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.

Guest authors do not need to e-mail a draft to me or ask permission to pursue a story idea. Just register for an account (using the “sign up” link near the upper right), log in, write a post, edit as needed, and hit “submit for review” when you are ready to publish. The piece will be “pending” until I approve it for publication, to prevent spammers from using the site to sell their wares. You can write under your own name or choose any pseudonym not already claimed by another Bleeding Heartland user. I do not reveal authors’ identity without their permission.

I also want to thank everyone who comments on posts here. If you’ve never participated that way, feel free to register for a user account and share your views. If you used to comment occasionally but have not done so lately, you may need to reset your password. Let me know if you have any problems registering for an account, logging in, or changing a password. My address is near the lower right-hand corner of this page.

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.

Republicans are testing potentially damaging messages about Iowa House Democratic candidates, along with statements that might increase support for GOP candidates in battleground legislative districts. After listening to several recordings of these telephone polls and hearing accounts from other respondents, I have three big takeaways:

• Republicans are seeking ways to insulate themselves from voter anger over inadequate education funding and the Branstad administration’s botched Medicaid privatization;
• The time-honored GOP strategy of distorting obscure legislative votes is alive and well;
• The Iowa Democratic Party’s platform plank on legalizing all drugs may be used against candidates across the state.

Read on for much more about these surveys.

An advocacy group run by former Iowa House Speaker Chris Rants “is operating with the primary purpose of influencing political campaigns” in violation of federal tax code, according to the watchdog group Citizens for Responsibility and Ethics in Washington.

Last month CREW filed Internal Revenue Service complaints against ten 501(c)(4) groups, which claim non-profit status as “social welfare” organizations but spent a large share of their funds on political activity during the 2014 election cycle. One of them was the Iowa-based Legacy Foundation Action Fund, for which Rants serves as president and secretary. (The fund did not seek to influence any Iowa elections in 2014.) CREW also filed criminal complaints against six of the ten groups for “falsely representing the amount of money they spent on political activity in 2014”; the Legacy Foundation Action Fund was not among them.

Although Rants’s 501(c)(4) does not disclose its donors, CREW was able to determine that most of its 2014 funding came from American Encore, a “secretive” 501(c)(4) group “formerly known as the Center to Protect Patient Rights.” American Encore has been described as “the linchpin” of the Koch brothers dark money network. The Legacy Foundation Action Fund reported $980,000 in “contributions and grants” on its 2014 tax return; $880,000 of that amount came from American Encore.

More details on CREW’s IRS complaint are below. Rants responded via e-mail, “I am confident that Legation Foundation Action Fund is in compliance with the IRS rules. Legal counsel is reviewing the tax returns and we will file any amendment necessary to ensure the tax returns accurately reflected the organizations actives.”

UPDATE: Oldson won this race by a 67 percent to 33 percent margin.

One of the most closely-watched state legislative results tonight will be the contest between seven-term State Representative Jo Oldson and Democratic challenger Eddie Mauro in Iowa House district 41. The district covering parts of the west and south sides of Des Moines contains more than twice as many Democrats as Republicans, so the winner of today’s primary will almost certainly be elected in November, even if the GOP nominates a candidate late here. (No one filed in time to run in the GOP primary.)

Both campaigns have been working the phones and knocking on doors for months. Iowa’s two largest labor unions, AFSCME and the Iowa Federation of Labor, as well as the National Abortion Rights Action League have been doing GOTV for Oldson, as have a number of her fellow Iowa House Democrats. As of May 24, the early voting numbers in House district 41 were higher than for any other state House race.

Bleeding Heartland posted background on Oldson and Mauro here. I’ve encouraged my friends in the district to stick with Oldson. She has been a reliable progressive vote on major legislation, and she was among only thirteen House Democrats to vote against the costly and ineffective 2013 commercial property tax cut. I have no problem with an entrenched incumbent facing a primary challenge. No one is entitled to hold a legislative seat for life. But even if women were not already underrepresented in the Iowa House–which they are and will continue to be–I would need a better reason to replace a capable incumbent than the reasons Mauro has offered in his literature and in an interview with me last month. Excerpts from that interview are below, along with examples of campaign literature Democrats in House district 41 have been receiving in the mailbox and at the doorstep.

“Mark me down as Never Trump,” State Senator David Johnson said today, becoming the most prominent Iowa Republican elected official to renounce the presumptive presidential nominee. The longtime Senate incumbent told the Des Moines Register’s William Petroski he became a no-party voter because of Donald Trump’s “racist remarks and judicial jihad.”

