Polk County District Court Judge Douglas Staskal ruled yesterday that a lawsuit challenging Governor Terry Branstad’s line-item vetoes of mental health facility funding can move forward.

A group of Democratic state legislators and AFSCME, Iowa’s largest public employee union, filed the lawsuit in July. Last month, attorneys for the state filed a motion to dismiss the lawsuit or force the plaintiffs to “recast” (revise and resubmit) their court filing.

But in a thirteen-page ruling, Judge Staskal rejected the state’s arguments that “the plaintiffs lack standing, have failed to state a claim upon which relief could be granted and that the case presents a nonjusticiable political question.” He found that AFSCME Iowa Council 61 President Danny Homan has standing because he represents the interests of state workers who were laid off when the state government closed in-patient mental health facilities in Clarinda and Mount Pleasant. The judge also noted that state legislators “have standing to challenge the propriety of the Governor’s exercise of his veto authority.” Judge Staskal found plaintiffs had stated a claim: “a challenge to the Governor’s exercise of his line-item veto authority.” As for the political question, the ruling noted, “Whether to close Clarinda and Mount Pleasant is a policy matter for the other branches of government. Whether the Governor’s particular use of his line-item veto power is constitutional is a matter for the courts.”

Judge Staskal did find in favor of one argument advanced by state attorneys, releasing Iowa Department of Human Services Director Chuck Palmer as a co-defendant: “The Director [Palmer] plainly has no authority to veto legislation and there is no allegation that he did veto legislation. Therefore, there is no conceivable set of facts upon which relief could be granted on the claim that the Director exercised an improper veto.”    

The legislators who joined this lawsuit are State Senators Rich Taylor, Tom Courtney, Janet Petersen, Tony Bisignano, Herman Quirmbach, and Dick Dearden, and State Representatives Bruce Hunter, Curt Hanson, Jerry Kearns, Mark Smith, Art Staed, Ako Abdul-Samad, Jo Oldson, Ruth Ann Gaines, Sharon Steckman, Todd Taylor, Mary Gaskill, Kirsten Running-Marquardt, Timi Brown-Powers, and Dave Jacoby.

This Sunday’s Des Moines Register carried another front-page story by Tony Leys about the substandard treatment some patients have received since being transferred from the now-closed state mental health facility in Clarinda. Leys reported last month that eight former Clarinda patients were sent to nursing homes “rated ‘below average’ or ‘much below average’ on a federal registry,” and that two of the patients “died shortly after their transfers.”

“Transfer trauma” can endanger a frail person’s health even if the new facility offers excellent care. Unfortunately, the Perry Health Care Center’s handling of three former Clarinda patients left much to be desired, according to an Iowa Department of Inspections and Appeals report cited at length by Leys. Failure to monitor and care appropriately for one man led to severe dehydration and breathing problems, and eventually his hospitalization. The man died two weeks later. Staff carelessness caused a shower accident that broke a woman’s leg. A third woman did not receive a blood-clot prevention medication for six days in a row. Click through for many more depressing details. The whole 28-page inspector’s report is embedded at the bottom of the page. The company that owns the nursing home rejects the inspector’s findings and will appeal the fines, its manager told the Register.

From where I’m sitting, the nursing home is fortunate to face only $13,500 in fines for the long list of documented problems. I’m shocked that failure to administer a medication for six days, or to inform the prescribing physician that the patient had not received the drug, resulted in only a $500 fine (pages 24 and 25 of the report). Failing “to provide adequate supervision when transferring a resident from a shower chair,” leading to a broken leg, resulted in only a $5,000 fine (pages 16 to 23).  

Most stunning: the nursing home will receive only an $8,000 fine for repeated staff failures to properly assess or treat a man who was becoming lethargic and dehydrated. Nor did staff always provide supplemental oxygen as indicated when the man’s saturation levels dropped below 90 percent. The brother of the (now dead) man told Leys that a doctor at Mercy Medical Center “said she’d never seen a person so dehydrated in her life.”

Eight years ago, an Iowa nursing home received state and federal fines totaling $112,650 for failing to change a woman’s wound dressing for 25 days, resulting in gangrene and amputation of the affected leg. A settlement later reduced that fine to $75,397.

I don’t know how much discretion state inspectors have in assessing penalties. Iowa nursing homes can’t be fined at all for some of the most common health and safety violations, under a law Governor Chet Culver signed in 2009. The Iowa House and Senate had unanimously approved that bill, ignoring concerns raised by some advocacy groups, the Iowa Department of Elder Affairs, and the Iowa Department of Inspections and Appeals.

Leys reported that the woman who failed to receive her anti-clotting meds has moved “a more highly rated nursing home near Bloomfield, which specializes in treating elderly people with mental illnesses.” The woman whose leg was broken would like to move from the Perry facility but has no place to go.

The final Clean Power Plan released on August underplays the role of natural gas in reducing carbon emissions in comparison to the draft Clean Power Plan rules released in 2014. According to the America’s Natural Gas Alliance President Martin Durbin, initial indications from the final Clean Power Plan rues indicate that the White House discounted gas’s ability to reduce GHG emissions quickly and reliably while contributing to growth and helping consumers.

For the last few years, natural gas was considered to be a bridge between carbon-intensive fuels such as coal and the clean energy of the future. Given that natural gas releases 50% fewer greenhouse gas emissions compared to coal, it was certainly a great substitute. However, the recent growth in the renewable energy industry is quickly proving that we may not need this bridge fuel after all.  Here is why.  

Two months after the Iowa Supreme Court unanimously ruled unconstitutional a proposed state ban on using telemedicine for abortions, the Iowa Board of Medicine and Governor Terry Branstad are at last ready to accept the court ruling as the final word on the subject.  

Governor Terry Branstad didn’t run for re-election last year on a plan to let private insurance companies manage health care for some 560,000 Iowans on Medicaid. He didn’t work with key state legislators to draw up his administration’s “Medicaid Modernization” plans. The governor’s draft budget, submitted in January, projected some $51 million in savings on Medicaid for the 2016 fiscal year. But key lawmakers like the chair of the Iowa Senate Health and Human Resources Appropriations subcommittee didn’t learn that four private companies would be selected to handle almost all Medicaid services until the Iowa Department of Human Services made its request for proposals public in February.

Recent accusations of bias and conflicts of interest, as well as allegedly inaccurate scoring of insurers’ proposals, have raised many questions about how the Iowa DHS selected the four companies now negotiating contracts to manage Medicaid for one-sixth of Iowans. Reports of campaign contributions by lobbyists and political action committees representing firms that sought Iowa’s Medicaid business prompted one watchdog to decry “pay to play” politics.

Those news stories point to a conclusion that isn’t getting enough attention: various insurance companies and their paid representatives knew what was coming down the pike long before the Branstad administration disclosed its plans to privatize Medicaid.

The Branstad administration has justified its “Medicaid Modernization Initiative” with optimistic projections about more “efficient, coordinated and high quality healthcare” and greater “accountability in health care coordination,” delivered at a savings to taxpayers.

Jason Clayworth shared a less encouraging perspective in the August 21 Des Moines Register: all four private insurance companies now negotiating contracts to manage Medicaid in Iowa have “faced serious charges of fraud or mismanagement” related to serving Medicaid recipients in other states. Some of those violations led to “hundreds of millions of dollars in fines” against the insurers.  

Can we please treat women’s health like industrial agriculture?

