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.

Maridith Morris is a nurse and the Democratic candidate in Iowa House district 39. -promoted by desmoinesdem

This picture is my nephew Fin. He is an adorable, happy little guy and I love him to pieces. Fin has autism spectrum disorder. Fin is just one vulnerable Iowan who is going to be hurt by Medicaid privatization.

At Fin’s age, early intervention therapy is crucial for his positive outcomes. Therapy can mean the difference between him becoming a high functioning adult, one who is able to live independently, work, and pay taxes and a disabled adult needing tax payer support. Despite the crucial nature of Fin’s therapy, the rush to privatize Iowa’s Medicaid puts those services in jeopardy. To receive therapy, Fin’s parents will have to transport him from Indianola to appointments at Blank Children’s Hospital in Des Moines because services are no longer in network in Indianola.

Iowa House Republicans have substantially altered a bill that would expand the legal uses of cannabis derivatives to treat certain illnesses. State Representative Peter Cownie introduced the bill last week, but an amended version was presented at a subcommittee hearing today without explanation. Follow me after the jump for background and details.

This morning the Iowa Senate passed Senate File 2125, which would terminate contracts the state has signed with insurance companies picked to manage care for Iowans on Medicaid. Governor Terry Branstad announced his administration’s “modernization” plans early last year and selected four managed care providers in August, with a view to fully privatizing Medicaid by January 1, 2016. The state later terminated a contract with one of those four companies, and the federal government refused to grant the necessary waivers, saying Iowa would not be ready to shift to managed care until March 1 at the earliest.

Iowa Senate leaders made clear on day one of this year’s legislative session that Medicaid privatization would be a pressing concern. Senate President Pam Jochum has been sounding the alarm since last year, worried about how privatization would affect her developmentally disabled adult daughter and other Iowans with special needs. Jochum gave the opening and closing remarks in support of Senate File 2125 today. She repeatedly warned that the Branstad administration has tried to do too much, too fast, without input from state lawmakers or other stakeholders with expertise in the area. Fellow Democrats Chris Brase, Liz Mathis, Mary Jo Wilhelm, Rich Taylor, and Amanda Ragan echoed many of those concerns in their speeches.

During the floor debate, Republican State Senator David Johnson explained why he would vote for the bill. He read e-mails from numerous constituents expressing concern about access to health services for their loved ones on Medicaid. He pointed out that Minnesota took 20 years to transition to managed care, while Iowa is trying to implement the same changes over just one year. “It’s moving too fast. That’s the issue here. We need to put a dagger in this.”

Last week Johnson became the first GOP lawmaker to come out in favor of terminating the privatization program; I enclose below excerpts from Jason Clayworth’s report for the Des Moines Register. Johnson’s fears about “children at risk of losing services” stem from the failure of the managed care companies to sign contracts with thousands of providers who have been treating Iowans on Medicaid, including children on HAWK-I (Iowa’s version of the State Children’s Health Insurance Program). Scroll to the end of this post for more details on that access problem, based on data from the Iowa Department of Human Services.

Republicans who spoke against the bill today included Senators Jason Schultz and Mark Chelgren. Schultz claimed Democrats took “ownership” of managed care by putting assumptions about Medicaid savings into the health and human services budget for the current fiscal year. During her concluding remarks, Jochum pushed back hard against the idea that a vote for last year’s health and human services budget was a vote for managed care. Rarely do I ever agree with Schultz, but I think Senate Democrats walked into a trap there. The Branstad administration’s estimates on reduced Medicaid costs after privatization were never grounded in reality, but Democrats accepted those assumptions in the budget they passed–not because they supported the Branstad effort, but likely because doing so gave them an extra $51 million to spend on other health-related priorities.