“I will not stand silent if the party of Lincoln and the end of slavery buckles under the racial bias of a bigot,” Johnson said, referring to Trump. His criticism was prompted by Trump’s comments that a judge presiding over a lawsuit involving his business was biased because of his Mexican heritage. […]

“If Mr. Trump is the nominee, he becomes the standard bearer for a party that’s on the verge of breaking apart. He simply cannot unify the GOP. If there is a profound split, I’ll gladly re-join Republicans who are dedicated to equality and justice for all, and let Mr. Trump lead his supporters over the cliff,” Johnson said. […]

“There are consequences to the decision to suspend, for now, my Republican registration. I am fully aware of that,” Johnson said. “As I have for the past 18 years, I will put a high priority on constituent service. Many of the voters who elected me are supporting Mr. Trump. I respect that, but disagree that he is qualified to lead the nation and the free world.”

Johnson represents one of the most heavily Republican state Senate districts, covering five counties in northwest Iowa. Ted Cruz carried two of those counties (Lyon and Osceola) by a relatively wide margin, while Trump carried the other three (Dickinson, Clay, and Palo Alto) by slim margins. Johnson endorsed former Texas Governor Rick Perry for president in early 2015, eventually backing Carly Fiorina last October.

Conservation funding aside, I rarely find myself in agreement with Johnson. But kudos to him for speaking out while Senator Chuck Grassley, Governor Terry Branstad, and others tried to sidestep Trump’s steadfast assertion that a federal judge is biased because “he’s Mexican.”

UPDATE: A reader asked whether Johnson had endorsed Representative Steve King’s re-election, given King’s long history of offensive statements regarding Latinos. Johnson was not on the list of state legislative supporters the King campaign released on May 24.

King himself has not yet endorsed Trump, for reasons unrelated to the presidential candidate’s comments about immigrants.

SECOND UPDATE: Added below excerpts from Johnson’s interview with Ben Jacobs of The Guardian.

Rhonda Shouse, a Medicaid recipient and member of Iowa’s Mental Health Planning and Advisory Council, is a leading advocate for Iowans affected by Medicaid privatization. She is an admin for the MCO Watchdog Facebook group and has previously shared resources to help people report problems with managed-care providers. The Cedar Rapids Gazette published a shorter version of this commentary last week. -promoted by desmoinesdem

Iowa Medicaid Enterprises (IME) Director Mikki Stier wrote a guest column on Iowa’s Medicaid Modernization which appeared in the Cedar Rapids Gazette, Fort Dodge Messenger, and Sioux City Journal in April. I am writing in response to Ms. Stier’s column.

If IME considers making it more difficult for Medicaid beneficiaries to get much needed items such as catheters, diapers, medication, transportation to medical appointments, and permission for guardians to represent their wards, then Iowa’s Medicaid Modernization is a huge success. These were not obstacles under the old Medicaid system.

In IA Health Link’s first month, the bulk of the problems point directly to the Department of Human Resources and IME to adequately provide the MCOs with accurate information. It is likely due to the unrealistic time frame established by Governor Terry Branstad, or DHS, depending on who tells the story of who came up with the idea for Iowa’s Medicaid Managed Care program. Most states that have moved to a managed care approach have moved only portions of their beneficiaries at a time and done so over a two to five year period.

It is very unfortunate that Governor Branstad, DHS, and IME have been perpetrating a public relations campaign for more than a year now to misinform Iowans on how their tax dollars will be spent, who Medicaid beneficiaries are, and how services will be delivered to approximately half a million Iowa residents. Healthcare should not be a partisan political issue.

The Iowa House and Senate adjourned for the year this evening. As usual, the health and human services budget was one of the last deals Senate Democrats and House Republicans agreed on. Both sides gave significant ground on oversight of Iowa’s recently-privatized Medicaid program; a future post will look more closely at the terms of that agreement. In another example of history repeating itself, key negotiators had trouble finding common ground on what to do about Planned Parenthood funding through the Iowa Family Planning Network.

The outcome of last year’s budget talks left little doubt that Republicans wouldn’t achieve their goal of creating a new state family planning program, excluding abortion providers. Yet House Speaker Linda Upmeyer had promised a “deliberate and unwavering battle” on “pro-life issues,” and specifically to make defunding Planned Parenthood a “priority” for her caucus.

I’ve been wondering what Democrats might offer Republicans in exchange for preserving status quo language on state funding for Planned Parenthood’s non-abortion services.

As it turned out, they didn’t have to make any real concession.

