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Watch as candidates for governor answer questions about the state of mental health in Iowa during the Register’s mental health forum at Des Moines University.
Iowa’s crisis in mental health care is getting overdue attention, due to recent tragedies and events organized in response. But it’s clear that the candidates for governor — and state leaders as a whole — have a lot to learn about how to reform the system.
At a forum Tuesday sponsored by the Register, Des Moines University and the Iowa Hospital Association, 12 candidates answered questions on how to improve mental health care in Iowa. A 13th, Gov. Kim Reynolds, had a scheduling conflict and provided a pre-recorded video statement.
The postmortem: The event included a dose of denial (thanks to the governor), a dearth of details and plenty of delusions. But advocates saw signs of hope from the discussion.
“There were platitudes, sure, but there were also sharp observations and specific suggestions. It was not all political talking points,” said Peggy Huppert, executive director for NAMI Iowa. “Honestly, when I compare their performance at the forum to what they had to say to me in July and August, the progress is remarkable.”
The candidates present — Democrats, Republicans, Libertarians and an independent —were nearly united in their criticism of privatized Medicaid management under Reynolds and her predecessor, Terry Branstad. Our editorial board, of course, agrees that it has been a disaster. Private managed care organizations have pulled the plug on care for some mental health patients and reduced payments for providers. An innovative crisis-stabilization program in Centerville was forced to close because state officials failed to write rules to allow Medicaid payment for such services.
Iowa’s problems go much deeper than Medicaid privatization, however. The state had barriers to care, a shortage of psychiatrists and funding issues long before the new system launched April 1, 2016.
“They all criticized Medicaid managed care, but none of them addressed the big question on that — how would they contain costs if it went back to the state?” Huppert noted.
In fact, none of the candidates had any realistic answers on how to pay for improving mental health care. Manage the state budget better than Reynolds and Branstad have? OK, how? Establish programs to divert mentally ill Iowans from jail or psychiatric hospitals? Great – that should save money in the long run, but it still requires upfront investment. Pass single-payer health care and legalize cannabis? That might be a realistic solution in another state or nation.
Obradovich: Iowa governor candidates combat mental-illness stigmas with personal stories
Prompted by a question, some candidates agreed that the state should lift a state law that caps the amount of property taxes that counties can collect to pay for mental-health services. The cap is stuck at 1996 levels, even though some counties have seen large population increases since then. But none of the candidates addressed how to overcome the primary barrier to lifting the cap: The Iowa Farm Bureau Federation, which opposed any changes last legislative session.
Other candidates, such as Democrat Jon Neiderbach and Libertarian Marco Battaglia, questioned why Iowa ties mental-health funding to property taxes. It’s a great question, and it’s worth re-examining Iowa’s regional system that is governed by county supervisors.
A few candidates took the easy answer: reopen the Mental Health Institutes in Clarinda and Mount Pleasant. But other candidates — including Republican Ron Corbett and Democrats Fred Hubbell, Andy McGuire and John Norris — recognized that the state doesn’t necessarily need to reopen the institutes, but create more community-based approaches that include several types of beds: acute, transitional and long-term.
A separate event could be organized just to address the night’s final question, on creating a mental health system that serves children. Iowans should demand answers from all elected leaders on how we can intervene earlier to treat children.
But sometimes it’s just better for candidates to keep their mouths closed. Independent candidate Brent Roske said it’s an “obvious correlation” that Iowa has seen an increase in violent crime and that it ranks last in its proportion of mental health beds. This comment perpetuates the unfounded stereotype that mentally ill people are violent.
Candidates and public officials have come a long way, but they must spend more time with Iowans to solve this issue — people like Leslie and Scott Carpenter of Iowa City, who were in the audience of about 400 people at DMU. In 2008, their then-16-year-old son was first hospitalized for suicidal thoughts. He’s since been diagnosed with schizo-affective disorder and other illnesses. They’ve struggled with long waits for a bed; privacy laws that prevent them from even talking with their son’s doctors without a release; a lack of continuity of care between rotating doctors and community agencies; and other holes in the system.
