# Medicaid



Iowa should comply with National Voter Registration Act

State Representative Adam Zabner being sworn in as a legislator in January 2023

Adam Zabner represents Iowa House district 90, covering part of Iowa City. He delivered remarks on this topic as a point of personal privilege in the Iowa House on April 10; you can listen here.

American democracy is at its best when Americans participate. Unfortunately, Iowa’s Department of Health and Human Services is holding some Iowans back from participating in our elections.

In 1993, Congress, with bipartisan support from Iowa’s federal delegation, passed the National Voter Registration Act to encourage participation. The NVRA is the reason you are asked to register to vote every time you renew your driver’s license.

The bill also requires that Americans be given a chance to register to vote every time they register or renew their registration for Medicaid. Nationally, the NVRA has been a roaring success. In particular, the provisions around Medicaid have helped improve voter registration rates among low-income Americans and people of color, groups that have historically been underrepresented in elections and in government.

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Let Iowans with disabilities Work Without Worry

Supporters of the Work Without Worry bill lobby at the state capitol on March 12. From left: Derek Fike, State Representative Josh Turek, Jordan True, Julie Russell-Steuart, and Jen Sinkler.

Jordan True chairs the Iowa Democratic Party’s Disability Caucus. He emailed the message enclosed below to Republican members of the Iowa House Appropriations Committee on March 13.

Honorable Representatives of the House Appropriations Committee,

Please support appropriations for HF 2589 Work Without Worry by asking Chair Gary Mohr to assign to a subcommittee and schedule a vote as soon as possible in the Appropriations Committee. Although this bill has survived the funnel, please help employed people with disabilities get this through appropriations, through the House, and onto the Senate by the end of March. 

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A mother's perspective: How AEA reform will hurt Iowa's children

Heather Sievers is the founder of Advocates for Iowa’s Children and an Altoona mother of a child of rare disabilities. Photo of Heather with her daughter Rowan was provided by the author and published with permission.

I am speaking out to educate our communities and give voice to thousands of families across the state who are begging our Iowa legislators to stop the Area Education Agency (AEA) education reform bill from being passed into law during the 2024 legislative session.

Having spent years building my professional experience in effective health care transformation, performance and process improvement in large systems, I know we are not doing this the right way. We are not taking time to perform a credible and thorough study to determine what reform is needed before enacting a bill. A change of this magnitude cannot be rushed, or it will inevitably fail. The risk is too high to gamble on our children’s well-being and their futures. 

Any harm to our children as a result of the decisions made this legislative session will never be forgiven, nor forgotten. Our integrated AEA system works and is a national treasure. Many states aspire to implement a system like we have, and my personal story demonstrates that our system works. 

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Iowa legislature's clock runs out on feeding hungry kids

Interactive School Nutrition Dashboard created by the Iowa Hunger Coalition

At least four bills that would have helped needy Iowa families feed their children didn’t make it through the state legislature’s first “funnel.”

Most bills not related to taxes or spending are considered dead for the 2024 session if not approved by at least one Iowa House or Senate committee by February 16. Efforts to expand access to meals didn’t receive a subcommittee hearing, let alone consideration by a full committee. That was true even for one school lunch bill with 20 Republican co-sponsors.

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Advocates say Iowa Medicaid violating federal voter registration law

Zachary Roth is the national democracy reporter for States Newsroom. Jared Strong is senior reporter for Iowa Capital Dispatch, where this article first appeared.

Iowa’s health department is failing to comply with the federal requirement to make voter registration accessible to people applying for Medicaid, multiple advocates say, likely leading significant numbers of low-income Iowans to be left off the rolls.

“I would regard this as major noncompliance with an agency’s obligations under the NVRA,” said Brenda Wright, special litigation and policy counsel at the NAACP Legal Defense Fund. She was referring to the National Voter Registration Act, the 1993 law that requires state agencies to offer their clients the chance to register to vote. 

The concerns come at a time when Iowa already appears to be struggling to get people on public assistance to register, and as the 2024 election approaches.

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2024 Iowa maternal health priorities: Birth centers, Medicaid, and midwives

Photo provided by the author, showing maternal health advocates advocating for licensure of certified professional midwives during an Iowa House Ways and Means subcommittee meeting in February 2023.

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

This time last year I wrote about five policies that would improve maternal health in Iowa. I’m updating the piece for the 2024 legislative session with a focus on three core priorities. 

Although access to abortion care and contraceptives are critical to maternal and infant health, I do not discuss those topics here. I want to highlight lesser-known aspects of maternal health specific to prenatal, birth, and postpartum care, which receive much less media coverage.

For the 2024 legislative session, I am focusing on three issues I raised last year, which have a strong chance to be enacted. These policies would improve maternal health in Iowa by expanding access to midwives and expanding prenatal care options. I wrote at length in 2021 about how midwives save lives, and it seems like every week a different study or article underscores how the midwifery model of care leads to better outcomes. If you’re interested in diving deeper, one of my favorite resources released in 2023 is this Issue Brief on Maternity Medicaid Strategies from the Maternal Health Hub.

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Seven bad policies Iowa Republicans slipped into budget bills

Second in a series on under-covered stories from the Iowa legislature’s 2023 session.

During the seven years of the Iowa GOP trifecta, the majority party has often enacted significant public policy through eleventh-hour appropriations bills. Just before adjourning in 2019, Republicans amended spending bills to change the judicial selection process, restrict medical care for transgender Iowans on Medicaid, and block Planned Parenthood from receiving sex education grants.

A lengthy amendment to a budget bill approved in the closing hours of the 2020 session made it harder for Iowans to vote by mail and sought to restrict some companies from bidding on electric transmission lines projects.

The Iowa Supreme Court sent the legislature a message in March, blocking the 2020 provision on transmission lines, on the grounds that it was likely passed through unconstitutional “logrolling.”

Republican legislators weren’t pleased with the ruling known as LS Power, but seem to have adapted to it. This year’s “standings” appropriations bill was relatively short and focused on spending and code corrections—a far cry from the usual “Christmas tree” featuring unrelated policy items from lawmakers’ wish lists.

Nevertheless, many surprises lurked in other bills that allocated spending for fiscal year 2024, which begins on July 1.

This post focuses on seven provisions that appeared in budget bill amendments published shortly before Iowa House or Senate debate. Most of this policy language never appeared in a stand-alone bill, allowing Republicans to avoid the scrutiny that comes with subcommittee and committee discussions. Democratic legislators had little time to review the proposed budgets before votes on final passage, which mostly fell along party lines.

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Six ways the GOP budget shortchanged Iowans with disabilities

The biggest stories of the Iowa legislature’s 2023 session are well known. Before adjourning for the year on May 4, historically large Republican majorities in the Iowa House and Senate gave Governor Kim Reynolds almost everything on her wish list. They reshaped K-12 public schools; passed several bills targeting LGBTQ Iowans; enacted new hurdles for Iowans on public assistance; cut property taxes; reorganized state government to increase the power of the governor and “her” attorney general; and undermined the state auditor’s ability to conduct independent audits.

Many other newsworthy stories received little attention during what will be remembered as one of the Iowa legislature’s most influential sessions. This post is the first in a series highlighting lesser-known bills or policies that made it through both chambers in 2023, or failed to reach the governor’s desk.


As the Iowa House and Senate debated one appropriations bill after another last week, Democrats repeatedly objected to plans that imposed status quo budgets or small increases (well below the rate of inflation) on services for disadvantaged Iowans.

Iowans with disabilities or special needs were not a priority in the education and health and human services budgets that top Republican lawmakers negotiated behind closed doors.

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What's done, what's left as Iowa legislature's 2023 session winds down

The Iowa House and Senate finished work this week on several priority bills for Republicans, and leaders are closer to agreement on the next state budget.

The accelerating pace raises the prospect that the Iowa legislature may adjourn for the year close to the session’s scheduled end date of April 28. Stalemates over policies related to education and COVID-19 vaccines pushed the last two legislative sessions well into overtime; the 2021 session ended on May 19, and last year’s work wrapped up on May 24.

This piece highlights where things stand with high-profile bills approved in either the House or Senate this week, and other legislation that will likely be part of late deal-making. Forthcoming Bleeding Heartland posts will focus on many of those bills separately.

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Democrats must offer a vision for children and families

Charles Bruner served in the Iowa legislature from 1978 to 1990 and was founding director of the Child and Family Policy Center from 1989 through 2016. For the last six years, he headed a Health Equity and Young Children initiative focusing on primary child health care for the Robert Wood Johnson Foundation.

