While most of us are focused on insurance or universal care, the Bush Administration has been incrementally shredding Iowa’s existing public health safety net in ways that have yet to become apparent.  The most recent assault on our public health care infrastructure is escaping the notice of mainstream media and citizen journalists alike, probably because it is not easily explained. I am referring to a proposed set of arcane regulation changes by the Center for Medicaid and Medicare Services (CMS) which, if enacted, will result in $15 billion dollars in cuts over five years to service providers, closing or scaling back emergency rooms, medical education and school based services in Iowa communities.