The U.S. Senate is fast-tracking a vote on its “health care” bill–more aptly described as a trillion-dollar tax giveaway for the rich, paid for by spending cuts that will cause millions of Americans to lose their health insurance. Older people and those with low incomes, especially people on Medicaid, are at greatest risk of losing access to health care.

Senate leaders are sticking to the plan of having no public hearings on the revised American Health Care Act, no committee markup, and no amendment process. An all-male group of thirteen Republican senators–not including Iowa’s Chuck Grassley or Joni Ernst–are drafting its terms in secret. (UPDATE/CORRECTION: Ernst has been added to the informal working group.) Other Republican senators have only been briefed on progress. Leaders will send the unpublished bill to the Congressional Budget Office, planning to bring the legislation straight to the Senate floor this month, possibly with only 24-48 hours for the public to learn about its provisions before senators vote.

Calls to U.S. Senate and House offices have recently returned to “normal” levels from before President Donald Trump was inaugurated. That needs to change immediately.

Elizabeth Dinschel, state leader of Action Iowa, makes the case for public protests and for good communication between activists and law enforcement. -promoted by desmoinesdem
 
Passive resistance is not the “high road.”  The world never changed because of a Facebook post or a counter event.  The world has, however, changed because of the brave, nonviolent direct actions taken by leaders such as John Lewis, Malcolm X, the Dalai Lama, Marsha P. Jackson, the organizers of the Arab Spring, the Orange Revolution, and many more nonviolent revolutions in Central and South America.

In America, however, we are being conditioned to believe that direct action is somehow rude or impedes on the free speech of other Americans. This is patently false and is a direct result of people enjoying their privilege. If a person cannot understand how civil disobedience could change the narrative of history or politics it is because they are treated with respect in public or can afford things such as food, healthcare, or housing. Are you uncomfortable?  Good, because that is what direct action is.

Direct action forces politicians to hear the messaging of people and groups they do not typically communicate with or, maybe, do not even care about.

Matt Chapman reflects on Senator Chuck Grassley’s town hall in Greenfield on June 2. A video of that event is at the end of this post. -promoted by desmoinesdem

I have had a chance to ask Representative David Young, Senator Joni Ernst, and Senator Chuck Grassley about the American Health Care Act and the cuts to Medicaid that would occur if it passed. Out of the three, none would even come close to addressing it.

Kelly Roberts is a part-time writer/blogger, full-time Human Resources consultant, and newly minted political activist. Pictured above: her grandfather, Charles Moel (Pompoo, to her) -promoted by desmoinesdem

Once upon a time, during the dark, discombobulating night of a medical crisis, my family encountered Medicaid.

Iowa Department of Human Services Director Chuck Palmer is retiring effective June 16, Governor Kim Reynolds announced today. Critics including Democratic State Senator Matt McCoy have called on Palmer to resign for months, charging that inadequate staffing at DHS facilitated more suffering and premature deaths among abused children. The department’s handling of Medicaid privatization has also drawn criticism. Despite Palmer’s promises to hold the line, the DHS agreed to pay private insurance companies more for managing Medicaid. In addition, DHS officials have downplayed numerous, ongoing reports of those companies cutting back on health care services and failing to reimburse providers promptly or adequately.

In keeping with Governor Terry Branstad’s playbook when Teresa Wahlert ended her disastrous tenure at Iowa Workforce Development, Reynolds didn’t acknowledge any problems with Palmer’s management of the DHS today. On the contrary, she and acting Lieutenant Governor Adam Gregg praised Palmer’s work in the official press release, enclosed in full below.

Governor Kim Reynolds promised today not to “stop working until every Iowan, no matter where they live, has the same opportunity to succeed, have a satisfying career, raise a family and have a great quality of life.”

Judging by her first speech in her new role, Reynolds has some major blind spots about her own record and the challenges facing Iowans.

Matt Chapman has been a committed citizen lobbyist on many issues this year, including health care reform. -promoted by desmoinesdem

I have always been laser-focused on Medicaid and health care access for the poor. And when Iowa Dems twisted Terry Branstad’s arm until he cried “Medicaid Expansion!” I was elated. So in my bubble, the worst thing going on seemed to be the privatization of Medicaid or “Branstad’s Revenge.”

With the private insurance companies all pulling out of Iowa, now that I am aware of the astronomical raises in premiums, I feel a little shame at my blissful ignorance. All I can tell you is at 51 years old the Affordable Care Act gave me dental insurance for the first time in my life. And I’ve had the same doctor for five years. Before the ACA, the folks around the poverty line would have to drive sometimes 200 miles just to see a doctor. And rarely the same one twice. For dental they line up at Broadlawns (the Polk County public hospital) at six in the morning and hope they’re in bad enough shape to get in.

But what really made me aware was after the Drake forum with Senator Joni Ernst in March.

The collapse of Iowa’s health insurance exchange could leave more than 70,000 people with no way to purchase individual policies for 2018.

More than half the Iowans at risk of becoming uninsured would have qualified for some services under the Iowa Family Planning Network. But our new state-run family planning program–created at great expense because Republican lawmakers and the Branstad/Reynolds administration insisted on defunding Planned Parenthood–won’t be able to accommodate an influx of patients who had been on the exchange.

Gary Kroeger’s thoughts on the coming campaign in a targeted Congressional district where Democrats Abby Finkenauer and Courtney Rowe are already running. -promoted by desmoinesdem

Two years ago I was in the Democratic primary to unseat Representative Rod Blum in Iowa’s first Congressional district. Along with businessman Ravi Patel and Cedar Rapids city council member Monica Vernon, I ran on progressive values and we strengthened each other’s resolve by engaging every single day with constituents and with each other.

By late summer, Mr. Patel left the primary race and former State Representative Pat Murphy joined. By the following spring (the race was so long I saw seasons change 7 times), I bowed out to support Monica Vernon because I felt that she had the best chance of winning. I went on to run for the Iowa House and Vernon gained the nomination to run against Blum, but incumbents are hard to beat and political intangibles were not in our favor and we both lost.