The latest attack on Planned Parenthood came in the form of an edited video, secretly taped, claiming to “expose” the practice of selling “baby parts.” But if Planned Parenthood had been a factory farm, that video wouldn’t have happened, because that video would have been illegal to make!

Since that video, Iowa governor Terry Branstad, like the internet, has been shocked! Outraged! He joined the “Truth Exposed” rally and called for an investigation into Planned Parenthood. Though no federal or state money goes to abortions, Branstad wanted to look into all money going to Planned Parenthood because he wants “to protect the interest of the taxpayers.”

Ironically, Branstad applauds an undercover video from a state that was an early “Ag Gag” law adopter, a law that essentially prevents videotaping industrial agriculture facilities in America. Violators could be charged with a Class D Felony, “Animal Facility Interference.”  

On Monday, the Iowa Department of Human Services announced the four private insurance companies selected to manage care for almost all of the 560,000 Iowans on Medicaid. Pending successful contract negotiations, Amerigroup Iowa, AmeriHealth Caritas Iowa, UnitedHealthcare Plan of the River Valley, and WellCare of Iowa will start managing care for Iowans on January 1, 2016. It’s too early to say how the change will affect medical services. Speaking to the Des Moines Register, Democratic State Senator Amanda Ragan expressed concern “that people will fall through the cracks” and said she hopes Iowans will contact state lawmakers “if problems develop” under the new system.

Some losers have emerged from the process already: namely, two companies now managing care for some Iowans on Medicaid, which were not selected to continue in that role next year. Follow me after the jump for background on the Medicaid privatization plan and the fallout from the Iowa DHS not choosing Magellan Health Inc and Meridian Health Plan as managed care organizations for 2016.  

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

Ryan Foley’s August 3 story for the Associated Press was disturbing on several levels. A “Serious Mismanagement Report” described a “decade of dysfunction” at the Effigy Mounds National Monument in northeast Iowa. Between 1999 and 2010, “78 construction projects costing a total of $3.4 million were approved there in violation of federal laws meant to protect archaeological resources and historic sites.” Also troubling: National Park Service officials have suppressed the report’s publication and recently denied that it existed. They have commissioned another team to write a separate (less critical) review of Effigy Mounds operations. National Park Service deputy regional director Patricia Trap delivered some unintentional comedy when she said, “I’m not denying some serious mismanagement […] But also there were actions taken along the way that were actually appropriate management.” I’m so relieved to know that Effigy Mounds officials handled some matters appropriately in addition to the seventy-eight projects that failed to comply with federal law.

Iowa Public Radio’s Morning Edition with Clay Masters interviewed Foley about the mismanagement and next steps at Effigy Mounds. Click through for the audio and transcript.

The Des Moines Register published a front-page piece by Grant Rodgers on August 5 about the “uncertain future” for Iowa’s regional drug courts. Those courts steer defendants into treatment rather than prison, turning lives around at lower cost than incarceration. “Yet despite their popularity among prosecutors, judges and community leaders, several Iowa drug courts have experienced sluggish legislative funding – so much so that they now are in jeopardy,” Rodgers reports. What a classic case of penny-wise and pound-foolish budgeting by state legislators who brag to their constituents about fiscal responsibility. With an ending balance (surplus) of at least $300 million expected for Iowa’s budget in the 2016 fiscal year, it’s ridiculous that the drug court in Council Bluffs will shut down on October 1, with courts in Burlington and Ottumwa “at risk of closing” later this year.

The front page of today’s Sunday Des Moines Register features a depressing must-read by Tony Leys about former residents of the now-closed Iowa Mental Health Institute at Clarinda, which “cared for some of the frailest and most complicated psychiatric patients in the state.” Of the eighteen people who lived in the Clarinda facility earlier this year, eight

were transferred to four traditional nursing homes, all of which are rated “below average” or “much below average” on a federal registry. The four facilities are in the bottom 29 percent of Iowa nursing homes for overall quality, according to the Medicare registry. Two of those eight patients died shortly after their transfers.

I’ve enclosed excerpts from all of the above stories after the jump, but I recommend clicking through to read the articles in their entirety.

Yesterday the U.S. Environmental Protection Agency released the final version of its Clean Power Plan for existing power plants, the “first-ever national standards to limit carbon pollution from power plants.” The final rule differs from the EPA’s original proposal last June in several respects. An EPA fact sheet spells out the key changes to the Iowa targets:

The goals are much closer together than at proposal. Compared to proposal, the highest (least stringent) goals got tighter, and the lowest (most stringent) goals got looser.

o Iowa’s 2030 goal is 1,283 pounds per megawatt-hour. That’s on the high end of this range, meaning Iowa has one of the least stringent state goals, compared to other state goals in the final Clean Power Plan.

o Iowa’s step 1 interim goal of 1,638 pounds per megawatt-hour reflects changes EPA made to provide a smoother glide path and less of a “cliff” at the beginning of the program.

You can read the final Clean Power Plan and related documents here. The EPA has posted a good summary of current climate change research here. After the jump I’ve enclosed excerpts from a White House list of benefits from the plan, the EPA’s two-page fact sheet about Iowa, and a graphic showing how much power plants contribute to U.S. carbon emissions relative to other major sources.

Renewable energy resources should make it easy for Iowa to meet the carbon emissions targets. I’ve also enclosed below excerpts from Donnelle Eller’s report for the Des Moines Register and Alisa Meggett’s commentary for the Cedar Rapids Gazette. The facts about wind and solar power’s potential belie scary rhetoric from the U.S. Chamber of Commerce and various groups funded by fossil fuels interests about how the Clean Power Plan will affect businesses and consumers.

Reducing carbon emissions will incur massive collateral health benefits. The Physicians for Social Responsibility report Coal’s Assault on Human Health is still the best one-stop shop on why coal combustion causes so many premature deaths and chronic health problems. On the editorial page of today’s Des Moines Register, Dr. Yogesh Shah, associate dean of global health at Des Moines University, outlined the “human health effects of climate change,” which “are real and already being felt in Iowa.” Scroll to the end of this post to read excerpts, or better yet, click through to read his whole piece.  

U.S. Senator Joni Ernst’s bill seeking to end all federal funding for Planned Parenthood failed to reach the 60-vote threshold today to pass a cloture motion for proceeding to debate. Background and details on today’s vote are after the jump, along with the full text of the legislation and some Iowa political reaction to the Planned Parenthood funding controversy.

UPDATE: Added more comments from Senator Chuck Grassley. The Senate Judiciary Committee chairman is spearheading an inquiry into Planned Parenthood’s fetal tissue donation practices. Whereas Ernst would end all federal funding for Planned Parenthood immediately, Grassley appears open to continuing to fund the organization, depending on the findings from that investigation.  

Governor Terry Branstad’s vetoes of education and mental health funding will stand, as the two-thirds majority needed to call a special legislative session has failed to materialize in either the Iowa House or Senate.

A special session always looked like a long-shot, given that Iowa House Republican leaders didn’t want to spend extra money on education and only reluctantly agreed to extend funding for mental health institutions. In addition, 23 of the 24 Iowa Senate Republicans voted against the supplemental spending bill. They had no stake in the compromise the governor blew apart.

