A two-decade-old state administrative rule “clearly discriminates against transgender Medicaid recipients on the basis of gender identity by excluding coverage for medically necessary gender affirming surgery” while covering the same surgeries for non-transgender Iowans, a Polk County District Court ruled on June 7. Chief Judge Arthur Gamble found the rule violates both Article I, section 6 of the Iowa Constitution, which guarantees equal protection, and the Iowa Civil Rights Act, which has prohibited discrimination on the basis of gender identity since 2007.

The Iowa Department of Human Services “cannot ensure the accuracy, completeness, or reliability” of data released to the public about any programs administered by Iowa Medicaid Enterprise, including the managed-care system for some 600,000 Iowans on Medicaid.

When responding to all requests for information about Medicaid or related programs, the DHS also warns users that “there may be errors, omissions, or inaccuracies in the data provided.” Leading Iowa Senate Democrats were unaware of the disclaimer, which they described as “odd,” “troubling,” and “unacceptable.”

Republican lawmakers made big promises last year that Iowans would have “more access” to family planning services under a new state program that excluded Planned Parenthood.

As anyone could have foreseen, the opposite was true. In the first nine months of the State Family Planning Program’s existence, the number of Iowans enrolled dropped by a third. The number who obtained at least one reproductive health care service fell by more than 40 percent from the first quarter to the second quarter the program was operating. The number of health care providers billing the program also declined by 40 percent during the same time frame.

Republican lawmakers don’t want to hear how poorly the new system is serving their constituents. Even worse, GOP state senators voted unanimously last week to compound the mistake by blocking Planned Parenthood from participating in sex education programs.

High-profile departures from the Des Moines Register newsroom have happened too often over the last decade. A series of layoffs and buyouts left readers less informed about important topics. For instance, ever since the Register let its last Washington-based correspondent go, readers rarely hear about what our state’s members of Congress are doing, unless the story originated from a press release or comments during a conference call with journalists.

The recent turnover at Iowa’s most important agenda-setting news organization is worrying for heavy consumers of political coverage.

Complaints to the Iowa Office of Ombudsman regarding privatized Medicaid increased by 157 percent last year, reflecting “systemic frustration” over cuts to health services for patients and unpaid bills for providers. Ombudsman Kristie Hirschman has “yet to be convinced” that the Department of Human Services is providing “adequate oversight” of the private insurance companies that control access to care and reimbursements, she wrote in a report released on April 2. The three outrageous examples she recounted resemble too many other tragic cases since Iowa shifted to a managed-care model for more than half a million Medicaid recipients.

Hirschman has assigned a full-time staffer to handle Medicaid-related complaints. The same issues come up again and again, more than a year after she, the state’s Long Term Care Ombudsman, and the advocacy group Disability Rights Iowa informed the DHS director about recurring problems with Medicaid managed-care organizations.

Although the ombudsman praised the legislature for “taking steps to correct some of the problems we and others have identified,” Senate Republican leaders haven’t brought up a Medicaid oversight bill that passed the Iowa House unanimously last month.

The Iowa Senate confirmed Jerry Foxhoven as director of the Iowa Department of Human Services in an unusually close vote on March 21.

Most of Governor Kim Reynolds’ appointees have won unanimous confirmation, as has typically been the case in Iowa for many years. Foxhoven’s nomination was controversial because of how privatized Medicaid has been managed, along with several tragedies involving abused children. Senate Democrats asked to defer consideration on the DHS director last month “until we can fully assess his leadership.”

During the last week before the filing deadline, Republican State Senators Mark Chelgren and Rick Bertrand announced that they will not seek re-election in 2018. Iowa Senate districts 41 and 7 were already the best Democratic pickup opportunities on a difficult midterm election map. Of the 29 Republicans now serving in the upper chamber, only four–Chelgren, Bertrand, Dan Dawson, and Tom Greene–hold seats where registered Democrats outnumber Republicans (barely in Dawson’s district). Dawson and Greene won’t be up for re-election until 2020.

Winning an open seat is usually easier than defeating a legislative incumbent, and Bertrand’s retirement clearly improves Democratic chances in Senate district 7.

But Republicans have likely increased their odds of holding Senate district 41 by swapping out Chelgren for Mariannette Miller-Meeks.