I’m not pointing this out to re-live the narrative of defeat, but to re-vive the spirit on which we all ran. It was the conviction that we, as Iowans, and as Americans, can do better. We each ran in our respective races because we believed that a dramatic course correction was necessary.

Representative David Young (IA-03) is denying that the American Health Care Act “will kick millions of people off of Medicaid,” telling constituents the bill “Modernizes and strengthens Medicaid so the state can better serve our Iowa neighbors and patients who are most in need.”

Of all the misleading things Young has said to justify his late decision to support an atrocious bill, this one may be the most blatant lie.

First-person accounts of meetings with elected officials are always a good read. Thanks, Matt Chapman. -promoted by desmoinesdem

Friday afternoon, leaders of the Indivisible Central Iowa Leadership had a 30 minute meeting with Representative David Young. Tyler Higgs, Jess McCord, Bill Ekhardt, Jordan Hobfoll, Marie Herring, Mark Brooks and myself attended.

The topics scheduled for discussion were the repeal of the Affordable Care Act and its replacement with the American Health Care Act as well as the border wall with Mexico, two of the new president’s signature campaign promises during the election.

There is a transcript below with most of the Q & A. David Young is very approachable and easy to have discussions with. Like most political animals, getting some of the more controversial positions pinned down before a vote is taken can be difficult. If the goal is not to obfuscate but more a testing of which way the political wind is blowing, I think that’s a sign that positions can be moved. It is up to us then, either by having discussions or by just showing up to vote to get what we want and expect from our elected leaders.

The Iowa House and Senate adjourned for the year around 7:15 am on Saturday, after staying up all night while Republican leaders tried to hammer out last-minute deals on medical cannabis and water quality funding.

The medical cannabis compromise passed with bipartisan majorities in both chambers, but I’m not convinced the revised House File 524 will be an improvement on letting the current extremely limited law expire on July 1. The bill senators approved last Monday by 45 votes to five would have provided some relief to thousands of Iowans suffering from nearly 20 medical conditions. House Republican leaders refused to take it up for reasons Speaker Linda Upmeyer and House Majority Leader Chris Hagenow never articulated.

The new bill thrown together during the all-nighter theoretically covers nine conditions, but as Senator Joe Bolkcom explained in a video I’ve enclosed below, the only form of cannabis allowed (cannabidiol) will not be effective to treat eight of those. Although few if any Iowans will be helped, Republicans can now claim to have done something on the issue and will consequently face less pressure to pass a meaningful medical cannabis bill during the 2018 legislative session.

Republicans shut down the 30-year-old Leopold Center for Sustainable Agriculture, which supported research on farming practices that could preserve our soil and water resources. But on Friday night, they gave up on doing anything serious to clean up our waterways, 750 of which are impaired, according to the latest data released by the Department of Natural Resources. CORRECTION: More recent DNR data indicate Iowa “contains 608 waterbodies with a total of 818 impairments.” (Some waterways have more than one impaired segment.) On the opening day of this year’s session, Hagenow promised “significant new resources to water quality efforts.” Why not come back next week and keep working until they find some way forward?

I’ll tell you why: lawmakers’ per diems ran out on April 18. Heaven forbid Republicans should work a few more days with no pay to address our state’s most serious pollution problem. Incidentally, this crowd just passed an education budget that will force thousands of students to go deeper in debt. They voted earlier this year to cut wages for tens of thousands of Iowans living paycheck to paycheck in counties that had raised the minimum wage. These “public servants” also handed more than 150,000 public workers an effective pay cut by taking away their ability to collectively bargain over benefits packages. As if that weren’t enough, they made sure many Iowans who get hurt on the job will be denied access to the workers’ compensation system or will get a small fraction of the benefits they would previously have received for debilitating shoulder injuries.

Lives will be ruined by some of the laws Republicans are touting as historic accomplishments.

Even worse, lives will likely end prematurely because of cuts in the health and human services budget to a wide range of programs, from elder abuse to chronic conditions to smoking cessation to Department of Human Services field operations. I enclose below a Democratic staff analysis of its provisions. During House and Senate floor debates, Republican floor managers offered lame excuses about the tight budget, which doesn’t allow us to allocate as much money as we’d like to this or that line item. Naturally, they found an extra $3 million for a new family planning program that will exclude Planned Parenthood as a provider.

Different Republican lawmakers used the same excuses to justify big cuts to victims assistance grants in the justice systems budget. That choice will leave thousands of Iowans–mostly women–without support next year after going through horrific assaults or ongoing abuse.

Despite some big talk from House Appropriations Committee Chair Pat Grassley, Republicans didn’t even try to rein in business tax credits, which have been the state’s fastest-growing expenses in recent years. The budget crunch is real and may get worse. But no one forced Republicans to inflict 100 percent of the belt-tightening on those who rely on public services.

More analysis of the 2017 legislative session is coming to Bleeding Heartland in the near future. All posts about this year’s work in the Iowa House and Senate are archived here. The Des Moines Register’s William Petroski and Brianne Pfannenstiel summarized some of the important bills that passed this year.

After the jump you’ll find Bolkcom’s commentary on the medical cannabis bill that offers “false hope” to Iowans “who have begged us to help,” along with closing remarks on the session from House Minority Leader Mark Smith and Senate Minority Leader Rob Hogg.

The multimillion-dollar cost of excluding Planned Parenthood as a provider in Iowa’s new family planning program will come directly out of the health and human services budget, Iowa Senate Appropriations Committee Chair Charles Schneider has confirmed to Bleeding Heartland. Republican lawmakers and Governor Terry Branstad have committed to creating a fully state-run program because federal rules do not allow states to disqualify Planned Parenthood from the Medicaid Family Planning Waiver. Under that waiver, federal funds have covered 90 percent of the Iowa Family Planning Network’s costs for many years.