Still, the outcry over school funding (including dozens of normally non-political superintendents speaking out) created an opening for Republican lawmakers. Even if they didn’t believe in the substantive value of additional education or mental health funding, they could have taken a big issue off the table for next year’s statehouse elections. So far, very few Republicans seem worried about the political fallout from not overriding Branstad’s vetoes. Democrats appear ready to remind voters at every opportunity who created the holes local education leaders are scrambling to fill.  

The best news in Iowa this week came out of a federal courtroom in Cedar Rapids. As Ryan Foley reported for the Associated Press, “Iowa’s second-largest power company agreed Wednesday to drastically cut pollution at several coal-fired power plants under a Clean Air Act settlement that’s expected to make the air safer and easier to breathe around the state.” You can read the full consent decree here and the complaint filed against the Alliant Energy subsidiary Interstate Power and Light here.

Huge credit for the victory goes to the Sierra Club Iowa chapter. Foley reports that this federal government enforcement action “started in 2011 when the Sierra Club filed a notice accusing the company [Interstate Power and Light] of violating the Clean Air Act.” The Sierra Club advocates for a range of policies to reduce air pollution and Iowa’s reliance on coal to generate electricity.

I enclose below highlights from Foley’s article and five reasons the changes at the affected power plants will save Iowans’ lives.

The agreement U.S. officials reached with Interstate Power and Light is also an encouraging sign that a recent U.S. Supreme Court decision against the Environmental Protection Agency’s rule on mercury emissions is at most a temporary setback for clean air. In some communities, the court’s ruling won’t even slow down efforts to convert coal-fired plants to other fuel sources.

If only Governor Terry Branstad, who has often spoken of his desire to make Iowa the “healthiest state,” could recognize the benefits of burning less coal. Although Branstad was happy to bask in the reflected glory of new pollution controls at one of the affected Interstate Power and Light power plants, he welcomed the U.S. Supreme Court ruling against the mercury rule, which the governor’s office characterized as a “misguided” EPA regulation.  

While Congress is on recess until after July 4, it’s time to catch up on an unusually busy few weeks in June for U.S. House members. Bleeding Heartland previously covered how Iowa’s representatives voted on the failed and successful attempts to pass trade promotion authority, repeal of country-of-origin labeling requirements for meat, a bill to eliminate a tax on medical devices, and the Intelligence Authorization Act.

Follow me after the jump to find out how Democrat Dave Loebsack (IA-02) and Republicans Rod Blum (IA-01), David Young (IA-03), and Steve King (IA-04) voted on the latest defense budget bill, more trade-related policies, and legislation dealing with chemical safety, Medicare cost controls, and regulations of greenhouse gas emissions from power plants. Iowa’s representatives also voted last week on a matter relating to the growing national controversy over Confederate symbols.

Something you don’t see often when looking through Congressional roll calls: three of Iowa’s four House members crossed party lines more than once during the floor debate on the defense budget.

The Iowa legislature’s 2015 session drags on amid unresolved conflict over various budget issues, especially K-12 school funding. But one aspect of the lawmakers’ work is complete for this year. The Democratic-controlled Iowa Senate has confirmed all but one of Governor Terry Branstad’s more than 200 nominees. The overwhelming majority of those votes were unanimous or nearly so.

In recent years, senators have voted against confirming one or two Branstad nominees. This year no nomination failed on the Iowa Senate floor, and only one department head was ever in real danger of not being confirmed to do his job: Department of Human Services Director Chuck Palmer.

Branstad has occasionally withdrawn nominees who didn’t have support from the necessary two-thirds majority in the Iowa Senate. This year the governor didn’t need to exercise that power, although he sidestepped a near-certain rejection by accepting Teresa Wahlert’s resignation in January, rather than reappointing her to run Iowa Workforce Development. In addition, Iowa Law Enforcement Academy Director Arlen Ciechanowski recently announced plans to retire, tacitly acknowledging the votes weren’t there to confirm him.

Follow me after the jump for background on the controversies surrounding Palmer and Ciechanowski and details on Palmer’s confirmation vote–the closest call by far for any Branstad appointee this year.

Catching up on Congressional news, last week the U.S. House approved a joint Republican framework setting top-line numbers for the federal budget as well as the first two spending bills for the 2016 fiscal year, which begins on October 1. Along the way, House members considered amendments covering a wide range of issues, from regulations on incandescent light bulbs to “prevailing wage” rules for federal construction projects to medical marijuana advice for Americans who receive their health care through the Veterans Administration.

Follow me after the jump for details on the latest votes by Iowa Democrat Dave Loebsack (IA-02) and Republicans Rod Blum (IA-01), David Young (IA-03), and Steve King (IA-04).

Governor Terry Branstad is forging ahead with some major policies he didn’t campaign on last year, oblivious to concerns about the impact on Iowa’s Medicaid recipients and people served by two mental health institutions the governor wants to close.

According to Public Policy Polling’s latest Iowa survey, the governor’s plans are deeply unpopular.

Iowans who advocate for people with disabilities have deep concerns about Governor Terry Branstad’s plan to privatize Medicaid, shifting most recipients into managed care. Iowa Senate President Pam Jochum, who has been caregiver to a daughter with developmental disabilities, has been warning for weeks that the reorganization of Medicaid is too hasty and needs oversight from state lawmakers. Last week she discussed potential problems in more detail, citing the Kansas experience with Medicaid privatization as a cautionary tale. After the jump I’ve posted the transcript from that press conference. Supporting documents are available here on how managed care has affected Kansans with disabilities.

Meanwhile, Disability Rights Iowa Executive Director Jane Hudson shared her take on the “empty promises” in Branstad’s plan for Medicaid. You can read the full text of her April 20 guest column for the Des Moines Register at the newspaper’s website or at Disability Rights Iowa. I’ve enclosed a few passages after the jump, but you should click through to read the whole piece. Nearly 20 advocacy groups for Iowans with disabilities or mental health challenges signed on to Hudson’s editorial; the full list is below.

Last Tuesday morning, I woke up a lifelong Iowan, a working mom, a wife, a small business owner. By dinner, I was being portrayed by national – and international – media as a “fake” Iowan.

It has taken nearly a week for the reality of my unexpected cup of coffee with Hillary Clinton to sink in. As soon as she sat down, I realized how privileged I was to have her ear that morning. The experience, from start to now, has been surreal, to say the least.  

Governor Terry Branstad made a remarkable claim at his latest press conference: because “the people of Iowa elected me to reduce the size and cost of government,” he has the authority to “make tough decisions” on closing state-run mental health facilities and reorganizing Medicaid services for more than half a million Iowans.

To justify his position, Branstad channeled President Harry Truman: “The buck stops with me.” But his view of governance reminds me more of Mel Brooks in the movie “History of the World, Part 1”: “It’s good to be the king.”

At least 40,000 Iowans are in danger of losing their health insurance later this year, and not only because of the King v Burwell case before the U.S. Supreme Court. Regardless of how justices decide that case, Iowans could lose access to federal subsidies they need to buy insurance policies.

State legislators and Governor Terry Branstad could eliminate the risk by working together to establish a fully state-run health insurance exchange this year. But for reasons I can’t comprehend, I see no sense of urgency to prevent a potentially devastating outcome for thousands of families.  

