Real-world data don’t match figures Governor Terry Branstad and Lieutenant Governor Kim Reynolds released yesterday in order to demonstrated the alleged “continued success of modernizing our state’s Medicaid program.”

April 1 marked a year since Iowa allowed three private insurance companies to manage care for more than half a million Medicaid recipients. The shift was disruptive for thousands of Iowans as well as for caseworkers and service providers, some of which went out of business. Reimbursement problems and cutbacks to care are still affecting many people, Chelsea Keenan reported in this retrospective on the first year of the policy.

Although privatization was supposedly designed to save money and bring predictability to the state budget, the Branstad administration agreed last fall and again in February to hand over millions more state dollars to the managed-care organizations (MCOs), unlocking some $225 million in extra federal funding for the corporations, which have much higher administrative costs than Iowa’s state-run Medicaid program did.

I enclose below the latest deceptive official statements about the “modernization,” along with a demolition fact-checking job by Democratic State Senator Liz Mathis. I’ve also included independent State Senator David Johnson’s reaction to what he called a “lousy, lousy” press release. While still a member of the Republican caucus during the 2016 legislative session, Johnson worked with Democrats trying to halt Medicaid privatization or at least provide stronger legislative oversight of the program.

The Iowa Hospital Association can’t substantiate the Branstad/Reynolds claims on hospitalization rates, Tony Leys reported yesterday for the Des Moines Register. Excerpts from that story are at the end of this post.

On a related note: thousands of Iowans who follow this issue closely are mourning Rhonda Shouse, who died unexpectedly in late March. I never met Rhonda in person, but we communicated through social media, and I admired her relentless advocacy on behalf of those adversely affected by Medicaid privatization. Keenan marked her passing in the Cedar Rapids Gazette, and Leys did so in the Des Moines Register. May her memory always be for a blessing.

The Iowa legislature’s second “funnel” deadline passed on March 31. In theory, aside from appropriations bills, any legislation that hasn’t yet cleared one chamber and at least one committee in the other chamber is no longer eligible for consideration for this year. However, leaders can resurrect “dead” bills late in the session or include their provisions in appropriations bills. The Des Moines Register’s William Petroski and Brianne Pfannenstiel reviewed important bills that did or did not make it through the funnel. James Q. Lynch and Rod Boshart published a longer list in the Cedar Rapids Gazette.

This paragraph caught my eye from the Register’s story.

Senate Majority Leader Bill Dix, R-Shell Rock, said everything that lawmakers are doing is a reflection of learning from states where prosperity is occurring as a result of business-friendly policies. That formula includes low-cost government, innovative public services, and easing regulatory burdens on businesses to spur job creation and to allow Iowa companies to compete in a global marketplace, he added.

Not so much: Republicans following a similar playbook drove Kansas and Louisiana into the ground. Wisconsin has performed poorly in employment growth, poverty reduction, household income, and wages compared to neighboring Minnesota, where corporate interests didn’t capture state government.

This is an open thread: all topics welcome. I enclose below links and clips about bills I haven’t had time to write about yet. Two are “business-friendly” policies that will hurt Iowans suffering because of exposure to asbestos or medical malpractice. One would make local governments and first responders less accountable by excluding all “audio, video and transcripts of 911 calls involving injured victims of crimes or accidents” from Iowa’s open records law.

Quick update on House File 484, the bill to dismantle the Des Moines Water Works: once seen as almost a sure thing due to covert support from the Iowa Farm Bureau, the bill was on the House debate calendar for many days in March but never brought to the floor. Majority Leader Chris Hagenow put House File 484 on the “unfinished business” calendar on March 30, after House Republicans voted down a Democratic motion to exclude it from that list.

Opponents of the Water Works bill have become more confident lately, as several GOP representatives and senators have said privately they oppose the legislation. In addition, a Harper Polling survey commissioned by the Water Works showed that 68 percent of respondents oppose disbanding independent water works boards in Des Moines, West Des Moines, and Urbandale in order to give city councils control over the water utility. The same poll indicated that by a 55 percent to 23 percent margin, respondents said an independent board of trustees rather than the city council is “best qualified to manage your local water utility.” By an 88 percent to 5 percent margin, respondents said “people who live in the community” and not the state legislature should have “the final say” on municipal utilities. No one should be complacent, because powerful forces are behind this legislation. Republican leaders could attach Water Works language to must-pass budget bills.

P.S.- The legislature is supposed to wrap up its business this month and adjourn for the year before the end of April. I suspect that even with unified Republican control, the session will go into overtime. Lawmakers haven’t finalized budget targets for the 2018 fiscal year yet. With less money to go around following the recent downgrade in revenue forecasts, and legislators of both parties calling for a review of increasingly expensive tax credits and exemptions, I expect several more weeks of behind the scenes negotiations before the House and Senate are ready to approve appropriations bills.

As Iowa lawmakers consider proposals to allow the use of cannabis derivatives for some medical conditions, Matt Chapman makes the case for going further to legalize smokeable marijuana. -promoted by desmoinesdem

I illegally used marijuana for pain for years and it would be disingenuous to say I didn’t enjoy the side effects. It would also be disingenuous to say I don’t like the effect of hydrocodone or don’t like the effect of a large dose of ethanol as well. But to use ethanol every evening to take the edge off of pain and to get some good sleep would be a disaster.

And while it is under prohibition and illegal to use, it gave me a lot of relief and helped stave off the point where I could not take the pain any longer. I would use it in the evening. And before I went to bed I would use some along with amitriptyline and would sleep well. And I have no problem publicly discussing this as I had to choose which medication I would use and hydrocodone was the winner.