Their solutions include opening more psychiatric beds in regional medical centers and more efforts to recruit more psychiatrists, social workers, nurses and other care providers.
The Carpenters suggested the next event should include parents, medical professionals and others living the crisis every day. We agree. All of us must be involved in the solutions, from patients to whoever will be the next governor.
Obradovich: Here’s why Gov. Kim Reynolds and I cried at her news conference today
Watch as candidates for governor answer questions about the state of mental health in Iowa during the Register’s mental health forum at Des Moines University.
A dozen candidates for governor gathered Tuesday night to lay out their plans for improved access, funding and treatment for mental health services across the state.
At a public panel hosted by The Des Moines Register, the candidates voiced near-universal criticism of Iowa’s privatized Medicaid system, which has faced a tumultuous couple of months following the departure of one of the private companies hired to provide services.
The Register hosted the panel following an outpouring of support and concern after Mary and Larry Neubauer penned an emotional obituary for their son, Sergei, who committed suicide. They called on policymakers to better address the “crisis” of declining access to mental health treatment.
“(We) believe it is a crisis facing America, one that must be acknowledged, better understood and ultimately addressed for people to have the tools to heal,” they wrote. “Iowa did not have adequate mental-health resources during Sergei’s times of crisis and he spent several months out of state this year in residential treatment.”
Every candidate for governor was in attendance, with the exception of current Gov. Kim Reynolds, a Republican, who is traveling this week. In her absence, the other candidates — Democrats, Republicans, Libertarians and independents — took turns leveling their criticism of her leadership.
They were also nearly united in their frustration over the closing of two state mental health institutes under former Gov. Terry Branstad, which dramatically reduced the availability of mental hospital beds in the state. Iowa currently ranks 49th out of 50 states for its number of state mental hospital beds.
Many candidates also expressed hope that Iowa could move away from a system they say criminalizes mental health and unnecessarily jails and imprisons those with mental health or substance abuse issues. The focus needs to be on reducing the stigma associated with mental health, they said, and ensuring access to treatment.
Here’s a look at some of the key points raised by each candidate.
Ron Corbett, outgoing mayor of Cedar Rapids: Corbett said the closure of two mental health institutes in Clarinda and Mount Pleasant has resulted in compression of the system.
“The state may have saved some money on their line item, but the people didn’t evaporate,” he said. Instead, the results are being manifested as homelessness, higher rates of incarceration and overcrowded hospitals.
He said it may not make sense to reopen the two facilities now, but it would make sense to increase the number of available beds.
Steven Ray, Boone City Councilman: “I started seeing this 30 years ago,” said Ray, who previously worked in law enforcement. “We would have requests for committals through the sheriffs’ office where I started out at. And we were often finding, even back then, that it was difficult to find a bed in this state. Sometimes deputies would have to drive 150 miles to find a bed, and that’s inexcusable.”
He said that although closing two state mental institutions may have saved the state money, local taxpayers are still bearing the costs in other ways, including through the criminal justice system.
“That is not where this should be dealt with, and our law enforcement people are not mental health specialists,” he said.
Kim Reynolds, Iowa governor: In a video statement, Reynolds highlighted the states’ efforts to expand access to jail diversion programs as well as its efforts to provide a regionalized approach to mental health services.
“My administration has taken a number of steps to address the critical mental health needs in our state,” she said. “Today, Iowa’s mental health system is serving more Iowans in more modern ways with better services and more local home and community settings than ever before.”
Nate Boulton, state senator and attorney: Boulton levied criticism of Reynolds and the Republican-controlled Legislature for presiding over a “manufactured budget crisis” that favors special interest “tax giveaways” over mental health funding.
“One of the critical problems that I can see right now is the fact that we just had an address of a video from our governor who doesn’t seem to acknowledge that there’s much of a problem here,” he said.