Iowa Senate Ways and Means Committee Chair Joe Bolkcom has introduced a bill to make medical marijuana more broadly available to Iowans suffering from life-threatening or chronic illnesses. Senate Study Bill 1243 would allow the possession and use of medical cannabis (not just the cannabis oil derivative legalized last year) for any of the following “debilitating medical conditions”: cancer, multiple sclerosis, epilepsy, AIDS or HIV, glaucoma, hepatitis C, Crohn’s disease or ulcerative colitis, Amyotrophic lateral sclerosis (often known as Lou Gehrig’s disease), Ehlers-danlos syndrome, or post-traumatic stress syndrome. Scroll to the end of this post for a detailed summary of the bill.

The latest Des Moines Register poll by Selzer & Co indicates that 70 percent of Iowans favor allowing medical marijuana use. Yet Iowa’s new law allowing cannabis oil treatments has yet to benefit a single patient. Nevertheless, persuading Iowa House Republicans and Governor Terry Branstad to legalize marijuana for additional medical conditions may be an uphill battle. Follow me after the jump for more background on this issue, and excerpts from recent testimony before members of the Iowa Senate.

Several recent tragedies in the Des Moines area have been on my mind this week. Last Friday, a body was found in Water Work Park, later identified as Richard Miles, a Iraq War veteran who had been suffering from post-traumatic stress disorder after three deployments. He had sought in-patient help at the VA hospital in Des Moines on February 15, but was sent home with medication. He disappeared two days later. U.S. Senator Joni Ernst has written to the inspector general of the Department of Veterans Affairs seeking a federal investigation into Miles’ case and more generally the mental health programs of the Veterans Affairs Central Iowa Health Care System.

After the jump I’ve posted a list of mental health resources available to veterans, as well as a timeline and statement that Miles’ friends released this week.

Two girls who attended Urbandale Middle School committed suicide within a week of each other. One was 12 years old and in sixth grade; the other 14 years old and in eighth grade. Police haven’t found evidence of bullying in the first case and are investigating the second case. The sixth-grader’s father has urged parents “to monitor their children’s social media activity and for others to speak out if they see anything unusual on a friend’s account.” I’ve enclosed more of his comments below.

Child psychiatrist Dr. Donner Dewdney encourages parents to watch closely for sign of depression in their children, and to talk to teens specifically about alternatives to suicide.

Here are some resources and hotline numbers for Iowans of any age who are experiencing suicidal thoughts. Many resources for children or teenagers who have experienced the death of a friend or close relative are available here and here.

This is an open thread: all topics welcome.

The Iowa Board of Medicine released a remarkable file on Thursday detailing its settlement agreement with Dr. Fredric Sager, an obstetrician/gynecologist based in Clive. You can read the full document here (pdf). After the jump I’ve enclosed the first five pages, which cover the charges of “unethical or unprofessional conduct” and “disruptive behavior,” as well as the main terms of the settlement. Reading what Sager did with some of his patients, including staying with them at his vacation home in Florida, it’s mind-boggling that his license to practice medicine was not revoked or at least suspended. Instead, he will pay a fine of $7,500 (a token amount for a well-compensated doctor in Iowa), undergo some counseling on “professional boundaries,” transfer certain patients out of his care, and be forced to have a “female healthcare professional chaperone” present when treating female patients in the future.

Multiple acquaintances who work with vulnerable populations in Polk County have told me that Sager treated many patients without a strong support system, such as pregnant teens, homeless youth, and young single women. In fact, one person had heard a teen in Sager’s care talk about possibly going to Florida with him, but brushed it off as delusional thinking. It makes me sick that the Iowa Board of Medicine is allowing him to continue to practice medicine as an OB/GYN–even with a chaperone–after establishing his pattern of predatory and inappropriate behavior with patients.  

In contrast, the state Board of Medicine rushed through without adequate public input a rule banning the use of “telemedicine” for medical abortions at Planned Parenthood clinics around Iowa. Board members moved to ban that procedure despite studies demonstrating the safety of telemedicine abortions. Advocates were not able to cite any evidence of adverse outcomes among more than 5,000 Iowa women who had used the teleconferencing system to receive abortifacients. Planned Parenthood’s lawsuit challenging the state rule is pending before the Iowa Supreme Court.

Governor Terry Branstad appointed all ten current members of the Iowa Board of Medicine. Six are physicians, and four are members of the public.  

Iowa’s new U.S. Senator Joni Ernst is often described as the first female combat veteran to serve in the U.S. Senate, but Andrew Reinbach took issue with that label in a recent commentary for the Huffington Post. I’ve posted excerpts after the jump, along with Ernst’s response. Reinbach’s main point is that while Ernst technically qualifies as a combat veteran, she should not use that label, never having come under enemy fire during her service in Iraq and Kuwait.

No one will ever mistake me for a big fan of Ernst, but I disagreed with those who grumbled about the “combat veteran” label last year, and I disagree with Reinbach now. Ernst served in a war zone during wartime. Lots of Americans were severely wounded or killed while performing supply or supporting roles during the Iraq War. Fortunately, the Iowa National Guard’s 1168th Transportation Company was not ambushed and never drove over a bomb. That fact doesn’t diminish the real risks facing everyone who served in the company.

Reinbach did make one valid argument, in my opinion: Ernst should correct those who say she “led troops into combat,” because that phrase gives a misleading impression of her role. Speaking to Radio Iowa about the criticism, Ernst did not directly acknowledge the point but said in her defense, “I have never once claimed that I have a combat action badge. I have never claimed that I have had a purple heart. What I have claimed is that I have served in a combat zone.”

Far too many combat veterans take their own lives after completing their wartime service. Congress recently addressed this national disgrace by approving the Clay Hunt Suicide Prevention for American Veterans Act unanimously in the U.S. House and Senate. This bill should have become law last year, but a jackass who has since left the Senate blocked the bill from passing by unanimous consent during the lame-duck session.

Meanwhile, new Veterans Affairs Secretary Robert McDonald put his foot in his mouth in a huge way during a House committee hearing today. Pete Kasperowicz reported for The Blaze,

At the end of a few minutes of sniping, McDonald ended by barking at [GOP Representative Mike] Coffman, “I’ve run a large company, sir. What have you done?”

As it turns out, Coffman is a combat veteran who started his own company, and is the only member of Congress to have served in both Iraq wars.

The comments from McDonald, who once ran Procter & Gamble, were later described by Coffman’s office as “obnoxious.”

Hey, corporate genius: next time you go up to the Hill, have your staff brief you ahead of time on who will be asking the questions.

This is an open thread: all topics welcome.

U.S. Senator Rand Paul came to central Iowa this weekend. He drew more than 200 people to an event in Des Moines on Friday night, packed a restaurant in Marshalltown on Saturday morning, and took in the Iowa State men’s basketball game that afternoon. It was Paul’s first visit to our state since October, when he campaigned in eastern Iowa with Congressional candidate Rod Blum and Senate candidate Joni Ernst. Clips with more news from Paul’s appearances are after the jump, along with excerpts from Shane Goldmacher’s recent article for the National Journal, which depicted former Iowa GOP chair A.J. Spiker as an “albatross” for Paul’s caucus campaign.

Before I get to the Rand Paul news, some quick thoughts about Representative Blum, who joined Paul for his Marshalltown event. Blum didn’t endorse a candidate before the 2012 Iowa caucuses and told The Iowa Republican’s Kevin Hall that he doesn’t “plan to endorse anyone” before the upcoming caucuses, adding,

“I might at the very end. We need a strong leader. We need genuine, authentic leadership and I may rise or fall in my election in two years based on who this presidential candidate is.”