Across the United States, trans health care is an unstable patchwork of “islands.” Nowhere is this more evident than in Midwest states like Iowa and Indiana. -promoted by desmoinesdem

Iowa Senate Republicans are barreling ahead to debate a regressive tax plan that would reduce state revenues by 10 to 15 percent within five years. Senate Ways and Means Committee Chair Randy Feenstra, lead author of Senate File 2383, continued to describe his proposal as “bold, pro-growth tax relief” after a non-partisan analysis projected massive revenue losses.

Meanwhile, newly-released records show that in communications with other GOP senators, Feenstra greatly understated the cost of an earlier draft of his tax proposal. The documents don’t indicate whether the head of Senate’s tax-writing committee misunderstood numbers provided by the Iowa Department of Revenue or misrepresented them to downplay the price tag. (Feenstra has not responded to my inquiry.)

What is clear: the Department of Revenue never predicted that deeply cutting taxes would produce “excess” economic growth. Which isn’t surprising, since no economic boom materialized in states like Kansas and Louisiana after Republicans destroyed those states’ ability to pay for essential services.

A personal commentary by Matt Chapman to coincide with the “Day on the Hill” for our state’s National Alliance on Mental Illness chapter. NAMI Iowa’s “mission is to raise public awareness and concern about mental illness, to foster research, to improve treatment and to upgrade the system of care for the people of Iowa.” -promoted by desmoinesdem

In the last few years I have found myself politically active and seem to be trying to make up for years of not having the right to vote and taking it for granted when I did participate. I would like to share where my focus is and relate how I came to feel so intensely about these issues. You never know when you may find your voice, and if it took me until my 50s, so be it.

Jeff Cox sees one gubernatorial contender best positioned to help Democrats become the majority party again. Bleeding Heartland welcomes guest posts advocating for candidates in competitive Democratic primaries. Please read these guidelines before writing. -promoted by desmoinesdem

There is only one word to use when surveying the damage the Republicans are doing to Iowa and America: depressing. We need to keep our eye on the ball, though, and avoid being diverted into competitive name-calling with Republicans. We need to elect Democrats until we regain a majority at every level of government. In the present crisis, any Democratic victory is a win, no matter how awful the Democrat.

In addition to issuing an “all hands on deck” call to elect Democrats, we should also have a discussion about how we got into this mess of being a minority party at every level of government. We could do worse than look back to a period of history when Democrats were the natural party of government, the half century beginning in 1932.

Shawn Harmsen is a progressive activist in Iowa City. Bleeding Heartland welcomes guest posts advocating for candidates in competitive Democratic primaries. Please read these guidelines before writing. -promoted by desmoinesdem

Dear Editor and fellow Iowans,

I am supporting Nate Boulton for Iowa governor because a year ago I saw him out front with Iowa Democrats who, against near-impossible odds, fought back on behalf of Iowa families like mine.

The Department of Human Services, state universities, and Department of Corrections would have to absorb large mid-year spending cuts under recommendations Governor Kim Reynolds released this week. The governor’s focus is strikingly similar to cuts her predecessor Terry Branstad proposed and Republican lawmakers approved in early 2017.

Governor Kim Reynolds continues to take credit for a major benefit of the Affordable Care Act, even as she calls on Congress to repeal and replace the 2010 health care reform law. During today’s Condition of the State address, the governor boasted that compared to a few years ago, “150,000 more Iowans have mental health coverage today and have access to more local and modern service.”

She didn’t mention that those Iowans gained health insurance only because the Affordable Care Act included funding to expand Medicaid.

The Iowa House and Senate convened Monday with the usual big promises and platitudes about working together to build a better future for Iowans.

Behind the optimistic rhetoric, all signs point to another contentious legislative session. The opening day speeches by Republican and Democratic leaders, enclosed in full below, revealed almost no common ground about the focus of lawmakers’ work and no indication that the most important bills will incorporate Democratic ideas. My takeaways:

Senator Chuck Grassley hit a new low last week in running interference for the White House on the Trump/Russia investigation. After leaders of the private research firm Fusion GPS called on Congressional Republicans “to release full transcripts of our firm’s testimony” about the so-called Steele dossier, Grassley and Senator Lindsey Graham wrote to the Department of Justice and the FBI “urging an investigation into Christopher Steele.” Ranking Senate Judiciary Committee Democrat Dianne Feinstein was not consulted about the referral, which she accurately characterized as “another effort to deflect attention from what should be the committee’s top priority: determining whether there was collusion between the Trump campaign and Russia to influence the election and whether there was subsequent obstruction of justice.”