Democrats prioritize investing in children but don’t stress the importance of parents in raising the next generation. Republicans do the opposite.

The electorate wants both.

Until we make children’s issues part of our political dialogue, we will not do either.

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Where things stand with bills targeting Iowans on public assistance

Proposals that would cause thousands of Iowans to lose Medicaid coverage or federal food assistance through the Supplemental Nutrition Assistance Program (SNAP) are eligible for floor debate in both the Iowa House and Senate.

Republicans in each chamber’s Health and Human Services Committee changed some provisions in the bills, now numbered House File 613 and Senate File 494, then approved the legislation before the March 3 “funnel” deadline. However, the amended versions would still threaten health care or food assistance for many Iowans who now qualify.

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What Iowa's remarkable medical malpractice debate revealed

“Medical Malpractice Reform gets Iowa back in the game of recruiting and retaining physicians to care for Iowans!” Governor Kim Reynolds tweeted on February 16. She had just signed House File 161, a bill limiting damages in medical malpractice lawsuits.

Reynolds waited a long time for that moment. Two years running, similar proposals failed to reach her desk for lack of support in the GOP-controlled state House.

The bill signing capped one of the most dramatic debates in recent Iowa political memory.

It’s rare for more than a handful of Republican lawmakers to go on record against any bill that’s a priority for leadership. Not only did seventeen GOP lawmakers oppose passage of House File 161, six members of the majority party explained their objections during the hours-long debates in the House and Senate on February 8.

In addition to exposing divisions within Republican ranks, some remarks from the legislative proceedings may become important if the new law is challenged in court.

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Wrong-headed bill on food assistance raises questions

Rick Morain is the former publisher and owner of the Jefferson Herald, for which he writes a regular column.

Sometimes it’s easy to understand legislative proposals. Other times, not so much. House File 3, filed early in the Iowa legislature’s 2023 session, falls in the second category. To understand its potential effect on needy people, take a quick look at two preexisting food programs whose nutritional goals differ.

First, the Supplemental Nutrition Assistance Program (SNAP) is the federal program once called food stamps. It exists to help low-income households and those on Medicaid buy groceries.

Second, the Special Supplemental Nutrition Program for Women, Infants, and Children (commonly known as WIC) aims to meet the specific nutritional needs of its designated recipients. WIC doesn’t allow recipients to use those funds for meat, sliced cheese, butter, flour, or fresh produce.

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Five policy priorities to improve maternal health in Iowa

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

A 2022 report from March of Dimes shows that “36% of counties nationwide — largely in the Midwest and South — constitute ‘maternity care deserts,’ meaning they have no obstetric hospitals or birth centers and no obstetric providers.” While their report does not provide state rankings, you can see whether your county classifies as being a maternity care desert here. Additionally, a report from Stacker in June 2022 ranked Iowa eleventh on a list of “states where the most people live in maternal health care deserts.”

Even if your area has maternal health care providers (OBGYNs, family physicians, midwives), finding quality care is another challenge facing pregnant and postpartum individuals in both urban and rural areas. I’ve discussed some of those problems in previous articles for this website

The good news is relatively low-cost, evidence-based solutions are available to make maternal health care more accessible in Iowa, which would improve outcomes. I have identified and prioritized opportunities that should be bipartisan based on successes in other states.

Note: I am not including abortion access in these recommendations, since the procedure continues to be legal in Iowa, the media regularly cover this topic, and several organizations advocate on this issue. This article from Commonwealth Fund explains how states with restrictive abortion laws have worse maternal health outcomes.

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End the Medicaid coverage gap

Sue Dinsdale leads Health Care For America NOW in Iowa.

This month Medicare and Medicaid celebrate their 57th Anniversary. These two biggest government health insurance programs in the nation were created by President Lyndon B. Johnson and the Democratic-controlled Congress in 1965. Together, they provide coverage and services to more than 150 million people in the United States, including 637,388 Medicare enrollees and 812,017 Medicaid enrollees in Iowa.

Medicaid has been a lifeline and resource for workers, families, state budgets and people of all ages. Whether it’s regular preventive care, prenatal or maternity care for new moms, addiction treatment in the swelling opioid epidemic or rapid response to national crisis like hurricanes, terrorist attacks and epidemics, Medicaid is a fundamental pillar of the American health care system that we all depend on.

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Iowa Democratic Party's Disability Caucus endorses Dr. Glenn Hurst

Julie Russell-Steuart is a printmaker and activist who chairs the Iowa Democratic Party’s Disability Caucus.

Glenn Hurst is a rural doctor in the small southwestern Iowa town of Minden and a founding member of Indivisble Iowa, whose activism helped elect U.S. Representative Cindy Axne. He faces Abby Finkenauer and Mike Franken in the June 7 Democratic primary for U.S. Senate.

Dr. Hurst has earned our endorsement for his strong experience advocating for people with disabilities and because he is laser focused on improving the lives of the American people in crucial ways.

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Iowa Republicans fund anti-abortion clinics but not proven maternal health solutions

Iowa’s health and human services budget for the coming fiscal year includes a $500,000 appropriation for a new “maternal health” initiative modeled on an ineffective, wasteful Texas program.

But the bill, negotiated by House and Senate Republicans and approved on party-line votes in both chambers May 23, does not extend postpartum coverage for Iowans on Medicaid, a documented way to reduce maternal mortality.

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Capping costs no substitute for lowering drug prices

Sue Dinsdale is the director of Iowa Citizen Action Network and leads the Health Care For America and Lower Drug Prices NOW campaigns in Iowa.

U.S. Senator Chuck Grassley got it right when speaking about efforts to lower prescription costs. He acknowledged the “difficulty of passing something like this in a Republican Congress,” adding, “If we want to reduce drug prices, then we need to do it now.”

For years we’ve been hearing members of Congress promise to tackle rising drug prices without any action. Prescription drugs and the outrageous price of medicine has made reform a top issue that attracts bipartisan support. A recent national poll indicated that 91 percent of voters consider lowering drug prices a very important issue in the upcoming election, ranking it above COVID-19 worries. 

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RJ Miller: Why I'm running for Iowa House district 34

RJ Miller: I chose to run to take the voices of my community and make their voices louder.

I am a community activist who’s been organizing in Des Moines since 2019 around the issues of racial discrimination, civil and human rights, and urban violence.  Originally a victim of gun violence in Minneapolis, I overcome the obstacles of gang activity and incarceration in order to inspire and support my community in a collective effort to defeat the issues that plague the inner city. 

My mission is to uplift, empower, and transform the Des Moines community through restorative justice, empowering the youth, and investing in solutions that will combat the forces of colonization and oppression at large.

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Corporate Kim Reynolds ignores working families' needs

Matt Sinovic is the executive director of Progress Iowa, a research, communications, and issue advocacy organization with a network of more than 75,000 across the state and country.

Iowans work hard to take care of our families. We want leaders who will do what’s right so that we can do our best. But for the past decade, the needs of working families have been ignored by Corporate Kim Reynolds.

Fewer Iowans are working today than when Corporate Kim Reynolds took office. There aren’t enough workers to keep schools, hospitals, and small businesses open. But the governor continues to double down on the policies that created her workforce crisis. The ones that give the wealthy and big businesses tax breaks, while taking money away from our public schools, public safety, and health care services.

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Understanding single-payer health care: Medicare for All

Glenn Hurst is a family physician in southwest Iowa and a Democratic candidate for U.S. Senate.

Several years ago, my wife and I had a friend our family called Grandma Ruth. Ruth was special to us. She was one of the first people we brought my newborn daughter to meet. She had taken a special interest in our kids and was always present for their big events. Often, we would pick her up and bring her to our house for football parties and holidays. She included us in the celebration of her life events as well. She was estranged from her own family and just became part of ours.

I learned a lot from observing how Ruth navigated her world. She had learned how to use senior transportation services to get to doctor appointments as well as to the grocery store or other activities. She knew how to arrange Meals on Wheels and how to keep current with her disability to remain eligible for services she absolutely needed.

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Medicaid bills deserve a hearing

Jenn Wolff of Waverly is a member of Upgrade Medicaid.

Iowans with all different kinds of disabilities, their families, caregivers, and allies have spoken out about the need for changes to Medicaid since the Branstad-Reynolds administration privatized the program more than five years ago.

The U.S. Department of Justice report on state-run institutions in Glenwood and Woodward, released in December 2021, provides additional evidence of pervasive bias and segregation, caused by Iowa’s failure to invest in Home and Community Based Services.