I will be surprised if Blum doesn’t officially back Paul sometime before the caucuses. The “Liberty” movement got behind him early in the GOP primary to represent IA-01. At that time, many Iowa politics watchers expected the nomination to go to a candidate with better establishment connections, such as Iowa House Speaker Kraig Paulsen or State Representative Walt Rogers. Paulsen eventually chickened out of the race, and Rogers bailed out a few months before the primary after overspending on campaign staff. Arguably, Blum owes Liberty activists for helping him scare off the strongest Republican competition. Without them, he might be a two-time failed GOP primary candidate, rather than a first-term member of Congress.

The case against Blum endorsing Paul before the caucuses is that doing so might anger GOP supporters of other presidential candidates. Even if Paul remains in the top tier by this time next year, 70 percent to 80 percent of Iowa Republican caucus-goers will likely prefer someone else. Blum will need all hands on deck to be re-elected in Iowa’s first district, which is now one of the most Democratic-leaning U.S. House seats held by a Republican (partisan voting index D+5). It will be a top target for House Democrats in 2016.

Still, I think Blum would be better off endorsing than staying neutral. Most Republicans in the IA-01 counties will vote for him in the general election either way. By getting behind Paul when it counts, Blum would give Liberty activists more reasons to go the extra mile supporting his campaign later in the year, regardless of whether Paul becomes the presidential nominee or (as I suspect) seeks another term as U.S. senator from Kentucky. Besides, if Blum really believes that Paul’s outreach to youth and minorities has the potential to grow the GOP, he should invest some of his political capital in that project.

What do you think, Bleeding Heartland readers?  

Brad Anderson, the Democratic candidate for Iowa secretary of state in 2014, has taken a new job as executive director of the Des Moines-based non-profit Above + Beyond Cancer. The official announcement is after the jump. The organization “takes cancer survivors on incredible adventures” in order “to elevate the lives of those touched by cancer” and provide “an example for healthy living and cancer prevention in their communities.”

A former staffer for Senator Tom Harkin and Governor Chet Culver, Anderson has worked on many Iowa campaigns, most famously as manager of President Barack Obama’s 2012 effort in Iowa. Although he lost last year’s secretary of state race to Republican Paul Pate, Anderson proposed a lot of good ideas and ended up winning more votes statewide than the top of the Democratic ticket. I’m sure the whole Bleeding Heartland community (regardless of partisan affiliation) wishes Anderson success in his new position. Most Iowans have been affected by cancer in some way, and there’s no question that “health, fitness and good nutrition” are important for preventing or surviving the disease.

UPDATE: On February 11, Anderson sent an e-mail blast to supporters of his campaign for Iowa secretary of state. Scroll down to read.

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

Both in the “real world” and on social media, it seems like everyone I know is talking about the controversy over mandatory vaccinations in light of the current measles outbreak. Following up on yesterday’s post about some Republican presidential candidates’ comments, here are more related links:

Over at Iowa Starting Line, Pat Rynard compiles reaction from other GOP presidential hopefuls, including Ben Carson, Bobby Jindal, Marco Rubio, and Ted Cruz. (Scot Walker also issued a strong pro-vaccination statement.) Rynard sees Christie and Paul getting “burned” on an issue they didn’t handle well. I’m not so sure. Social conservatives do not agree with big government imposing its judgment on any aspect of child-rearing. Arguably Christie has no hope with that crowd anyway after signing the New Jersey law that banned gay conversion therapy for teenagers, but Paul has a shot with them.

A nurse-practitioner who survived measles as a child wrote this open letter to parents who aren’t immunizing their children.

I believe it’s a huge mistake to discount anti-vaxxers as “anti-science.” I have encountered hundreds of parents who opt against vaccinating and talked with many of them about why we choose to vaccinate our children. My impression is similar to what German Lopez wrote after interviewing a prominent anti-vaccine activist:

Vaccine skeptics do think they believe in scientific evidence. They can cite dozens of studies and cases. They see themselves as the side in this debate that’s actually following the evidence, while the pro-vaccine side is blindly trusting in authority and ultimately getting taken in by a massive pharmaceutical scam.

I also believe that images and accounts of vaccine-injured children (yes, there are some adverse reactions) evoke such a powerful emotional response that it becomes difficult for many parents to imagine deliberately injecting a vaccine into their child. Statistically, every time you put your baby in a car and drive somewhere, your baby is at greater risk of serious injury than when getting a shot at the doctor. Statistically, the number of lives saved by vaccinating against diseases like HiB and meningitis vastly outnumbers the serious adverse reactions to vaccines. But in all the times I have used those arguments, I don’t think I have ever convinced a single skeptical parent to start vaccinating.

Since the year 2000, a growing number of Iowa families have sought medical or religious exemptions from state vaccination requirements. The Des Moines Register reports that there are no efforts in the Iowa House or Senate to tighten the rules on vaccine exemptions. Governor Terry Branstad is also satisfied with current policy, according to a statement from his office.

The recent measles outbreak has sparked more media discussion of the trend away from routine vaccination. New Jersey Governor Chris Christie tried to walk a fine line when asked about the issue yesterday, saying parents should have “some measure of choice” over immunizing their kids. I enclose his comments and his staff’s later attempts to clarify below.

Meanwhile, U.S. Senator Rand Paul, who is also a medical doctor, told a popular right-wing radio host yesterday, “I’m not anti-vaccine at all but…most of them ought to be voluntary. […] I think there are times in which there can be some rules but for the most part it ought to be voluntary.” He took a shot at former Texas Governor Rick Perry, who has said it was a mistake for his administration to try to require the human papillomavirus vaccine for pre-teen girls in Texas.

As these and other Republican presidential candidates tour Iowa this year, I guarantee that they will face many more questions about the vaccine issue. In my non-blogging life, I have encountered hundreds of Iowa parents who choose not to vaccinate their children. They are a diverse group and can’t be stereotyped as “crunchy hippie” lefties or religious conservatives. Some don’t trust the government to regulate toxins in products pushed by pharmaceutical companies. Others may not believe vaccines cause autism but fear different adverse reactions. Or, they think “natural immunity” acquired through getting a disease is stronger. Many conservative evangelicals and Catholics shun vaccines because of concerns about the use of fetal tissue in their manufacture (see also here). Although the most influential homeschooling group, the Network of Iowa Christian Home Educators, does not take a position for or against immunizations, my impression is that anti-vaccine views are more prevalent among homeschoolers than among parents who send their children to public or parochial schools. Homeschoolers were a critical base of support for Mike Huckabee’s 2008 Iowa caucus campaign and were courted by multiple presidential candidates before the 2012 caucuses.

Some libertarian-leaning conservatives may not worry about the safety or ethics of vaccines, and may even have their own children immunized, but on principle don’t think the government should tell parents anything about how to raise kids. That group looks like a natural Rand Paul constituency, but they may be open to other candidates who cater to their views.

Regardless of how far the measles outbreak spreads, this issue will remain a minefield for GOP candidates.

Side note: In central Iowa, more and more pediatric practices are rejecting families whose parents want to deviate from the accepted vaccine schedule. In my opinion, that is a huge mistake. There is no one perfect immunization schedule. Medical associations in different countries recommend that babies and toddlers get shots for various diseases at different times. Based on my conversations, many of these parents would agree to most or all of the vaccines eventually; they just feel uncomfortable with so many shots clustered close together. Instead of accommodating those concerns with a delayed schedule, pediatricians are driving families away. So worried parents either stop taking their kids to regular wellness checks, or seek medical care only from chiropractors or alternative health providers.

