Dave Leshtz is the editor of The Prairie Progressive, where this essay first appeared.

Earlier this year, State Representative Josh Turek wrote an excellent Des Moines Register guest column on why “Iowa is not a good place to be disabled.” He cited long waiting lists for in-home and community-based care, severe restrictions on Medicaid eligibility, legislative efforts to dismantle services for special education provided by our Area Education Agencies, and more. Yet this is only the tip of the iceberg.

Iowa also lags in providing community services.

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.

When Iowa Republicans gained the trifecta following the 2016 elections, defunding Planned Parenthood was near the top of their agenda. GOP legislators promised a new state-funded family planning program would increase access to reproductive health care and give women more options, especially in rural Iowa.

The latest official data, first reported by the Des Moines Register’s Michaela Ramm, show the program has flopped. In just five years, the number of Iowans receiving services such as contraception, pregnancy tests, Pap smears, and testing or treatment for some sexually transmitted infections dropped by 90 percent compared to the population served during the last year of the previous Medicaid waiver. The number of health care providers involved is down by a staggering 97 percent.

The Iowa Department of Health and Human Services has done almost nothing to promote the program, even as enrollment crashed.

The reality could hardly be more different from the scenario Republicans described in 2017: “connecting folks with their home health care” for essential services by taking Planned Parenthood’s mostly urban clinics out of the equation.

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.

It’s time for another review of Bleeding Heartland’s most widely-read posts from the year that just ended. I always struggle a bit with this task, because the work I’m most proud of doesn’t always overlap with what resonated most with readers. Also, I’m wary of watching traffic numbers too closely, because I try not to let potential clicks drive my editorial decisions.

However, I always gain some insight from this review, so here goes.

This list draws from Google Analytics data about total views for 598 posts this website published during 2021: 362 written by me and 236 by other authors. I left out the site’s front page and the “about” page, where many people landed following online searches.

Iowa’s former State Medical Director Dr. Caitlin Pedati began working last week as Virginia Beach Health District Director, the city of Virginia Beach announced on December 10.

Jason Clayworth reported on December 14, “Pedati’s new gig is a recently created position that pays $190,000 a year, according to records obtained by Axios Monday.” He noted that was substantially less than Pedati’s annual salary in Iowa. The state employee salary book lists Pedati’s annual gross pay at $229,545.41 for fiscal year 2020 and $282,131.62 for the 2021 fiscal year.

Governor Kim Reynolds’ disaster emergency proclamations allowed state employees who normally would not be eligible for overtime pay to receive it for work related to the COVID-19 response. Bleeding Heartland reported last year that Pedati received more than $55,000 in overtime pay from March through early July 2020. Documents I received through a subsequent public records request showed that Pedati collected a total of $67,653.29 in overtime pay during the first six months of the pandemic.

Pedati grew up in the Virginia suburbs and attended college and medical school in the Washington, DC area. So it’s not surprising she would want to return to her home state—even for a lower salary—after four and a half years in the Midwest.

State Medical Director and Epidemiologist Dr. Caitlin Pedati is leaving the Iowa Department of Public Health (IDPH) in late October, the agency announced on September 22.

The leader of Iowa’s COVID-19 response had hardly been seen in public all year and granted few media interviews. Pedati was an occasional speaker at Governor Kim Reynolds’ televised news conferences during the first eight months of the pandemic, but had not appeared at one since November 2020.

The unexplained departure raised questions about whether Pedati walked or was forced out. Reynolds’ new spokesperson Alex Murphy told Bleeding Heartland via email that no one in the governor’s office asked the medical director to leave. “This was a personal decision by Dr. Pedati.” Murphy also said the governor won’t pick her successor; rather, IDPH Director Kelly Garcia “and her team will handle the hiring.”

I’ll be seeking records that could show whether Pedati (a board-certified pediatrician) disagreed with any aspects of Iowa’s COVID-19 mitigation strategy, such as grossly inadequate guidance for schools or the retreat from recommending masks, even for unvaccinated people crowded together indoors.

Whether or not Pedati had any private misgivings, she repeatedly failed to keep Iowans safe or adequately informed during this pandemic, which has already killed more than 1 in 500 Iowa residents who were alive eighteen months ago.

Once upon a time, Governor Kim Reynolds postured as an advocate for mask wearing to reduce community transmission of COVID-19. Although she never consistently masked up when near others, and often sent mixed messages about whether face coverings were advisable for everyone or mainly for vulnerable people, she appeared in videos last year that promoted masks as one way to “step up and stop the spread.”

The governor stopped touting masks some months ago. In recent interviews and public appearances, she has claimed it’s not clear whether face coverings reduce virus transmission in schools, and has asserted that masks can harm children.

The Iowa Department of Public Health has similarly retreated from recommending masks as part of a layered COVID-19 mitigation strategy. The governor’s staff have micromanaged the public health agency’s communications with the media since the earliest days of the pandemic. At Reynolds’ latest news conference, she and a staff member intervened twice to stop IDPH Director Kelly Garcia from answering questions about the benefits of masks.