Chelgren argued that lawmakers should keep their word after voting for a budget that assumed Medicaid would shift to managed care. He likened the situation to Congressional Republicans voting to repeal the 2010 Affordable Care Act without having a plan ready to replace “Obamacare.” The analogy fails because terminating Medicaid privatization that hasn’t been fully implemented would not be like repealing Obamacare after several years of operation. The status quo is an available and less disruptive alternative to serving the 560,000 Iowans on Medicaid. Chelgren claimed that halting Medicaid privatization and starting the process over would “betray” those who signed up as providers under the new system. That argument made no sense; public comments from Iowans on Medicaid and health care stakeholders have overwhelmingly opposed the Branstad policy.

During her concluding remarks, Jochum refuted claims that 39 other states have put Medicaid in managed care. In reality, only four states have fully privatized the system, as the governor is doing.

Shortly after the floor debate, senators voted 29 to 19 to approve SF 2125. Republicans Jake Chapman and Tom Shipley joined Johnson and all 26 Senate Democrats. Notably, those three Republicans all represent strongly GOP districts, not marginal seats.

The bill now goes to the Iowa House, where Speaker Linda Upmeyer has indicated she does not plan to bring the measure up for debate. For a nurse practitioner by training, Upmeyer is remarkably insensitive to ordinary people’s health care needs–not only those on Medicaid, but also chronically ill Iowans who could benefit from medical cannabis. A post in progress will catch up on the state of play for medical marijuana in the Iowa legislature.

UPDATE: Added more links and comments on the Medicaid debate below. According to Erin Murphy, Upmeyer confirmed today that the House will not take up SF 2125, because the governor would certainly veto it. Given how unpopular Medicaid privatization is, the public would likely support a legislative override of that veto. But at least five more Republican senators would have to change their stands to override a veto in the upper chamber. In the House, at least 24 GOP state representatives would need to support an override, assuming all 43 House Democrats voted in favor.

In an emotional White House address, President Barack Obama announced today new executive actions aimed at reducing gun violence, including suicides as well as homicides and other crimes.

• Background Checks: Require all gun sellers — including online and at gun shows — to have a license and perform background checks. Have the FBI overhaul the existing background-check system.
• Enforcement: Improve the use of America’s existing gun laws, and add 200 new agents to the Bureau of Alcohol, Tobacco, Firearms and Explosives.
• Mental Health: Remove barriers that can keep states from reporting and sharing information about people barred from owning guns for mental health reasons, and spend $500 million to increase access to mental health care.
• Technology: Push for research in gun safety technology, such as “smart guns” that can only be fired by authorized users. The research would be done by the Departments of Defense, Justice, and Homeland Security. The White House notes the federal government is “the single largest purchaser of firearms in the country.”

I enclose below more details on steps the president ordered as well as Iowa political reaction. I will update this post as needed, since some of the Iowans in Congress neither released statements on this issue nor responded to my requests for comment.

They were so close. Florida-based WellCare played the game almost perfectly to win a contract for its Iowa subsidiary to manage care for Medicaid recipients, which could have been worth hundreds of millions of dollars over the next three years.

The first sign that WellCare’s ambitions might come to nothing attracted little notice, appearing just before the long Thanksgiving weekend. More bad tidings for WellCare arrived yesterday in a late Friday afternoon dump, the classic way for government officials to bury news. Reading Jason Clayworth’s report for the Des Moines Register, it’s easy to see why the Branstad administration sought minimal attention for fixing an embarrassing oversight.

For months, Governor Terry Branstad has dismissed warnings from patients, advocates, doctors, hospitals, editorial boards, and lawmakers that the state’s rush to privatize Medicaid would disrupt health care for some 560,000 Iowans. Today the governor finally got the message in a form he can’t ignore. Director Vikki Wachino of the federal government’s Centers for Medicare and Medicaid Services wrote to Iowa Medicaid Director Mikki Stier,

Based on our review last week of Iowa’s progress, as well as the information you have provided, CMS expects that we will ultimately be able to approve Iowa’s managed care waivers. However, we do not believe that Iowa is ready to make this transition Jan. 1. CMS previously outlined the requirements to provide high quality, accessible care to Medicaid beneficiaries, and Iowa has not yet met those requirements, meaning that a transition on January 1 would risk serious disruptions in care for Medicaid beneficiaries. While you have made progress in some areas of readiness, our review also identified significant gaps that need to be addressed before CMS can authorize your waiver requests. For that reason, CMS will work with you toward approval of your request effective March 1, 2016, provided that the state demonstrates progress toward readiness consistent with the actions in the attachment to this letter.