When the filing deadline passed for major-party candidates to run in Iowa’s June 7 primary, seven Republican state senators up for re-election this year had no challengers: Randy Feenstra (Senate district 2), Dennis Guth (Senate district 4), Mark Segebart (Senate district 6), Mark Costello (Senate district 12), Amy Sinclair (Senate district 14), Tim Kapucian (Senate district 38), and Ken Rozenboom (Senate district 40). Recruitment continued, as special district conventions may nominate candidates for seats where no one filed in time to be on the primary ballot.

Based on 2012 election results and incumbent weirdness, the most potentially competitive of the uncontested GOP-held Iowa Senate seats was arguably Guth’s. Democrats announced on April 25 that Susan Bangert will run in Senate district 4. I enclose below a map of this district and details about its recent voting history, along with background on Guth and Bangert.

Also on Monday, Dennis Mathahs confirmed plans to drop out of the Democratic primary in Iowa House district 75 in order to run against Kapucian in Senate district 38. A future post will preview that race.

For six years running, the Democratic-controlled Iowa Senate has confirmed almost all of Republican Governor Terry Branstad’s nominees unanimously or nearly so. But every year, one or two Branstad nominees don’t get through. On Thursday Dr. Mariannette Miller-Meeks became the first (and probably the only) nominee to fail an Iowa Senate confirmation vote this year.

What’s on your mind this weekend, Bleeding Heartland readers? This is an open thread: all topics welcome.

On April 1, three months later than originally planned, Iowa officially switched to a managed-care model for the Medicaid program. Erin Murphy explained here how privatization will affect almost all of our state’s roughly 560,000 Medicaid recipients.

Many Iowans on Medicaid are learning that their current health care providers are now out of network, a particular concern for those who have special medical needs. The Mayo Clinic in Rochester, Minnesota has not signed contracts with any of the three insurance companies selected to be managed-care providers in Iowa. KCRG’s Katie Wiedemannn reported on March 31 about a 9-year-old cancer patient whose scheduled treatment at Mayo has been delayed because of the new policy. I am aware of other families whose children on Medicaid have relied on out-of-state medical specialists to treat their children’s rare genetic or chronic conditions.

Iowa House Republican leaders have refused to act on an extensive Medicaid oversight bill that cleared the Senate with bipartisan support. However, they promise to unveil their own Medicaid oversight proposal soon. Senate Democrats will seek to add many oversight provisions to the human services budget, which is often one of the last bills to be resolved before lawmakers adjourn for the year.

One major red flag: Iowa hired only “two ombudsmen to investigate and work as advocates for the 560,000 poor or disabled people” on Medicaid. As Jason Clayworth reported for the Des Moines Register in January, a working group that studied the issue recommended hiring 134 more ombudsmen at a possible cost of $17 million annually.

Rhonda Shouse has been among the most vocal opponents of Medicaid privatization. She shared with Bleeding Heartland some resources for recipients who run into problems with their new managed-care providers. I enclose those below.

Some good public health news: state lawmakers recently approved a bill that would allow “First responders, emergency medical service providers, police, firefighters and licensed health care professionals” to maintain a supply of the drug Naloxone (also known as Narcan). The medication can prevent death after an overdose of heroin or prescription opioid pain-killers, both of which have become more prevalent in Iowa, as in many other states. Senate File 2218 passed the upper chamber the Senate unanimously and cleared the House by 93 votes to 2 (the dissenters were Republicans Stan Gustafson and Mike Sexton). Several groups representing law enforcement or medical professionals lobbied for this bill. At this writing, Governor Terry Branstad has not yet signed it.

UPDATE: Branstad signed the bill about the overdose drug on April 6.

Two bills to address the impending privatization of Medicaid died in the Iowa House this week. Effective April 1, some 560,000 Iowans on Medicaid will have their health care services managed by one of three private insurance companies. Last month, three Republicans joined Iowa Senate Democrats to pass approved Senate File 2125, which would terminate the state’s contracts with the managed care companies. Last week, six GOP senators voted with their Democratic colleagues for Senate File 2213, which would strengthen oversight of Medicaid by the Iowa Department of Human Services and the state legislature.

To stay alive after the Iowa legislature’s second “funnel” deadline today, non-appropriations bills must have been passed by one chamber and by a committee in the other chamber. However, the bill to end privatization and the oversight bill both died in House Human Resources subcommittees. To my knowledge, the only bill related to Medicaid privatization that remains alive is Senate File 2260, which would prohibit the Iowa DHS from releasing to managed care organizations certain information about board members of non-profits that provide Medicaid services in Iowa.