In contrast, the state will be on the hook for every dollar spent on the new family planning services program. According to a fiscal note prepared by non-partisan legislative staff, that program is estimated to “increase General Fund expenditures by $2.1 million in FY 2018 and $3.1 million when implemented for a full year in FY 2019.”

The governor proposed using part of Iowa’s federal Social Services Block Grant funding to cover that cost, which is consistent with spending bills House Republicans approved during the 2015 and 2016 legislative sessions.

Instead, “a general fund appropriation in the health and human services budget” will pay for the new family planning program, Schneider said during an interview following the April 8 legislative forum in Waukee. After reviewing the proposal from the governor’s office, he explained, he chose to file “our own [bill] that didn’t take the money from the Social Services Block Grant.”

It’s understandable that Republican appropriators rejected Branstad’s idea. As Bleeding Heartland discussed here, the Social Services Block Grant is not a reliable funding stream. The U.S. House Ways and Means Committee leader has called for eliminating the grant, and House Republicans voted to do so last year.

But Republican plans to give up millions of federal family planning dollars look even more foolish now than they did a few months ago, when one considers Iowa’s worsening state revenue picture and the huge spending cuts already inflicted on human services.

Real-world data don’t match figures Governor Terry Branstad and Lieutenant Governor Kim Reynolds released yesterday in order to demonstrated the alleged “continued success of modernizing our state’s Medicaid program.”

April 1 marked a year since Iowa allowed three private insurance companies to manage care for more than half a million Medicaid recipients. The shift was disruptive for thousands of Iowans as well as for caseworkers and service providers, some of which went out of business. Reimbursement problems and cutbacks to care are still affecting many people, Chelsea Keenan reported in this retrospective on the first year of the policy.

Although privatization was supposedly designed to save money and bring predictability to the state budget, the Branstad administration agreed last fall and again in February to hand over millions more state dollars to the managed-care organizations (MCOs), unlocking some $225 million in extra federal funding for the corporations, which have much higher administrative costs than Iowa’s state-run Medicaid program did.

I enclose below the latest deceptive official statements about the “modernization,” along with a demolition fact-checking job by Democratic State Senator Liz Mathis. I’ve also included independent State Senator David Johnson’s reaction to what he called a “lousy, lousy” press release. While still a member of the Republican caucus during the 2016 legislative session, Johnson worked with Democrats trying to halt Medicaid privatization or at least provide stronger legislative oversight of the program.

The Iowa Hospital Association can’t substantiate the Branstad/Reynolds claims on hospitalization rates, Tony Leys reported yesterday for the Des Moines Register. Excerpts from that story are at the end of this post.

On a related note: thousands of Iowans who follow this issue closely are mourning Rhonda Shouse, who died unexpectedly in late March. I never met Rhonda in person, but we communicated through social media, and I admired her relentless advocacy on behalf of those adversely affected by Medicaid privatization. Keenan marked her passing in the Cedar Rapids Gazette, and Leys did so in the Des Moines Register. May her memory always be for a blessing.

“I respectfully ask for the vote of every Iowan who is fed up with politics and government as usual.” So reads the tag line on Jon Neiderbach’s campaign website. Neiderbach was the second Democrat to join a field that may eventually include six or more candidates for governor.

Speaking to a packed room of activists in Des Moines recently, the 2014 nominee for state auditor described himself as a “policy wonk” but also “a community advocate” who has spent most of his political life “on the outside. As an advocate, as an organizer, as somebody who isn’t happy with the status quo.”

The basic principles driving Neiderbach’s candidacy appear on his Facebook page:

In 2018 let’s elect a Governor who believes Iowa needs to Stand Tall for our values and Aim High with our ambitions. A Governor who understands Iowans are FED UP with politics controlled by the wealthy and government that is unresponsive to the needs and concerns of our working families. A Governor who rejects big contributions so as to be beholden only to the voters, and who will fight harder and do more to shake up Iowa politics and government than anyone else you can vote for in 2018. I respectfully ask for your support and for your vote.

Neiderbach elaborated on those themes in an early version of his stump speech, which I enclose below. I also transcribed a short interview, in which Neiderbach shared his approach to finding common ground with some political adversaries, as well as thoughts on lingering divisions within the Iowa Democratic Party between those who favored Hillary Clinton or Bernie Sanders.

Johnson County Supervisor Mike Carberry has confirmed rumors that he is thinking about running for governor in 2018. A longtime environmental activist and current member of the Iowa Democratic Party’s State Central Committee, Carberry was the most prominent elected official in our state to endorse Bernie Sanders for president. He spoke to Bleeding Heartland this week about why he is considering a bid for higher office, even though running for governor was never part of his life plan.

No matter how strained Iowa’s fiscal condition may be, count on Governor Terry Branstad to lend a sympathetic ear to corporations asking for more handouts. Tony Leys brought the latest example to light in a late Friday scoop for the Des Moines Register. The Iowa Department of Human Services will “help private Medicaid management companies shoulder huge losses they’ve suffered in covering more than 500,000 poor or disabled Iowans.” DHS officials estimate the deal struck in February will cost the state about $10 million, “which would be paid more than a year from now.”

The Branstad administration agreed last fall to transfer an extra $33.2 million to the three private firms picked to manage the state’s Medicaid program. It wasn’t enough to satisfy Amerigroup, UnitedHealthcare and AmeriHealth Caritas. They soon asked for much higher payments from the state, saying they were losing money under their contracts. Documents indicate each company lost at least $100 million during the first year of managing care for Iowans on Medicaid, Chelsea Keenan reported earlier this month for the Cedar Rapids Gazette.

One salient fact from Keenan’s story: administrative costs for the insurers totaled 6.8 percent, 11.6 percent, and 11.9 percent of expenditures. Before Branstad unwisely rushed to privatize Medicaid, our state-run program was only spending about 4 percent on administrative costs.