Click through to read the full four-page letter and four-page attachment from Wachino to Stier, which the Des Moines Register posted online. CMS officials found that “significant areas of the state did not have many provider types within a reasonable distance,” and that “Relying too heavily on out-of-network providers is likely to create confusion among beneficiaries and providers, result in access issues for beneficiaries, and disrupt continuity of care for beneficiaries.” Many of the points raised echo concerns three Democratic state senators expressed during meetings with CMS officials in Washington last month.

The CMS readiness review also showed that nearly half of Medicaid recipients who tried to call the state’s call centers earlier this month could not get through. Many Iowans who did reach a staffer on the phone were not able to find out whether any of their current doctors had signed contracts with the four managed care providers approved to run Medicaid. The CMS findings are consistent with what I’ve been hearing from acquaintances: the enrollment packets sent to Medicaid recipients did not include basic details they would need to make an informed choice of managed care provider (such as where their family’s current doctors will be in-network).

I enclose below reaction to today’s news from Branstad, who struck an upbeat tone, and key Democratic lawmakers, who vowed to keep fighting to improve legislative oversight of the Medicaid privatization. The Democratic-controlled Iowa Senate approved such a bill during the 2015 session, but the Republican-controlled Iowa House declined to take it up. Oversight is the very least state lawmakers could do to prevent the transition to managed care from becoming a pretext for denying services to vulnerable Iowans.

David Pitt noted in his report for the Associated Press,

Two legal challenges continue including one from the Iowa Hospital Association, a trade group for the state’s hospitals. It sued the state claiming the privatization plan is illegal because it takes millions of dollars from a dedicated hospital trust fund and gives it to the four managed care companies.

Any relevant comments are welcome in this thread. I am grateful that so many Iowans took the time to contact federal officials about Branstad’s disastrous policy. Bleeding Heartland reader Rhonda Shouse has been one of the superstar organizers in that fight.

UPDATE: Added below reaction from Representative Dave Loebsack (D, IA-02). I expect that during next year’s re-election campaign, Loebsack will highlight his efforts to shield constituents from the negative consequences of shifting Medicaid to managed care. His only declared Republican opponent is State Senator Mark Chelgren, who like his GOP colleagues in the upper chamber has done nothing to slow down the privatization or strengthen legislative oversight of the process.

SECOND UPDATE: Added more news and commentary related to this issue.

A Republican challenger to three-term State Senator Jeff Danielson in Iowa Senate district 30 emerged last week. Bonnie Sadler is on Facebook here and on Twitter here. Danielson has a campaign website as well as a Facebook page and Twitter feed.

Danielson was the Iowa legislative incumbent re-elected by the narrowest margin in 2008, beating Walt Rogers by just 22 votes out of more than 32,000 cast. Although Danielson won his third term by a somewhat larger margin in 2012, Republicans are still likely to target this race as one of their top two or three pickup opportunities. The Republican State Leadership Committee has committed to play for the Iowa Senate majority in 2016. Democrats currently control the chamber by 26 votes to 24.

I enclose below a map of Senate district 30, a review of its voter registration numbers and recent voting history, background on both candidates, and first thoughts on what should be a central issue during next year’s campaign.

November 11 first became a day to honor war veterans in 1919, one year after the First World War ended. Congress officially designated “Armistice Day” a national holiday in 1926 and changed its name to Veterans Day in 1954. Many Americans will make a special effort today to thank the veterans they know. In that spirit, Bleeding Heartland acknowledges some of the Iowans in public life who have served in the armed forces.