My question to all Iowa elected officials and legislators is, why does legislation seeking to improve Medicaid die without discussion or opportunity for public comment?

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Four thoughts about Mary Ann Hanusa's state auditor campaign

Former State Representative Mary Ann Hanusa finally gave up her Congressional ambitions and announced on January 5 she’s running for state auditor. She won’t face any competition in the Republican primary, coming out of the gate with endorsements from Governor Kim Reynolds, Senator Chuck Grassley, and Senator Joni Ernst.

Democrat Rob Sand won the 2018 state auditor’s race by 660,169 votes to 601,320 for GOP incumbent Mary Mosiman (50.9 percent to 46.4 percent). Turnout set a modern midterm record for Iowa that year. Participation could be far lower in 2022—perhaps 1.1 million to 1.2 million voters.

Whether Hanusa emerges as a strong challenger will become more clear as her campaign unfolds, but here are some initial thoughts.

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State appeals ruling on law targeting trans Iowans

The Iowa Department of Human Services (DHS) is appealing a Polk County District Court ruling that found the state law and policy designed to deny Medicaid coverage for gender-affirming surgery are unconstitutional. The state filed notice of its intent to appeal on December 17, near the end of its 30-day window to do so following the District Court’s decision in November.

The Iowa Attorney General’s office had no comment on the appeal. Governor Kim Reynolds’ office also had no comment on why the governor is determined to prevent transgender Iowans on Medicaid from receiving medically necessary care approved by their doctors.

Plaintiffs Aiden Vasquez and Mika Covington have been waiting for years to obtain surgery and first challenged the state law in court within weeks of Reynolds signing the provision into law in May 2019.

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Court finds law targeting trans Iowans unconstitutional

For Aiden Vasquez and Mika Covington, the news was life-changing. Polk County District Court Judge William Kelly ruled on November 19 that Iowa’s law designed to deny Medicaid coverage for gender-affirming surgery “violates the equal protection clause of the Iowa Constitution.”

He ordered the Iowa Department of Human Services to change a longstanding regulation “excluding coverage for sex reassignment surgery” and said the agency must apply the revised rule to allow “transgender individuals coverage under Iowa Medicaid for medically necessary gender affirming surgery for the treatment of Gender Dysphoria and other relevant diagnoses.”

Vasquez and Covington are transgender Iowans who qualify for Medicaid and have been unable to obtain the health care they need for years. They have been seeking legal redress since soon after Governor Kim Reynolds signed the discriminatory statute in May 2019.

Naturally, not everyone was happy with what the ACLU of Iowa’s legal director Rita Bettis Austen described as a “historic win for civil rights in Iowa.” Soon after the court ruling was published on November 22, Reynolds’ spokesperson Alex Murphy told reporters, “The governor’s office is disappointed in today’s decision and disagrees with the district court’s ruling on Medicaid coverage for transgender reassignment surgeries.”

Reynolds echoed the sentiment when speaking to reporters on November 23: “Of course we were disappointed with the ruling and disagree […] My legal team is looking at it. There will be more to come later on. We’re still looking through it and trying to determine what our options are.”

She should stop fighting this battle.

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Iowa governor wrongly claims credit for large budget surplus

Tax and budget policy expert Randy Bauer was Governor Tom Vilsack’s budget director for six and a half years and has evaluated tax and revenue policies for many state and local governments.

In late September, Governor Kim Reynolds announced that the State of Iowa had a $1.24 billion surplus for fiscal year 2021, which ended on June 30. In a news release, she and the state’s interim budget director credited their own fiscal management for the surplus. Top Iowa Republican lawmakers have echoed that message.

Was it really all that praiseworthy? I’d suggest not. Here’s why this record surplus was not the big deal Reynolds and her minions made it out to be.

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Iowa House district 37: Mike Bousselot banks on false ads

The short special election campaign in Iowa House district 37 has been a costly affair, as expected. Disclosures filed last week show the Iowa Democratic Party has spent $306,470.21 on behalf of Andrea Phillips, while the Republican Party of Iowa has spent $234,327.12 supporting Mike Bousselot.

As is typical for targeted Iowa legislative races, the bulk of the spending has gone toward television and digital advertising: roughly $285,000 on the Democratic side and just under $230,000 from Republicans.

Bleeding Heartland analyzed the introductory ads for Phillips and Bousselot here. During the last two weeks of the campaign, I’ve seen more negative advertising about both candidates on Des Moines-based broadcast and cable television. The difference is that the Democratic ads highlight truthful claims about Bousselot’s past work, whereas the Republican ads are wholly false–much like the spots they ran against Phillips in 2020.

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Iowa's Medicaid enrollment up 17 percent during pandemic

Approximately 702,800 Iowans were enrolled in some version of the Medicaid program last month, up by roughly 100,000 since the COVID-19 pandemic began in March 2020, according to analysis by Charles Gaba at the ACA Signups website.

The biggest increase was in the Iowa Health and Wellness Plan, the state’s version of Medicaid expansion under the Affordable Care Act. Gaba’s analysis indicates that some 225,300 Iowans were participating in that plan as of May 2021, up from about 177,200 people fourteen months earlier.

Enrollment in traditional Medicaid increased by a smaller rate from about 425,000 in March 2020 to some 477,500 last month. The federal government recently released statistics on state level Medicaid enrollments from July 2019 through December 2020. Gaba’s estimates for 2021 are based on monthly reports published by the Iowa Department of Human Services, adjusted to compensate for how closely the state’s numbers tracked with the federal figures for 2020.

Gaba commented on his website,

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An open letter to Governor Kim Reynolds

This post first appeared on Laura Crossett’s website The New Rambler. -promoted by Laura Belin

Dear Governor Reynolds:

It is my understanding that you have decided to discontinue additional federal unemployment payments to Iowans who lost their jobs due to the COVID-19 pandemic because you want people to get back to work. As one of those Iowans, I’m writing to you because I would very much like to go back to work, but I’m having some difficulty figuring out how I might do so.

I have a child who suffers from significant mental illness. As I know both mental health services and child care are interests of yours, I thought perhaps you might have some advice.

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Five terrible bills Iowa Republicans didn't pass in 2021

The Iowa House and Senate adjourned late in the evening on May 19 after finishing most of their work for this year. (Lawmakers will almost certainly come back for a special session to consider new maps of Iowa’s legislative and Congressional districts.)

In the coming days, Bleeding Heartland will closely examine several bills that passed in the late session rush. For now, I want to review the legislation that by some minor miracle didn’t make it to Governor Kim Reynolds’ desk, in spite of support from powerful interests.

All of these bills are likely to return in some form during the 2022 session, so don’t celebrate too soon. House Republicans were unable to pass a “water quality” bill backed by agricultural groups in 2017. But the Iowa Farm Bureau and its allies spent the interim chipping away at the GOP holdouts. The bill sailed through the House early in the 2018 session. The same scenario could play out with any of the proposals discussed below.

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Anti-vaxxers hate Iowa's "vaccine passports" bill

The governor signed this bill on May 20. Original post follows.

“I look forward to signing this important legislation into law!” Governor Kim Reynolds tweeted on May 6, after the Iowa House and Senate approved a bill purportedly banning “vaccine passports.”

House File 889 fits a pattern of Republican bills that are best described as solutions in search of a problem. No state or local government agency intends to issue COVID-19 vaccine passports, nor are Iowa-based businesses rushing to require that customers show proof of coronavirus vaccinations.

A “message” bill can be useful politically, if it pleases a constituency Republicans need in the next election. The odd thing about this last-minute push is that Iowa’s most vocal vaccine skeptics don’t support the bill heading to the governor’s desk. On the contrary, they’re demanding a veto in the name of freedom.

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Law blocking health care for trans Iowans facing new court challenge

Two years ago this week, on the day before the Iowa legislature completed its work for 2019, Republicans added two new discriminatory provisions to the state’s health and human services budget. Both code sections quickly spawned litigation. Planned Parenthood’s lawsuit against language designed to exclude the organization from sex education grants is now pending before the Iowa Supreme Court, after a District Court found the prohibition violated the state constitution’s equal protection guarantee.

A case challenging language that authorized discrimination against transgender Iowans on Medicaid never got that far. But on April 22, the ACLU of Iowa and the national ACLU LGBTQ & HIV Project filed a new lawsuit in Polk County District Court.

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Governor endorses plan targeting Iowans on public assistance

A longstanding effort by Iowa Senate Republicans to reduce the number of Iowans receiving various forms of public assistance got a quiet boost last week from Governor Kim Reynolds.