Johnson County Supervisor Mike Carberry has confirmed rumors that he is thinking about running for governor in 2018. A longtime environmental activist and current member of the Iowa Democratic Party’s State Central Committee, Carberry was the most prominent elected official in our state to endorse Bernie Sanders for president. He spoke to Bleeding Heartland this week about why he is considering a bid for higher office, even though running for governor was never part of his life plan.

Did you know drug companies exploit charities to increase their profits? Neither did I before reading this piece by Austin Frerick. -promoted by desmoinesdem

Susan, a 52-year-old mother of two from Indianola, thought she had landed the perfect job. She would be sitting behind a desk in Des Moines after years of working on her feet in retail and even got new benefits like the day off on Christmas Eve. But her excitement ended when her life insurance application was denied because she had Hepatitis C.

Susan is one of 3.5 million Americans living with chronic Hepatitis C, nearly 80 percent of whom are “baby boomers” (born between 1945 and 1965). Susan, like most other baby boomers, was likely infected during a blood transfusion before hospitals screened blood for the virus. The infection can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer. Many other baby boomers in Iowa only recently discovered that they were infected, either through a routine physical or when they started showing symptoms. A new report by the state Department of Public Health found that reported cases in Iowa have increased by nearly 200 percent since 2000.

Iowa’s current medical cannabis program sunsets on July 1, and no proposal to replace it advanced in a state House or Senate committee before the legislature’s first “funnel” deadline. However, appropriations bills are exempt from the funnel, and Senate Appropriations Committee Chair Charles Schneider confirmed today he is working with colleagues in both parties to make medical cannabis more available to Iowans suffering from a wider range of medical conditions.

No medical cannabis bills made it through the Iowa legislature’s “funnel” this week. Quinn Symonds comments on the debate and recounts a March 1 event advocates organized to inform state lawmakers about the issue. -promoted by desmoinesdem

In my previous Bleeding Heartland post, I talked about key differences between Republican and Democratic proposals on medical cannabis. I’m hoping that if you did catch the last piece, you understand how neither of the bills are adequate. After visiting the Capitol on Wednesday and talking to many leaders, one thing became clear to all of us: there isn’t so much a party divide as a lack of enthusiasm from Republican leaders.

A new bill that would have named a task force to study licensing requirements in Iowa will not move forward this legislative session, Republican State Representative Dawn Pettengill told representatives of the National Association of Social Workers Iowa chapter. House Study Bill 174 replaced an earlier proposal from Governor Terry Branstad, which would have eliminated licensing requirements for numerous professions. During the past week, House Study Bill 138 generated as many constituent contacts to Iowa lawmakers as the bill passed earlier this month to destroy collective bargaining rights. Among other things, the governor’s licensing bill would have reduced insurance coverage for mental health care services. On February 27, an Iowa House State Government subcommittee voted not to move that bill forward.

House State Government Committee Chair Ken Rizer introduced the replacement licensing bill on February 28. In addition to changing regulations in several other areas, House Study Bill 174 called for a new task force to review Iowa’s licensing requirements and report back to the legislature by the end of 2017.

Although Rizer’s bill would not have immediately affected marriage and family therapists, mental health counselors, or social workers, the leading association representing Iowa’s social workers expressed concern that “the taskforce as outlined would mostly be selected by the Governor, who has demonstrated that he wants to de-professionalize many different important professions that serve some of our most vulnerable populations.” (You can read the task force membership provisions on on page 37.) The social workers group was seeking an amendment to give licensed professionals greater influence over the task force membership. But last night, Pettengill–one of two Republicans on the subcommittee where the new bill was assigned–said House Study Bill 174 was dead.

Most non-appropriations bills must be approved by at least one Iowa House or Senate committee by March 3 in order to stay alive for this year. Bills need to clear a subcommittee before coming up for a full committee vote.

Whether the licensing task force language led to the new bill’s demise is not clear. The lobbyist declarations on House Study Bill 174 show substantial opposition, presumably related to other provisions on regulating hospitals and electricians.

P.S. Attention-seeking State Representative Bobby Kaufmann could have let the governor’s original licensing bill die quietly by not scheduling a subcommittee hearing, as is normal practice in the Iowa legislature. Instead, the publicity hound wasted a lot of people’s time before drawing cheers as he ripped up the bill’s cover sheet. Alas, television cameras had already left the meeting room before Kaufmann’s dramatic gesture. The young Republican lawmaker was literally not ready for prime time.

Governor Terry Branstad has introduced a bill that would make Iowa the only state not to license mental health counselors. House Study Bill 138 would remove licensing requirements for a number of professions and eliminate some state boards, including the Board of Behavioral Sciences and the Board of Social Work. Mental health counselors are expressing alarm about language that would make social workers, marriage or family counselors, and mental health counselors “registered” rather than “licensed.”

The likely consequence would be insurance companies refusing to cover services by unlicensed providers, depriving Iowans of access to therapy unless they are able to pay the full cost of mental health counseling out of pocket.

I enclose below an action alert the Iowa Mental Health Counselors Association posted yesterday, which contains talking points to use when communicating with state lawmakers about House Study Bill 138. The bill has been assigned to a subcommittee of Republican State Representatives Bobby Kaufmann and Dawn Pettengill and Democratic State Representative Mary Mascher.