Iowa’s Congressional delegation includes only one person who has served in the military: Senator Joni Ernst. The number of veterans in Congress has declined dramatically over the last 40 years. In 1971, “when member military service was at its peak, veterans made up 72 percent of members in the House and 78 percent in the Senate.” But in the current Congress, just 81 U.S. House representatives and 13 U.S. senators have served in the military. I enclose below more statistics from Rachel Wellford’s report for NPR.

Governor Terry Branstad is the only veteran among Iowa’s current statewide elected officials.

Of the 50 Iowa Senate members, seven are veterans: Democrats Jeff Danielson, Tom Courtney, Dick Dearden, Bill Dotzler, and Wally Horn, and Republicans Bill Anderson and Jason Schultz.

Of the 100 Iowa House members, nineteen are veterans: Republicans John Kooiker, Stan Gustafson, John Landon, Dave Maxwell, Kraig Paulsen, Sandy Salmon, Quentin Stanerson, Guy Vander Linden, Matt Windschitl, Dave Heaton, Darrel Branhagen, Ken Rizer, Zach Nunn, John Wills, and Steve Holt, and Democrats Dennis Cohoon, Jerry Kearns, Todd Prichard, and Brian Meyer.

The population of veterans faces some special challenges, including higher rates of mental health problems such as post-traumatic stress disorder (PTSD). An estimated 22 U.S. military veterans die by suicide every day, which means suicide “has caused more American casualties than wars in Iraq and Afghanistan.” The Military Suicide Research Consortium provides information on the problem and resources for those needing help, in addition to white papers summarizing current research on factors that contribute to suicides. For instance, sexual assault in adulthood or childhood sexual abuse both increase the risk of suicidal thoughts and attempts. Also, veterans who know someone who died by suicide “reported more than twice the frequency of suicidal ideation.” I was surprised to read in this paper that major public holidays are not associated with higher rates of suicide. On the contrary, “holidays may act as more of a protective factor” against suicide, possibly because of greater “social integration during holiday periods.”

Last month the Iowa Department of Public Health released the Iowa Plan for Suicide Prevention 2015-2018, which “seeks to reduce the annual number of deaths by suicide in Iowa by 10 percent by the year 2018 – a reduction of 41 from the 406 three-year average from 2012-2014 – with an ultimate goal of zero deaths by suicide.” The full report (which does not focus on veterans) is available here (pdf). Iowans with suicidal thoughts or who are concerned a loved one may be considering suicide can call the Suicide Prevention Lifeline at (800) 273-TALK or Your Life Iowa at (855)-581-8111. For online assistance: Suicide Prevention Lifeline or Your Life Iowa.

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

In what the Des Moines Register’s editors described as a “new low in the out-of-control race to keep or attract employers,” a state board unanimously approved $4.75 million in financial assistance to Kraft Heinz, which plans to replace a large factory in Davenport with a new facility on the northwest side of town. Although at least 900 people are expected to lose their jobs in the downsizing, the city of Davenport will put up $10 million in tax-increment financing to support the project. The Iowa Department of Transportation and the city are expected to commit $5.8 million for road work around the new factory site too. Never one to shy away from handing state funds to large corporations, Iowa Economic Development Authority Director Debi Durham has let all downsizing companies know that the state of Iowa’s wallet is open: “‘Will I take this deal any day? You bet,’ Durham said Thursday morning. ‘This is a future play.’” Durham also told reporters she “expects the state to do more of these kinds of deals in the future, as more massive companies merge.”

Iowa State University economist Dave Swenson characterized the Kraft Heinz incentive package as “bizarre,” adding, “The idea of providing public assistance for a company that has billions of dollars of annual sales cannot make sense to anybody.” The Register’s editors noted, “the company could get $20.75 million in state and local assistance,” which “works out to nearly $43,700 for every job Kraft Heinz agrees to keep”–and roughly 200 of the jobs the company promised to save will pay less than $37,000 a year.”