Speaking to journalists yesterday, Iowa Senate President Pam Jochum described the House failure to act on the oversight and termination bills as a “disappointment” but added, “I can assure you the fight over Medicaid is not done. You will see the human services budget bill contain many of the measures that we believe are needed to protect Iowa’s most vulnerable citizens.” Click here for a detailed summary of the oversight bill’s provisions. Maridith Morris described here how privatization will affect services available for her nephew on Medicaid.

House Speaker Linda Upmeyer told statehouse reporter Erin Murphy that Senate Democrats spent too long “working on killing the Medicaid modernization plan,” while passing the oversight bill too close to the funnel deadline: “That’s an 80-page bill that arrived very late last week. So we will look at oversight. We will work on oversight. But that bill just could not be managed in the time frame we were given. So we’ll look at opportunities.”

For the last five years of divided control at the statehouse, the human services budget has been one of the last bills to be resolved before lawmakers adjourn. Count on history to repeat itself this spring, because negotiations could drag on for months over Medicaid oversight and the near-certain Republican effort to eliminate Planned Parenthood funding for contraception services. A Bleeding Heartland post in progress will cover the family planning funding debate, as well as the fate of abortion-related legislation in the Iowa House and Senate this year.

Maridith Morris is a nurse and the Democratic candidate in Iowa House district 39. -promoted by desmoinesdem

This picture is my nephew Fin. He is an adorable, happy little guy and I love him to pieces. Fin has autism spectrum disorder. Fin is just one vulnerable Iowan who is going to be hurt by Medicaid privatization.

At Fin’s age, early intervention therapy is crucial for his positive outcomes. Therapy can mean the difference between him becoming a high functioning adult, one who is able to live independently, work, and pay taxes and a disabled adult needing tax payer support. Despite the crucial nature of Fin’s therapy, the rush to privatize Iowa’s Medicaid puts those services in jeopardy. To receive therapy, Fin’s parents will have to transport him from Indianola to appointments at Blank Children’s Hospital in Des Moines because services are no longer in network in Indianola.

Since Terry Branstad returned to the governor’s office, the overwhelming majority of Iowa Senate votes on contentious political issues have fallen along strict party lines: 26 Democrats one way and 24 Republicans the opposite. However, the Branstad administration’s rush to privatize Medicaid has created space for bipartisanship, as a growing number of Republicans acknowledge the dangers of shifting to managed care for a program through which one in six Iowans access health services.

Last month, three GOP senators joined their Democratic colleagues to vote for a bill that would have halted Iowa’s Medicaid privatization. That legislation is going nowhere in the Republican-controlled state House, and federal officials recently approved waivers to allow the Iowa Department of Human Services to implement the managed care policy as of April 1.

Yesterday a quarter of the GOP state senators voted with all 26 Democrats for a Medicaid oversight bill that had cleared the Senate Human Resources Committee unanimously. In her remarks to open floor debate on Senate File 2213, Human Resources Committee Chair Amanda Ragan said the bill was designed “to safeguard the interests of Medicaid members, encourage the participation of Medicaid providers, and protect Iowa taxpayers.” She told colleagues, “we must require DHS and the managed care companies to protect consumers, preserve provider networks, address the unique needs of children and assure accountability.”

I enclose below highlights from the debate on SF 2213, the roll call on final passage, and Ragan’s full remarks, along with a Democratic staff analysis summarizing the bill’s key points.

Iowa’s Medicaid program will shift to managed care for some 560,000 recipients on April 1, in accordance with waivers granted by the federal Centers for Medicare and Medicaid Services. CMS had previously denied the request from Governor Terry Branstad’s administration to privatize Medicaid by January 1, citing numerous signs that the state was not ready. In a letter the Branstad administration released today, Vikki Wachino of CMS noted “significant improvement” in several areas: the provider networks of three insurance companies picked to manage care for Medicaid recipients; plans for reimbursing out-of-network providers for services; better communication between state officials and Medicaid providers and recipients; and training of case managers to assist Medicaid beneficiaries during the transition.

I enclose below reaction to today’s news from the governor, key state lawmakers, and other stakeholders, as well as the full five-page letter from CMS to Mikki Stier, director for Medicaid in the Iowa Department of Human Services. Federal officials set several conditions on their approval of Iowa’s plans, such as monitoring the actions of the three managed-care organizations, making sure call centers are running their helplines competently, and preserving some “continuity of care” for Medicaid recipients.

Although the delay until April 1 will allow more time to prepare for the transition, the policy’s likely impact remains the same: more money for insurance company overhead and profit and less for health care services; a deterioration in care for disabled people, as seen in Kansas and other states; and less access to health care providers (a key issue for the three Iowa Senate Republicans who recently voted with Democrats to terminate Medicaid privatization).

