2017 Issue #7

Issue 8, 4/28/2017

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The Iowa Legislature finished its work for the year after a sleep-deprived final week that only ended after legislative leaders decided to pull an all-nighter, working through the night and adjourning finally at 7:15 am on Saturday morning (April 22).

If you were listening into the debate, you may have wondered why things were quiet.  While inside the House and Senate chambers was quiet, the halls of the Capitol were filled with lobbyists scurrying around trying to get a last minute deal on two remaining issues - medical cannabis and water quality.   As one Senator who probably would not like to be named said, "it's down to weed and water."  

The mad-rush end to session seemed appropriate this year, after new Senate leaders started the year off with decadess of bottled up energy and ideas. They had their bills ready to go, and they wasted no time in running them.  Every week was busy - the normal "hurry up and wait" cycle broken.  Even the normally quick House had trouble keeping pace with their swift Senate colleagues.

To recap, legislators sent bills to the Governor that:

  • Legalize fireworks.
  • Allow guns to be carried at the Capitol (with a permit).
  • Allow people who feel threatened by another to "stand their ground" and use a gun for defense.
  • Expand the use of the medical cannabis oil (cannabidiol) but not the cannabis plant.
  • Defund Planned Parenthood and ban all non-emergency abortions after 20 weeks.
  • Limit worker's compensation paid out for on-the-job injuries.
  • Cap "pain and suffering" damages in medical malpractice claims at $250,000.
  • Stop five counties from raising the minimum wage in their area.
  • Limit public employee union collective bargaining (negotiating) power.
  • Require voters to show an ID before voting, and cut back time allowed for early voting.
  • Allow police to stop you for texting while driving (and leave you with a $30 ticket).
  • Allow Iowans with a terminal illlhess to try investigational treatments that do not yet have FDA approval.
  • Give doctors freedom to direct patients with Lyme's disease to alternative treatment options without losing their license.
  • Direct hospitals and physicians to test newborns with hearing loss for congenital cytomegalovirus (CMV).
  • Require insurance plans pay for applied behavior analysis (ABA) - a proven intervention for autism.
  • Add acts intended to embarrass or humiliate a dependent adult to the definition of "dependent adult abuse."
  • Require hospitals use and regularly update the psychiatric bed tracking system so beds can be quickly located.
  • Allow mental health professionals (not just doctors) to evaluate and report on a person being committed.
  • Set guidelines for insurers that use "fail first" policies for medication and allow a physician override.
  • Got a good start on fixing the funding for the regional mental health/disability services (MH/DS) system. 

That's just a snapshot of the bills passed this year, with more to come next year as legislators try to figure out how to restructure (and cut) income taxes and tackle water quality, opioid addiction epidemic, and the changes coming on Medicaid with the ongoing discussions in Congress to repeal or modify the Affordable Care Act (aka "Obamacare").  All that, with an election on the horizon in 2018.  It'll be another fast - and furious - year.

If you have an issue that is important to you - don't wait to talk to your legislator.  The summer and fall are the best times to get started, when legislators have more time to talk and learn about your issue.

  • Start by sending your legislators a "congratulations on the end of session" or "thanks for your service to Iowans" type of letter.   If you can, write the note out by hand (handwritten notes take time, and people don't get many of them).  Ask your legislator to let you know how you like to be contacted during the summer - sometimes they don't check their legislative emails regularly, so it's good to know they'd rather be contacted through a personal email or via phone.  
  • Show up at local events - get involved!  Just say hello - you don't need to (and shouldn't) ask them for something every time you see them.  Or ask them to help you with your idea for next year.  They can ask for a bill to be drafted, help you get in touch with the "right people" in state government, etc.  
  • Best advice - don't wait until session starts, or the holiday season.  That's too late, and if this session proved anything, it's that the plans are in motion well before legislators start work at the Capitol!

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Legislators pack up their desks and bring important papers home when session is done. It is always a sign that the end is near when the boxes come out.  Legislators each get a box (or two for hoarders like me), and the high school pages that work at the Capitol like to give their favorite legislators' boxes a bit of flair.  This year the pages went above and beyond on their artwork - thought you'd enjoy it too!