Speaking of lousy deals, Iowa’s plan to privatize Medicaid looks worse and worse. A post in progress will discuss this policy in more detail; for now I enclose below excerpts from several stories by Jason Clayworth for the Des Moines Register. In recent weeks, Clayworth has exposed damning facts, including:

• Some claims made in bidding documents from the four private insurers chosen to manage Medicaid in Iowa “contain unverifiable data, misleading statements or half-truths.”

• No data support the government’s estimate that privatizing Medicaid would save $51 million from the state budget during the first six months of the program.

• The insurers selected to manage Medicaid “have each been held accountable in other states for serious service and administrative errors, including some that wrongly delayed or denied medical services to poor residents […].”

• Iowa’s Medicaid director Mikki Stier “had improper communications with an insurance company consultant and former lawmaker during a critical review period that ended with the for-profit company being selected” as a managed care provider for Medicaid.

A November 6 letter from the Centers for Medicare and Medicaid Services to Stier enumerated “significant concerns” about the transition to managed care; excerpts from that letter are at the end of this post. Federal officials and Iowa Senate Democrats have scheduled “listening sessions” around the state to focus on Medicaid privatization. Click through for meeting details, as well as a list of state and federal officials to contact with concerns. Only the feds can stop this train by denying the necessary waivers. Branstad administration officials have been unmoved by any of the Register’s revelations or by the risks to vulnerable Iowans, which many speakers raised during Legislative Oversight Committee hearings on November 3.

Polk County District Court Judge Douglas Staskal has dismissed a lawsuit challenging Governor Terry Branstad’s authority to veto funding intended to keep two in-patient mental health facilities open. Twenty Democratic state lawmakers and the president of Iowa’s largest public-employee union filed the lawsuit in July, arguing that the governor’s line-item vetoes violated Iowa Code provisions requiring that the state “shall operate” mental health institutes in Mount Pleasant and Clarinda. But Judge Staskal found that “Existing statutes cannot limit the Governor’s item veto authority,” which “is of constitutional magnitude. The only limitations that have been placed on that authority have been derived from the language of the constitution itself. […] And, there is no language in the item veto provision which suggests a statutory limitation on the power it creates. It is elementary that, to the extent there is conflict between a constitutional provision and a statute, the constitution prevails.”

I enclose below longer excerpts from the court ruling, which can be read in full here. Mark Hedberg, the lead attorney representing the plaintiffs, told Bleeding Heartland they “are preparing an appeal” to the Iowa Supreme Court “and will ask that it be expedited.”

Note from desmoinesdem: Cross-posted from the Abram Mayhem blog. The Iowa legislature adopted and Governor Terry Branstad signed into law a measure to legalize cannabis oil for some seizure disorders in 2014.

Dear US Senator Joni Ernst,
I was in the Drake Diner in Des Moines, Iowa the day you came to celebrate your win for the US Senate. I was sitting in the booth right by the front door. I had my small son who was two at the time and you had a large group in the back who cheered loudly and clapped for you as you came in.

You didn’t notice that when your group of supporters began screaming for you, that my son slammed his head twice on the edge of table. The noise your group suddenly made (without regard to any of the other patrons) both terrified and overwhelmed him. The metal edging on those old vintage-style tables there really did a number on my son’s forehead and he had a lump and a bruise for over a week. Two of your supporters noticed my son in hysterics as they walked by. Instead of smiling or offering some form of apology for the uproar, they sneered at us as I was trying to calm him down. I’m sure they saw the huge welt on his forehead and thought of me as a terrible mother. They were both still smoking outside when we left.

You didn’t acknowledge my son that day in the Diner and you aren’t acknowledging him now. So, it didn’t surprise me when you accidentally sent me the response to “crude oil” instead of “cannabis oil” to my e-mail. It’s those little attention-to-details things one has to do when someone truly cares about their people. I was pleased to see that I received an additional e-mail today with your response to “cannabis oil” instead of “crude oil” today.