For the first time, the governor’s draft human services budget included provisions that would create asset tests for federal food assistance and require the Iowa Department of Human Services to establish a new “eligibility verification system” for Medicaid and several other public assistance programs.

State Senator Jason Schultz has pushed similar legislation for several years running. Each session, Senate Republicans have approved the bills, which died in the House Human Resources Committee (see here and here).

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Most Iowans in Congress supported latest COVID-19 package

The U.S. House and Senate on December 21 approved a $2.3 trillion package to fund the federal government through September 30, 2021 and provide approximately $900 billion in economic stimulus or relief connected to the coronavirus pandemic.

No one in either chamber had time to read the legislation, which was nearly 5,600 pages long, before voting on it. Statements released by Iowans in Congress, which I’ve enclosed below, highlight many of its key provisions. The unemployment and direct payments to families are clearly insufficient to meet the needs of millions of struggling Americans. Senate Republicans blocked aid to state and local governments, many of which are facing budget shortfalls. President-elect Joe Biden has vowed to push for a much larger economic stimulus package early next year.

The legislation headed to President Donald Trump’s desk includes some long overdue changes, such as new limits on “surprise billing” by health care providers for emergency care and some out-of-network care.

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Randy Feenstra is at the center of Iowa's failed policies

This commentary is the collective work of three Iowa Democratic Party county chairs: Brett W. Copeland in Dickinson County, Mitch Day in Clay County, and Laura Hoffman in Emmet County. -promoted by Laura Belin

State Senator Randy Feenstra has promised Iowans that he will be riding shotgun to President Donald Trump’s second term agenda. His devastating legislative record on health care and mental health shows that he will make the perfect Congressional lackey.

Feenstra has been at the center of the worst ideas in the Iowa Senate. He voted against bills to improve oversight of Iowa’s Medicaid program and helped orchestrate a plan to allow Iowans to buy junk health insurance policies. He pushed to end block grants that ensured counties could provide decent mental health services, fund law enforcement, and keep taxes low.

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The Disability Caucus: Fighting for inclusion

Eric Donat: “It’s important for inclusion to show people with disabilities in all possible roles – not just in disability-specific ones.” -promoted by Laura Belin

I’m excited to be part of the new leadership on The Iowa Democratic Party Disability Caucus as vice chair. I am Eric Donat of Waterloo and Black Hawk County.

I got my start in politics through advocacy training at the Center for Independent Living in Waterloo, Iowans with Disabilities in Action, and the Iowa Developmental Disabilities Council. Consumers at the center were connected to state legislators via our work on systems change advocacy.

Through being an advocate, I supported legislation making it easier for people with disabilities, particularly those using wheelchairs, to travel about in their communities. I also supported reorganizing Iowa’s counties into today’s mental health service regions. In addition, I advocated against privatizing Medicaid in Iowa.

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Iowa Senate district 26 preview: Waylon Brown vs. Deb Scharper

Deb Scharper launched her campaign today in Iowa Senate 26, one of two Obama/Trump state Senate districts where no one filed to run in the June 2 Democratic primary.

While outside the top tier of Democratic pickup opportunities in the upper chamber, this district was decided by a narrow margin in 2012. Scharper’s race against first-term State Senator Waylon Brown is also worth watching for clues on whether Republicans, who now hold a 32-18 Senate majority, can maintain their advantage in the part of Iowa that swung most heavily to Donald Trump in 2016.

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Highlights, dog whistles from an Iowa Senate debate

Matt Chapman closely follows Iowa legislative affairs, especially bills like the one discussed here. -promoted by Laura Belin

Iowa Senate Republicans have approved another bill targeting people receiving public assistance, such as Medicaid or Supplemental Nutrition Assistance Program (SNAP) benefits.

Senate File 2272, which passed along party lines February 26, would require the state to contract for extra screening, looking for evidence of Iowans enrolled in more than one state. Labor and Business Relations Committee chair Jason Schultz introduced and floor-managed the bill. He has been attempting to pass versions of this legislation for years and sponsored five bills in a similar vein in 2019.

The vendor that would receive the contract, LexisNexis, does similar work in other states, often flagging 15 percent of beneficiaries as possibly fraudulent. In the five southern states that have adopted this screening, further checks have confirmed dual participation by just 0.1 percent to 0.2 percent of enrollees, on average.

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Iowa House district 64 preview: Bruce Bearinger vs. Chad Ingels

UPDATE: Bruce Bearinger announced in April 2020 that he will not seek re-election. Original post follows:

In a colossal recruiting failure, Republicans did not field a candidate last cycle in Iowa House district 64, which Donald Trump had carried by a 13-point margin in 2016.

The GOP will not give State Representative Bruce Bearinger a pass this year. On the contrary, Chad Ingels should be able to make this race highly competitive.

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The 19 most-viewed Bleeding Heartland posts of 2019

Chasing traffic never has been and never will be my primary goal for Bleeding Heartland. If it were, I’d publish weekly posts about puppies or Casey’s pizza instead of Iowa wildflowers.

And anyone who has worked on an online news source can vouch for me: a writer’s favorite projects are often not the ones that get the most clicks.

Still, people do ask me from time what posts tend to do well, and I find it fun at year-end to recap the pieces that were particularly popular with readers. Since I started this exercise a few years ago, I’ve always uncovered some surprises.

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Recognizing Bleeding Heartland's talented 2019 guest authors

More than 125 authors contributed to the 290 guest posts Bleeding Heartland published this calendar year–way up from the 202 pieces by about 100 writers in 2018 and the 164 posts by 83 writers the year before that. I’m immensely grateful for all the hard work that went into these articles and commentaries and have linked to them all below.

You will find scoops grounded in original research, such as John Morrissey’s exclusive reporting on Sedgwick landing a lucrative contract to administer Iowa’s worker’s compensation program for state employee, despite not submitting the high bid.

The most-viewed Bleeding Heartland post this year was Gwen Hope’s exclusive about the the Hy-Vee PAC donating $25,000 to the Iowa GOP, shortly before President Donald Trump headlined a Republican fundraiser at Hy-Vee’s event center in West Des Moines.

Several commentaries about major news events or political trends were also among the most widely read Bleeding Heartland posts of 2019. I’ve noted below pieces by Ed Fallon, Tim Nelson, Bruce Lear, Randy Richardson, J.D. Scholten, Dan Guild, State Senator Claire Celsi, and others that were especially popular. (This site has run more than 630 pieces since January 1.)

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Health care according to our needs: Time to consider it a human right

Iowa State University economist Dave Swenson: Of three possible approaches to health policy, only Medicare for All “reduces the damage that the existing system causes and remedies the cumulative policy failures of the past 70 years.” -promoted by Laura Belin

Health care delivery in the U.S. is a market failure and a governmental failure.

The private sector cannot adequately supply all that is demanded because many of those seeking health care cannot pay for what they need. Government systems, while attentive to the needs of the elderly, disabled, poor, and many veterans, nonetheless fail to cover all who require health care, because policies and funding are inadequate.

As a consequence, too little health care is delivered. And too little health care is socially destructive.

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Reaching rural America

Bruce Lear suggests a Democratic message resting on “four pillars that sustain small towns.” -promoted by Laura Belin

When I was a kid, my mom always warned, “Keep a screen door between you and the Fuller Brush Man.” Back in the day, Fuller Brush salesmen were mobile carnival barkers. They would literally get a foot in the door and then grow roots on the couch until Mom gave up and bought something.

They were fast talkers.

They weren’t from around here.

I am afraid that too many candidates now treat rural America like the Fuller Brush man of old. They barnstorm a small community without ever stopping to hear what makes the heart of rural America beat.

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Hundreds of Iowans are alive today thanks to Medicaid expansion

Expanding Medicaid “saved the lives of at least 19,200 adults aged 55 to 64” during the four years after the Affordable Care Act went into effect, including an estimated 272 Iowans, according to a new paper by Matt Broaddus and Aviva Aron-Dine for the Center on Budget and Policy Priorities.

Conversely, 15,600 older adults died prematurely because of state decisions not to expand Medicaid. […] The lifesaving impacts of Medicaid expansion are large: an estimated 39 to 64 percent reduction in annual mortality rates for older adults gaining coverage.

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Iowa Senate district 32 preview: Craig Johnson vs. Pam Egli

Republicans won six Democratic-held Iowa Senate districts in 2016. All of them were among the eighteen Iowa Senate districts where voters had favored President Barack Obama in 2012 but Donald Trump four years later.*

Some of the largest swings toward Trump occurred in northeast Iowa. Parts of four counties make up Senate district 32, where Democrat Pam Egli recently announced that she will challenge first term State Senator Craig Johnson.