UPDATE: Added below further comments from Rand Paul on why vaccines should be voluntary.

Likely Democratic presidential nominee Hillary Clinton weighed in on Twitter: “The science is clear: The earth is round, the sky is blue, and #vaccineswork. Let’s protect all our kids. #GrandmothersKnowBest”

A Bleeding Heartland reader reminded me about this report from last year, indicating that “In West Des Moines, 37 percent of home-schooled children are not fully vaccinated.”  

On the 42nd anniversary of the U.S. Supreme Court’s decision in Roe v Wade, the U.S. House approved a bill that could make abortion an unaffordable choice for many women. Emily Crockett reported for RH Reality Check,

The “No Taxpayer Funding for Abortion Act and Abortion Insurance Full Disclosure Act” would make permanent the Hyde Amendment, which restricts federal funding for abortion except in cases of rape, incest, or life endangerment.

The bill, HR 7, would also go much further than Hyde by prohibiting women or small businesses from using tax credits or subsidies under the Affordable Care Act to pay for any health insurance plan that covers abortion care.

The bill has no exceptions for a patient whose health is endangered by her pregnancy. […]

The effect of the bill could be to cause the entire insurance market to drop abortion coverage, according to a statement from the American Civil Liberties Union.

Traditionally, health insurance policies have covered abortion services, because doing so is much less costly than covering prenatal care and labor/delivery.  

The bill passed by 242 votes to 179 (roll call), with only one Republican opposed and three Democrats in favor. Iowa’s U.S. representatives split on party lines: Rod Blum (IA-01), David Young (IA-03) and Steve King (IA-04) voted yes, while Dave Loebsack (IA-02) voted no. I enclosed King’s statement below and will update if I see any other official comment from the Iowans in Congress.

House leaders had originally planned to pass a 20-week abortion ban on the Roe v Wade anniversary, to coincide with an annual March for Life in Washington, but that bill was pulled at the last minute “following a revolt from female members who objected to language regarding exceptions for rape.” The bill would have allowed abortion in the case of rape only if the victim had reported the alleged crime to police. House Majority Whip Steve Scalise says the bill will come back to the floor at a later date. On Wednesday, fifteen of the sixteen Republicans who spoke in favor of the 20-week abortion ban were men.

Governor Terry Branstad will expand the number of Medicaid recipients who are covered under private managed-care companies, Tony Leys reported for the January 21 Des Moines Register.

Details are scarce on how the plan would work, but Branstad projects it would save $51.3 million from January through June 2016, its first six months. […]

“Through better coordinated care in Medicaid, focused on improving outcomes, Iowa can better serve Medicaid patients and provide more predictability for Iowa taxpayers,” [Branstad spokesman Jimmy Centers] wrote in an email to the Register. “The growth of Medicaid spending in Iowa is unsustainable over the long-term and it limits Iowa’s ability to provide high-quality and stable health services to our most vulnerable residents as well as our ability to invest state taxpayer dollars in other key programs aimed at growing our state.” […]

Rep. Linda Miller, a Bettendorf Republican who serves on the [Human Resources] committee, said most of the savings would come from improved care, so Medicaid members wouldn’t need hospitalization or other expensive services as often. She said legislators want to make sure the shift won’t lead to cuts in services or in payment rates to medical providers.

Amy McCoy, a spokeswoman for the Iowa Department of Human Services, said the state and federal governments spend about $4.2 billion annually – including $1.5 billion of state money – on Iowa’s Medicaid program. That’s up 73 percent since 2003, she said.

If Branstad’s plan really would save $51.3 million each year (I am skeptical), that figure represents a little more than 1 percent of Medicaid’s total annual costs in Iowa, or about 3.4 percent of the state’s share of Medicaid costs.

Approximately 564,000 Iowans are now covered under the Medicaid program. It’s not clear how many of them would be shifted to private companies; the Department of Human Services is expected to release a plan in March. Magellan of Iowa has offered “a broad range of mental health and substance abuse services” to most Iowans on Medicaid since 1995. Meridian Health Plan has been providing coverage to some Medicaid recipients since 2012 “through a contract with the Iowa Department of Human Services.” Currently about 17,000 beneficiaries are covered through Meridian.

Leys quoted Iowa House Republican Dave Heaton as saying the governor can implement this change without legislative approval.

Any relevant comments are welcome in this thread.

P.S. – Who is old enough to remember when Republicans demonized the idea of “managed care” as evil interference between doctors and their patients?

Benton Mackenzie passed away at home this morning, his wife Loretta Mackenzie told Brian Wellner of the Quad-City Times. Mackenzie was convicted last summer on drug charges, having grown dozens of marijuana plants in order to treat his terminal cancer. During the trial, the judge did not allow Mackenzie or his attorney to say that the defendant was seeking to use cannabis as a cancer treatment. Mackenzie was later sentenced to probation. The family had hoped to move to Oregon; Mackenzie had visited the state and received a valid Oregon medical marijuana card before his health deteriorated late last year.

Many Iowans who favor legalizing medical marijuana were outraged by the prosecution of a terminal cancer patient. State Senator Joe Bolkcom described the case as a waste of taxpayer money. During last year’s legislative session, Bolkcom defied long odds to get a baby step toward legalizing medical cannabis approved in the Iowa House and Senate. However, the new law only permits the use of cannabis oil in order to treat certain seizure disorders, and even the affected families have been unable to obtain the treatment so far.  

Thousands of Iowans are battling cancer or suffering from chronic illnesses that can be treated with cannabis or its derivatives. They should not be subject to criminal prosecution merely for attempting to obtain marijuana for personal use. Benton Mackenzie’s death may not be enough to spur a majority of lawmakers to act this year, but I hope his sad story will eventually create the political space to expand Iowa’s medical marijuana law.

Merry Christmas to everyone in the Bleeding Heartland community who is celebrating the holiday, and peace on earth to all regardless of religious beliefs and customs. This is an open thread: all topics welcome.

In past years I have posted some links about the religious origins of Christmas celebrations as well as some traditional food for the holiday.

Children often look forward to the toys they will receive on Christmas. Unfortunately, not all of those toys are safe or appropriate. The Campaign for a Commercial-Free Childhood gives out “awards” annually for the worst toys of the year. This year’s nominees were atrocious. The U.S. Public Interest Research Group’s annual “Trouble in Toyland” report is an excellent resource for parents, and I recommend checking to see if any of your children’s gifts ended up on the danger list. I’ve posted the executive summary after the jump, along with excerpts from a good Des Moines Register article on keeping your kids safe during the holidays.

Speaking of safety, the long Christmas weekend tends to be a busy time for travel. If you are driving to see friends or family, one of the best presents you can give yourself, your loved ones, and everyone else on the road is not using your cell phone while driving. It doesn’t matter whether you are talking or texting, or whether you are holding the phone or using hands-free technology: “There is no safe way to use a cell phone while driving.” Legislative bans on texting while driving or using hand-held phones haven’t reduced crashes (including in Iowa), only partly because of noncompliance. Hands-free devices give drivers a “false sense of security,” and drivers aware of texting bans may attempt to hold their phones out of view, increasing the amount of time they take their eyes off the road.