Here in Iowa, the Department of Human Services recently acknowledged that privatizing Medicaid “will save the state 80 percent less money this fiscal year than originally predicted,” Tony Leys reported for the Des Moines Register. The Branstad/Reynolds administration has claimed since 2015 that shifting care for one-sixth of Iowans to private companies would result in big savings for the state. Officials were never able to show the math underlying those estimates. Staff for Governor Kim Reynolds and the DHS now portray the miscalculation as an honest mistake, which a more “comprehensive methodology” will correct. The governor would have been wiser to pull the plug on this disaster last year.

Forthcoming Bleeding Heartland posts will address those failures in more depth. But now it’s time to hold myself accountable for the 17 Iowa politics predictions I made at the beginning of 2017. Did I improve on my showing of seven right, two half-right, and seven wrong out of my 16 predictions for 2016?

Since I started writing for this website a decade ago, I’ve never worked harder than I did in 2017. This momentous year in Iowa politics provided an overwhelming amount of source material: new laws affecting hundreds of thousands of people, our first new governor since 2011, and a record number of Democrats seeking federal or statewide offices.

In addition, my focus has shifted toward more topics that require time-consuming research or scrutiny of public records. As I looked over the roughly 420 Bleeding Heartland posts I wrote this year, I realized that dozens of pieces were as labor-intensive as some of those I worked hardest on in 2015 or 2016.

Bleeding Heartland published 140 guest posts by 81 authors in 2016, a record since the blog’s creation in 2007.

I’m happy to report that the bar has been raised: 83 authors contributed 164 guest posts to this website during 2017. Their work covered an incredible range of local, statewide, and national topics.

Some contributors drew on their professional expertise and research, writing in a detached and analytical style. Others produced passionate and intensely personal commentaries, sometimes drawing on painful memories or family history.

Zach Wahls announced his candidacy today in Iowa Senate district 37, where Democratic State Senator Bob Dvorsky plans to retire at the end of 2018. Janice Weiner launched her campaign for the same seat earlier this week, but Wahls will be heavily favored to win the Democratic nomination.

Follow me after the jump for background on both candidates and the political landscape in this must-hold district for Democrats.

Clear majorities of Iowans disapprove of how the state legislature and executive branch are handling mental health care, Medicaid, education funding, and taxes, according to the latest statewide survey by Selzer & Co for the Des Moines Register and Mediacom.

Even worse for Republicans: more than 70 percent of respondents said each of those issues would be a “major consideration when you choose how you will vote in the 2018 election.”

Scott County activist Emilene Leone joined the statewide steering committee for John Norris last month. Bleeding Heartland welcomes guest posts advocating for candidates in competitive Democratic primaries. Please read these guidelines before writing. -promoted by desmoinesdem

I am strongly endorsing John Norris for Iowa governor, and I encourage all concerned parents here in Iowa to do the same. John Norris is the best choice to protect Iowa’s future for our children.

Declaring the two-party system “badly broken,” State Senator David Johnson announced this morning that he will seek re-election as an independent in Iowa Senate district 1 next year. The former Republican won his first state House race in 1998 and was a successful candidate for the state Senate four times, serving for a decade as an assistant leader of the GOP caucus. He left the party in June 2016 to protest the nomination of Donald Trump as president.

In a statement enclosed in full below, Johnson said, “Politics in Des Moines has reached a bitterly partisan tipping point. Principle must come before party.” He added that “constituents of all political stripes have encouraged him to run again,” and that the “storied history of the House and Senate includes legislators who have not been affiliated with major parties.” According to Johnson, the last candidate to win an Iowa Senate race as an independent was William Schmedika in 1923.

Johnson didn’t face an opponent in his last two Senate races, but next year’s campaign is sure to be a hard-fought battle.

Governor Kim Reynolds made a strategic error by not distinguishing herself from her predecessor in any meaningful way, judging by the new Iowa poll by Selzer & Co for the Des Moines Register and Mediacom.

Changing course on even one high-profile policy could have demonstrated strong critical thinking and leadership skills. Instead, Reynolds is in effect running for a seventh Terry Branstad term. Unfortunately for her, Iowans are inclined to think it’s “time for someone new” in the governor’s office.

Bleeding Heartland welcomes guest posts advocating for candidates in competitive Democratic primaries. Please read these guidelines before writing. -promoted by desmoinesdem

I am Lane Kunzie and a senior at Wayne Community Schools in Corydon. This is my first political blog post and the Democratic primary on June 5, 2018 will be the first election I can vote in. My first vote I am going to cast will be for Andy McGuire.