While this race does not currently appear to be among the best 2020 pickup opportunities for Democrats in the upper chamber, it could become competitive. Either way, state legislative elections in this part of Iowa will be important to watch for signs of whether Republicans are able consolidate their 2016 gains.

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Charlie Hodges is second Democrat running for Iowa Senate district 20

Two Democrats are now running in Iowa Senate district 20, likely to be one of next year’s most competitive state Senate races.

Information technology professional Charlie Hodges of Urbandale will seek the Democratic nomination in a district covering the northwest suburbs of Des Moines (see map below). Johnston City Council member Rhonda Martin has been campaigning here since May. The winner of the June 2020 primary will face four-term Republican State Senator Brad Zaun.

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Celebrating what's working in Iowa Medicaid

Upgrade Medicaid is a grassroots group of individuals with disabilities “who are dedicated to building a space for Iowans to tell the stories that need to be seen and heard for Medicaid policy to change.” -promoted by Laura Belin

October 13 through October 19 is National Case Management Week. In recognition of this occasion, the #UpgradeMedicaid team would like to recognize and celebrate what is working in Iowa Medicaid.

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Five thoughts about Linda Upmeyer's tenure as Iowa House speaker

Iowa House Republicans meet in Des Moines this morning to elect new leaders for the 2020 legislative session. Linda Upmeyer announced on September 30 that she will step down as House speaker when the legislature reconvenes in January and will not seek re-election next November. She said in a written statement that she wants to spend more time with her husband, children, and grandchildren.

Speaking to WHO Radio’s Jeff Angelo on October 1, Upmeyer said she was also influenced by her predecessor Kraig Paulsen’s decision to leave the post long before an election. A new speaker is “well-served” by having a session under their belt, which helps them with fundraising and recruiting candidates, she explained. “I wanted to make sure that whoever was going to be leading the caucus in the future had those tools at their disposal going into this next election.”

Sources close to the legislature indicate that current House Appropriations Committee chair Pat Grassley is likely to become the next speaker, with Matt Windschitl moving up from House speaker pro-tem to majority leader. Current Majority Leader Chris Hagenow may not be part of the new leadership team, for reasons that remain unclear. UPDATE: The caucus selected Grassley as speaker, Windschitl as majority leader, and State Representative John Wills as speaker pro tem.

I’ve been thinking about Upmeyer’s legacy and how she influenced the chamber.

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Exclusive: Iowa Democrats recall first Congressional vote on Hyde amendment

Forty-three years ago this week, Congress overrode a presidential veto to enact an appropriations bill containing the first ban on federal funding for abortion. Republican U.S. Representative Henry Hyde of Illinois had proposed language prohibiting Medicaid coverage of abortion during House debate on what was then called the Health, Education, and Welfare budget. Ever since, the policy has been known as the “Hyde amendment.”

Four Iowans who served in Congress at the time spoke to Bleeding Heartland this summer about their decisions to oppose the Hyde amendment and the political context surrounding a vote that had long-lasting consequences.

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Iowa House district 16 preview: Mary Ann Hanusa vs. Jen Pellant

UPDATE: Hanusa announced in March 2020 that she will not seek re-election. Original post follows.

Democrats need a net gain of four seats to take control of the Iowa House after the 2020 elections. One seat that wasn’t on the party’s 2018 target list (but should have been) was House district 16, covering part of Council Bluffs. State Representative Mary Ann Hanusa had a close shave there, defeating Democrat Steve Gorman by only 114 votes, a roughly 1 percent margin.

Gorman is running for the Iowa Senate this cycle, but as of October 1, Democrats have a strong challenger for the House seat: Jen Pellant.

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Jack Hatch running for Des Moines mayor

Former State Senator Jack Hatch will run for Des Moines mayor, he announced on WHO-TV on September 19, the last day for local candidates in Iowa to file nominating papers. A few minutes later, his campaign released a statement and a video, both enclosed below, and launched a website at JackHatchforMayor.com.

Key issues for Hatch will include fixing roads and neighborhood infrastructure, addressing “the urgent mental health care crisis that has been ignored,” protecting drinking water, improving area schools, and public safety measures including steps to reduce gun violence. All of those topics were mentioned in a telephone poll Hatch commissioned earlier this month, which Bleeding Heartland summarized here.

Defeating sixteen-year incumbent Mayor Frank Cownie will not be easy, and Hatch will have only six and a half weeks to build his case with voters. However, unlike most challengers, he already has very high name recognition. Hatch represented parts of Des Moines in the Iowa House or Senate for more than 20 years, was the 2014 Democratic nominee for governor, and is a well-known property developer.

Hatch told WHO-TV’s Dave Price he started thinking about running for mayor after Cownie “decided not to protect our drinking water when he had a chance to,” adding that Cownie “was silent” as Republican legislators tried to break up the Des Moines Water Works in 2017. Hatch acknowledged he was starting his campaign late, saying others had considered running against Cownie but backed off. He’s in the race because sees the future of Des Moines “being blurred” without strong leadership.

Turnout on November 5 may be higher than usual for a city election, because Des Moines has multiple competitive city council races, and this is the first year school board elections will be held concurrently with elections for municipal offices. Early voting begins on October 7.

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It is about the beds

Leslie Carpenter of Iowa City is an advocate for people with serious brain disorders and works to improve the broken treatment system in Iowa and across the country. -promoted by Laura Belin

Here in Iowa, we have heard for several years that we should realize the mental health crisis “isn’t about the beds.”

The argument was couched in a way to say it wasn’t about the beds, but the type of beds. The goal was to divert our attention from the fact that our state has the worst proportion of state bed numbers per capita: just two beds per 100,000 people. The Treatment Advocacy Center ranked Iowa dead last, 51st in the country on this metric. We have only 64 adult beds and 32 child beds at our state-run Mental Health Institutes in Independence and Cherokee.

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Loretta Sieman on the public option and why she's in that ad

Industry-funded groups have recently spent more than a million dollars on television and online advertising in Iowa opposing Democratic plans to expand access to health insurance.

Some ads primarily focus on single-payer plans (often known as Medicare for All), which more than half a dozen presidential candidates are supporting. But Partnership for America’s Health Care Future has used its hundreds of thousands of dollars in the Des Moines market targeting more modest proposals to offer a “public option” on exchanges selling private health insurance policies.

Many central Iowa Democratic activists were surprised and upset to see Loretta Sieman, a longtime West Des Moines city council member, in one of the partnership’s commercials. Sieman spoke to Bleeding Heartland on September 11 about why she opposes the public option and why she agreed to appear in the ad, now in heavy rotation on YouTube as well as Des Moines broadcast and cable stations.

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Urbandale's longtime Republican mayor now a Democrat

Urbandale Mayor Bob Andeweg recently changed his party registration and will manage Democratic State Representative John Forbes’ 2020 campaign in Iowa House district 40.

Speaking at a fundraiser for Forbes in Lions Park on September 7, Andeweg said he’s “been a Republican my whole life.” Because he believes in nonpartisan local government, he has rarely spoken publicly about his party affiliation as mayor since 2005 or on the city council prior to that. Regarding his party switch, Andeweg said, “I truly believe this is where I need to be at this point in time.”

He and Forbes have been friendly since the early 1990s, and Forbes managed Andeweg’s first campaign for city council in 1999. He fell short in that effort but was later appointed to fill a vacancy, then won his next city council race and subsequently four terms as mayor. The two men “worked well together” when Forbes served on the city council, and Andeweg praised Forbes’ ability to get things done in a Republican-controlled chamber.

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Governor's health policy adviser claims ignorance about Medicaid problems

Service cuts to Iowans with disabilities under privatized Medicaid prompted a 2017 lawsuit, became a central theme of the 2018 governor’s race, and were a featured problem in an annual report from the state ombudsman.

Yet in a meeting with advocates last week, Governor Kim Reynolds’ health policy adviser said she is unaware of major problems for patients trying to obtain essential services.

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At what cost?

This commentary was a group effort by Upgrade Medicaid organizers Jenn Wolff, Shelley Jaspering, Kyle Spading, Elaine Gartelos, Tucker Cassidy, and Evan Schultz. -promoted by Laura Belin

Thousands of disabled Iowans rely on Long Term Support Services through Medicaid. Those services were designed to provide daily living assistance for individuals to maintain normal lives in their homes.

Because of Medicaid privatization, some individuals have been forced to consider nursing home placement, which is typically more expensive than community living.