The bare-boned truth here is you didn’t take the time to actually hear what my real concerns were at all. My name was just pasted into a bulk e-mail (just like the “crude oil” response) and sent on out, without any real regard to what is happening to people in the Unites States of America, let alone your home state, Iowa. You yourself claimed in your campaign that you are a “normal, everyday” Iowan. If that were true, you would listen to the concerns of the mothers and families in this state who are reaching out to you for help in Iowa and in Congress.

Iowa Senate President Pam Jochum endorsed Hillary Clinton for president today in a guest column for the Des Moines Register. This afternoon, she will elaborate on her reasons at a Women for Hillary event in Dubuque.

Jochum joins the list of prominent Iowa supporters of Barack Obama before the 2008 caucuses who are now backing Clinton. An Iowa House Democrat at that time, Jochum headed Obama’s leadership team in Dubuque County. Obama easily won a plurality of delegates in Dubuque and carried all of the neighboring counties too.

More important, Jochum is a hero to many on what you might call “the Democratic wing of the Iowa Democratic Party.” I’m thinking of the 26 percent who voted for Ed Fallon in the 2006 gubernatorial primary, as well as people who have long advocated for campaign finance reform at the state level. Although I think highly of Senate Majority Leader Mike Gronstal, he’s not the progressive champion Jochum is–not by a long shot. She has helped fight some very tough fights, where powerful interest groups were lined up on the other side. I can’t think of an Iowa state legislator in my lifetime who has reached such a senior leadership position while being as consistently progressive as Jochum.

My impression is that many on the “Democratic wing” of the party have already committed to caucus for Bernie Sanders. Others feel conflicted as I do, drawn to Sanders for his passion and his uncompromising policy agenda, while recognizing Clinton’s strengths as a candidate and what it would mean for this country to elect a woman president. That Jochum is on board with Clinton could carry a lot of weight with undecided Democrats like me.

Before today, eight Democratic state senators and nine state representatives had already endorsed Clinton for the 2016 caucuses. I’ve enclosed the full list after the jump, along with excerpts from Jochum’s Des Moines Register op-ed.

A new Iowa Domestic Violence Helpline started taking calls today, MacKenzie Elmer reported for the Des Moines Register.

Survivors from any corner of the state can call the free and confidential number, 800-770-1650, to reach one of fifteen staff members who are trained to handle everything from crisis situations to counseling. […]

Before the hotline, survivors called either law enforcement or their local advocacy program. Though most programs have someone ready to answer the local crisis line 24/7, some survivors’ calls may have gone unanswered.

Local programs and advocates can now forward those calls to the hotline, where an expert can direct that survivor to the services he or she needs. […]

The statewide hotline should also provide a greater level of anonymity for survivors, [Iowa Attorney General’s Office crime victim assistance division director Janelle] Melohn said, since those living in rural areas may be hesitant to call their local program for fear that the person on the other line will recognize them.

The helpline’s launch coincides with the start of Domestic Violence Awareness Month, which grew out of efforts during the 1980s to “connect advocates across the nation who were working to end violence against women and their children.” In that spirit, I enclose below twelve links to resources for people who have been or are currently threatened by domestic violence, or care about someone in an abusive relationship.

On Monday the U.S. Environmental Protection Agency released the final version of “stronger protections for the nation’s two million agricultural workers and their families working on farms, forests, nurseries, and greenhouses. These revisions to the 1992 Agricultural Worker Protection Standard will afford farmworkers similar health protections that are already afforded to workers in other industries.” Under the old rules, exposure to chemicals incurred “an estimated $10 million to $15 million in annual health costs” among farm workers The new rules do not cover “persons working with livestock” and exempt “farm owners and their immediate family with an expanded definition of family.” I’ve enclosed after the jump a fact sheet summarizing key changes, a short summary of the public health case for the rule, and a graphic that shows the old and new rules side by side. Click here for the EPA’s press release on the changes and here for a more detailed five-page chart.