DHS Director Chuck Palmer told reporters in January that the state would not offer the Medicaid managed-care providers more money for the 15-month period running through the 2017 fiscal year. Only weeks later, officials amended the current-year contracts with “risk-corridor agreements” calling for the DHS “to shoulder the management companies’ financial losses if they grow beyond a certain point.”

Federal officials “have signed off on the contract amendments,” but no one informed key legislators about the development. Republican State Representative Dave Heaton, who co-chairs the Health and Human Services Appropriations Subcommittee, found out from Leys.

Speaking of appropriations, where will Iowa find extra money to pay the Medicaid managers? Around the time DHS leaders signed the contract amendments last month, the department was forced to absorb $25.5 million in spending cuts before June 30.

State lawmakers have not yet set fiscal year 2018 budget targets, but money will surely be tight following a recent downward revision to revenue projections. Mid-year budget cuts can’t be ruled out for next year either.

Meanwhile, Medicaid recipients are getting less care than before privatization or having to fight insurance companies over denied claims. Managed-care companies have slashed in-home services for Iowans with disabilities. About a quarter of the Iowans on Medicaid cannot access a program providing transportation to and from medical appointments. AmeriHealth Caritas is cutting payments to agencies that serve people with disabilities, leaving some caseworkers out of a job. Reimbursement problems drove some providers out of business last year.

Given Branstad’s track record of doing whatever big business asks of him, it wasn’t hard to predict that the DHS would end up shoveling more money to the Medicaid managers. The governor’s imminent departure creates an opportunity for Lieutenant Governor Kim Reynolds to learn from her predecessor’s mistakes. Here’s hoping she will demonstrate her capacity for independent thinking by pulling the plug on Iowa’s failed Medicaid privatization.

A little more than two weeks after House Republicans released their alternative to the Affordable Care Act, U.S. Representative Rod Blum (IA-01) announced on Twitter that he will not support the American Health Care Act. According to Blum, the bill “doesn’t do enough to lower premiums for hardworking Americans. I’m a ‘no’ on current version – need to drive down actual costs!” Speaking to The Hill the same day, he added, “We need real competition driving prices down. We don’t need the government telling us what should be in an insurance policy. The government has a role to play. We need to help people who need the help.” Blum had previously said directly and through staff that he was studying the bill.

Like all other House Republicans, Blum has voted multiple times for “Obamacare” repeal bills that would have done nothing “to lower premiums for hardworking Americans,” let alone “drive down actual costs.” However, the stakes are higher now that a GOP-controlled Senate and Republican president might enact new health care legislation. I don’t know what kind of plan Blum is envisioning, but there is no magic wand Congress can wave to “help people who need the help” without the government setting minimum standards for health coverage and regulating the market in other ways.

Blum belongs to the House Freedom Caucus. Although that group has not taken an official stand against the AHCA, some of its prominent members are on various “whip counts” of Republicans opposing the bill. Since no Democrats are backing a plan that would leave millions uninsured and drive up costs for millions more, House leaders can’t spare more than 21 GOP members in any floor vote on their health care bill. Some Congress-watchers have already counted more defectors than that.

Representative Steve King (IA-04) was among the first House Republicans to come out against the AHCA. He supports “rip it out by the roots” repeal of “Obamacare” instead. I doubt the amendments unveiled this week to satisfy House conservatives will change his mind. UPDATE: A staffer told the Des Moines Register’s Jason Noble on March 22 that King is “undecided–leaning no” on the bill. SECOND UPDATE: White House spokesperson Sean Spicer announced that King will support the bill. Seeking confirmation. A member of the House whip team told Jonathan Martin of the New York Times that King “went from no to yes in the WH [White House] today after assurances about Senate tweaks.” UPDATE: King released a video statement explaining his decision to support the AHCA. He’s still committed to repealing Obamacare. He hopes Republicans will strip “essential health benefits” out of the bill, paving the way for other measures he wants, like health savings accounts and selling insurance across state lines. He said he told President Donald Trump in a White House meeting today that he worked very hard for total repeal of the Affordable Care Act, but that legislation won’t be brought up this year, because leaders don’t think they can get the votes. He said he had a “firm commitment” from Senate Majority Leader Mitch McConnell for a manger’s amendment to strip out “mandates” and “essential health benefits” from the House bill. King views this bill as the “best chance” for the “closest thing” to total repeal of Obamacare in the current political environment. He later tweeted that he and Trump had negotiated “the best possible improvement on ObamaCare Repeal.”

Representative David Young (IA-03) has repeatedly said he is studying the bill and the Congressional Budget Office analysis of its impact. Young’s staff have told constituents this week that he is still undecided. I consider him likely to vote yes if the bill comes to the floor–which may never happen, if leaders conclude they don’t have the votes. For what it’s worth, The Hill’s whip count put Young in the “leaning/likely no” camp because he said on March 15, “I want to make sure it is something that works in the end for all Americans, and that it would pass if it gets over to the Senate.” Several GOP senators have said the AHCA will not pass the upper chamber. UPDATE: Young announced in a March 22 statement, “While the American Health Care Act, legislation to repeal and replace Obamacare, is a very good start, it does not yet get it right and therefore I cannot support it in its’ [sic] present form.” I’ve added his whole press release below.

Neither of Iowa’s U.S. senators have clarified how they would vote on the Republican bill. Senator Chuck Grassley has made conflicting statements, telling House members the bill must be changed so that insurance premiums don’t skyrocket for older people not yet eligible for Medicare. On the other hand, Grassley has said Republicans can’t afford to miss what could be their only opportunity to keep six years of promises. Senator Joni Ernst said at town-hall meetings in Cedar Rapids and Des Moines on March 17 that she is studying the AHCA’s potential impact on Iowans and insurance premiums. I hate to break it to her: no alternative plan will magically make cheap insurance widely available while maintaining guaranteed coverage for people for pre-existing conditions and letting children stay on their parents insurance through age 26.

