and greater efficiency, particularly for society’s most vulnerable.” Researchers who compiled the 2011 state scorecard uncovered huge disparities in terms of access to care, health care quality, and health outcomes:

There is a twofold or greater spread between the best and worst states across important indicators of access and affordability, prevention and treatment, and potential to lead healthy lives (Exhibit 1). The performance gaps are particularly wide on indicators assessing developmental screening rates, provision of mental health care, hospitalizations because of asthma, prevalence of teen smoking, and mortality rates among infants and children. Lagging states would need to improve their performance by 60 percent on average to achieve benchmarks set by leading states.

If all states were to improve their performance to levels achieved by the best states, the cumulative effect would translate to thousands of children’s lives saved because of more accessible and improved delivery of high-quality care. In fact, improving performance to benchmark levels across the nation would mean: 5 million more children would have health insurance coverage, nearly 9 million children would have a medical home to help coordinate care, and some 600,000 more children would receive recommended vaccines by the age of 3 years.

Leading states-those in the top quartile-often do well on multiple indicators across dimensions of performance; public policies and state/local health systems make a difference. The 14 states at the top quartile of the overall performance rankings generally ranked high on multiple indicators and dimensions (Exhibit 2). In fact, the five top-ranked states-Iowa, Massachusetts, Vermont, Maine, and New Hampshire-performed in the top quartile on each of the four dimensions of performance. Many have been leaders in improving their health systems by taking steps to cover children or families, promote public health, and improve care delivery systems.

Iowa was the top-performing state in just one category: percentage of young children receiving all recommended doses of the six key vaccines. However, Iowa’s relatively high scores (among the top 5 states on nine indicators and in the top quartile for 14 indicators) made our state number one overall and in the “prevention and treatment” subgroup, number two in “potential to lead healthy lives” subgroup, and number six in the “access and affordability” subgroup. More detail on Iowa’s rankings can be found on this chart. To compare Iowa to other states, use this interactive map or download the full report here.

The new report’s executive summary highlights the benefits of the federal Children’s Health Insurance Program (generally known as SCHIP):

The Scorecard’s findings on children’s health insurance attest to the pivotal role of federal and state partnerships. Until the start of this decade, the number of uninsured children had been rising rapidly as the levels of employer-sponsored family coverage eroded for low- and middle-income families. This trend was reversed across the nation as a result of state-initiated Medicaid expansions and enactment and renewal of the Children’s Health Insurance Program (CHIP). Currently, Medicaid, CHIP, and other public programs fund health care for more than one-third of all children nationally. Children’s coverage has expanded in 35 states since the start of the last decade and held steady even in the middle of a severe recession. At the same time, coverage for parents-lacking similar protection-deteriorated in 41 states.

SCHIP used to be a favorite punching bag for Representative Steve King, who voted against funding what he called “Socialized Clinton style Hillarycare for Illegals and their Parents.” Fortunately, the majority in Congress recognized this program’s potential.

After the jump I’ve posted a sidebar from the general summary of the Commonwealth Fund’s report, called “Iowa’s Comprehensive Public Policies Make a Difference for Children’s Health.” I also included some methodological notes and listed the 20 indicators measured by researchers.