Everyone could have guessed Alec Baldwin would get Iowa Democrats laughing with jokes at President Donald Trump’s expense.

But who would have predicted the serious part of the actor’s speech would evoke an even stronger response from the crowd?

Follow me after the jump for audio and highlights from Baldwin’s remarks and those of the seven Democratic candidates for governor, along with Stefanie Running‘s photographs from a memorable evening in Des Moines.

Thanking a veteran is easy. Tackling problems that face veterans is hard.

At no time is that political reality more apparent than on the 11th day of the 11th month.

The usual expressions of respect and gratitude can be found in the latest batch of Veterans Day tweets by Senators Chuck Grassley and Joni Ernst and Representatives Rod Blum (R, IA-01), Dave Loebsack (D, IA-02), David Young (R, IA-03), and Steve King (R, IA-04).

After the jump I’ve posted some concrete ways members of Congress could show they care about veterans. This is an open thread: all topics welcome.

For the second straight year, Iowa Senate Democrats will head into the legislative session with a new minority leader. Senators met at the Capitol today to elect Janet Petersen, replacing Rob Hogg, who had led the caucus since last November.

Governor Kim Reynolds won’t call a special legislative session to balance the budget for the year that ended on June 30, her office announced this morning.

They haven’t explained how a fiscal year 2017 shortfall that non-partisan analysts estimated at $104 million in July and around $75 million a few weeks ago became a $14.6 million shortfall, according to the governor’s staff.

Reynolds didn’t take questions from the press today. She didn’t even attend the briefing where Department of Management Director Dave Roederer handed out a puzzling table.

Whatever the Reynolds administration did to avert a short-term political problem will likely worsen the strain on the state budget in the coming months.

To all the Democrats who want to hear directly from each contender in the Iowa governor’s race before deciding how to vote next June: this post’s for you.

Since Bleeding Heartland published seven pitches for gubernatorial candidates from a major party event this summer, Todd Prichard has left the race and Ross Wilburn has joined the field.

All seven Democrats running for governor appeared at the Progress Iowa Corn Feed in Des Moines on September 10, speaking in the following order: Cathy Glasson, Fred Hubbell, John Norris, Ross Wilburn, Jon Neiderbach, Andy McGuire, and Nate Boulton. I enclose below the audio clips, for those who like to hear a candidate’s speaking style. I’ve also transcribed every speech in full, for those who would rather read than listen.

As a bonus, you can find a sound file of Brent Roske’s speech to the Progress Iowa event at the end of this post. With his focus on single-payer health care and water quality, Roske should be running in the Democratic primary. Instead, he plans to qualify for the general election ballot as an independent candidate, a path that can only help Republicans by splitting the progressive vote.

Who could have guessed that privatizing Medicaid would lead to for-profit companies cutting essential services to Iowans with disabilities? Aside from anyone who spent five minutes reading how the same approach had played out in Kansas?

When Iowa Democratic lawmakers sounded the alarm two and a half years ago, Governor Terry Branstad and his aides dismissed the warnings as “Washington D.C.-style partisan attacks.” They insisted privatization would allow Iowa patients to “enjoy the increased quality of service and care that comes with modern plans administering Medicaid.”

Instead, thousands received less in-home care or had trouble accessing medications and services after private insurance companies began managing their cases. The state now faces a class action lawsuit on behalf of 15,000 Iowans with disabilities.

Iowa Department of Human Services Director Jerry Foxhoven admitted yesterday what should have been obvious from the start: letting for-profit companies control access to health care for people with disabilities makes no sense.

The hits just keep on coming from the health and human services budget Iowa Republicans enacted this year.

As if big spending cuts to public health programs, child care assistance, social worker field services, the closure of four Planned Parenthood clinics, and ending on-site ombudsmen visits to nursing homes didn’t do enough to harm vulnerable people, that budget bill also called for short-changing Iowans who sign up for Medicaid.

The Reynolds administration is moving forward with the plan to end decades-long practice on covering health care for new Medicaid recipients.

Are Iowa Democrats more likely to support a successful businessman who is not a politician? Are they sympathetic to the argument that a self-funding candidate for governor is less susceptible to influence by special interests? Are they more impressed by private- or public-sector jobs Fred Hubbell has held, or by his charitable giving to causes like Planned Parenthood?

A recent survey of Democratic voters appears to be the Hubbell campaign’s first attempt to answer those and other questions.