UPDATE: Forgot to mention that the Iowa Hospital Association estimates between 200,000 and 250,000 Iowans would lose their insurance coverage under the Republican plan. More on that story below.

Tom Witosky follows up on recent correspondence with his U.S. House representative. -promoted by desmoinesdem

March 13, 2017
Dear Congressman Young,

I am writing this open letter to you because the time is fast approaching when your words will be put to the test with your vote on the proposed American Health Care Act.

Make no mistake, the Republican majorities’ decision to amend key portions of the Affordable Care Act will change coverage for millions of us who have obtained insurance through federal or state exchanges.

In your Feb. 21 letter to me, you outlined your concerns about the current law and what you believed needed to be corrected with new legislation. Those concerns included:

“We need a healthcare law that works for all Iowans, the facts are that the current healthcare law works for some but it does not work for others.”

Analysis of this proposal by a variety of experts and expert groups – conservative and liberal — indicates strongly that the House proposal does nothing to provide a law “that works for all Iowans.”

Privatizing Medicaid is one of the most harmful things Terry Branstad has ever done to Iowans. -promoted by desmoinesdem

I have only been in this job a few weeks, but this is the first time I have come home simply seething with anger. The five of us on the Johnson County Board of Supervisors had to tell roughly 5/6 of the Mental Health and Disability caseworkers that they were going to lose their jobs, leaving 500+ of #JoCo’s most vulnerable twisting in the wind, and there’s not a damn thing we can do to stop it.

Worth noting: We didn’t start it either.

An Iowan living with disabilities wants to know: “How can you help me become a productive, taxpaying member of society?” -promoted by desmoinesdem

Dear President Trump:

I’m disabled due to a brain injury, heart problems and PTSD from an abusive marriage. I live on $735 per month Supplemental Security Income (a Social Security program), $138 in food stamps, and—thank God—I receive Medicaid. And thank God as well that my home is almost paid off, because today I couldn’t afford my own apartment on that income.

Because many of your supporters feel I’m a “drain” on the system, I’d like to tell you how I’ve spent my time on what some like to call “entitlements.”

As of this week, Iowa state senators are no longer able to give speeches about matters of political or personal importance at a predictable time of day, when the chamber is relatively full.

For many years, members have been allowed to offer “Points of Personal Privilege” shortly after the Senate gavels in at 9:00 a.m.

Republicans ended that tradition on a party-line vote last Thursday. GOP leaders have not explained their reasons for moving the open discussion period to the end of each session day. The rule change is likely designed to reduce the visibility of Democratic remarks highlighting controversial legislation or Branstad administration policies. A former Democratic senator decried the move as “pushing public discourse in the dark.”

GOP lawmakers have been trying to defund Iowa’s leading provider of reproductive health care for years. Their previous efforts attracted relatively little public attention, since the Democrats in control of the state Senate would not go along.

Democrats no longer hold enough seats in the legislature to stop Republicans from enacting a plan that will require Iowa to spend ten times more, even as family planning services become less accessible.

As expected, an Iowa Senate Judiciary subcommittee advanced Senate File 2 during a January 24 meeting. The outcome was a foregone conclusion, since all 29 Senate Republicans are co-sponsoring the bill that would create a state-run family planning program, excluding Planned Parenthood as a qualified provider.

But the vast majority of Iowans support continued state funding for Planned Parenthood’s non-abortion services. Republicans weren’t prepared for hundreds of them to show up at the Capitol yesterday.

On a dark day for Democrats across the country, the Iowa Democratic Party announced most members of the “Building Blocks” committee that will analyze what went wrong in the 2016 elections. Representative Dave Loebsack spearheaded the initiative and will help raise money to cover the costs of a listening tour and research including a professional focus group. Members named in a January 20 press release:

– Joe O’Hern- Campaign Manager Loebsack for Congress
– Laura Hubka- 1st District SCC Member
– Kate Revaux- 2nd District SCC Member
– Jason Frerichs- 3rd District SCC Member
– Penny Rosfjord- 4th District SCC Member
– Emily Parcell- Wildfire Consulting
– Jessica Vanden Berg- Maverick Consulting and Mail
– Erich Schmidt- Laborers International Union
– Representatives from House Truman Fund
– Representatives from State Senate Majority Fund
– Representatives from the Iowa Democratic Party Staff

Best of luck to this group. I look forward to reading their report sometime this spring. Broadly, we know that white voters without a college degree were the key to Iowa’s massive swing to Trump. But we have a lot to learn about why so many people in counties that had voted for Barack Obama twice either did not vote or voted for Trump. We need to figure out how to reconnect with voters in eastern Iowa communities that were Democratic strongholds for decades. We need to assess the party’s early GOTV strategy, which seems to have inadvertently turned out Trump voters. We also need to understand why some of our hard-working Iowa Senate incumbents and state House candidates performed so poorly in down-ballot races. Why didn’t Governor Terry Branstad’s disastrous Medicaid privatization and under-funding of education and mental health care resonate more with voters in communities of all sizes?

P.S.- I learned after publishing my latest Throwback Thursday post that Jessica Vanden Berg and Scott Ourth (an Iowa House Democrat since 2013) worked on John Judge’s campaign for the January 1999 special election to replace Patty Judge. I hope to hear their stories someday and publish an account of that race from the Democratic perspective.

Two weeks late and humbled by the results from previous efforts to foretell the future, I offer seventeen Iowa politics predictions for the new year.

I struggled to compile this list, in part because it’s harder to come up with things to predict during a non-election year. I didn’t want to stack the deck with obvious statements, such as “the GOP-controlled Iowa House and Senate will shred collective bargaining rights.” The most consequential new laws coming down the pike under unified Republican control of state government are utterly predictable. I needed time to look up some cases pending before the Iowa Supreme Court. Also, I kept changing my mind about whether to go for number 17. (No guts, no glory.)