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Iowa Senate district 36 preview: Jeff Edler vs. Dave Degner

Some sobering facts about the bloodbath that was the 2016 election in Iowa:

Donald Trump carried eighteen state Senate districts that had voted for President Barack Obama in 2012.*

Eleven of those eighteen were even-numbered districts, which are on the Iowa ballot in presidential election years.

The four Republicans who already represented Obama/Trump districts all easily won another term in the Iowa Senate.**

But six of the seven Democratic senators up for re-election in Obama/Trump districts lost: Majority Leader Mike Gronstal (Senate district 8), Mary Jo Wilhelm (Senate district 26), Brian Schoenjahn (Senate district 32), Steve Sodders (Senate district 36), Tom Courtney (Senate district 44), and Chris Brase (Senate district 46).

With Republicans now enjoying a 32-18 majority in the upper chamber, Democrats need to win back at least a few Obama/Trump seats next year to have a realistic chance of regaining Iowa Senate control after the next round of redistricting.

Democrats have been actively campaigning in Senate districts 8 and 44 for some time. Now GOP State Senator Jeff Edler has a strong challenger in Senate district 36.

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Questions and answers: Jerry Foxhoven's wrongful termination claim

Former Iowa Department of Human Services director Jerry Foxhoven revealed more details about his wrongful termination claim on August 1. He asserts that he was fired after expressing concern about the DHS continuing to pay a large share of the salary for the governor’s deputy chief of staff, Paige Thorson.

As Bleeding Heartland reported last week, Thorson worked extensively on Medicaid-related issues for some time, but she became less involved with the DHS this spring, as Governor Kim Reynolds brought on a new health policy adviser.

Foxhoven and his attorney Tom Duff released a written statement and answered many follow-up questions during a 45-minute news conference. Radio Iowa posted the full audio. The questions and answers below are not a transcript from the conference, but rather my effort to put information about Foxhoven’s case in context for readers.

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Amy Klobuchar's practical health care plan for seniors

Bill Witt represented part of Black Hawk County in the Iowa House for ten years and is a well-known advocate for improving health care services and environmental causes. -promoted by Laura Belin

While the big political noise machines have traded barrages in a host of high-profile battles over border security, student debt, the Affordable Care Act, Afghanistan, and more, U.S. Senator Amy Klobuchar has quietly, and with her customary adroitness, slipped around the flanks of the clanking, clattering behemoths and planted her standard on strategic, long-term high ground: the security and health of America’s seniors.

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Jerry Foxhoven stopped playing along. This will end badly for Kim Reynolds

Editor’s note: Bleeding Heartland’s coverage of this story continues here and here.

Governor Kim Reynolds didn’t want the public to learn why she forced out Jerry Foxhoven as director of the Iowa Department of Human Services. The vague official narrative about Foxhoven’s unexpected departure remained intact for a month.

But the ground shifted last week. As further details emerge, the governor and her top staff will have more explaining to do.

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Justice should be blind. Not willfully blind

A Polk County District Court has ruled that transgender Iowans must exhaust all administrative remedies before challenging in court a new state law designed to prevent Medicaid from covering gender-affirming surgery.

In a July 18 order dismissing the ACLU of Iowa’s lawsuit on behalf of Mika Covington, Aiden Vasquez, and the LGBTQ advocacy group One Iowa, Judge David Porter wrote that the plaintiffs seeking surgery “have an adequate remedy at law” and that their case “is not ripe for judicial consideration.”

In other words, Covington and Vasquez must jump through hoops that will take many months, possibly years, before any court can consider their claim that denying Medicaid coverage for medically necessary procedures violates their constitutional rights.

Porter’s decision ignored evidence pointing to the law’s discriminatory intent as well as its impact on the plaintiffs.

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Kim Reynolds keeps giving away the store to for-profit Medicaid managers

Governor Terry Branstad and then Lieutenant Governor Kim Reynolds promised endlessly that privatizing Medicaid would make the system more “sustainable.” The talking point became a crutch for Governor Reynolds whenever she faced questions about problems privatization has created for patients, caregivers, and health care providers.

The old state-run Medicaid system wasn’t sustainable, Reynolds told reporters again and again. The new system was becoming more sustainable, she claimed during all three debates against her 2018 opponent Fred Hubbell.

The latest reality check arrived on July 10. For the second year in a row, for-profit companies that manage care for hundreds of thousands of Iowans on Medicaid will receive more than an 8 percent increase in government payments.

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Auditor: Service cuts to some Iowans on Medicaid violate state contracts

State Auditor Rob Sand warned the Iowa Department of Human Services on June 26 that service cuts to two quadriplegic Iowans indicate that Amerigroup and UnitedHealthcare “have failed to comply” with their state contracts. Sand said the managed-care organizations (MCOs) have pushed both Medicaid recipients to move into assisted living, rather than meeting their contractual obligations to ensure members have access to covered benefits and adequate health care services.

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Iowa Medicaid oversight chief to be governor's new health policy analyst

Elizabeth Matney, who has led the Iowa Medicaid Bureau of Managed Care since the state began privatizing nearly the whole program in 2015, is leaving the Department of Human Services to become Governor Kim Reynolds’ health policy advisor, Matney’s LinkedIn profile shows. Her starting date is unclear; the governor’s office has not announced Matney’s hiring or responded to Bleeding Heartland’s inquiries on the subject. A DHS organizational chart dated June 17 still shows Matney as bureau chief for MCO Oversight & Supports, the state’s leading official for overseeing the private companies picked to manage care for more than 600,000 Iowans on Medicaid.

When the new fiscal year begins on July 1, the governor’s office will receive additional funding for staff, so Matney’s work for Reynolds may formally begin at that time. The governor’s previous health policy advisor, Paige Thorson, appears to be staying on as deputy chief of staff, meaning that new funds would be needed to pay Matney (the governor’s staff have not clarified that point).

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Iowa DHS director Foxhoven resigns; governor appoints Gerd Clabaugh (updated)

Jerry Foxhoven has resigned as Iowa Department of Human Services director, effective today, Governor Kim Reynolds’ office announced on June 17. The news release did not give a reason for Foxhoven’s departure. Staff for DHS and the governor did not immediately respond to questions including:

  • Did Reynolds request Foxhoven’s resignation? UPDATE: Foxhoven confirmed that she did. See update below.
  • Was the resignation related to UnitedHealthcare’s impending departure from the Iowa Medicaid program on June 30?
  • Was the resignation related to DHS negotiations with Centene/Iowa Total Care, which will begin managing care for hundreds of thousands of Iowans on Medicaid as of July 1?
  • What is the status of negotiations with the state’s negotiations with Centene/Iowa Total Care regarding the Medicaid program?

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  • What candidates said about health care, reproductive rights at the Hall of Fame

    Nineteen presidential candidates had five minutes each to make their case to more than 1,000 activists at the Iowa Democratic Party’s Hall of Fame event in Cedar Rapids on June 9. Most offered at least one really good applause line. Teams of reporters from the Des Moines Register and Iowa Starting Line pulled together some of the memorable parts of each speech here and here.

    I decided to focus on how the candidates spoke about health care and women’s ability to access abortion for a couple of reasons. First, while the candidates highlighted a wide range of problems and proposals, almost all of them addressed those topics in some way.

    Second, this post represents my gesture toward what media critic Jay Rosen has called the “citizens agenda” approach to covering campaigns. Although I lack survey data to know for sure what Iowa Democrats want the presidential contenders to be talking about, I believe health care and reproductive rights are among the most salient for caucus-goers, because:

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    Affected Iowans, Kim Reynolds discuss policy targeting transgender people

    Two transgender Iowans and an LGBTQ advocacy group are challenging the new statute intended to deprive transgender people of Medicaid coverage for gender-affirming surgery. The ACLU of Iowa filed suit in Polk County District Court on May 31 on behalf of Aiden Vasquez, Mika Covington, and One Iowa.

    Listening to the plaintiffs explain why they took this step, I was struck by the contrast between their heartfelt, compelling words and Governor Kim Reynolds’ heartless, clueless excuses for signing discrimination into law.

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    LGBTQ lives cannot be compromised

    One Iowa Action: “We should not be encouraging half-measures and disparate treatment of our fellow Iowans.” -promoted by Laura Belin

    Des Moines Register Opinion Editor Kathie Obradovich’s recent column sets out a laudable goal; protecting both religious liberty and the LGBTQ community (What if Iowa could protect both religious freedom and LGBTQ rights?).