Pete D’Alessandro would be a first-time candidate if he joins the large group of Democrats challenging Representative David Young in Iowa’s third Congressional district. But no one in the field has more Iowa campaign experience than this longtime political operative.

D’Alessandro has been thinking seriously about this race for months. In a recent telephone interview, he told me he has set Saturday, August 26–the date of the Iowa Democratic Party’s third district workshop in Atlantic–as “the day to fish or cut bait.”

He also discussed the points he would raise as a candidate and how Democrats can accomplish “real change,” capitalizing on the activism that fueled Bernie Sanders’ campaign.

Ruth Thompson shares her remarks from the Our Lives on the Line health care rally in Des Moines on July 29. She has previously described how the Affordable Care Act saved her daughter from potentially severe medical complications and crushing debt. -promoted by desmoinesdem

I’m a person with lived experience with disability and I’m the vice-chair pro-tem of the Disability Caucus of the Iowa Democratic Party, I serve on the board of the Central Iowa Center for Independent Living and a very active member of the Polk County Democrats.

I’m speaking as a representative of those groups and as an individual who cares about health care.

If you haven’t had a chance to hear directly from the Democrats running for governor, Bleeding Heartland has you covered with audio and highlights from the speeches at Thursday night’s big Hall of Fame event in Des Moines.

Republican efforts to replace the Affordable Care Act suffered a major setback this week, as the U.S. Senate rejected three repeal bills. It may not be the last “near-death experience” for Obamacare, as Senate Majority Leader Mitch McConnell could bring one of the bills up again. But the Democratic caucus is unmovable on the issue, and it’s not clear what could bring GOP Senators John McCain, Lisa Murkowski, or Susan Collins on board.

Iowa Senators Chuck Grassley and Joni Ernst voted for all three Republican bills, of course, as everyone following this debate had expected. Grassley told reporters earlier this week that he would support any legislation that could get 51 votes in the Senate, leading to conference negotiations with House Republicans. Though Ernst never expressed it in such terms, she too demonstrated that she was willing to vote for anything her leader brought to the floor, regardless of its costs and impact on Iowans.

Let’s take a quick look at what Iowa’s senators promised to stand for on health care policy, compared to what they voted for when the chips were down.

TJ Foley, a recent graduate of Valley High School in West Des Moines, on how top Iowa Republicans failed to speak out against an “attack on the most basic principles of equality, freedom, and rural fairness.” -promoted by desmoinesdem

It’s been a rough week for Senate Republicans. Two conservative senators announced that they would oppose the reckless GOP plan to overhaul America’s health care system and drop millions from the health insurance rolls. This legislation emerged from secret negotiations and violated some of the most basic Iowa values we all hold dear.

Only 29 percent of Iowans “mostly support” the “direction Congressional Republicans are heading in health care legislation,” according to a new poll by Selzer & Co for the Des Moines Register and Mediacom. About 58 percent of the 800 Iowa adults surveyed between July 9 and 13 said they “mostly oppose” the GOP approach to the issue.

Public policy experts, health care advocacy groups, and insurance industry representatives often don’t agree on how the government should regulate the sector that accounts for roughly one-sixth of our economy. But all have reached the same conclusion about the bill that may come to a vote in the U.S. Senate next week: the latest version of the Better Care Reconciliation Act (BCRA) would cause Americans with chronic or expensive medical conditions to pay much higher rates or lose insurance coverage entirely.

Iowa’s Senators Chuck Grassley and Joni Ernst have repeatedly said people with pre-existing conditions would be protected in any Republican bill to repeal and replace the 2010 Affordable Care Act. Now, they are poised to break that promise.

An Iowan with in-depth knowledge of the health care sector looks at lesser-known benefits that could be lost if Congress replaces the Affordable Care Act. -promoted by desmoinesdem

The debate on Republican efforts to repeal and replace the 2010 health care reform law has focused on the provision of health care and the repeal of some taxes. In particular, attention has been directed at the effort to reduce Medicaid coverage.

What isn’t being discussed: the Affordable Care Act (ACA) included many provisions aimed at addressing serious issues in the health care system, such as quality, safety, and workforce shortages. None of those can be found in the House-approved American Health Care Act (AHCA) or the Better Care Reconciliation Act (BCRA), proposed by Senate Republican leaders.

So, in addition to reducing (or eliminating) coverage for poor people and individuals with illnesses, the Republican bill would be a step backward in terms of efforts to improve the health care system, which accounts for 17 percent of our gross domestic product.