The lobbyist for the association representing mental health counselors said yesterday, “The bill as drafted will not be having a subcommittee next week and is taking on serious water. The speaker’s office said that [House Speaker Linda Upmeyer’s] members are getting more emails on the licensure provisions of that bill than they did on collective bargaining.” According to one rumor, the bill may be revised and reintroduced next week, so concerned citizens should call the governor’s office (515-281-5211) to share their views with Branstad’s staff.

UPDATE: A Facebook commenter reached Kaufmann, chair of the subcommittee, by phone on February 24: “He said this bill was assigned to him, he thinks it’s a bad bill and he’s going to kill it.”

SECOND UPDATE: On a different Facebook thread, someone reported speaking to House Majority Leader Chris Hagenow about this bill, having run into him while shopping. Hagenow indicated House Study Bill 138 would not advance in its current form.

Multiple sources confirmed on Friday that lawmakers have been bombarded with constituent contacts about this legislation. When the governor’s staff introduce a new and improved version of this proposal, I would guess they will leave licensing of mental health care professionals alone.

According to Claire Celsi, Hagenow announced at a February 25 legislative forum in Clive that the governor is wrong on this bill and that lawmakers do not support it.

Advocate Quinn Symonds shares his perspective on some medical cannabis proposals recently introduced in the state legislature. Iowa’s very limited current law, which is unworkable even for families of those suffering from seizure disorders, expires in July. Efforts to expand it failed in the Iowa House last year. -promoted by desmoinesdem

I’ve been asked to talk about the medical cannabis bills. There are basically two sides to watch right now. There are several bills introduced by Democrats and bills introduced by two Republicans, Iowa House Public Safety Committee Chair Clel Baudler and Iowa Senate Judiciary Committee Chair Brad Zaun. I will be referring to Democratic State Senator Joe Bolkcom’s proposals. He has two out currently: a version of last year’s bill that failed to pass, and a “newer” version of the same bill. On the Republican side I will focus on Baudler’s bill. These bills aren’t exactly great: they are supposed to help patients, and neither would do much of that.

State Representative Todd Prichard spoke to a packed room at last night’s Northwest Des Moines Democrats meeting. Now in his third term representing Floyd and Chickasaw counties in the Iowa House, Prichard is ranking member on the Agriculture Committee and also serves on Natural Resources, Veterans, and Ways and Means, as well as on an Appropriations subcommittee. Pat Rynard recently profiled the army veteran and former prosecutor who may run for governor in 2018.

I’ve transcribed most of Prichard’s remarks from the Des Moines gathering below and uploaded the audio file, for those who want to listen. He speaks directly and fluidly without coming across as rehearsed or too polished, a common problem for politicians.

At one point, Prichard commented that Republicans didn’t spend a million dollars trying to defeat him last year, as the GOP and conservative groups did against several Iowa Senate Democratic incumbents. Republicans tested some negative messages against him with a telephone poll in August, but apparently didn’t sense fertile ground. Prichard’s opponent Stacie Stokes received little help from her party, compared to some other GOP candidates for Iowa House seats, including a challenger in a nearby district.

Based on the speech I heard on Tuesday, I would guess that if Prichard runs for governor, Republicans may regret not spending a million dollars against him in 2016.

One more point before I get to the transcript: Prichard is living proof that retiring lawmakers should not be allowed to hand-pick their own successors. When State Representative Brian Quirk resigned to take another job soon after winning re-election in 2012, he wanted his former high school football coach Tom Sauser to take his place. As a Bleeding Heartland reader who’s active in Floyd County described here, Prichard decided to run for the House seat shortly before the special nominating convention and barely won the nomination.

Prichard had a chance to start his political career because several days elapsed between his learning about Quirk’s preferred successor and the House district 52 nominating convention. Too often, Iowa Democratic legislators announce plans to retire only a day or two before candidates must submit papers to the Secretary of State’s Office. If Quirk had retired right before the March 2012 filing deadline, as three House Democrats did last year, his friend with the inside track would have been the only Democrat able to replace him. Nothing against retired teachers, but Sauser was not a potential future leader of the party, as Prichard is becoming.

Pro-gun advocates spent a lot of money to help Republicans gain control of the Iowa Senate in last year’s elections. The GOP majority will likely move several of the gun lobby’s legislative priorities soon, including so-called “Stand Your Ground,” an amendment to Iowa’s constitution establishing the right to keep and bear arms, and relaxed rules on concealed carry permits and youth firing of handguns.

If they are smart, Republicans who venerate the Second Amendment will steer clear of State Senator Jake Chapman’s new bill, which would trample on the First Amendment and prevent potentially life-saving conversations.

Privatizing Medicaid is one of the most harmful things Terry Branstad has ever done to Iowans. -promoted by desmoinesdem

I have only been in this job a few weeks, but this is the first time I have come home simply seething with anger. The five of us on the Johnson County Board of Supervisors had to tell roughly 5/6 of the Mental Health and Disability caseworkers that they were going to lose their jobs, leaving 500+ of #JoCo’s most vulnerable twisting in the wind, and there’s not a damn thing we can do to stop it.

Worth noting: We didn’t start it either.

An Iowan living with disabilities wants to know: “How can you help me become a productive, taxpaying member of society?” -promoted by desmoinesdem

Dear President Trump:

I’m disabled due to a brain injury, heart problems and PTSD from an abusive marriage. I live on $735 per month Supplemental Security Income (a Social Security program), $138 in food stamps, and—thank God—I receive Medicaid. And thank God as well that my home is almost paid off, because today I couldn’t afford my own apartment on that income.