Cathy Glasson, nurse and president of SEIU Local 199: Glasson, who has positioned herself as the more progressive candidate, said the state should immediately move to reverse the privatization of Medicaid, which “has been devastating to so many families and providers in the state.” In the longer term, she said Iowa should move toward a Medicare-for-all system.
“If we can’t count on the politicians in Washington, D.C. to do the right thing, I believe we need to fight and work to pass a universal single-payer health care plan right here in Iowa,” she said. “Everybody covered. Nobody left behind.”
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Fred Hubbell, retired insurance executive and philanthropist: Hubbell said the state needs about 50 to 75 more acute, long-term care beds as a result of the closure of state institutions, but he also said he favors generally a community-based approach.
“At the same time, we don’t have enough psychologists, we don’t have enough psychiatrists, we don’t have enough trained clinicians to help in these issues,” he said. “We’re going to need to incentivize more of them to get the training and we’re going to need to incentivize more of them to stay in Iowa once they get trained.”
Andy McGuire, health care executive and past chairwoman of the Iowa Democratic Party: McGuire said one of the biggest problems Iowa needs to confront is the stigma of substance abuse and mental health issues.
“As a doctor, this is a disease,” she said. “It’s not a character flaw. It’s not a problem with a person. It’s a disease and we need to treat it as such.”
She said the state needs all kinds of additional beds, not just those for acute mental health issues. She said that includes transitional beds, long-term beds and community-based options.
Jon Neiderbach, former president of the Des Moines School Board: Niederbach said he does not believe mental health program should be funded with local property taxes, as the system is currently set up.
“We need to make this a statewide funded program, just like all other kinds of health,” he said. “I have proposed legalizing cannabis to raise $200 million. That would be a big shot of improvement and new money into the mental health and substance abuse system.”
John Norris, chief of staff under Tom Vilsack and official with the USDA’s Foreign Agriculture Service: Norris said the state should end its privatization of Medicaid.
“Commercial MCOs will never be motivated for health care first,” he said. “… The governor needs to admit failure. That’s part of being a leader.”
He said the state should convene experts to develop a strategic plan that includes oversight and a budget to match.
Ross Wilburn, former Iowa City mayor and city councilman: Wilburn said he would invest in increasing the number of mental health beds in the state as well as work to provide incentives or loan forgiveness programs for students who commit to working in mental health here. In addition, he said privatized Medicaid should be reversed.
“Iowans are not being served … providers are being put in a position where they have to think about getting a loan to cover their payroll because they’re not being reimbursed at a level that’s going to support the level of care they’re providing.”
Marco Battaglia, musician: Battaglia said he’s opposed to tying mental health funding to local property taxes, as the system currently is designed. He said mental health should be funded in a more transparent way through the overall budget.
“We treat so many people suffering from mental illness as criminals,” Battaglia said. “And I think that is where we have to start.”
Jake Porter, business consultant and co-founder of a web design company: Porter said the biggest hurdle to addressing mental health issues is overcoming the stigma. He said he’s faced struggles in his own life and understands how difficult it can be to talk about.
“There’s all kinds of things we can do within the legislative process as well, whether it be making sure that budget cuts are not impacting mental health…” he said. “Also looking at the policies we’ve got for our drug policies.”
Brent Roske, filmmaker: Roske said it’s important not only to attract new medical professionals to Iowa, but to retain graduates who often don’t stick around.
“We need more culture, we need more funding for culture.” he said.
Roske called the move to managed care under privatized Medcaid “managed chaos,” and said the system is not serving Iowans. He also advocated for single-payer health care.
The Sentinel Enterprise asked the four candidates seeking the state Senate seat in the Worcester and Middlesex district a series of 10 questions on regional and state issues. The newspaper is publishing their replies over the next five days.
The special election is scheduled on Tuesday, Dec. 5.
Question: Healthcare now consumes 42 percent of the state’s $40 billion budget, taking away funding for other discretionary needs like education. Is a single-payer system a possible solution or would it make things worse?