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

The Urgency

On August 11, a Wednesday morning, four moms of school-aged kids arrived at the Iowa State Capitol to put on an event called the Safe at School Sit-In. Two of them had met the previous day, but this was the first time everyone had met each other in person. The fifth member was anxiously keeping an eye on her Facebook Messenger and waiting for the live feed from the Iowans for Public Education Facebook page.

Twelve days earlier, Erin Dahl and Julie Russell-Steuart, both disability advocates, had discussed wanting to do something about the failure of virtually every state institution to protect vulnerable kids and Iowans in general from COVID-19. The next day, Erin saw a post by Brook Easton on Educators for a Safe Return to School Facebook group, saying how it was incredible no one had organized a protest yet, and tagged Julie.

The post turned up more moms wanting to take action. A group was quickly formed and the first of many Zoom meetings and probably hundreds of Facebook Messages started.

Governor Kim Reynolds loves to boast that Iowa “led the way” in bringing kids back to school during the COVID-19 pandemic, “and we did it safely and responsibly.” The talking point was debatable last year, since Iowa’s new cases and hospitalizations began surging several weeks after schools reopened.

It’s laughable now, as Iowa schools prepare to welcome kids back this week. While the Delta variant has caused spikes in pediatric cases and hospitalizations where schools are already in session, Reynolds and leaders of Iowa’s education and public health departments have blocked nearly every practice that helped reduce COVID-19 spread in schools last year.

An attorney representing the board chair of the Salt Lake Tribune has sued the Iowa Department of Public Health (IDPH) and its records custodian for failing to provide email correspondence related to the $26 million Test Iowa program.

Paul Huntsman confirmed on July 30 that the lawsuit Suzette Rasmussen filed in Polk County the previous day is part of his Jittai initiative. The Tribune’s board chair recently created Jittai in order “to learn more about TestUtah and its sister programs” created through similar no-bid contracts in Iowa, Tennessee, and Nebraska. Florida also implemented parts of the program.

According to the court filing, which is posted in full below, Rasmussen wrote to Sarah Ekstrand in March seeking “copies of all correspondence between the Iowa Department of Public Health, including but not limited to Interim Director Kelly Garcia, and the Iowa Governor’s Office, Utah state officials, Nebraska state officials, and Tennessee state officials regarding the Test Iowa Contract” from March 1, 2020 to March 11, 2021.

Concerned parent Tanya Keith reached out to Governor Kim Reynolds’ staff and interviewed infectious disease Dr. Megan Srinivas. -promoted by Laura Belin

Less than a month before school starts, Governor Kim Reynolds is putting politics ahead of my daughter’s life and well-being. I am one of the thousands of Iowa parents bearing the burden of having a child under 12, who is too young to be vaccinated against COVID-19.

Anyone following pandemic science updates has been fed a daily diet of rising concern. First, the World Health Organization recommended that all individuals mask inside, even if they are vaccinated. Then the American Academy of Pediatrics recommended that all K-12 students be masked, regardless of vaccination status. The U.S. Centers for Disease Control just echoed that guidance.

As an Iowa parent, I know that it is currently against the law for masks to be required at school. If you’re reading this from another state, that may sound bizarre, but I assure you it’s true. In May, Reynolds signed a bill in the middle of the night to ban mask mandates, so schools were left scrambling to come up with new policy days from the finish line of a grueling academic year.

Kyla Claussen is one of some 16,000 Iowans on waiting lists for disability services. -promoted by Laura Belin

My name is Kyla Claussen and I’m from Avoca, Iowa. I have an unknown progressive neuromuscular disorder that has been slowly taking skills away from me over the past five years. By March 2020, I was unable to walk independently anymore or work. Last August, I went on Social Security Disability Insurance (SSDI) and then applied for the Physical Disability Waiver and the Health and Disability Waiver.

I’m now waiting for services in my home, along with 15,956 Iowans on the waiting list for one of the waivers for people with disabilities. Most likely, I will be waiting for one to three years.

Governor Kim Reynolds told Iowans this week to “lean further into normal,” since “There’s no reason for us to continue to fear COVID-19 any longer.”

Iowa Department of Public Health Director Kelly Garcia obliged with new guidance urging schools and child care providers to “approach COVID-19 like other child illnesses.”

To justify abandoning precautions like mandatory face coverings and quarantines for children exposed to coronavirus, Garcia misrepresented the latest advice from the U.S. Centers for Disease Control.

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).

Governor Kim Reynolds has approved bonuses for at least five current state agency directors, allowing them to receive substantially more compensation than the top of the pay scale Iowa law sets for their positions.

The Iowa Department of Administrative Services disclosed information about four agency leaders now receiving such bonuses in response to Bleeding Heartland’s public records request. The Cedar Rapids Gazette’s Erin Jordan was first to report on Homeland Security and Emergency Management Director Paul Trombino’s bonus, in an article published April 7.

