Iowa tops new scorecard on children's health care

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

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

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

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

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

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

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

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

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

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Year in review: national politics in 2009 (part 1)

It took me a week longer than I anticipated, but I finally finished compiling links to Bleeding Heartland’s coverage from last year. This post and part 2, coming later today, include stories on national politics, mostly relating to Congress and Barack Obama’s administration. Diaries reviewing Iowa politics in 2009 will come soon.

One thing struck me while compiling this post: on all of the House bills I covered here during 2009, Democrats Leonard Boswell, Bruce Braley and Dave Loebsack voted the same way. That was a big change from 2007 and 2008, when Blue Dog Boswell voted with Republicans and against the majority of the Democratic caucus on many key bills.

No federal policy issue inspired more posts last year than health care reform. Rereading my earlier, guardedly hopeful pieces was depressing in light of the mess the health care reform bill has become. I was never optimistic about getting a strong public health insurance option through Congress, but I thought we had a chance to pass a very good bill. If I had anticipated the magnitude of the Democratic sellout on so many aspects of reform in addition to the public option, I wouldn’t have spent so many hours writing about this issue. I can’t say I wasn’t warned (and warned), though.

Links to stories from January through June 2009 are after the jump. Any thoughts about last year’s political events are welcome in this thread.

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Beware of Grassley's bipartisanship on health care

As the ranking Republican on the Senate Finance Committee, Senator Chuck Grassley will influence the shape of health care reform. For that reason, he and Senate Finance Committee Chairman Max Baucus of Montana were invited to lunch at the White House on Wednesday with President Barack Obama and Vice President Joe Biden.

Grassley’s message to the president and vice president, as well as to every journalist who’ll listen, is that health care reform should be done through a bipartisan bill that can receive 70 or 80 votes in the Senate. (See also Grassley’s recent guest editorial at Politico.)

Many Democrats want to include a health care bill in the budget reconciliation process, which would prevent a Republican filibuster. Grassley warns that it would be a mistake to reform such a large part of the U.S. economy without broad support from members of Congress in both parties.

After the jump I’ll explain why Grassley is wrong, wrong, wrong about health care reform.

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Grassley votes against expanding children's health care

The U.S. Senate voted 66-32 yesterday to expand the State Children’s Health Insurance Program (SCHIP). All of the no votes were Republicans, including Iowa’s own Chuck Grassley. He was ready to sign every blank check for George W. Bush, but when it comes to expanding the safety net for families lacking health insurance, he’s Mr. Deficit Hawk.

Senator Tom Harkin issued this statement about the bill:

Renewal of the program will allow Iowa’s HAWK-I program to enroll 11,000 more Iowa kids

Washington, D.C. – U.S. Senator Tom Harkin (D-IA) today released the following statement after the Senate passed legislation that will allow states to continue to provide basic health insurance to kids whose parents cannot afford private insurance, but who do not qualify for Medicaid. The State’s Children’s Health Insurance (SCHIP) Act, known as HAWK-I in Iowa, passed the Senate by a vote of 66-32.

“Hundreds of thousands of Americans are losing their jobs each month, which means more working-family kids are at risk of losing health care coverage. The passage of this bill means more of those parents won’t have to worry about whether they will be able to afford their son or daughter’s next doctor’s appointment,” said Harkin. “Extending health insurance to 11 million children from working families is not about ideology, and it is not about left or right. In a humane society, no child should go uninsured. I am proud that this is one of the first bills that we will pass in the new Congress because it is a great example of what we can do when we work together.”

Talk to anyone who works in the office of a pediatrician or family doctor. During a recession, families cut back even on checkups and other doctors’ visits for their kids.

Thousands of people are losing jobs (and in many cases health insurance) every month. Unemployed people rarely can afford to pay into COBRA plans:

The cost of buying health insurance for unemployed Americans who try to purchase coverage through a former employer consumes 30 percent to 84 percent of standard unemployment benefits, according to a report released yesterday.

Because few people can afford that, the authors say, the result is a growing number of people being hit with the double whammy of no job and no health coverage.

In 1985, Congress passed legislation enabling newly unemployed Americans to extend their employer-based health insurance for up to 18 months. But under the program, known as COBRA, the individual must pay 102 percent of the policy’s full cost.

“COBRA health coverage is great in theory and lousy in reality,” said Ron Pollack, whose liberal advocacy group, Families USA, published the analysis. “For the vast majority of workers who are laid off, they and their families are likely to join the ranks of the uninsured.”

The good news is that despite the misguided ideology of Republicans like Chuck Grassley (and Tom Latham and Steve King), thousands more Iowa families will be able to gain coverage for their kids through HAWK-I. We’re a long way from the universal health care reform we need, but this is a step in the right direction.

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King and Latham vote against health care for children (again)

Great news, everyone! Today the House of Representatives approved an expansion of the State Children’s Health Insurance Program (SCHIP). In Iowa, this program is known as HAWK-I, and it provides coverage for thousands of children whose families are not poor enough to qualify for Medicaid, but not wealthy enough to purchase health insurance:

The child health bill would provide $32.3 billion over four and a half years to continue coverage for seven million children who now rely on the program and to extend coverage to more than four million who are uninsured.