Because many of your supporters feel I’m a “drain” on the system, I’d like to tell you how I’ve spent my time on what some like to call “entitlements.”

On Thursday Iowa Senate Republicans approved a bill that would end most state and federal funding for Planned Parenthood’s family planning services. All 29 Republicans and independent Senator David Johnson voted for Senate File 2, while all 20 Democrats voted against the measure. The Senate Judiciary Committee had approved the bill on a party-line vote the previous day.

Passage was a foregone conclusion, since the entire GOP caucus co-sponsored the bill, and statehouse Republicans have been trying to defund Planned Parenthood for years.

Although I already knew Republican lawmakers were willing to force the state to spend ten times more for family planning services, with no reliable funding stream, I still learned some new things watching Senate File 2 move through the upper chamber.

Governor Terry Branstad and Republican leaders in the Iowa House and Senate are finally poised to eliminate Planned Parenthood’s state funding, a cherished goal Democrats had repeatedly blocked in recent years.

Branstad said during his Condition of the State address on Tuesday that his budget “redirects family planning money to organizations that focus on providing health care for women and eliminates taxpayer funding for organizations that perform abortions.” House and Senate leaders likewise depict their plan as a simple change to reimburse different health care providers, creating “better options for more women.”

What Iowa Republicans don’t broadcast: they are setting the state up to spend ten times more on family planning services, without a reliable funding stream.

A former southeast Iowa resident shares insight into an unusual rural county, where Trump supporters campaigned on a unique message. -promoted by desmoinesdem

Given the increasing attention being paid to the continuing decline of rural Iowa, Jefferson County is an interesting absurdity among these conversations and the 2016 presidential election.

Jefferson County, population 16,843, is a mesh of traditional rural Iowa and a hot pot coalition of Transcendental Meditation followers from around the globe. Fairfield, the county seat, is more than 60 miles to the nearest urban center and stands out as the rare rural Iowa community that has gained population in recent years: a 4 percent population increase between 2010-2014, according to a questionable census report. (Questionable because a portion of the census’s reported increase in residents may be international students who took classes in Fairfield, but live in other states for the majority of their student/work visa.)

Fairfield is also known for its progressive views on organic farming and green energy, as well as residents’ higher than average educational attainment and religious diversity. Given those facts, Jefferson County should have been an easy win for the Democratic Party and Hillary Clinton coalition in 2016. As it has been reliably, other than in 2000, when the Natural Law Party’s John Hagelin won 15 percent of the vote, shifting the county from the Al Gore to the George Bush column. Instead, Clinton lost Jefferson County to Donald Trump by 38 votes.

Thanks to One Iowa executive director Donna Red Wing for explaining a little-known problem for transgender Iowans. -promoted by desmoinesdem

Amerigroup, one of Iowa’s private Medicaid providers, agreed last month to cover gender-affirming surgery for Andrew Evans, a transgender Iowa man and client of the American Civil Liberties Union (ACLU).

While we are happy Evans will receive the surgery he needs, we realize that it means only one thing: Evans’ surgery will be covered. The Medicaid provider refused to acknowledge the medical necessity of the surgery, instead agreeing to coverage in order to “amicably resolve” the situation. In plain English, they didn’t want to tangle with the ACLU.

Exclusions for transgender surgery and other trans-related health care continue. Iowa’s Medicaid ban on transition-related surgeries remains.

Another one for the “elections have consequences” file: The Iowa Supreme Court unanimously ruled on November 10 that Governor Terry Branstad “did not exceed the scope of his constitutional authority” when he vetoed funds state lawmakers had approved to keep open mental health facilities in Mount Pleasant and Clarinda.

A large group of Democratic legislators, joined by the president of the public employee union AFSCME, filed suit soon after Branstad vetoed the funding in July 2015. Their lawsuit contended that Iowa Code contains language requiring the state to operate Mental Health Institutes in Mt. Pleasant and Clarinda. But last November, a Polk County District Court held that “Existing statutes are not conditions on appropriations” and “cannot limit the Governor’s item veto authority.” Bleeding Heartland published excerpts from Judge Douglas Staskal’s decision here.

Last week’s Iowa Supreme Court opinion by Justice David Wiggins affirmed Staskal’s ruling but found that the District Court “failed to address” a matter of constitutional law raised by the plaintiffs. After additional analysis of the legislative intent behind language designating the facilities in Mount Pleasant and Clarinda as “state hospitals for persons with mental illness,” the high court reached the same conclusion as Staskal: the governor had the power to veto funds earmarked for operating facilities he had closed. I enclose below excerpts from the opinion.

Branstad’s spokesperson Ben Hammes did quite the spin job in his statement:

Today’s unanimous Supreme Court decision affirms the Governor’s action by allowing more Iowans to have access to quality mental health care and substance abuse treatment than ever before. The State’s mental health care redesign allows Iowans to access treatment in a community-based setting and through more modern means. Gov. Branstad is committed to putting patients first, improving care, increasing access and modernizing the delivery of mental health services. In fact, there are currently at any time 60-100 psychiatric inpatients beds open across the state. Iowa now maintains a robust level of access to mental health beds that are more efficiently delivered.

Nice try, Hammes. In reality, the justices did not assess either the merits of Branstad’s decision to close the in-patient facilities or the quality of mental health care and substance abuse treatment in Iowa. In reality, Iowa “consistently ranks in the bottom five of all states in every single category of mental health programs and services.” In reality, Iowa “ranks dead last in the country for state psychiatric beds per capita.” In reality, “many Iowans with serious mental illnesses are being marooned” for weeks or months in hospitals, for lack of adequate facilities or services to monitor their care.