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There is no other way to say it - the budget this year is painful.  Legislators had little choice but to make deep cuts to the state's budget. Early in session, they cut the current year budget by $130 million, but it wasn't enough.  Legislators borrowed $131.1 million from the state's "emergency fund" to fill the growing hole in March.  Leaders decided they needed to be careful in spending funds this year, just in case they end up in the same position next year.  The result is a bare bones budget with a lot of cuts, and a lot of pain to spread around.  

As a wise friend said to me, "Sometimes you measure success by what you didn't lose."  Only you can be the judge! 

  • No change in funding for rental assistance to help those that qualify for HCBS waiver services or Money Follows the Person to live in the community ($658,000).
  • Eliminates the funding for the Newsline for the Blind ($52,000) and cuts the Department for the Blind by another  $86,000.
  • Cuts vocational rehabilitation funding by $116,958 - because this is matched with federal dollars the actual cut totals almost $550,000.  These are funds that help Iowans with disabilities get or keep a job. 
  • Cuts the Entrepreneurs with Disabilities Program, Centers for Independent Living, and independent living services by 5%, and keeps funding the same ($130,000) for the Easter Seals' Farmers with Disabilities program.
  • Cuts funding for Aging and DIsability Resource Centers by 20% (leaving $750,000).
  • No change in funding for donated dental services to individuals with disabilities, audiological services for kids, youth suicide prevention, Adverse Childhood Experience (ACES) study, brain injury programs, epilepsy education, and regional autism assistance program.  There is no change in funding for the medical cannabidiol administration - but $22,000 won't be enough for the Department of Public Health to manage the newly expanded program.  
  • Increases Medicaid funding by only 1%, but includes $35 million of "cost containment" measures that will make changes in the way providers get reimbursed, which could impact access to services.  These changes include:
    • Eliminating some consultation codes physicians use ($500,000 savings).
    • Increasing use of pharmaceutical drug rebates ($1.2 million savings).
    • Reducing reimbursement significantly for services performed in a hospital that are more appropriately done in a medical clinic ($2 million savings).
    • Reducing anesthesiologist reimbursement, which is much higher than in other states ($3.1 million savings).
    • Paying primary care providers at normal rate, not the federally-required enhanced rate that expired several years ago (savings $5 million).
    • Limiting the extra payment to providers for people who are eligible for both Medicaid and Medicare (called "cross over claims" - saving $7.7 million).
    • Changing reimbursement to hospitals for high-cost cases (saving $10 million).
    • Limiting payment for some services that were incurred prior to applying for Medicaid ($4.3 million savings).
    • Finding another $1,908,857 in savings (called "perfomance improvement").
  • Adds $60,000 to the Family Support Subsidy/Child at Home program to keep up with demand.
  • Reduces funding to the State Treasurer for the ABLE Savings Account administration by $50,000 ($200,000 available next year for the program).

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In a normal session (if there is such a thing), funding for regional mental health and disability services (MH/DS) is one of the last issues resolved.  This year, lawmakers worked with stakeholders to get a compromise a full week before session ended, with the final votes coming in before the end-of-session deals started being made.  

Rep. Ken Rizer (R-Linn) and Sen. Randy Feenstra (R-Sioux) worked out a final compromise (SF 504)  that will:

  • Allow regions to begin levying a per capita rate.  To come up with this new rate, the region would take its current dollar cap, and divide it by the total population. While this new rate is still based on 1995 budgets, it will now shift with population.  If a region grows in population, their budgets can grow as well.

  • Set new limits on fund reserves.  Because of the timing of property tax payments, counties need to have enough money in the bank to get through the first three months of their fiscal year (July-September).  That is why they are allowed to keep 25% of their budget in reserve. This bill changes that - smaller regions (less than 100,000 population) can still keep that amount in reserve, but regoins with more population are now limited to 20%.
  • Force regions to spend down large reserves.  Some regions were able to build up large fund balances, but most have a plan to spend those down.  In many areas, it takes time to roll out a new service.  Regions compare it to buying a house; you have to save money until you have enough for the downpayment.  The bill gives regions four years to spend down excess reserves (that is - funds over that allowed 25% or 20%).