“This is a day of triumph for America’s children,” Speaker Nancy Pelosi of California said. “We put women and children first.”

After years of frustration, Democrats were exultant.

“Today is a new day,” Representative Dave Loebsack of Iowa. Representative Chris Van Hollen, Democrat of Maryland, said, “Passing this bill sends a very important signal that change has come to Washington as a result of the last election.”

Representatives Bruce Braley and Leonard Boswell joined Loebsack in voting for the bill, which passed by a comfortable margin of 289-139. But as you can see from the roll call, Representatives Steve King and Tom Latham voted no.

King has been a proud opponent of the SCHIP program for years. In the bizarro world he inhabits, this program is Socialized Clinton-style Hillarycare for Illegals and their Parents.

Gee, I thought it was for people like my friend, who owns her own business but couldn’t afford health insurance for her kids after her husband got laid off. With the enormous job losses of the last few months, more and more families will need this program.

Anyway, we’ve all come to expect this kind of vote from King.

I hope some Democrats who crossed over in the fourth district to support Latham will open their eyes now. Today’s vote should not surprise anyone, because Latham has voted against expanding the SCHIP program on several occasions.

Still, I doubt this is what most voters had in mind when they saw television ads touting Latham’s “trusted leadership” on health care.

The Senate will take up this bill within the next two weeks, and I doubt Republicans will be able to filibuster it. So, Barack Obama will have a major achievement on health care very early in his presidency. Let’s hope it will be the first of many.

UPDATE: In typically dishonest fashion, Steve King (who never met a tax cut for the rich he didn’t like) claims the SCHIP bill “provides new benefits to illegal immigrants and wealthy families at the expense of low-income children.”

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Help Rob Hubler get his message out

Steve King keeps adding to the multitude of reasons to elect Rob Hubler to represent Iowa’s fifth district in Congress. He is running a misleading television ad in the Sioux City market:

Friday, October 17, 2008                  

         COUNCIL BLUFFS – Rob Hubler, Democratic candidate for Congress in Iowa’s 5th district, today called on Rep. Steve King to pull his new television ad in which he falsely claims credit for “working with others” to widen Highway 20 from two lanes to four lanes.

         Following an announcement by the Iowa Department of Transportation on Tuesday that $48 million had been allocated for 11.7 miles of four-laning Highway 20, King began running a television commercial claiming credit for the funding.  All of the funding is from a special fund recently approved by the Iowa legislature and none of the funding is from federal sources.

         “Steve King taking credit for funding Highway 20 improvements would be like me taking credit for the sun coming up this morning,” said Hubler.  “Our state legislators and the Iowa Department of Transportation deserve credit for allocating the funding for Highway 20, which is long overdue,” he said.  “King had nothing to do with approving money for highway improvements but, three weeks before an election, he is desperate to show some accomplishments in Congress, by taking credit where it is not due.”

         State Sen. Steve Warnstadt of Sioux City, who has fought for funding in the Iowa legislature, said today that the legislature, “rather than wait for the promises of federal politicians to be fulfilled, worked in a bipartisan manner to not only create the funding for TIME-21, but ensured that projects like four-laning Highway 20 would be top priority for new funding.”

         “I’m pleased that the Iowa Transportation Commission did not wait for federal funds, and is using the resources provided to them by the legislature for critical projects like Highway 20,” said Sen. Warnstadt.

         In his television ad, that began running this week, King says:  “Six years ago I made a commitment to you that I would pull out all the stops to build four-lane Highway 20.  Today with the commission’s announcement, I can tell you that 46 more miles will be built within five years.  My number one transportation priority was a promise, now it’s a plan, soon it will be a reality.  We work together and we get things done.”

         In a press release issued the same day, King again took credit for the Highway 20 improvement project.  “Steve King had absolutely nothing to do with any of that funding and is shamelessly trying to take credit for it,” said Hubler.  “I suppose this is what you do when you’ve spent six years in Congress and have only a resolution encouraging people to celebrate Christmas to show for it,” he added.

         Hubler pointed out that King is unable to get anything done to help his district because he is not respected by other members of Congress, even those in his own party.  “By contrast, Rep. Leonard Boswell of Iowa has a program for Highway 34 in which he gets 20 miles paved every year,” he said.

         Hubler said that he will work with the rest of the Iowa delegation to make sure Iowa gets help with maintaining our highways and bridges.  “I will sponsor and fight for legislation to fund at least ten miles of Highway 20 widening each year until it is completed,” he said.  “If Steve King had done this, we would have 60 miles completed during his three terms in Congress.”

This press release from the Iowa Department of Transportation confirms the above comments by Hubler and State Senator Steve Warnstadt. This project is funded by the state, not by any federal appropriation.