    Unfortunately, the substance of the piece misses the mark by pulling from erroneous source material that equates Utah and Iowa, two states with very different legal and political landscapes. In doing so Obradovich implies, perhaps unintentionally, that LGBTQ Iowans need to start from a place of compromise when their rights and freedoms are threatened.

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    Medicaid and pineapple on pizza

    This commentary was a collective effort by four people on the advocacy committee of the United Spinal Association’s Iowa chapter. -promoted by Laura Belin

    Is pineapple on pizza acceptable?

    This irrationally controversial question has divided households since the advent of Hawaiian pizza. Gordon Ramsay decisively says that pineapple has no place on pizza while Alton Brown is a staunch defender. How do we decide which reality cooking show host is the expert?

    Odds are, you will choose an expert based on your pizza preference. This is called “confirmation bias.” We are all quick to ignore information that doesn’t confirm our bias and latch on to information that does.

    This is exactly what happened last week when a Republican legislator took the words of disability advocates out of context on the Iowa Senate floor.

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    Iowa Republicans choose not to look for overspending on Medicaid prescriptions

    The Iowa Department of Human Services will not audit a practice that could be inflating costs for Medicaid prescription drug payments by millions of dollars a year.

    State Representative John Forbes raised concerns after finding discrepancies on bills for some prescriptions his Urbandale pharmacy filled for patients served by Amerigroup, one of Iowa’s Medicaid managed-care providers. Earlier this month, House members unanimously approved Forbes’ amendment to the health and human services budget, instructing DHS to “audit all prescription drug benefit claims managed by a pharmacy benefit manager under the Medicaid program.”

    However, House and Senate Republicans dropped that section from the final version of House File 766.

    State Senator Mark Costello, who floor managed the health and human services budget in the upper chamber, claimed Iowa’s Medicaid director Michael Randol and an Amerigroup representative had told him the audit was unnecessary.

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    Iowa Privatized Medicaid: It Has Been A Disaster. Here’s Why.

    By Simon Davis-Cohen for Tarbell.org

    This is a reprint from Tarbell.org, a news website pioneering journalism that reveals who runs America and empowers readers with solutions. Read this on Tarbell.org.

    If you have any feedback on this piece, please contact Tarbell’s engagement editor, Danielle Keeton-Olsen, at danielle@tarbell.org.

    In 2016, Iowa privatized Medicaid under then-Governor Terry Branstad. He was a founding member of the American Legislative Exchange Council (ALEC). “Obamacare” is often attacked by the David and Charles Koch-backed group that opposes government action in health care or the economy.

    Branstad claimed outsourcing Medicaid would save the state and taxpayers money. However, Iowa has not been able to provide any data that shows privatization saved the state money. In fact, privatization is now costing Iowa money. (Branstad resigned the governorship in 2017 to become the U.S. Ambassador to China.)

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    Elizabeth Warren is running to do the job

    Dubuque Democrat Rachel Wall didn’t plan to commit to a candidate this early but “lost my own bets with myself” after seeing Elizabeth Warren in person last month. -promoted by Laura Belin

    I will preface this piece by stating my only commitment for the 2020 cycle was to caucus for a woman. Some may say that is blind feminism, but it is the promise I made to myself. In order to normalize women running for all offices, I made that pledge.

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    An army of misery forced to decamp with UnitedHealthcare's departure

    John Morrissey is a longtime Des Moines resident who has investigated state spending increases, financial anomalies, and payment disruptions associated with Medicaid privatization in Iowa. -promoted by Laura Belin

    The “he said/she said” controversy between an insurance company CEO and Iowa’s governor about why UnitedHealthcare decided to leave the state’s Medicaid program might make entertaining copy, but it doesn’t address who is going to manage the care of 420,000 Iowans left in the lurch.

    Nor does it address whether the remaining company (Amerigroup) is adequately prepared to handle more members, and whether a new player poised to enter our state’s Medicaid market (Iowa Total Care) has the expertise to handle special populations in Iowa such as the elderly, disabled, and very ill.

    It also doesn’t consider whether the state’s traditional fee-for-service Medicaid offering has the financial wherewithal to shoulder an even larger share of the enrollment and cost. Fee-for-service was held over from the old state-run program when most of the Medicaid program was privatized in 2016. The fee-for-service program pays the claims of Iowa’s sickest and most frail Medicaid members, which the for-profit managed care organizations (MCOs) don’t want or can’t handle.

    The Iowa Deparment of Human Services (DHS) did not respond to a request for comment on these issues.

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    Where things stand with Republican bills targeting Iowa workers

    Republican attacks on working Iowans have received less attention this year than in 2017, when new laws shredded public employee collective bargaining rights, blocked local governments from raising the minimum wage, and reduced workers’ compensation benefits, especially for those who hurt their shoulder on the job.

    But below the radar, GOP lawmakers have moved several bills lately that would make life harder for working people, including some facing the difficult circumstances of unemployment or workplace injury.

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    The 2007 votes that made 2019 a historic year for transgender Iowans

    Only three months in, 2019 is already the most significant year for transgender equality in Iowa since 2007, when state lawmakers and Governor Chet Culver added sexual orientation and gender identity to the list of protected classes in the Iowa Civil Rights Act. That 1965 law hadn’t been significantly amended in decades.

    The crucial Iowa House and Senate votes on the civil rights law happened during the first year since the 1960s that Democrats controlled both legislative chambers and the governor’s office. Support for LGBTQ equality is often taken for granted now in Democratic circles, but the issue was seen as more politically volatile twelve years ago. The bill amending the civil rights act came late in the 2007 legislative session and could not have passed without some Republican votes.

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    State auditor to Iowa Medicaid recipients, providers: "Know your rights"

    Iowans affected by UnitedHealthcare’s impending exit as a Medicaid managed-care provider should be aware that they have rights under the contract the state signed with the insurer, State Auditor Rob Sand announced at an April 1 news conference.

    Sand reviewed the company’s 287-page contract with the Iowa Department of Human Services before news broke on March 29 that UnitedHealthcare will not continue to manage care for Iowans on Medicaid in the coming fiscal year, which begins on July 1. That development suddenly made the contract’s termination provisions “very important and relevant.”

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    Laughable spin casts Reynolds as hero of latest Medicaid fiasco

    When a government press release arrives at 4:45 pm on a Friday, you know it’s not bearing good news. UnitedHealthcare will soon pull out of Iowa’s Medicaid program, the governor’s office announced on March 29. The company “manages health care for more than two-thirds of Iowans on Medicaid,” at least 425,000 people, Tony Leys reported for the Des Moines Register.

    The official spin portrayed Governor Kim Reynolds as a hero who resisted a for-profit insurer’s “unreasonable” and “unacceptable” demands.

    The real story is that nearly three years into our costly Medicaid privatization experiment, Iowa’s dominant managed-care organization (MCO) still can’t handle normal business practices like paying health care providers on time.

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    Senate ignores deadbeat corporations while targeting Iowans on Medicaid

    Matt Chapman closely follows Iowa legislative happenings, including bills affecting Iowans on public assistance. -promoted by Laura Belin

    Iowa Senate Republicans on March 19 approved new work requirements for tens of thousands of Iowans on Medicaid or receiving food assistance. Senate File 538 would instruct the Iowa Department of Human Services to request a federal waiver for the Iowa Health and Wellness Plan, our state’s version of Medicaid expansion. Approximately 170,000 adults receive Medicaid through that plan, and roughly 61,000 of them also receive Supplemental Assistance Nutrition Program (SNAP) benefits.

    If the waiver were approved, Medicaid recipients would face new reporting obligations for “community engagement.” If not part of an exempted group, they could lose coverage due to paperwork errors, even if they were working the requisite number of hours per week. Nonpartisan analysis estimated this bill would cost the state budget nearly $5 million the first year after the waiver and nearly $12 million each subsequent year.

    During floor debate (beginning at 11:53:20 of this video), Republicans characterized the bill as a way to hold Iowans accountable. Democrats offered two amendments that would have extended that accountability to large employers and the for-profit insurers known as managed-care organizations (MCOs), which oversee Iowa’s privatized Medicaid.

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    "Workfare" bill for Iowa Medicaid would cost nearly $17 million over two years

    Matt Chapman has closely followed this year’s legislative proposals affecting Iowans on public assistance. He previously reported on a separate bill with a $40 million price tag. -promoted by Laura Belin

    A Republican bill seeking to impose new work requirements on some 170,000 Medicaid recipients in Iowa would cost the state budget nearly $5 million more the first year and an additional $12 million every year thereafter, according to analysis by the nonpartisan Legislative Services Agency. Any savings to the state would be “minimal.”