Some Iowa statehouse Republicans are more extreme, more ignorant, more unhinged, more dishonest, or more mean-spirited than Peter Cownie.

But few lawmakers make less effort than Cownie to demonstrate that they deserve to be in a position of power.

A television commercial in heavy rotation on Des Moines stations doesn’t name even one legislative accomplishment from Cownie’s eight years in the Iowa House, including two years leading the State Government Committee and two as Commerce Committee chair. Cownie has rarely if ever knocked doors to talk to his constituents in West Des Moines. He doesn’t show up at many local public forums. He doesn’t consistently answer e-mails. He doesn’t follow through on some of his promises.

Recent campaign disclosure forms show the Iowa GOP has spent more than $300,000 on tv ads promoting Cownie or trashing his Democratic challenger, my friend Claire Celsi. Tens of thousands more went toward direct mail to benefit Cownie’s campaign.

Why did Republicans hit the panic button?

The Republican Party has spent more than $400,000 defending Iowa House Majority Leader Chris Hagenow’s seat in the Des Moines suburbs, which he held by only 23 votes in the last presidential election cycle. Most of the money has bought television commercials, beginning six weeks ago and continuing in heavy rotation to the end.

Hagenow led with a ludicrous spot portraying himself as some kind of champion for education funding and the preschool program he voted to eliminate. He moved to a deceptive hit piece against Democratic challenger Jennifer Konfrst, followed by an ad touting his role in making EpiPens more widely available for kids. A second negative spot was a narrowly-focused attack on a tax lien Konfrst resolved many years ago–the height of hypocrisy, since Republican leaders were simultaneously funding the campaign of a House candidate with a much larger, still unpaid federal tax liability. In the last few days, local television stations have been running Hagenow’s initial positive ad, which misrepresents his record on education funding.

Hagenow is running scared, for good reason.

When the dust settled after the 2012 general election, I was frustrated to see how close Iowa Democrats came to winning back the Iowa House majority. Democratic candidates picked up seven GOP-held state House seats that year, but lost half a dozen other races by extremely narrow margins, leaving Republicans with 53 of the 100 seats in the lower chamber.

One of the “seats that got away” was House district 72, where Dean Fisher beat Nathan Wrage by only 216 votes in an open seat due to GOP State Representative Lance Horbach’s retirement. President Barack Obama outpolled Mitt Romney by about 3 percentage points among voters in the district.

The GOP expanded its Iowa House majority to 57-43 in the 2014 midterm election, but many state legislative seats are competitive this year, putting control of the chamber in play. As Wrage challenges Fisher again, Democrats won’t repeat their 2012 mistake of not targeting this race.

Fulfilling the hopes of residents who have been working toward this goal for many years, the Windsor Heights City Council voted 4-1 last night to approve a new sidewalks ordinance with a view to installing sidewalks soon on more city streets.

To the surprise of many who don’t live here, sidewalks have aroused passionate opposition in Windsor Heights, becoming a key issue in multiple local elections.

U.S. House and Senate members returned to work Tuesday, no better equipped to handle basic tasks of governance than they were before their unusually long summer recess.

You might think funding to combat a public health emergency would be easy to pass even in a hyper-partisan, election-year atmosphere. But you would be wrong, because legislation to pay for a Zika virus response remains tied up over “poison pills.”

Republicans are testing potentially damaging messages about Iowa House Democratic candidates, along with statements that might increase support for GOP candidates in battleground legislative districts. After listening to several recordings of these telephone polls and hearing accounts from other respondents, I have three big takeaways:

• Republicans are seeking ways to insulate themselves from voter anger over inadequate education funding and the Branstad administration’s botched Medicaid privatization;
• The time-honored GOP strategy of distorting obscure legislative votes is alive and well;
• The Iowa Democratic Party’s platform plank on legalizing all drugs may be used against candidates across the state.

Read on for much more about these surveys.

Outrage has been building for several days over news that the Mylan corporation jacked up wholesale prices for EpiPens from $56.64 to $317.82 between 2007 and 2015. Mylan is the sole suppler of devices patients can use to inject epinephrine in case of life-threatening allergic reactions. Manufacturing costs for EpiPens have not increased, and the active ingredient is a “generic drug that has been in use for decades.” Adding to the scandal, the annual total compensation for Mylan CEO Heather Bresch has increased from $2,453,456 to $18,931,068 since 2007. The company exploited a loophole called “inversion” two years ago to reduce its tax bill.

Yesterday Democratic presidential nominee Hillary Clinton called on Mylan to reduce the price of EpiPens. Members of Congress including Iowa’s Senator Chuck Grassley have asked the company to explain the pricing changes and asked the Food and Drug Administration “to answer questions about its approval process and other steps for alternatives to the EpiPen.” Michael Hiltzik reported for the Los Angeles Times that another device used to self-inject epinephrine “was taken off the market last year because of manufacturing defects,” and a similar product from a generics company “hasn’t yet won approval from the Food and Drug Administration.” Another generic product is available at a lower cost but works differently, “in ways that can lead to critical errors if users aren’t properly trained,” and it “can’t be substituted when filling a prescription” for an EpiPen.

Mylan promised today to offer more assistance for people who need to buy EpiPens. But as Andrew Pollack reported for the New York Times, the extra discounts are “not lowering the list price of EpiPen, just making it easier for consumers to pay for it. So insurance companies, federal health programs like Medicare and Medicaid and school districts that stock the products could still pay the same price.” Bresch sounded shameless this morning during a CNBC interview, justifying the price increase because of higher marketing and distribution costs and other improvements to the product. “No one is more frustrated than I am,” she claimed.

