SULLIVAN'S SALVOS

June 18, 2024

Sullivan’s Salvos 6/20/24

In this edition:

*Obituaries

*So Much Outrage!

*Medicaid Crisis

*Did You Know?

*Obituaries

A friend mentioned to me recently that she liked the obituaries that appear in Salvos. I thanked her for that, and it got me thinking:

I love it here. I know many of you do as well. Why do you love it here? Maybe there are physical characteristics, such as you love the Iowa River. Maybe you love a place with four distinct seasons. But you can get that all over Iowa.

Maybe you love the built environment – Old Capitol, Goosetown, Hancher, trails, etc. That is certainly an attractive part of where we live.

But the reason you love this place is probably the people. Wonderful, brilliant, passionate, caring, quirky people. That is what does it for me. And when one of those folks leaves us, we lose a little of what I love.

So I like to call it out. In a place full of special people, we should note when one leaves us.

*So Much Outrage!

There is a lot about which we should be outraged. Inattention to poverty, inattention to climate change, Gaza, anything Trump does, etc. It is all worthy of outrage. In my very next article, I mention something about which we should all be outraged. So I get it.

But I swear to God, this community has an insatiable appetite for outrage! And there is a tendency to focus that outrage in all the smallest places and for all the smallest things. It all gets very tiresome.

I started thinking about the famous Niemoller quote. Here it is:

First they came for the socialists, and I did not speak out—because I was not a socialist.

Then they came for the trade unionists, and I did not speak out—because I was not a trade unionist.

Then they came for the Jews, and I did not speak out—because I was not a Jew.

Then they came for me—and there was no one left to speak for me.

—Martin Niemöller

I think it needs to be reworked to fit our community:

First I came for the School Board, because they did not agree with everything I said. So I got them defeated.

Then I came for the City Council, because one of them said something I found objectionable. So I got them defeated.

Then I came for the Board of Supervisors, because they did not share my outrage. So I got them defeated.

Then I came for their replacements, who were Republicans, and they told me to shut up and go away.

Most people who see themselves as progressive activists know nothing of our history. They don’t understand that conservatives ran everything 15 years ago. Everything! Progressives have only controlled things for the past 8-10 years or so. The hold can be quite tenuous. So progressives are ripe to suffer some backlash. I don’t want to see it. I’ve worked too hard to get us where we are.

Instead of always increasing our capacity for outrage, what if we tried a little grace? Outrage has a place, of course. But we get virtually nothing else. It is the outrage version of the little boy who cried wolf. And it is exhausting.

*Medicaid Crisis

You may get tired of me mentioning another crisis, but I wanted to update everyone on yet another huge problem in Iowa – low Medicaid rates. I used to work with the Iowa Medicaid program when I worked for DHS. I learned a lot about who gets Medicaid and why. More importantly, I learned how many things could be improved.

Some background: Medicaid is a program of the Great Society efforts the Johnson Administration passed in the 1960s. This was absolutely groundbreaking legislation! Prior to FDR in the 1930s, the US had a system of County poor farms. That was it. Many Americans starved to death, and few lived to old age. The English philosopher Thomas Hobbes had a famous quote that fit the situation perfectly. He argued in his book Leviathan that, without government, life would be “solitary, poor, nasty, brutish, and short.” Hobbes was right. And FDR did a lot to help improve that situation. FDR addressed this primarily through the creation of Social Security.

FDR had proposed a system of national healthcare several times, but it never had the votes. Meanwhile, the poor in America, while certainly much better off than before, were dying from easily treatable medical conditions. Finally, in 1965, Medicaid and Medicare passed the US Congress. But it was never easy. Conservatives opposed their creation, and have fought to weaken, undermine, and diminish these programs since the day they passed.

Medicaid provides health insurance coverage to poor people across the US. These poor people include many disparate groups. Most are senior citizens living in care facilities. Medicaid is the top payor of this service. Others covered include poor children, foster children, people with disabilities, and in many states, the working poor. Medicaid eligibility is always income dependent, so recipients must meet income and resource guidelines.

Medicaid is primarily a federal program, but with a smaller state match. Over the years, states have been given greater and greater flexibility in terms of designing and administering Medicaid. This has led to several good innovations, but has more often led to conservative states diminishing this benefit for their poorest residents.

In Iowa today over 1 in 4 residents receives Medicaid. One in four! But Iowa has a created a HUGE problem with its Medicaid program – unsustainably low rates.

What does that mean? Medicaid has set rates for every available service. If you need an appendectomy, there is a set rate. If you need nursing home care, there is a set rate. If you need a ride in an ambulance, there is a set rate. These rates rarely cover the cost of the service provided; that is a problem nationwide. But in Iowa, the problem is at a crisis level, and getting worse. Rates in Iowa are SO low that services are at risk.

For example, Iowa underfunds fund group home settings for folks with intellectual disabilities. (Locally you may be familiar with Systems Unlimited or Reach for Your Potential; there are others.) These organizations do incredible work caring for our most vulnerable residents. And Iowa is making it impossible. Medicaid rates are so low that these agencies cannot even figure out how to pay minimum wage. It is a crisis.

Another example: Iowa is almost devoid of substance misuse providers. (Locally you may remember MECCA, later known as Prelude, then acquired by CFR.) There are only a few counties in Iowa where you can get treatment for substance misuse. Agencies have simply closed, and more are closing. Medicaid rates are so low that these agencies cannot keep the doors open. It is a crisis.

One more example: I recently sat in on a meeting of folks trying to get dental appointments for poor kids. Almost ZERO dentists in Iowa accept Medicaid. Literally almost ZERO! It is a money loser, and dentists are not required to take it. So they don’t. Meanwhile, thousands of children from all 99 of Iowa’s counties flock to the UI to be treated at the College of Dentistry. Waiting lists are so long that the associated health problems become serious. The kids are seen in emergency rooms. They suffer lifelong serious consequences because they couldn’t see a dentist as a kid. Meanwhile, the dentists you know make a lot of money. It is a crisis.

Those are just three examples. There are likely 300. The government of the State of Iowa is quite simply underinvesting in the Medicaid program. Which means we are failing our most vulnerable residents.

What can be done? It’s really quite simple – Iowa could raise the Medicaid rates for these and other services. We have the money – Iowa is sitting on a lot of money! Iowa ended Fiscal Year 2023 with a $1.83 billion surplus in the general fund, in addition to $2.74 billion in the state's Taxpayer Relief Fund and $902 million in reserve funds, according to the March Revenue Estimating Conference. (Note: Iowa received about $6 billion from the federal government as part of various federal relief programs.)

So yes, we have the ability to greatly improve these situations. We can do it, we should do it, and I believe we must do it. But don’t hold your breath! This Governor has sat idly by and watched poor Iowans die on a number of occasions – Medicaid Managed Care, COVID, etc. She will do it again. Our poorest residents are dying. She refuses to help. She’s got to go.

*DID YOU KNOW? State Medicaid matches are based upon each state’s relative wealth. Connecticut (1) has the highest state match, while Mississippi (50) has the lowest. Iowa’s match is 35% - ranking us 31^st. Not at the bottom, but poor. (When I worked there in the 90s, Iowa was 24^th. We have fallen.)

Anyone interested in learning more about County government should take a look at the County website-

www.johnsoncountyiowa.gov.

"Sullivan’s Salvos" is sent once per week to any interested party. It will give a brief update on issues of interest to Johnson County residents.

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---Rod

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SULLIVAN'S SALVOS

June 18, 2024

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