I want to mention one prediction that isn’t on this list, because I don’t expect it to happen this year or next. I am convinced that if the GOP holds the governor’s office and both chambers of the Iowa legislature in 2018, they will do away with non-partisan redistricting before the 2020 census. I don’t care what anyone says about our system being a model for the country or too well-established for politicians to discard. Everywhere Republicans have had a trifecta during the last decade, they have gerrymandered. Iowa will be no exception. So if Democrats don’t want to be stuck with permanent minority status in the state legislature, we must win the governor’s race next year. You heard it here first.

The Iowa House and Senate convened for the 2017 legislative session yesterday. If all goes according to schedule under Republican control of both chambers for the first time since 2004, lawmakers will complete their work by late April or early May.

Listening to the platitudes in opening day speeches by GOP leaders, you’d never guess what some of their top priorities are for this year.

A personal story about the impact of Obamacare. -promoted by desmoinesdem

For the past couple days I’ve been encouraging folks to share their Affordable Care Act story with their senators and congressperson. Fair’s fair. So here’s mine:

Dear Congressman Young,

You and I have talked a number of times since you introduced yourself to me and my husband Scott at the Iowa State Fair in 2014. I’ve always appreciated your willingness to listen to me.

I know that Congress will be acting on the Affordable Care Act and today I’m writing to you to tell you my Affordable Care Act story.

One of my blogging new year’s resolutions for 2016 was to publish more work by other authors, and I’m grateful to the many talented writers who helped me meet that goal. After the jump I’ve linked to all 140 guest posts published here last year.

I encourage readers to consider writing for this site in 2017. Guest authors can write about any political issue of local, state, or national importance. As you can see from the stories enclosed below, a wide range of topics and perspectives are welcome here.

Pieces can be short or long, funny or sad. You can write in a detached voice or let your emotions show.

Posts can analyze what happened or advocate for what should happen, either in terms of public policy or a political strategy for Democrats. Authors can share first-person accounts of campaign events or more personal reflections about public figures.

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The Branstad-Reynolds Scholarship Fund, which collected money to pay for Governor Terry Branstad’s 2011 and 2015 inaugural celebrations, has not disclosed the names of donors who contributed $1.1 million in 2015, Ryan Foley reported today for the Associated Press. That information should have been included on the non-profit’s 2015 tax return. However, the return filed on November 15, 2016 named only one donor: Principal Financial Group, which gave $25,000.

Before considering Branstad’s nomination to be U.S. ambassador to China, the Senate Foreign Relations Committee should insist that the governor bring his non-profit into compliance with federal law. Senators should also scrutinize all donations to the group, to see whether Branstad did any political favors for individuals or businesses that bankrolled his inaugural.

Former Republican State Senator David Johnson will remain an independent during the Iowa legislature’s 2017 session, but he will not be entirely shut out of committee work. William Petroski reported for the Des Moines Register this weekend that Democrats offered Johnson one of their positions on the Natural Resources Committee, recognizing his work on issues in that committee’s jurisdiction. In recent years, Johnson has been the leading Republican advocate for increasing conservation spending in the state budget as well as for raising the sales tax to fill the Natural Resources and Outdoor Recreation Trust Fund.

Johnson quit the Republican Party in June to protest the nomination of Donald Trump for president. He had occasionally found himself at odds with this GOP colleagues before then. For instance, he supported the unsuccessful Democratic effort to stop Medicaid privatization and later voted for a Democratic bill on stronger Medicaid oversight.

First elected to the Iowa House in 1998 and to the Senate in 2002, Johnson told Petroski he hasn’t decided whether to run for re-election in Senate district 1 next year. Zach Whiting, a staffer for U.S. Representative Steve King, announced in August that he will run in Johnson’s district, which is the GOP’s second-safest seat in the state. The latest figures from the Secretary of State’s office show Senate district 1 contains just 7,900 active registered Democrats, 21,374 Republicans, and 13,574 no-party voters. The five counties in the district voted for Trump by wide margins in November. The GOP nominee received 81.4 percent in Lyon, 78.8 percent in Osceola, 68.2 percent in Clay, 65.5 percent in Palo Alto, and 65.2 percent in Dickinson.

Despite having only one committee assignment for the coming legislative session, Johnson sounds content with his new independent status:

“I have made some votes in the past that I wasn’t comfortable with, and I don’t believe really represented the district that I am honored to represent,” Johnson told The Des Moines Register. “I am free now to really follow my conscience and my constituents. We always talk about how you should put your district first. Well, I can now because I represent everybody. I don’t represent Republicans here. That has created quite a furor among some Republican leaders, and that’s fine.”

According to legislative records cited by Petroski, an independent hasn’t served in the Iowa Senate since 1925 or in the Iowa House since 1972.

Jeff Cox presses his case on why Donald Trump won the presidency. Many Democrats from the party’s Bernie Sanders wing will agree. -promoted by desmoinesdem

What Went Wrong, and the Way Forward.

Democrats continue to be in denial about what went wrong in the November elections. It was not the fault of the FBI, or “the Russians”, or the unjustly vilified Julian Assange, or Wikileaks, or Clinton’s emails. It was a nationwide rejection of the policies of the Democratic Party, which have generated an economic recovery characterized by low wages, wealth inequality, job insecurity, and health care insecurity.

Our first political task is to turn the Democratic Party back into a majority party at every level of government and in all parts of the country, as it was in the wake of the New Deal. In order to do that, it is important to understand what went wrong under Democratic leadership.

Progressive advocate Ruth Thompson warns how much Iowans have to lose if “Obamacare” is repealed. -promoted by desmoinesdem

With the new Administration and Republican led congress, The Affordable Care Act (ACA) is in peril. Republican leadership plans to use the Budget Reconciliation process to repeal at least parts of the ACA. They are expected to hold a vote in January that may include language to do just that. If this doesn’t happen in January, it will almost certainly happen by September, 2017.