My friend Colleen Kinney, a Des Moines mother of a child with severe food allergy, is mailing Bresch a care package today. She gave me permission to publish this photo of the cookies she baked and will send along with a note: “Heather Bresch, Please provide explanation for epipen price hike. Enjoy these treats. If my son ate these, he would die without Mylan’s epi-pen.”

Hours after Democrats across the country had begun to celebrate President Barack Obama’s re-election on the night of November 7, 2012, Iowa’s political junkies were still on the edge of our seats, waiting for votes to be reported in the last few state Senate races. Sometime after 1 am, results from Senate district 42 in Iowa’s southeast corner confirmed that Democrats would control at least 26 seats in the upper chamber. For at least two more years, that firewall would stop Republicans from implementing some of the disastrous policies seen in places like Wisconsin, Kansas, or Ohio.

Democrats are still clinging to the ledge with a one-seat Iowa Senate majority. While Republicans have several districts to target in their quest for 26, Democrats have only one obvious pickup opportunity: Senate district 28 in the northeast corner of the state. This race was the “one that got away” four years ago, as former State Representative John Beard fell an agonizing 17 votes short against Republican Mike Breitbach in the battle for an open seat. Now Breitbach has the advantages of incumbency as he seeks re-election against Jan Heikes.

Follow me after the jump for more on this district’s political make-up and voting history, along with background on both candidates and Breitbach’s first television commercial.

Maridith Morris is a registered nurse and the Democratic challenger to State Representative Jake Highfill in Iowa House district 39. -promoted by desmoinesdem

A recent American College of Gynecology study uncovered concerning data about maternal mortality from Texas. Since 2011 the number of women dying during the time of pregnancy and childbirth doubled in only two years, from 18.8 to nearly 40 deaths per 100,000 live births.

The study’s authors found the data “puzzling,”-stating that-, “in the absence of war, natural disaster, or severe economic upheaval, the doubling of a mortality rate within a 2-year period in a state with almost 400,000 annual births seems unlikely.” However, when we compare the shift in data to Texas’ legislative attacks on women’s healthcare, the trend makes sense.

Dozens of U.S. House Democrats staged a protest in the House chamber yesterday, demanding a vote on gun control legislation. Shouting ensued when Speaker Paul Ryan gaveled the House back in for late-night votes after a recess that had lasted most of the day. The “#NoBillNoBreak” sit-in kept going overnight and continues this morning, even though House Republicans voted to adjourn until July 5 shortly after a 3 am vote on a Zika virus funding bill. UPDATE: Democrats ended the protest early Thursday afternoon.

Iowa’s Representative Dave Loebsack joined the sit-in late yesterday morning and stayed for much of the day. He returned to the House floor Wednesday evening, giving a short speech around 10 pm central time. O.Kay Henderson posted the full audio clip at Radio Iowa. My partial transcript is below.

I would prefer for the sit-in to be about legislation such as stronger background checks or an assault weapons ban, rather than the “no fly, no buy” bill that has grabbed the most attention since the Orlando massacre. But it is symbolically important for Democrats to stand up to the National Rifle Association and expose Republican cowardice on this issue. Eric Boehlert observed last night that in 1999, “31 Senate Republicans voted in favor of mandating background checks at gun shows,” and in 1994, “42 House Republicans voted for President Bill Clinton’s crime bill, which included a ban on assault weapons.” Now hardly any Congressional Republicans will back even the most popular gun control measures. Large majorities of Republicans and many gun owners support universal background checks, including for private gun sales.

Representative Steve King showed up in the House chamber Wednesday evening, around the time Loebsack spoke. Unlike his GOP colleague Louis Gohmert, King didn’t mix it up with Democrats. But a little before 2 am, he vented on Twitter, “I’ve had it with the gun grabbing Democrats and their sit in anti 2nd amendment jihad. I’m going to go home and buy a new gun.”

Apparently he is under the impression that Democrats get upset when someone buys a gun. As long as the purchase happens with an appropriate background check, I couldn’t care less if King prefers to spend money on additional firearms. I trust the congressman will store his new weapon appropriately, so his young grandchildren can’t get hold of it and hurt someone.

Former State Senator Rich Olive died of cancer yesterday at the age of 66. He represented Wright and Hamilton counties, along with some rural areas in Story and Webster counties, from 2007 through 2010. During that time, he chaired the Iowa Senate Government Oversight Committee.

Many Iowans who knew Olive through his work in the legislature agreed to share some of their memories with Bleeding Heartland readers.

Photo of Rich Olive at the capitol taken by Senate Democratic staff; used with permission.

Thanks to Stephen Nein for this first-person account. Many central Iowa Democrats I talk to are still undecided on this primary race. -promoted by desmoinesdem

(I just want to say that I apparently do journalism like every thing else – I’m an unrepentant slowpoke. -SN)

Unlike the Presidential campaign, I’ve been undecided on my candidate for the House and Senate election. In the House race: I’ve admired Jim Mowrer for his run against Steve King (& and I grew up in a house across the street from his current home in Waveland); Desmund Adams has a remarkable narrative and palatable thirst for the job; and Mike Sherzan is no slouch in his progressive business-based values.

Thankfully, the Ankeny Area Democrats helped by holding a candidate forum this week. If you missed it, it’s cool – there’s an even BIGGER forum next Tuesday for the Democratic candidates for both seats.