Charlene DiCalogero, Rainbow-Green Party — Single payer/Medicare for all is essential. With it, all people get covered and can get preventive care, which saves money. No one wastes time and money trying to understand complicated, expensive insurance plans, struggling to find practitioners covered by their insurer, and avoiding getting treatment until there’s a crisis. We save money by taking profit-making out of health insurance.
Sue Chalifoux Zephir, Democrat — I believe access to quality affordable health care is a basic right, and we need to get big profits out of our healthcare system. A single-payer “Medicare for All” system would save families money by reducing administrative and advertising costs. We also need to take on the pharmaceutical industry and get control of the absurd, rising cost of prescription drugs.
Claire Freda, Unenrolled — The healthcare issue is a difficult one to answer and the fact that no solutions have been found indicate that.
From most reports Canada’s system seems to be working. We have no idea what the federal contribution will be and what we will have to support. I don’t believe there is enough information to make a determination.
Dean Tran, Republican — With respect to healthcare, my goal is twofold: (1) to ensure the Commonwealth can serve an appropriate role collaborating with the healthcare community to reduce costs for consumers and; (2) reduce the overall burden on the state budget. I believe the bipartisan healthcare reform passed in 2006 is the right foundation. Just a few years ago, the state tried to layer on additional federal regulations, which wound up breaking the Health Connector and costing us nearly a billion dollars. Given that past experience, I believe it would be unwise to pursue a massive, $35 billion program for single-payer. I think we should instead continue the work the Legislature started around cost containment, and pursue reforms like the governor outlined to protect taxpayers from subsidizing people who can obtain insurance through their employers.
Question: Should communities that place a ban on the sale of marijuana within their borders be allowed to share in state government tax proceeds derived from the industry?
Charlene DiCalogero, Rainbow-Green Party — How are proceeds distributed for communities that have no or very limited cigarette sales, or sales tax for small towns with few commercial outlets? That precedent could provide a solution. Another alternative: provide higher revenue percentages to towns with stores selling marijuana than those without, and/or in funding substance treatment services.
Sue Chalifoux Zephir, Democrat — Smaller towns like Lancaster, Lunenberg, and Sterling may not have a retail area that makes sense for the sale of marijuana, and marijuana retailers may decide not to locate in towns with less foot traffic. Those communities shouldn’t be penalized for that. Every community should have a share in state tax revenues from the new marijuana industry.
Claire Freda, Unenrolled — Communities that chose to ban marijuana from their communities should be allowed to share in the revenue. It would be logistically impossible, in my opinion, to attempt it. Until we know the effect of the new law and issues that may or may not arise, all communities will be affected.
Dean Tran, Republican — I have no strong preference either way but I would lean toward sharing the proceeds and benefits with all communities regardless of their stance on banning or not banning the sale of marijuana.
COMING SUNDAY: Questions on increasing the minimum wage and placing a 4 percent surcharge on those earning $1 million and more.
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The major party candidates in Virginia’s closely watched race for governor are both promising to improve the state’s health care system.
But Republican Ed Gillespie and Democrat Ralph Northam differ sharply on how to curb costs and increase care.
Their biggest difference is on Medicaid expansion. Northam wants to expand the health care program for the poor to cover more low-income Virginians, with the federal government picking up most of the cost. Gillespie opposes Medicaid expansion, saying its long-term price tag will be unsustainable.
Northam, a pediatric neurologist, has made health care a major plank of his campaign and been critical of President Donald Trump’s efforts to overhaul the country’s health care system. Gillespie has largely avoided taking positions on specific federal GOP proposals but supports repealing the Affordable Care Act.
Also running is Libertarian Cliff Hyra, an intellectual property attorney who favors less government intervention in the health care system.
The next governor will have to navigate a shifting and uncertain health care market. Trump and top Republicans have not fulfilled campaign promises to repeal former President Barack Obama’s health care law, but Trump has taken steps on his own to reshape the health care market. He jolted health insurers earlier this month with an abrupt cutoff of subsidies that reduce costs for low- and middle-income earners.