Senate Democrats continue to push for “tough, bipartisan oversight and accountability protections.” Chelsea Keenan reported for the Cedar Rapids Gazette that the Senate Human Resources Committee will consider that bill (Senate File 2213) on February 24. I don’t expect that legislation to go anywhere. All I’ve heard from Iowa House Republicans is happy talk, backed up by no evidence, that privatizing Medicaid will save the state money and improve patient care.

Bleeding Heartland welcomes guest posts on state legislative races. Great to see a candidate stepping up in this district. Democrats failed to field a challenger against Heaton in 2012 or 2014. By the way, some Iowa politics junkies have Heaton on retirement watch. -promoted by desmoinesdem

Carrie Duncan is running for State Representative in House District 84 against eleven-term incumbent Dave Heaton (R-Mount Pleasant), as a Democrat. With the controversy surrounding the potential closure of a mental health facility in Mount Pleasant. Carrie felt the need to run against Representative Heaton, feeling that he was not a strong enough of a voice against the Branstad Administration’s plans to close the facility.

Carrie’s support for organized labor is fierce and deep. She is a proud member of the International Association of Machinists and Aerospace Workers (IAMAW), Chief Steward, Local 1010 She works at the American Ordinance LLC in Middletown. Carrie’s son, Zach also works at American Ordinance LLC. Zach lives with his wife Randee, in Mount Pleasant. Carrie has also worked at Pioneer Corn and Pinnacle Foods. She resides in New London.

Carrie got into this race as a voice for the middle class and the poor in the state of Iowa. She believes that the state government is simply giving too much away, using tax breaks to procure agreements with big corporations while not doing enough to educate our children. The unemployment rate is too high in District 84; this means that we need leaders in Des Moines that are regularly communicating with small businesses instead of constantly trying to lure extremely large companies, many times hiring out of state labor to fill the positions.

Carrie has worked in the New London School District as well; she has gained knowledge about the issues that our educators face daily. She has worked in some different industries, always fighting for fair wages and equal treatment for all in the workplace. She currently serves as the Vice President of the North Lee County Labor Council.

She is also hoping to see an end to the Governor’s plan to privatize Medicaid, and wants to see a more transparent process when large economic development agreements come to the area.

District 84 encompasses portions of Northern Lee County, Henry County, and Jefferson/Washington townships. [note from desmoinesdem: A map is after the jump, along with the latest voter registration numbers.]

Carrie is originally from Chillicothe, Illinois and she grew up on a family farm. She has a lifetime appreciation for our state’s local ag producers. Carrie is involved in a number of terrific charitable organizations in Southeast Iowa, as well.

For more information go here:

http://kilj.com/2016/01/news/carrie-duncan-announces-run-for-state-representative-in-washington-henry-jefferson-and-lee-counties/

One of the four companies the Iowa Department of Human Services initially selected to manage care for Medicaid recipients has given up the fight to keep a contract that would have been worth hundreds of millions of dollars. Follow me after the jump for details on the final stages of WellCare’s unsuccessful effort to overturn state officials’ decision to terminate that contract.

Who watched the six remaining Republican presidential candidates debate in Greenville, South Carolina last night? It was such a free-for-all that the Washington Post’s Alexandra Petri had trouble satirizing some of the exchanges: “nothing I can say is actually more ridiculous than what the candidates in fact said.”

The New York Times posted the full transcript here. I’ve enclosed some excerpts below.

What struck me most about the debate was how Donald Trump kept playing to the nationwide audience, ignoring the crowd that booed many of his comments. In contrast, Ted Cruz seemed to do better with the house, but I’m not convinced he came across as well on television. Jeb Bush continues to gain confidence on the debate stage, but where he can start winning states remains a mystery. Marco Rubio seemed relieved to have most of the attention on others and neither reverted to “robot mode” nor lost his cool in a heated exchange with Cruz over immigration policy. Carson and Kasich failed to make any case for their candidacies. The Ohio governor’s whining about negative campaigning won’t win any votes, nor will his defense of expanding Medicaid–though I agree with him on that issue. Carson’s only memorable comment was a Joseph Stalin quote that turned out to be fake.

As has so often occurred since last summer, pundits quickly concluded that Trump “went too far” and would be hurt by some of his attacks, especially denigrating President George W. Bush’s leadership. I’m not so sure. A sizable number of Republicans may share Trump’s views: Bush didn’t “keep us safe” on 9/11, the Iraq War was a disaster, and the Bush administration lied about weapons of mass destruction. The only comment likely to do significant harm to Trump with the GOP base is his admission that Planned Parenthood does “wonderful things” for women outside of its abortion services.

This is an open thread: all topics welcome.