This post discusses each official’s bonus pay in the order that they were awarded. The governor’s spokesperson Pat Garrett did not respond to an April 7 email seeking to clarify whether any other heads of state departments are receiving greater compensation than the statutory maximum for their positions.

Since the Iowa Department of Public Health (IDPH) changed how it counts and reports COVID-19 deaths on December 7, fatality numbers on the official website coronavirus.iowa.gov have become more accurate in several respects. The state’s dashboard no longer routinely lowballs how many Iowans have died in the pandemic. Instead, the IDPH numbers track closely with weekly figures published by the U.S. Centers for Disease Control.

We now know that COVID-19 deaths accelerated in Iowa this fall even more rapidly than was previously apparent. Through the end of November alone, at least 3,308 Iowans had died in the pandemic. That number was more than 600 higher than the state website indicated before the IDPH began implementing the new counting method.

Two drawbacks have accompanied this important policy change. First, there is a greater lag time between when an Iowan dies and when that fatality tends to appear on the dashboard. In addition, updates to the state website have become more erratic, with IDPH staff adding few or no deaths on some days, and more than 100 deaths on others.

Now more than ever, media organizations that report COVID-19 statistics daily must put those numbers in context. Anyone following news on the pandemic needs to understand that changing totals from one day to the next on the IDPH website do not reflect how many Iowans died of COVID-19 during the previous 24 hours.

That said, the more accurate counting method is bringing the horrifying scale of the pandemic into focus.

Iowa’s new Infectious Disease Advisory Council will continue to meet behind closed doors, Iowa Department of Public Health (IDPH) interim Director Kelly Garcia confirmed on December 16. Garcia established the council earlier this month, naming 25 “external and internal subject matter experts” to help the agency develop guidelines for allocating limited supplies of COVID-19 vaccines and therapeutics.

Iowans are unable to observe council members as they consider how to balance the needs of disparate groups at high risk from the novel coronavirus. Ryan Foley reported for the Associated Press on December 16 that the council “has met twice this month without giving prior notice to the public, publishing an agenda or allowing the public to participate as required by the Iowa Open Meetings Act.”

The IDPH maintains that Iowa Code Chapter 21 does not apply to an advisory council created by a state agency. But not every expert on the law concurs.

Iowa Medical Director Dr. Caitlin Pedati received a 45 percent raise this summer despite a state policy limiting within-grade pay increases, records obtained by Bleeding Heartland show.

Department of Administrative Services (DAS) Interim Director Paul Trombino III advocated for Pedati to receive the unusually large raise three weeks after informing state agency directors that they could give employees within-grade salary hikes of up to 3 percent.

State rules also require that “any within grade pay increase must be accompanied by a current performance evaluation,” Trombino reminded directors in the same memo. However, staff with the Iowa Department of Public Health (IDPH) and DAS did not answer questions about whether anyone has formally reviewed Pedati’s work this year.

The state of Iowa is looking for a private company to help integrate programs of the Iowa Department of Human Services (DHS) and Department of Public Health (IDPH).

Governor Kim Reynolds indicated this summer that she planned to merge many operations of the departments, which serve a combined total of more than 1 million Iowans. After Gerd Clabaugh announced plans to retire as IDPH director, Reynolds appointed DHS Director Kelly Garcia to serve simultaneously as interim director of public health, saying in a news release, “This is an opportunity to increase cooperation and collaboration between these two agencies to better serve Iowans.”

A Request for Proposal reveals more details about the planned scope of the reorganization, which is scheduled to begin early next year. Notably, control of infectious diseases is among the areas of the IDPH’s work that will be “excluded from the redesign.”

The base pay for Iowa’s medical director and state epidemiologist Dr. Caitlin Pedati increased by 45 percent as the current fiscal year began on July 1, records obtained by Bleeding Heartland show. The additional $3,144 that Pedati began receiving per two-week pay period would translate to an extra $81,744 in base salary over twelve months.

The doctor leading the state’s COVID-19 pandemic response also received more than $55,000 in overtime pay from March through early July, even though her job class would not normally be eligible for overtime compensation.

“I am embarrassed and saddened by the way the media has been treated during COVID,” Polly Carver-Kimm wrote in an email to the Des Moines Register on July 15. “You are not receiving timely answers and you are getting scripted talking points when you do get an answer.”

Carver-Kimm discussed the state’s handling of press inquiries hours after being shown the door as communications director for the Iowa Department of Public Health.

Members of the Iowa House and Senate begin the work of the 2020 legislative session this morning. Speaking to journalists last week, GOP leaders described plans to work on a wide range of issues in the coming months, including workforce development, taxes, child care, and medical cannabis.

But top statehouse Republicans aren’t planning any oversight hearings on what’s been happening at the Glenwood Resource Center for Iowans with severe intellectual disabilities.