Federal action or inaction causes significant ripples at the state level. State officials had to scramble earlier this year to recruit a health insurer to sell individual plans in several Virginia counties. And Gov. Terry McAuliffe wrote to the state’s congressional delegation Wednesday saying Virginia won’t have enough money to provide government-funded health care to thousands of children and pregnant women by early next year if Congress doesn’t reauthorize the Children’s Health Insurance Program.
There’s been little movement in a multi-year debate over expanding Medicaid to able-bodied low income Virginians, with most Republicans in the GOP-controlled General Assembly opposing expansion. McAuliffe, who is barred from seeking a consecutive term, has promised to put Medicaid expansion into his planned budget proposal next year before leaving office and has predicted that Republicans will pass it to avoid having to make major cuts in public education.
Other key state-level health care issues include mental health and addiction treatment, abortion regulations and whether to scrap or severely limit the state’s Certificate of Public Need law. The law regulates medical facilities’ construction plans which supporters say avoids unnecessary duplication of services. Opponents say the regulations needlessly stifle competition and limit choices.
WHERE THE CANDIDATES STAND:
Northam said it is “immoral” that Virginia has not yet expanded Medicaid and said he would make it a top priority of his administration. Northam said he would work to persuade Republican state leaders to switch positions.
“It’s time to put the excuses aside and take the politics out of it,” Northam said.
Republican legislators have consistently opposed Medicaid expansion and shown no sign of change.
Gillespie opposes it too, calling it a costly burden for the state. He’s said his goal as governor would be a more robust free market in the state’s health care system, which would include allowing Virginians to buy out-of-state health care plans. Gillespie wants to see Virginia enter into a compact with surrounding states to sell insurance plans across state lines.
“Bringing down costs through more competition in the insurer and provider market would make health care more affordable and more accessible to more Virginians,” Gillespie said.
Experts say there’s no guarantee that selling insurance across state lines would trigger competition that brings down premiums, partly because health insurance reflects local medical costs that vary widely around the country.
Northam and Gillespie clash on abortion issues. Northam is a strong abortion-rights advocate and said he would expand access to contraception. Gillespie opposes abortion and said he would work to stop state funding for Planned Parenthood.
Both candidates have plans to improve the state’s mental health care system and move Virginia’s response to addictions away from criminal prosecution toward more treatment options.
Gillespie and Northam both say they’re open to reforming the Certificate of Public Need law, while also voicing support for hospitals’ positions that the law not be gutted or scraped entirely.
Hyra, the Libertarian, opposes Medicaid expansion and says he favors a repeal of Certificate of Public Need regulations.
Minnesota State Representative Paul Thissen answers a question pertaining to rural health care during the DFL Gubernatorial Debate Tuesday night at the Heintz Center in Rochester. Other DFL candidates are, from left, State Auditor Rebecca Otto, U.S. Representative Tim Walz, State Representative Tina Liebling, Thissen, and State Representative Erin Murphy.
A trio of potential Alabama gubernatorial candidates made their early cases to a crowd of voters eager to hear the platforms and policies of those who could potentially lead the state starting next year.
Candidates and Tuscaloosa residents gathered at Capitol Park Saturday morning for Alabama Standing for Unity: A Political Forum.
Announced candidates former Alabama Chief Justice Sue Bell Cobb (Democrat) and Mark Johnston (Independent), along with Tuscaloosa Mayor Walt Maddox (Democrat), spoke to residents about their plans for the future of the state.
While Maddox has yet to formally announce his candidacy, he certainly sounded like someone who intends to enter the race.
In a forum moderated by Tamika Alexander, they addressed human rights, health care, the economy, the environment and other issues concerning the state.
Cobb’s platform says “It’s time to focus on what’s critical for Alabama’s future,” emphasizing the following as her biggest priorities: Children and families, quality jobs, roads and bridges, education and lottery, public safety and moral compass.
Johnston told supporters he believes the only way Alabama can change is to “change the system.”
“I’m offering you an opportunity to change the system by putting the first independent in the governor’s office in the history of Alabama,” he said.