The nonpartisan Urban Institute estimates that the partial repeal of the ACA would cause almost 70 million people Americans to lose health insurance. In 2016, 55,089 Iowans enrolled in health insurance coverage for 2016. US Census data show that the uninsured rate in Iowa in 2015 was 5 percent as compared to 9.3 percent in 2010.

In 2016, of the Iowans who signed up through the Health Care marketplace, 85 percent of them were eligible for an average tax credit of $303 per month and 70 percent could obtain coverage for $100 or less.

As to the impact to employers, the Kaiser Family Foundation reports that employer-sponsored health plans grew just 3.4 percent in 2016, extending a period of unusually slow growth since 2010. The White House Council of Economic Advisers reports that the average family premium in Iowa was $3,500 lower in 2016 than they would be if premiums had grown at the same rate as the pre-ACA decade.

Thanks to One Iowa executive director Donna Red Wing for explaining a little-known problem for transgender Iowans. -promoted by desmoinesdem

Amerigroup, one of Iowa’s private Medicaid providers, agreed last month to cover gender-affirming surgery for Andrew Evans, a transgender Iowa man and client of the American Civil Liberties Union (ACLU).

While we are happy Evans will receive the surgery he needs, we realize that it means only one thing: Evans’ surgery will be covered. The Medicaid provider refused to acknowledge the medical necessity of the surgery, instead agreeing to coverage in order to “amicably resolve” the situation. In plain English, they didn’t want to tangle with the ACLU.

Exclusions for transgender surgery and other trans-related health care continue. Iowa’s Medicaid ban on transition-related surgeries remains.

Nearly every day brings news of another Donald Trump cabinet appointee whose agenda would hurt millions of Americans. Yesterday, we learned that the next secretary of Health and Human Services will be U.S. House Budget Committee Chair Tom Price, who favors rapid privatization of Medicare, less protection for people with pre-existing health conditions, and total repeal of the Medicaid expansion that has saved lives.

But I want to set government policy aside for now and focus on an equally urgent matter. The president-elect is not mentally fit for the world’s most important job. Unfortunately, all signs point to Republicans in Congress enabling and normalizing his erratic and dangerous behavior.

Iowa Senate Democrats unanimously chose Rob Hogg today to serve as Senate minority leader during the upcoming legislative session. Amanda Ragan will be the new minority whip, and the incoming assistant leaders will be Bill Dotzler, Liz Mathis, Rita Hart, Joe Bolkcom, Matt McCoy, and Herman Quirmbach.

Six Democratic senators lost their re-election bids this month, including Mike Gronstal, who had served as either minority or majority leader of the caucus since 1997. Pam Jochum, who was Senate president for the past four years, will not be on the new leadership team. Ragan, Dotzler, and McCoy were among last year’s assistant majority leaders, while Bolkcom served as majority whip.

Erin Murphy reported for the Quad-City Times,

Hogg said Senate Democrats will speak on behalf of Iowans “who need state government to work” and attempt to prevent Republicans from implementing policies that could damage the state’s economy or adversely affect its residents.

“I’m hopeful we can stop Republicans from going down a knee-jerk, partisan pathway,” Hogg said.

I see no realistic chance to stop Republicans from using their large majorities in both chambers to head down that partisan pathway. Among their likely top priorities: cutting taxes so that most of the benefits go to corporations and higher-income individuals, gutting Iowa’s 42-year-old collective bargaining law, restricting abortion rights, ending state funds for Planned Parenthood’s non-abortion services, adopting the gun lobby’s wish list (“stand your ground,” “constitutional carry,” and/or open carry), and making it harder for Iowans to vote. Republicans will almost certainly need to reduce funding for education and a variety of social net programs, such as Medicaid and child care assistance, to pay for those tax cuts.

All Democrats can accomplish these next two years is to warn ahead of time how such policies will hurt the majority of Iowans, and to “document the atrocities” after Governor Terry Branstad signs the various harmful bills into law.

I enclose below a news release with more comments from Hogg. O.Kay Henderson’s profile of Gronstal for Radio Iowa is worth reading.

Iowa is blessed with an unusually large number of competitive state legislative districts, thanks to our non-partisan redistricting process. Most election years, at least half a dozen Iowa Senate seats and twice as many House seats are in play. Campaign finance reports showing where candidates and party leaders are spending the most money provide the best clue on which legislative races are worth watching.

That said, most years at least one little-noticed candidate pulls off a big upset in an Iowa House or Senate district neither party was targeting. Now-disgraced Kent Sorenson won his first race in 2008, taking a House seat that had been considered safe for Democrats. Two years later, Kim Pearson got no help from GOP leaders en route to winning a House seat where the Democratic incumbent had been unopposed the previous election. Republican Mark Chelgren won an Ottumwa-based Senate district for the first time by ten votes. That seat had been considered so safe that the Democratic incumbent was knocking doors for a colleague in another district during the final weekend. I learned later that internal GOP polling had Chelgren almost 20 points down a couple of seeks before the election.

I can’t shake the feeling that in this strange campaign with two unpopular presidential nominees, something weird will happen in a down-ballot race no one is watching. So before I get back to Bleeding Heartland’s last few battleground Senate and House race profiles, a few words on why I feel a race in Iowa’s southeast corner could produce a shocking result.

During his long tenure, Governor Terry Branstad has typically been attentive to the concerns of for-profit corporations. So when the insurance companies picked to manage Medicaid for more than half a million Iowans reported in August that they were losing money on the deal, they got a favorable hearing.

A senior analyst from Iowa’s non-partisan Legislative Services Agency confirmed on Friday that the Branstad administration has agreed to pay an extra $33.2 million to the three Medicaid managed care providers for the contract period beginning on April 1 and continuing through June 2017. I enclose that e-mail below, along with reaction from several Democratic state senators.