Fruit and vegetable farming isn’t a huge industry in Iowa like it is in states with longer growing seasons, such as California or Florida. Still, Iowa farms have been producing more of what some call “specialty crops” as more consumers here seek out local food. Moreover, expanding fruit and vegetable production in Iowa has potential to create jobs and increase local incomes, according to this 2010 paper by Iowa State University economist Dave Swenson. So I sought comment from the Iowans in Congress on the new regulations. At this writing, I have not heard back from the offices of House Representatives Rod Blum (IA-01), Dave Loebsack (IA-02), David Young (IA-03), or Steve King (IA-04). I also haven’t received a comment from Senator Chuck Grassley. Senator Joni Ernst’s communications director sent the following:

Senator Ernst believes that once again the Obama Administration is overstepping its bounds, expanding onerous regulations that fail to consider the full impact on stakeholders, like Iowa’s agriculture industry. The EPA is continuing to act as an unchecked federal agency, adding burdensome new rules and costs. In addition, the EPA completely ignores the safety progress that has already been made under existing guidelines for our youth.

Iowa politicians tend to be hostile to any new regulation affecting farms or other agricultural facilities. Most of Iowa’s federal representatives opposed the U.S. Department of Labor’s efforts in 2011 to update protections for children on working farms. Every Iowan in Congress except for Senator Tom Harkin welcomed the department’s decision to withdraw that rule in April 2012.

A spokesperson for Governor Terry Branstad said they don’t have a reaction to the new farm worker safety rule yet but will evaluate it “in its entirety.” I can’t think of a time Branstad supported any regulation of farming practices, so I assume he will not be favorably disposed toward the new EPA rule. But if he’s serious about making Iowa the “healthiest state,” reducing unnecessary exposure to pesticides would be a worthy goal to embrace.

A bill to ban abortions after 20 weeks of pregnancy failed to overcome a U.S. Senate filibuster on September 22. Iowa Senators Chuck Grassley and Joni Ernst were among the 54 senators (51 Republicans and three Democrats) who supported cloture on the motion to proceed to debating the bill. But under Senate rules, 60 votes are needed for cloture. Republicans Mark Kirk of Illinois and Susan Collins of Maine joined 40 members of the Democratic caucus in opposing the motion. Collins cited problems with the legislation’s wording on exceptions for rape and incest and the “glaring deficiency” of providing “no exceptions for when the physical health of the mother is at risk of serious harm.”

In a Senate floor statement, Grassley claimed the bill was “aimed at protecting women and children.” He repeatedly cited the testimony of one gynecologist who used to perform abortions but became an anti-abortion activist after a family tragedy. While speaking in favor of the bill, Ernst recounted one Newton, Iowa family’s story of having a son who survived an early premature birth, asserting, “As Micah proves, babies at five months can survive outside of the womb.”

Grassley and Ernst appear ignorant about the circumstances that typically lead to abortions later in pregnancy.

Only about 1 percent of pregnancy terminations happen after 20 weeks gestation. Most abortion providers (including Planned Parenthood of the Heartland’s Iowa clinics and the Emma Goldman clinic in Iowa City) do not terminate pregnancies after 20 weeks. Many women seeking abortions after that point have discovered fetal abnormalities incompatible with life outside the womb, as described here and here, or they have a serious health condition making it dangerous to continue the pregnancy. The happy experience of Micah’s family does not “prove” that other women could have the same outcome if they continued a life-threatening pregnancy or carried to full term a fetus missing vital organs.

Other reasons for women to seek abortions after 20 weeks include domestic violence and logistical delays in accessing abortion earlier in pregnancy. The federal government and states should address those problems in other ways that do not limit women’s right to make their own medical decisions.

After the jump I’ve enclosed the full texts of Senate speeches by Grassley and Ernst about the so-called “Pain-Capable Unborn Child Protection Act.” I also included comments from Ernst after the Senate vote as well as the Guttmacher Institute’s case against the legislation.

P.S.- Ernst quoted Micah’s mother, Danielle Pickering: “I bet that if Micah could have gone up to everyone who opposes the bill and give them a big hug, he could change all of their minds.” I would suggest that Ms. Pickering open her mind by talking to women like Christy Zink or Danielle Deaver.