UPDATE: I should have included a few links on good toys. Here’s a piece on toys that encourage creative, imaginative play, and here’s a classic on “The 5 Best Toys of All Time” (though I would replace “dirt” with a ball).

Senator Tom Harkin cast his final votes in Congress yesterday as the upper chamber wrapped up the lame-duck session. He and Senator Chuck Grassley were on opposite sides as Democrats confirmed a batch of presidential nominees on Monday and Tuesday. You can view all the roll calls here; the nominees were approved mostly along party lines. They included several judges and assistant secretaries of various agencies and Dr. Vivek Murthy, confirmed as surgeon general by 51 votes to 43, with only one Republican yes vote. Murthy had been the target of a relentless “smear campaign” by conservative media and the National Rifle Association, because of his comment in October 2012 that “Guns are a health care issue.”

The conservative media attacks against Murthy began in early March. Coverage of his nomination focused on his past acknowledgement that gun violence affects public health, which conservative media spun as evidence Murthy is obsessed with gun regulations. (Murthy has actually said his focus as Surgeon General will not be on gun violence, but rather obesity.)

Because of strange Senate procedural rules, hardline conservative Republican Senator Ted Cruz inadvertently made this week’s raft of confirmations possible. His constitutional point of order against the massive federal government funding bill last Friday prompted Senate Majority Leader Harry Reid to convene the chamber on Saturday. That gave Democrats more time to set up confirmation votes on nominees this Monday and Tuesday. Rebecca Kaplan of CBS News explained here that the most controversial presidential nominees to be confirmed “thanks to Ted Cruz” are Murthy, Tony Blinken for Deputy Secretary of State, and Sarah Saldaña, for Immigration and Customs Enforcement Director in the Department of Homeland Security. Harkin voted for and Grassley against all of those nominees.

Iowa’s senators ended up on the same side in one big vote this week: the bill extending dozens of tax breaks for corporations and individuals. Steven Dennis noted in Roll Call,

Handing out mostly corporate tax breaks and adding to the debt to do it has proven to be a popular thing for Congress. Democrats including President Barack Obama spent the better part of 2013 trying to get Republicans to agree to more revenue as part of a budget deal, but are now signing on to deficit expansion for the sake of tax breaks that will expire, again, in two weeks.

Usually, these tax breaks – which range from the R&D tax break to breaks for NASCAR, racehorse owners and wind farms – are touted as incentives – and indeed some senators called them that Tuesday. But it’s hard to retroactively incentivize anything – a point made on the Senate floor by outgoing Finance Chairman Ron Wyden, D-Ore., who voted no and said the tax bill didn’t even have the shelf life of a carton of eggs. […] After President Barack Obama threatened to veto an emerging deal after the midterms that would have added close to half a trillion to the debt over a decade, the scaled-back bill was all Congress could muster.

The tax extenders bill passed by 76 votes to 16. Joining Iowa’s senators in the yes column were possible GOP presidential candidates Cruz, Rand Paul, and Marco Rubio. Opponents of this bill included Republican Rob Portman and Democrat Elizabeth Warren. Independent Bernie Sanders, who is exploring a presidential campaign as a Democrat, missed yesterday’s votes because he was in Iowa.

Any relevant comments are welcome in this thread. Grassley’s official statement on the tax extenders bill is after the jump.

Contrary to fantasies promoted by some social conservatives, improved sex ed programs appear to be making teenagers more likely to use birth control and far less likely to become pregnant. Tony Leys reported for the Sunday Des Moines Register,

Teen birth rates are plummeting in Iowa and across the country, and experts say it’s mainly because young people are being more careful about sex. Despite rosy memories about how wholesome kids were in the good old days, the fact is that American teens were three times more likely to become parents in the late 1950s and early 1960s than they are today. […]

Researchers and activists are trying to understand what’s behind the declining teen birth rates so they can keep the trend going.

“That’s the question of the day. Nobody can pinpoint exactly what’s causing this,” said Addie Rasmusson, a community health consultant with the Iowa Department of Public Health.

Rasmusson said part of the explanation is that educators have determined which types of lessons make the most difference. They have created carefully researched lesson plans for teachers to follow.

“Twenty years ago, maybe you could throw together whatever you thought sex ed should be,” she said.

Rasmusson added that lesson plans can be flexible. For example, she said, messages are tailored to reach teen boys and members of racial groups that have relatively high pregnancy rates. […]

A recent national report from the Guttmacher Institute, which studies reproductive health, said the teen birth rate decline is mainly because of increased and improved use of contraceptives. Teens are not becoming dramatically less sexually active, the report says. They’re also not having more abortions. But they are having fewer babies.

Leys’ report is worth reading in full, as he describes some innovative sex ed programs that teach teens “how to say no to unwanted sex, how to prevent pregnancies and how to avoid sexually transmitted diseases.” Toward the end, the article points to a big problem for birth control access in rural Iowa. I was not aware that Casey’s General Stores has a company-wide policy against selling condoms. They are the only retail outlet in many towns. Independently-owned pharmacies have been disappearing from Iowa communities, and Planned Parenthood of the Heartland has reduced the number of clinics it operates in small towns as well.  

Catching up on news from last week, the U.S. Environmental Protection Agency has released new standards for ground-level ozone that will reduce the incidence and severity of various respiratory diseases. Click here for details on the standards.

Ground level or “bad” ozone is not emitted directly into the air, but is created by chemical reactions between oxides of nitrogen (NOx) and volatile organic compounds (VOC) in the presence of sunlight. Emissions from industrial facilities and electric utilities, motor vehicle exhaust, gasoline vapors, and chemical solvents are some of the major sources of NOx and VOC. Breathing ozone can trigger a variety of health problems, particularly for children, the elderly, and people of all ages who have lung diseases such as asthma. Ground level ozone can also have harmful effects on sensitive vegetation and ecosystems.

Current regulations allow ozone at 75 parts per billion. The new rules would lower that to a level between 65 and 70 parts per billion. Mark Drajem reported for Bloomberg News, “The EPA’s independent science advisers this year recommended the administration set the standard at 60 to 70 parts per billion, and urged the agency to consider the lower end of that range.”

After the jump I’ve posted the EPA’s press release and excerpts from a commentary by EPA Administrator Gina McCarthy, along with some reaction by critics of the proposal. Predictably, some business groups say the new standards will be devastating for the economy. McCarthy pointed out that same dire warnings have accompanied every new environmental regulation for decades.

The Iowa Association for Business and Industry is concerned that the EPA proposal may be expensive for manufacturers. Data collected between 2011 and 2013 at various monitoring sites around Iowa indicate that ground-level ozone is already below 70 parts per billion at all tested locations. Some of the Iowa sites recorded levels below 65 parts per billion; others are slightly above that level. The EPA does not anticipate that any counties in Iowa will violate the new ozone standard by 2025. Counties with the worst smog problems, including many in California, will be given more time to comply with the new ozone standards.

The Iowa Hospital Association was one of many health care organizations that advocated strongly for Medicaid expansion. A new analysis of care provided by Iowa hospitals shows why.

Scott McIntyre highlighted the key findings on the Iowa Hospital Association’s blog yesterday.

During the first six months of this year, the number of people hospitalized in Iowa without insurance fell by 45.7 percent compared with the same period last year, an IHA analysis has found.  The analysis is based on data collected from 101 Iowa hospitals from January through June.

