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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

A third candidate is seeking the Democratic nomination in Senate district 22, which is likely to be among Iowa’s most competitive state legislative races in 2020.

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.

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.

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).

A third Democrat hopes to represent Iowa House district 46, where longtime State Representative Lisa Heddens stepped down this week to become a Story County supervisor.

Ross Wilburn confirmed in a June 20 telephone interview that he will seek the nomination at a special convention to be scheduled soon. UPDATE: on June 29.

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:

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:

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.

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.

Tyler Mills is a Democrat in Keokuk (Lee County). -promoted by Laura Belin

John Hickenlooper is the voice the country needs right now. His bid for the Democratic nomination for president will move us forward, particularly when it comes to a policy discussion. His accomplishments as governor of Colorado from 2011 to 2019 are quite impressive.

Heather Marie Dunn is a transgender Iowan and “recovering right-winger” in Polk County. -promoted by Laura Belin

“She lied to me,” were my first thoughts when I heard Governor Kim Reynolds had signed the health and human services budget that included a mean-spirited exclusion of transgender and intersex health care from Iowa’s Medicaid system.

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.

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.

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.)

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.

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.

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.

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.

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.”

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.

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.

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.”

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:

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.

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.

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.

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.

The first Democrat to serve as Iowa’s state auditor in more than 50 years has hired a “tri-partisan leadership team” to help run the office.

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.

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.