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    Five things to know about Trump's sabotage budget

    Matt Sinovic is the executive director of Progress Iowa. -promoted by Laura Belin

    This week, the Trump administration released its proposed budget for fiscal year 2020, which revives a call to repeal the Affordable Care Act and lays out massive cuts to Medicaid, Medicare, and the Department of Health and Human Services. The administration’s budget reveals just how steadfast it remains in trying to take away Americans’ health care.

    Here are five things you need to know about Trump’s Health Care Sabotage Budget:

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    Bill targeting Iowans on public assistance would cost $40 million by 2021

    Matt Chapman has closely followed this year’s legislative proposals targeting Iowans on public assistance. -promoted by Laura Belin

    A bill requiring more frequent reviews of Iowans’ eligibility for public assistance programs would cost the state an additional $40 million during the first two years alone, according to analysis by the nonpartisan Legislative Services Agency. The federal government would be on the hook for an additional $35 million during the same period.

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    Steve Bullock's testing these messages among Iowa Democrats

    Although Montana Governor Steve Bullock has not yet declared plans to run for president, a group supporting his ambitions has been polling Iowa Democrats to test positive messages about Bullock and several other declared or likely contenders.

    I’ve long encouraged readers to record or take notes on political surveys. This post draws on a recording an Iowan provided after receiving the call on the evening of March 7. (Bleeding Heartland never provides identifying information about respondents; I’m only interested in the questions asked.)

    The latest Selzer poll for the Des Moines Register, CNN, and Mediacom found Joe Biden and Bernie Sanders well ahead of the rest of the Democratic field in Iowa, with 27 percent and 25 percent, respectively. Bullock was among several candidates at 1 percent. Later today, Bleeding Heartland will publish analysis by Dan Guild, taking a historical view of polling this far out from the Iowa caucuses.

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    Five Senate bills target Iowans on public assistance

    Matt Chapman has attended Iowa House and Senate subcommittee meetings nearly every day. These bills were among the most significant he has tracked lately. -promoted by Laura Belin

    Over the past week, Iowa Senate subcommittees considered five bills drafted to address fraud in Iowa public assistance programs. Each bill would direct revenue generated by Iowa taxpayers to private vendors, who are charged with finding fraudulent claims. If investigation supports the claims of fraud, those funds could be recovered, and criminal charges filed.

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    Democratic statewide candidates need sharper rhetoric

    Joe Gorton: “Fred Hubbell’s campaign for governor is the most recent example of a candidacy that failed to couple a strong emotional tone to strong content.” -promoted by Laura Belin

    For the third consecutive time, Iowa Democrats are licking our wounds after a gubernatorial campaign loss. Not surprisingly, there are many competing explanations for what went wrong. Within those explanations one factor is largely ignored: dull campaign rhetoric.

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    Iowa DHS withheld records on "fishy" Medicaid deal before election

    For weeks this fall, the Iowa Department of Human Services stonewalled a journalist’s request for easily accessible public records that would have cast an unflattering light on management of the state’s Medicaid program.

    Three days after Governor Kim Reynolds won the election, the department sent a copy of one key document to Ryan Foley of the Associated Press. DHS released other relevant files on December 6, allowing Foley to confirm Director Jerry Foxhoven had cut a deal in April allowing UnityPoint Health affiliates to keep nearly $2.4 million they had been overpaid for services provided to Medicaid patients.

    The settlement agreement came shortly after UnityPoint agreed to remain part of the network for Amerigroup, one of the private companies DHS picked to manage care for Medicaid recipients.

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    IA-Gov post-mortem: One mistake and two missed opportunities

    Nate Williams is a labor attorney and served in the Iowa House from 2009 through 2012. -promoted by desmoinesdem

    I am not sure whether to think of this as “three mistakes Fred Hubbell’s campaign made” or “one mistake the Hubbell campaign made and two missed opportunities.”

    Either way, there are three things I wish the Hubbell campaign would have done very differently.

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    Half-baked state audit doesn't settle questions about Medicaid savings

    Privatizing Medicaid saved the state of Iowa about $126 million during the fiscal year that ended June 30, according to a report State Auditor Mary Mosiman released on November 26.

    I put low odds on that estimate holding up after a more diligent auditor takes office.

    Even if it did, this review of “savings” was too narrow to reveal whether turning Medicaid over to for-profit companies was a good deal for Iowans.

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    Grassley to chair Senate Finance Committee

    U.S. Senator Chuck Grassley told reporters today that he will lead the Senate Finance Committee in the new Congress. The current chair, Senator Orrin Hatch, is retiring. Grassley’s official website notes,

    Senator Grassley calls this committee the quality of life committee because of the committee’s jurisdiction, which includes all tax matters, health care, Social Security; Medicare, Medicaid, social services, unemployment compensation, tariffs and international trade. Legislation acted on by the Committee on Finance raises virtually all federal revenue, and expenditures authorized by this committee represent as much as two-thirds of the federal budget.

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    We need representatives who vote for us!

    ReShonda Young of Waterloo has been an advocate for small business owners on a variety of issues. -promoted by desmoinesdem

    My U.S. House Representative Rod Blum, along with his Iowa colleagues David Young and Steve King, has repeatedly voted to take away health care from me, my brother, my employees, and many other Iowans.

    This is personal for me, as it is for most of us. I have a serious health condition and, as a business owner, have employed people with serious conditions of their own.

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    "Fight for the best of who we are": Kamala Harris rallies Iowa Democrats

    Hundreds of Iowa Democrats got their first chance to hear U.S. Senator Kamala Harris on October 22. On her first major swing through the state, the senator from California had a packed schedule, including:

  • a morning gathering with the Asian and Latino Coalition;
  • an Ankeny rally organized by Des Moines Area Community College students, also featuring Iowa House district 38 candidate Heather Matson, Iowa Senate district 19 candidate Amber Gustafson, and third Congressional district nominee Cindy Axne;
  • a late afternoon event in Indianola;
  • a private fundraiser for Axne; and finally
  • a speech to a room full of Polk County Democrats in Des Moines.
  • Though Harris is widely viewed as a potential 2020 presidential candidate, she kept her focus on the election happening November 6. I enclose below the full audio and partial transcript of the evening speech, which was similar to remarks Harris delivered earlier in the day.

    Whereas some politicians tend to use convoluted, run-on sentences, Harris was striking in how she used simple sentence construction and repetition to great effect.

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    IA-Gov: Notes on the final Hubbell-Reynolds debate

    Governor Kim Reynolds and Democratic challenger Fred Hubbell debated for the third and last time today in Davenport. Too bad not many viewers are likely to tune in at 8:00 am on a Sunday morning, because the discussion was yet another study in contrasts. For those who prefer a written recap, I enclose below my detailed notes. Click here and here for Bleeding Heartland’s analysis of the first two Hubbell-Reynolds debates.

    As during the second debate, journalists kept the candidates on topic and within the time limit, so kudos to moderator David Nelson of KWQC-TV6 and panelists Erin Murphy of Lee Enterprises, Forrest Saunders of KCRG-TV9, and Jenna Jackson of KWQC-TV6.

    Both candidates recycled many talking points from their first two meetings. My impression was that Reynolds performed about equally well in all three debates, while Hubbell improved each time. For instance, after Reynolds noted that Iowa had moved up in mental health rankings three years in a row and was now rated sixth in the country for mental health, Hubbell pointed out that the study the governor cited covered the years 2013 through 2015. That was before the Branstad/Reynolds administration closed some mental health institutions and privatized Medicaid, which has led to worse care for thousands of Iowans.

    For those who prefer to watch the replay, KCRG-TV posted the video in a single file, which is the most user-friendly option. You can also find the debate on KWQC-TV (with closed captioning) and WOWT-TV’s websites, but you will have to watch a series of clips, with advertisements before each segment.

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    Former Iowa Medicaid carrier's financial sleight of hand

    John Morrissey investigates anomalies in financial reports filed by AmeriHealth Caritas, which left Iowa’s Medicaid program last year. -promoted by desmoinesdem

    A managed care company that left the Iowa Medicaid program last November financially engineered its first quarter report to state regulators this year, even as it dragged its feet in paying Iowa medical providers for claims that were then more than 90 days old.

    AmeriHealth Caritas Iowa, Inc. claimed in its calendar first quarter filing with the Iowa Insurance Division (IID) that general administrative costs to run its Iowa operation totaled $20 million. But at the end of June, the company reduced that expense to $6 million without explanation.

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