According to the study, out of about 159,000 hospital discharges from January to June in 2014 and 2013, 4,445 patients were uninsured this year compared with 8,181 in 2013.

[…] Because of Medicaid expansion, in a six-month span, Iowa hospitals cared for fewer uninsured patients in all settings, including patients admitted for inpatient care as well as those seeking care at hospital emergency rooms and at outpatient clinics.  Similar results are being seen in other states that expanded Medicaid under the Affordable Care Act. […]

For the period January 1-June 30, overall inpatient admissions at Iowa hospitals declined 4.4 percent compared with the same period in 2013.  Within that decline, the number of uninsured hospitalized patients with no source of payment for their health care fell by 45.7 percent in 2014.

Additionally, fears that expanding coverage would make care so easily accessible that use of hospital emergency rooms would rise to unprecedented levels have not materialized, the IHA analysis found.  Total visits to emergency rooms increased less than 1 percent when comparing the six-month spans in 2013 and 2014, despite approximately 30,000 patients with new policies purchased through the Health Insurance Marketplace.

With more Iowans now insured, hospitals’ charity care losses fell 18.5 percent, yielding a total six-month improvement of $32.5 million.

During the state legislature’s 2013 session, Iowa House Republicans and Governor Terry Branstad refused to expand Medicaid, but agreed to create an “Iowa Health and Wellness Plan” as a compromise. The arrangement was more complicated and more expensive than simply expanding Medicaid as foreseen under the 2010 federal health care reform law. Nevertheless, the deal was well worth it and is benefiting tens of thousands of Iowans.  

Many Iowans think of our state as a great place to settle down, thanks to relatively low unemployment, crime rates, living costs, and other quality of life factors (such as short commute times). After considering 44 criteria, the StateMaster website ranked Iowa the sixth best state to live. The latest Kids Count report by the Annie E. Casey Foundation ranked Iowa third in terms of children’s well-being.

So Danielle C. Belton’s article for The Root last week should be a wake-up call. For the roughly 102,000 Iowans who are African-American, this state doesn’t stack up nearly as well against the competition. In fact, Belton considers Iowa the fourth-worst state for black people.

If you’re black and into marijuana, avoid Iowa. The state arrests blacks at a rate eight times higher than whites for marijuana possession, despite the rate of drug usage between blacks and whites being about the same. For years, Iowa also held the title for locking up black people at a higher rate than any other state (it recently lost that crown to Wisconsin). While other states have large prison populations, what makes Iowa stand out is that it’s a relatively small state with a small population. In fact, its black population is only about 3 percent. Adding insult to injury, the poverty rate among African Americans in Iowa is 31 percent, compared with 11 percent for white Iowans.

The massive racial disparity in Iowa’s arrest and imprisonment rates has been one of the country’s worst for a long time. Way back in 2005, Bruce Dixon of the Black Commentator highlighted Iowa as one of the “ten worst places to be black” for this very reason. If Governor Terry Branstad wants to spend the next four years cementing his legacy as a leader who cares about all Iowans, he should try to do something about this persistent problem. I don’t know how to change the culture in local law enforcement or county attorney offices, but there’s no excuse for such a large disparity in whether people will be arrested or charged for the same unlawful behavior. Surely the governor’s staff could research, and Branstad could propose, policies Iowa can adapt from other states that have addressed this problem.

Happy election day to the Bleeding Heartland community. The weather forecast looks good for most parts of Iowa. Polls are open everywhere from 7 am to 9 pm. It’s too late to mail absentee ballots, but you can still hand-deliver completed absentee ballots to your county auditor’s office, or “surrender” you ballot at your regular polling place, then vote with an ordinary ballot.

Three new polls of the U.S. Senate race came out on Monday. Quinnipiac found Bruce Braley and Joni Ernst tied at 47 percent. (That pollster’s previous Iowa survey had Ernst leading by 49 percent to 45 percent.) Fox News found Ernst ahead by 45 percent to 44 percent. Public Policy Polling found Ernst ahead by 48 percent to 45 percent.

All three polls confirmed my belief that the Des Moines Register’s Iowa poll by Selzer & Co was an outlier. No other survey has found Ernst above 50 percent or ahead by such a large margin. If she does win the IA-Sen race by 7 points, I will declare Ann Selzer a polling genius.

Incidentally, the new polls also found Governor Terry Branstad ahead of Democratic challenger Jack Hatch by a smaller margin than in the Register’s final Iowa poll. Quinnipiac found Branstad ahead by 52 percent to 41 percent. That was similar to Public Policy Polling’s finding of Branstad at 54 percent and Hatch at 43 percent. Fox News found a bigger lead for the governor: 53 percent to 36 percent.

PPP has been the only firm to consistently poll down-ballot statewide races in Iowa this year. Its final poll found Democrat Brad Anderson ahead in the secretary of state race, with 44 percent support to 38 percent to Paul Pate and 3 percent each for Jake Porter and Spencer Highland. (Porter, a Libertarian, received about 3 percent of the statewide vote in the 2010 secretary of state race.)

PPP found State Auditor Mary Mosiman leading her Democratic challenger by 46 percent to 41 percent. State Treasurer Mike Fitzgerald is ahead of his Republican challenger Sam Clovis by 48 percent to 38 percent, with Libertarian Keith Laube pulling 5 percent. Iowa Secretary of Agriculture Bill Northey has a comfortable 51 percent to 33 percent lead over Democrat Sherrie Taha, with a minor-party candidate pulling 5 percent. Finally, Attorney General Tom Miller leads Republican Adam Gregg by 55 percent to 36 percent.

While canvassing in Windsor Heights and Clive on Saturday, Sunday, and Monday, I didn’t see any Republicans knocking on doors, nor did I see Republican campaign literature on doorknobs or front porches. Another Democratic canvasser in a different part of the state had a similar experience. I would like to hear from Bleeding Heartland readers about what you’ve seen of the Republican “ground game” during the final days. As far as I can tell, the GOP has relied mainly on robocalls and perhaps live-caller phone-banking. Republicans paid for many robocalls in the final days.

Speaking of robocalls, many Democratic households in the third Congressional district (including mine) received a call Monday evening recorded by Senator Chuck Grassley, making the case for David Young.

Any comments related to today’s election are welcome in this thread.

P.S. – A testy exchange with a reporter about how President Barack Obama has handled the ebola outbreak underscored why Joni Ernst’s handlers didn’t want her sitting down with most Iowa newspaper editorial boards.

It's official. EPA and USDA have both evaluated Dow Chemical's new  line of 2,4-D-resistant seeds, Enlist — and have approved both the seeds  and the accompanying pesticide formulation for market.

This is a turning point, not just for grain production but for food  production in the U.S. and internationally. The introduction of Enlist  corn and soybeans, and the widespread adoption of this new seed line,  will have pervasive impacts on farmer livelihoods, public health and  control of our food system.

This is a decision that our regulators should not have taken lightly.  And yet, it seems they did. Both USDA and EPA set up an intentionally  narrow scope for evaluating the potential harms posed by 2,4-D resistant  crops — one that ignored the biggest problems and held up irrelevant  factors as evidence of safety.

As small farmers brace for the impact of pesticide drift that will  hit with the introduction of Enlist crops, it is time for us to look  forward. It's time to demand a regulatory system that takes a rigorous  approach to pesticides and genetically engineered crops, one that values  small farmers as much as industrial agriculture — and public health as  much as corporate profit.