Hardly a week goes by without my hearing yet another story about an Iowan hurt by Medicaid privatization. Thousands of people have been forced to change doctors or have lost access to therapy for loved ones. This summer, a survey of care providers for Iowans on Medicaid found that:

90% say their administrative costs have increased;
80% say more health care claims are being denied;
79% of providers say they are not getting paid on time;
66% say they are being reimbursed at rates lower than their contracted rates;
61% say the quality of services they can provide has been reduced;
46% have or plan to cut their services; and
28% have taken out loans while waiting to be paid.

Branstad refuses to adjust his Medicaid policy to help patients who are suffering or care providers struggling to keep the doors open. On the contrary, he keeps spinning tales (backed up by no evidence) about “protecting the interests of the taxpayers” and “stopping significant fraud and abuse.” His administration hasn’t followed up on supposed new benefits for patients and puts out impossible-to-verify accounts of “success stories.”

Critics warned that any money saved by privatizing Medicaid would come at the expense of health care for vulnerable patients. They warned that those apparent savings would evaporate once for-profit insurers demanded more money from the state, as had happened in Florida following that state’s rapid privatization of Medicaid.

Iowa enjoyed low administrative costs under the old Medicaid system. Thanks to our governor and his Republican enablers in the state legislature, taxpayers will now experience the “nightmare” scenario that has already unfolded for Medicaid patients and care providers. Connecticut saved money by moving away from managed care, back to the state-run, fee-for-service model.

Don’t expect anything that sensible from Branstad, who happily spends other people’s money when corporations come calling.

UPDATE: Branstad claimed at an October 31 press conference that the state budget will still save money thanks to efficiencies in the new Medicaid system. If those savings materialize (they didn’t in Connecticut), it will happen through companies denying health care services to Iowans.

SECOND UPDATE: Added below excerpts from an excellent post by Iowa Policy Project Executive Director Mike Owen.

When the dust settled after the 2012 general election, I was frustrated to see how close Iowa Democrats came to winning back the Iowa House majority. Democratic candidates picked up seven GOP-held state House seats that year, but lost half a dozen other races by extremely narrow margins, leaving Republicans with 53 of the 100 seats in the lower chamber.

One of the “seats that got away” was House district 72, where Dean Fisher beat Nathan Wrage by only 216 votes in an open seat due to GOP State Representative Lance Horbach’s retirement. President Barack Obama outpolled Mitt Romney by about 3 percentage points among voters in the district.

The GOP expanded its Iowa House majority to 57-43 in the 2014 midterm election, but many state legislative seats are competitive this year, putting control of the chamber in play. As Wrage challenges Fisher again, Democrats won’t repeat their 2012 mistake of not targeting this race.

Republican State Representative Ken Rizer announced on Facebook Saturday evening that he “can’t in good conscience” vote for Donald Trump and will write in Mike Pence for president. Rizer, who supported Jeb Bush before the Iowa caucuses, said he had “aggressively prosecuted Airmen who sexually assaulted women” and is aware of “groping” and “lewd conduct” his college-aged daughters face. He concluded that Trump’s comments in a recently-released 2005 video “reveal an arrogant lack of character unfitting for a college undergrad, for an Airman, and most certainly for our Commander in Chief.”

Rizer represents House district 68, a swing seat in the Cedar Rapids suburbs. He defeated Democrat Daniel Lundby in 2014, but Barack Obama outpolled Mitt Romney here in the last presidential election cycle by 54.45 percent to 44.08 percent. The latest voter registration numbers show the district contains 6,596 active registered Democrats, 6,103 Republicans, and 7,384 no-party voters. As of October 7, Democrats in Rizer’s district lead Republicans in absentee ballots requested by 1,698 to 844 and lead in early votes cast by 672 to 221.

I enclose below more comments from Rizer this evening, a map of House district 68, and background on the incumbent and his Democratic challenger Molly Donahue. She’s on the web here and on Facebook here.

The precincts in House district 68 also lie in Iowa Senate district 34, where Democratic State Senator Liz Mathis faces Rene Gadelha in a race both parties are targeting.

I will update this post as needed if other sitting Iowa Republican lawmakers announce that they won’t support Trump. On the morning of October 8, State Senator Jack Whitver posted on Twitter, “The comments and actions by Donald Trump are inexcusable and despicable. He should step down.” However, Whitver did not clarify whether he will vote for Trump, assuming he stays in the race.

Also on October 8, State Senator David Johnson issued a statement calling on Governor Terry Branstad and Lieutenant Governor Kim Reynolds to “condemn Trump publicly” now that “Trump’s true anti-women sickness has been revealed.” Johnson is the only Iowa legislator affiliated with neither party, having left the GOP in June to protest Trump’s impending nomination for president.

Libertarian presidential candidate and former New Mexico Governor Gary Johnson made his first Iowa campaign stop this year over the holiday weekend. His September 3 rally in Des Moines attracted hundreds of people, making it possibly the largest Libertarian event in Iowa history. You can watch his full speech at C-SPAN or Caffeinated Thoughts.

Johnson will qualify for the ballot in all 50 states and is consistently polling far better than the Green Party’s Jill Stein, the only other minor-party candidate routinely included in public opinion surveys. I continue to hear the Libertarian’s radio ads on various Des Moines-based stations and have seen pro-Johnson television commercials by the Purple PAC on some cable networks.

The four most recent Iowa polls measured Johnson’s support at 8 percent (Emerson College), 12 percent (Quinnipiac), 6 percent (Suffolk), and 12 percent (Marist). Polls have historically overstated support for third-party candidates. Nevertheless, if the competition between Hillary Clinton and Donald Trump remains very close here, even a 2-3 percent showing for Johnson could determine who wins Iowa’s six electoral votes.

Though I wasn’t able to attend Saturday’s rally, listening to Johnson’s stump speech reinforced my view that he is on track to outperform all previous Libertarian presidential candidates in Iowa by a considerable margin.