This plan works works for most regions, and may even work for them permanently.  Two regions are not fixed by this, and needed an extra patch to make it work.  To address this, the bill will:

  • Require Broadlawns to give Polk County $6.3 million each year for three years.  Broadlawns is a taxpayer-supported hospital and has built up a large reserve, but that money will be gone soon with changes happening with nationally with health care reform and locally with the health insurance market. Polk will need a permanent fix after this - they are only allowed to levy $30.87 per capita, but their budget is $44.47 per capita.
  • Direct Scott County to work with DHS to come up with a plan, and in the meantime use their fund balance to get through the next two years.  Scott County is currently levying only $19.22, while the rest of their region is levying the max (most at $47.28).  This helps a little by allowing all of the counties in the region to levy $30.78 (including Scott) - but they still come up $3 million short.
  • Hold an interim committee during the summer of 2018 to see how things are going, and make recommendations to fix any "outlier" regions.  Legislators are hoping that this fix will take care of most regions, but they know there will be a few regions that need a special fix.  They also acknowledge that these special fixes may be different for each region. They would do that in 2018, and come back into session in 2019 to make any adjustments needed.

While this is more of a patch than a fix, counties and advocates supported the compromise because it gives them more stability than they've had before, and may very well fix things for most of the state.  Only time will tell, but the good news is that we have time to figure it out.

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The Governor is expected to sign HF 516 into law soon, making Iowa the 33rd state to require some form of identification when voting.  Seven states now require a photo ID in order to vote, but Iowa's proposed law does not require a photo ID. Iowans who are currently registerd to vote, but do not have an Iowa driver's license or ID, will be automatically sent a new voter card.  New voters will also receive a card when they register to vote.  

That bill also shortens the time for early voting from 40 days before the election to 29 days before the election.  Many Iowans choose to vote early because of class schedules, work trips, transportation or staffing issues, and just personal desire to get their vote in early.  Iowa's military personnel living overseas still have the full 40 days to vote (that's federal law).

If you are someone whose signature changes frequently (or you use a stamp or have someone else sign for you), you will want to know your rights under this new bill.  The bill allows a pollworker to challenge your identity if your signature doesn't match.  This is really an issue of poll worker training, but Iowans with disabilities will want to make sure they know their rights, and the bill does state that the person's signature is presumed valid (so they are supposed to have another reason to challenge your identity).  This is also something ID Action will be working on with the Secretary of State's office, so stay tuned.

Iowans frustrated with the timing of school board elections (held in September) will be happy to know that the Legislature passed a bill (HF 566) that now requires them to be held at the same time as city elections (held in November).  School elections have very low turnout and cost a lot to administer.  Counties supported the change because it saves money, and the legislators sponsoring this say it will boost turnout.   

Young voters will be able to pick their party's candidate in a primary, even if they are only seventeen at the time.  HF 516 allows seventeen-year-olds to vote in the June primary elections, as long as they will be eighteen years old by Election Day.  Primaries in Iowa are closed events (that is, only members of a political party can vote in them). Because a primary is the political party's way of picking their candidate for the general election, legislators thought it only appropriate that all of the people that will be voting in November get a chance to pick who they want to represent their party (even 17 year olds).

We know that changes to voting laws can be scary, but ID Action has your back. We have spent a lot of time and resources over the years on voter training, and we are already meeting with the Secretary of State's office to work on a new educational campaign to prepare you for these new voting laws.  While the voting laws go into effect July 1, 2017, they will not be enforced until January 1, 2019 (so after the 2018 election).  So we have time to make sure everyone knows what to expect on Election Day!

Stay tuned for more information, or contact ID Action if you want to get on the list to host a voter training, need more information, or want to volunteer to help in other ways (866-432-2846 or info@idaction.org).

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Legislators introduced 1,653 bill this year - but only 174 were sent to the Governor for a signature.  So far the Governor has signed all the bills sent to him, but he could veto a bill (so it does not become law) and can also line-item veto budget bills (that is, veto parts of a bill while signing the rest into law).

The Governor still has (as of this writing) 67 bills waiting for a signature, including most of the budget bills.  While the Governor has 30 days from the end of session, he will probably act sooner.  Governor Branstad's confirmation hearings have begun, and he will be leaving the state soon to become the Ambassador to China. He will want to wrap up his work at the Capitol soon, so he can concentrate on his new job, and turn over the reigns to Lt. Governor Kim Reynolds, who will become Iowa's first woman Governor.

Your advocacy isn't over - ask the Governor to sign (or veto) things you like (or don't like).  You can contact Governor Branstad using our online Grassroots Action Center here.  

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