Iowa Guy calls out the television ad as one of King’s “lies.” Here is a rough transcript that someone in the fifth district sent to me (if anyone has an official script, please send me a copy). Judge for yourself:

King: I’m Steve King. I approve this message. Six years ago I made a commitment to you that I would pull out all of the stops to build 4 lane Highway 20. Today with the commission’s announcement, I can tell you that 46 more miles will be built within five years. My number one transportation priority was a promise, now it’s a plan, soon it will be a reality. We work together and we get things done.

Voice Over: “Steve King for Congress”

King’s ad creates a false impression. Note how he refers to “the commission” without making clear that he’s talking about the Iowa Transportation Commission’s announcement regarding Highway 20. He talks about how his “promise” is now a “plan” that will soon be a “reality,” without specifying what he did to make that plan a reality (because he played no role).

I read in one of my parenting books that lying can be a form of wish fulfillment. If I had achieved as little for constituents as King has, I’d probably wish I could take credit for a popular highway project too.

Speaking of King’s record, you may recall this article the Sioux City Journal published over the summer, asking “How effective is Steve King?” (Answer: not very.) In the article, King described a “key moment” for him:

King said the extended 2007 funding debate for reauthorization of the federal State Children’s Health Insurance Program was a key moment. The measure was initially written for an increase of $35 billion, but was scaled back before being signed by President Bush in December.

King took to the House floor last fall with a sign that said the SCHIP acronym should instead stand for “Socialized Clinton-style Hillarycare for Illegals and their Parents.”

“I do believe if you took me out of the equation, there would have been a different (funding) result,” King said.

I have a close friend (self-employed) whose family was getting health coverage through her husband’s job. He was just laid off this month. Fortunately, their kids are eligible to be added to HAWK-I (that’s the Iowa version of SCHIP) as of November 1.

Plenty of children would be going without health insurance if not for HAWK-I, and in this economy, demand for the program will probably rise significantly.

Isn’t it great that King fought to scale back the funding?

Another recent “achievement” for King was his proposal to create a commission to study the current financial crisis. Hubler had some choice words about that idea, and I’ve put his full statement after the jump. Some excerpts:

       “For six years, Steve King has supported an administration that has refused to accept responsibility or to hold anyone accountable for policies that have devastated the middle class, provided tax breaks to big oil companies, mismanaged an unnecessary war, and now caused the worst financial meltdown since the Great Depression,” said Hubler.  “We don’t need to spend millions of dollars on a commission that will take months to find out what we already know; when there are no rules, and no regulators, markets do not regulate themselves.”

       “King opposed common-sense regulations designed to protect investors and consumers as his Republican-led Congress gave the Bush administration the authority to dismantle rules, allowing greedy Wall Street speculators and unscrupulous lenders free rein to engage in subprime lending with no oversight from Congress,” Hubler continued.  “Yet, instead of accepting responsibility for his part in creating this mess, King has tried to blame middle class borrowers for the collapse of the housing market,” said Hubler, referring to comments King made Saturday at a town hall meeting in Onawa.

Hubler is a strong Democrat as well as a strong candidate, which is why Wisconsin Senator Russ Feingold’s Progressive Patriots Fund is supporting him.

Hubler can win this race if he is able to get his message to voters. He’s already been up on the radio with at least one ad, featuring former Congressman Berkley Bedell. The Hubler campaign has also produced this voter guide (pdf file) to mail district-wide. To reach more voters through direct mail and broadcast media, the campaign needs your help. Please donate today.

We have a great opportunity to take advantage of the coming Democratic wave. This post at Swing State Project notes that seats once thought safe for Republicans are becoming competitive across the country. The author names IA-05 (as well as IA-04) among the “Republican seats at severe risk of being lost or swept away in the ensuing tide.”

The Republican Party is now spending money on behalf of incumbents in some districts comparable to western Iowa in terms of partisan makeup. This recent story from Politico notes:

GOP Reps. John B. Shadegg of Arizona, Lee Terry of Nebraska, Henry Brown Jr. of South Carolina and Dan Lungren of California are all fighting for their political lives, a reversal of fortunes that has caught even the most astute campaign observers by surprise.

Markos commented on the Politico piece,

Shadegg’s AZ-03 is R+5.9.

Terry’s NE-02 is R+9.0.

Brown’s SC-01 is R+9.6

Lungren’s CA-03 is R+6.7.

Iowa’s fifth district has a partisan voting index of R+8. As I’ve written before, ten House Democrats already represent districts at least as Republican. This election will increase that number. Let’s make IA-05 one of them.

King’s third-quarter FEC filing showed a financial advantage over Hubler, but hardly an intimidating war chest. His cash on hand may not even be sufficient to run television ads across the district for the remainder of the campaign. He certainly won’t have a turnout operation to rival what Barack Obama’s campaign and the Iowa Democratic Party have going in western Iowa.

It only takes a minute to donate to Hubler’s campaign, giving him the resources to spread his message in the final weeks. Please take the time to help send a good man to Congress.

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