Note from desmoinesdem: Iowa’s Chuck Grassley and Joni Ernst were among 29 Republican senators to vote against a cloture motion on an amendment that would add $1.1 billion for combatting the Zika virus to a larger budget bill. The motion passed yesterday by 68 votes to 29. Senate Democrats would prefer stand-alone legislation on Zika, to get the funding to President Barack Obama’s desk more quickly.

Not too much to say here friends.

Just click the link and shake your head at the callousness.

MAY 19 UPDATE from desmoinesdem: Senator Ernst’s office did not respond to my request for comment on this vote.

Patty Judge’s Senate campaign released this statement on May 17:

Statement on Grassley’s Votes Against Bipartisan Bills to Combat Zika Virus

DES MOINES, Iowa —Patty Judge released the following statement tonight after Chuck Grassley voted against multiple bipartisan bills to combat the Zika virus:

“Public health officials have warned Congress for weeks about the serious threat the Zika virus poses to the country. Yet instead of working across the aisle on commonsense solutions to help address the looming public health threat, Chuck Grassley voted multiple times today against bipartisan proposals to provide emergency funding to combat the Zika virus. Once again Chuck Grassley is refusing to do his job. Iowans expect their Senators to put their health and safety above partisan posturing, and yet after decades in Washington, it’s obvious Chuck Grassley is failing his constituents once again.”

A spokeswoman for Senator Grassley e-mailed this response to what she called a “misinformed comment from Patty Judge.”

This statement is confused and uninformed, at best. The government has already been authorized to spend more than $500 million in reprogrammed funds on the Zika threat. Sen. Grassley voted to proceed on a Cornyn amendment that was paid-for under budget rules. That amendment was prevented from moving forward. Sen. Grassley’s vote against proceeding on the next amendment was to say the legislation ought to be paid for and fiscally responsible. There hasn’t yet been a vote on that amendment. When the amendment is up for an actual vote in the next day or so, Sen. Grassley plans to vote for the legislation. Like the Senate majority leadership, Sen. Grassley understands the Zika threat and dealing with it now to protect mothers and children.

SECOND UPDATE from desmoinesdem: Ernst’s office e-mailed this comment.

Senator Ernst voted in support of a proposal that provides additional resources to combat Zika virus, without adding to our debt. This includes providing funding to the Centers for Disease Control, incentives for manufacturers to develop vaccines and treatments of the virus, and boosting mosquito control by removing layers of bureaucratic red tape so our local communities can more effectively and efficiently tackle this problem. Ultimately, Senator Ernst voted for the final passage of a larger package which does ensure we act quickly to prevent the Zika virus from spreading.

Thanks to AbramsMom for her first-person account of how Iowa House Republicans avoided a floor vote on legislation that would have genuinely expanded access to medical cannabis. The author blogs about her son at Abram’s Mayhem. -promoted by desmoinesdem

As a parent who has been advocating for medical cannabis both before and after we obtained a Cannabidiol Registration Card (the fluke identification card that decriminalizes me for possession of my son’s medicine), I want to share what happened this year with Medical Cannabis, why it failed miserably and why I feel that the amendment (to an amendment) to a Controlled Substance Bill that expanded conditions – yet still did NOT ALLOW ACCESS IN IOWA is absolutely disgustingly wrong.

I sat in the House Gallery not once, but twice as Medical Cannabis came to the House Floor. The first time, I thought I was going to hear a debate on a Democratic amendment (because our original Bill for this year was stalled and killed in the Ways and Means committee by House Leadership) that would allow for expansion of qualifying conditions and would have allowed ACCESS IN IOWA – which is what every parent and patient have been asking for and advocating on behalf of for YEARS.

I sat in the Gallery in the last week of the session to learn that the Democratic Amendment was pulled by House Leadership and instead we heard a debate on Medical Cannabis that stunned those sitting in the Gallery hoping to have access to medicine for their children, their loved ones or for themselves.

What transpired was nothing short of being absolutely blindsided by a garbage truck.

Iowa families hoping for guaranteed insurance coverage of autism services will have to wait at least one more year. Despite Democratic efforts to add an autism coverage mandate to the health and human services budget for fiscal year 2017, the compromise approved on the final day of this year’s legislative session excluded such language. Instead, lawmakers increased state funding for various autism-related grants and programs.

According to the lead Republican negotiator on the human services budget, families affected by autism will have insurance coverage by January 2017 without a mandate, thanks to Wellmark Blue Cross/Blue Shield’s decision to sell policies through Iowa’s public insurance exchange. But those policies will not be available to Iowans living in dozens of counties, nor will they cover applied behavior analysis (ABA) interventions, which are effective but prohibitively expensive for many people with spectrum disorders.

The 800-pound gorilla of Iowa’s health insurance market, Wellmark Blue Cross/Blue Shield, released new details today about its plans to sell policies for 2017 on the health insurance exchange created as part of the 2010 Affordable Care Act. More than half of Iowans are insured by Wellmark, mostly through employer-provided policies. The company controls about three-quarters of the state’s market for individual health insurance, but up to now, those policy-holders have not been eligible for federal subsidies. Wellmark announced last October that it would participate in Iowa’s exchange for 2017 and confirmed those plans last month, when UnitedHealthcare disclosed that it would exit “Obamacare marketplaces” across the country, including Iowa’s.