Johnston said that as an independent, he will not have a political platform, but will change the role of the governor to one that gets the two parties to collaborate and work for the common good.
“If not now, when are things ever going to change? If not us, who are the ones that are going to do it?” he asked. “I have a vision and a plan for Alabama, to make Alabama the place it could be.”
Maddox followed an opening quote from Winston Churchill with, “An undeniable truth about Alabama is that our state is in crisis.”
He emphasized the importance of education, workforce development and health care, repeating that the state’s politics is broken and that the government is in crisis.
“That is why we’re considering a run for governor,” Maddox said, highlighting his record as mayor of Tuscaloosa in the face of a national recession and a natural disaster (the 2011 tornado).
“Right now, the other party is offering status-quo. The status-quo is no strategy for building a dynamic future,” Maddox said. “If we’re going to solve the crisis that’s in the state government, it’s going to take leadership that understands and demands results. That’s what we’ve been about the last 12 years here in Tuscaloosa.”
Maddox then suggested his announcement to run for governor is imminent, quoting Mark Twain.
“‘The two most important days of your life are the day that you were born and the day you found out why. The why for me, professionally, has been serving this great city every single day,” Maddox said. “In the near future, I believe the why for me is going to be serving the great state of Alabama.”
On health care, Johnston read the letter he said he recently sent Gov. Kay Ivey, asking for expansion of Medicaid as well as opposition of the Graham-Cassidy health care bill.
“That spells disaster for Alabama’s Medicaid program,” he said.
Maddox also said that on day one, he would sign an executive order to expand Medicaid in the state of Alabama.
“If they’ll let a rural hospital close in the governor’s hometown, just imagine what will happen across the state,” he said.
Cobb agreed, saying that Alabama has “the leanest, meanest Medicaid program in the United States of America.”
“If we lose one more dime on Medicaid, we have lost it all,” she said.
Cobb said that Medicaid is one of her major priorities, with it hitting especially close to home as she’s been “in and out of the hospital with my elderly parents.”
Moderator Alexander moved on to the economy, asking the panel if they would support a living wage as determined by the local government.
“It’s important that as a state we don’t put this on local governments,” Maddox said, suggesting it would “pit one community against another.”
Maddox emphasized strengthening workforce development.
“We’ve got to train a workforce that’s going to meet the jobs of a technology-driven 21st century,” he said, as well as “expand pre-K offoerings to every child who is academically at-risk so we can have an educated workforce.”
Cobb said she wanted to get every legislator in Alabama to see if he or she can live on minimum wage.
“Not one day, week or month could they make it,” she said. “It is that important that they understand.
Cobb then said that as governor, she would go “from one end of the state to the other” to advocate for a lottery, giving Alabamians a chance to vote for it.
Her website says the following about a lottery: “Two-thirds of Alabamians want a lottery. I’ve heard you. I agree. We need it. It’s time for a lottery that will fund early childhood education programs that work, cutting-edge vocational training, and scholarships to ensure that all Alabamians can afford a college or technical education.”
Johnston then said he believes he is the most qualified person to improve Alabama’s economy thanks to his background in small business, where he said that everyone who worked for him received “well above minimum wage.”
Johnston said he also wants to fix what he calls “the most regressive tax system in the United State.”
Cobb was elected the first woman chief justice of the Alabama Supreme Court in 2006. Serving from 2007-11, Cobb was one of the last Democrats elected to statewide office in Alabama. Cobb, 61, grew up in Evergreen and attended the University of Alabama, where she got a bachelor’s in history and then a law degree in 1981.
Johnston has served as Executive Director at Camp McDowell for the past 26 years. Camp McDowell is part of the Episcopal Diocese of Alabama, located in Winston County. Johnston called his current position “the best job in the whole world,” but said he wants to start a movement in the state.
Maddox, who has been mayor since 2005, was re-elected to a fourth-term during an election in March by defeating his challenger Stepfon “Step” Lewis in a landslide. He has been praised for his economic development work and his handling of the aftermath of the deadly 2011 tornadoes that hit the city.