Wellmark’s Chairman and CEO John Forsyth said last year that the company decided to join the public exchange so members “can access subsidies that are critical to help reduce the cost of health insurance premiums for themselves and their families.” Many thousands of people will need those subsidies, because today Wellmark revealed that roughly 30,000 Iowans who hold individual policies compliant with the Affordable Care Act will likely see massive premiums increases of 38 to 43 percent next year.

Unfortunately, as Tony Leys reported for the Des Moines Register, Wellmark policies will be available on the public exchange only for residents of 47 Iowa counties–not statewide.

Rhonda Shouse, a Medicaid recipient and member of Iowa’s Mental Health Planning and Advisory Council, is a leading advocate for Iowans affected by Medicaid privatization. She is an admin for the MCO Watchdog Facebook group and has previously shared resources to help people report problems with managed-care providers. The Cedar Rapids Gazette published a shorter version of this commentary last week. -promoted by desmoinesdem

Iowa Medicaid Enterprises (IME) Director Mikki Stier wrote a guest column on Iowa’s Medicaid Modernization which appeared in the Cedar Rapids Gazette, Fort Dodge Messenger, and Sioux City Journal in April. I am writing in response to Ms. Stier’s column.

If IME considers making it more difficult for Medicaid beneficiaries to get much needed items such as catheters, diapers, medication, transportation to medical appointments, and permission for guardians to represent their wards, then Iowa’s Medicaid Modernization is a huge success. These were not obstacles under the old Medicaid system.

In IA Health Link’s first month, the bulk of the problems point directly to the Department of Human Resources and IME to adequately provide the MCOs with accurate information. It is likely due to the unrealistic time frame established by Governor Terry Branstad, or DHS, depending on who tells the story of who came up with the idea for Iowa’s Medicaid Managed Care program. Most states that have moved to a managed care approach have moved only portions of their beneficiaries at a time and done so over a two to five year period.

It is very unfortunate that Governor Branstad, DHS, and IME have been perpetrating a public relations campaign for more than a year now to misinform Iowans on how their tax dollars will be spent, who Medicaid beneficiaries are, and how services will be delivered to approximately half a million Iowa residents. Healthcare should not be a partisan political issue.

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.

A bill that would expand the legal uses of cannabis oil remains stuck in the Iowa House Ways & Means Committee, more than six weeks after Republicans on the House Commerce Committee significantly reduced its scope. But Governor Terry Branstad said yesterday he is “open” to further action on the issue before state lawmakers adjourn for the year.

Claire Celsi is the Democratic challenger to Peter Cownie in Iowa House district 42. -promoted by desmoinesdem

April is Autism month. I wish I had better news for all the parents out there who are trying to provide the best care for their children.

State Representative Peter Cownie (R-West Des Moines), Chair of the Iowa House Commerce Committee, single-handedly killed the bill that autism advocates in Iowa had worked all year to bring to a vote in the House Commerce Committee. Cownie had challenged the bill’s advocates to “find him seven Republican votes” so he could bring the bill up and pass it out of his committee for consideration by the entire House. The autism advocates (mostly parents of children who have autism) found the committee votes – both Democrat and Republican. On March 8, the Commerce Committee met, but the bill was never brought up for a vote. Cownie apparently decided that insurance companies were more important than kids. I have heard stories from some of the parents who worked very hard to convince legislators to vote for the bill and they are adamant that the bill would have passed if Cownie would have allowed it to come up for a vote in his committee.

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

On April 1, three months later than originally planned, Iowa officially switched to a managed-care model for the Medicaid program. Erin Murphy explained here how privatization will affect almost all of our state’s roughly 560,000 Medicaid recipients.

Many Iowans on Medicaid are learning that their current health care providers are now out of network, a particular concern for those who have special medical needs. The Mayo Clinic in Rochester, Minnesota has not signed contracts with any of the three insurance companies selected to be managed-care providers in Iowa. KCRG’s Katie Wiedemannn reported on March 31 about a 9-year-old cancer patient whose scheduled treatment at Mayo has been delayed because of the new policy. I am aware of other families whose children on Medicaid have relied on out-of-state medical specialists to treat their children’s rare genetic or chronic conditions.

Iowa House Republican leaders have refused to act on an extensive Medicaid oversight bill that cleared the Senate with bipartisan support. However, they promise to unveil their own Medicaid oversight proposal soon. Senate Democrats will seek to add many oversight provisions to the human services budget, which is often one of the last bills to be resolved before lawmakers adjourn for the year.

One major red flag: Iowa hired only “two ombudsmen to investigate and work as advocates for the 560,000 poor or disabled people” on Medicaid. As Jason Clayworth reported for the Des Moines Register in January, a working group that studied the issue recommended hiring 134 more ombudsmen at a possible cost of $17 million annually.

Rhonda Shouse has been among the most vocal opponents of Medicaid privatization. She shared with Bleeding Heartland some resources for recipients who run into problems with their new managed-care providers. I enclose those below.

Some good public health news: state lawmakers recently approved a bill that would allow “First responders, emergency medical service providers, police, firefighters and licensed health care professionals” to maintain a supply of the drug Naloxone (also known as Narcan). The medication can prevent death after an overdose of heroin or prescription opioid pain-killers, both of which have become more prevalent in Iowa, as in many other states. Senate File 2218 passed the upper chamber the Senate unanimously and cleared the House by 93 votes to 2 (the dissenters were Republicans Stan Gustafson and Mike Sexton). Several groups representing law enforcement or medical professionals lobbied for this bill. At this writing, Governor Terry Branstad has not yet signed it.

UPDATE: Branstad signed the bill about the overdose drug on April 6.