Any reform plan offered by Gov. Kim Reynolds demands skepticism and invites dismissal, especially since she will not run for re-election next November. Reynolds hung her hat on Medicaid privatization, and that led rural nursing homes to close and other providers to curtail services. Beware her latest idea.
Reynolds recently announced that she will ask for $1 billion over five years to be spent in sundry ways, some good and some awful. Good: recruit more rural physicians. Potentially awful: Develop a “hub and spoke” system for rural health care that no doubt will feed the hub and squeeze the spoke until the Pocahontas and Sac City hospitals breathe their last.
The federal money comes from the “Big, Beautiful Bill” as a $50 billion recompense for slashing Medicaid funding and other health care revenues (like grants through the National Institutes of Health).
It sounds as if much of the $1 billion Iowa requests goes for things like “partnerships” and “collaboration” — that is, vertical integration that further herds patients into networks where services are more efficiently rationed.
“Clearly, geographic and transportation barriers limit rural Iowans’ access to critical health care infrastructure,” the Reynolds application to the federal government states. “Iowa’s hub-and-spoke framework is well-positioned to address these challenges through strategic partnerships, workforce expansion, and care coordination. Identifying which areas will serve as specialty care hubs, and which will operate as spokes for primary and secondary care, will be key to transforming rural health care and improving access across the state.”
In short, more consolidation supplemented by telemedicine. You can see it coming.
It is stated outright in the application:
“Iowa will enhance hospital centers of excellence that share resources within a network of health systems and care sites. By formally pairing hospitals together to solve access, revenue, and sustainability problems, rural residents can receive primary and preventive care close to home while receiving access to specialized care at a nearby Health Hub. These formalized partnerships will improve health outcomes, reduce costs for rural Iowans, and be supported through the use of technology, including the Health Information Exchange Initiative and telehealth solutions.”
Local residents will be forced to the Hub of Sioux City, where St. Luke’s Hospital was just put on probation by the state. We are their spoke, and that is not a good place to be.
And further:
“The EMS Community Care Mobile project upskills Emergency Medical Services
(EMS) crews to deliver mobile prenatal care, postnatal care, and chronic disease management. This strategy uses technology to outfit existing mobile care units with telehealth capabilities and upskills the Iowa EMS workforce by providing specialized training in obstetrics and chronic disease management.”
The ambulance crew can take the place of the rural clinic or hospital.
Better training for EMS crews is good. So is better technology. Not if it is subtractive. Medicaid reform purportedly saved money; State Auditor Rob Sand disagreed before he ran for governor. Nursing homes vital to local families closed. Service deteriorates. That’s what is in store for health care under this latest scheme.
Rural health care providers need a sustained flow of revenue that covers costs through Medicaid, Medicare and private insurance. Consumers need Medicare. Patients deserve choice. This plan blows $1 billion on forced consolidation that will further deprive rural Iowans of the most advanced medicine, from what we can tell. Reynolds won’t be in office to speak for the results. She gets to blow the money as the insurance companies tell her to and then run off.
The government shutdown and a sharp increase in health premiums will conspire to make the Republican position increasingly untenable. Rural hospitals are curtailing services and closing. Consumers are fuming over their lack of choice and increasing health care costs. With the loss of subsidies for Obamacare premiums, which the Republican majority voted for twice this year, people are beginning to feel that they are the victims.
Democrats should insist on Medicare for All. This is their opening.
The Republicans are fumbling around with more rehashes of health savings accounts. People need relief from rising costs. They want to be able to see the doctor of their choice. They fear medical bankruptcy.
Corporate-owned Democrats attacked Elizabeth Warren and Bernie Sanders when they campaigned in Iowa on Medicare for All. Voters in the latest elections are coming around to that way of thinking. Even conservative Democrats running for governor in New Jersey and Virginia were solid in their support for subsidizing premiums, which is a half-step from Medicare for All. Rep. Marjorie Taylor Greene, R-Georgia, even defends insurance subsidies because her constituents say so.
You should not have to wait until your teeth fall out to get Medicare. People would be happy to pay for it, compared to the weak corporate policies that deny care while costing an arm and a leg. It should be the Democrats’ leading issue for the midterm elections. Americans are ready for health security. They’re paying for it now but not getting it.
Farmers are settling in to a winter of discontent with full bins and no place to go. Sen. Chuck Grassley says a bailout is forthcoming but he failed to say when. Even if Grassley could wave his wand and approve $10 billion tomorrow, it will be too little too late. It will take months to get the money out there, with farmers about to talk operating loans with the banker. The banker must assume no bailout. Talks will be difficult.
The agriculture department cannot say when a Trump bump will show up in the farm account. Congress has been unable to pass a farm bill, which is years overdue. Rep. Randy Feenstra, a member of the Agriculture Committee, has the temerity to run for governor after helping construct this scenario: lost export markets, an outdated farm bill under full Republican control, promises of a bailout just around the corner. Republican Ashley Hinson is running for US Senate. They can count their lucky stars that Iowa Republicans are blind to their indifference. More farmers go broke.
“Someone who says I am against abortion but I am in agreement with the inhuman treatment of immigrants in the United States, I don’t know if that’s pro-life.” Pope Leo, remarks to the press, Oct. 2
The US Conference of Catholic Bishops followed the lead of the Chicago-born pope by issuing a rare “Special Pastoral Letter” last week:
“We are disturbed when we see among our people a climate of fear and anxiety around questions of profiling and immigration enforcement. We are saddened by the state of contemporary debate and the vilification of immigrants. We are concerned about the conditions in detention centers and the lack of access to pastoral care. We lament that some immigrants in the United States have arbitrarily lost their legal status. We are troubled by threats against the sanctity of houses of worship and the special nature of hospitals and schools. We are grieved when we meet parents who fear being detained when taking their children to school and when we try to console family members who have already been separated from their loved ones.”
Earlier, the Iowa bishops issued their own statement of concern over immigration enforcement. The pastor of St. Mary’s Church addressed the issue in the weekly church bulletin.
The faithful may be paying heed. The administration is losing support over its sweeps. Even President Trump is defending some immigration because his resorts can’t operate without them. He promised to deport all undocumented immigrants repeatedly during the campaign. When it started to actually happen, people re-examined their consciences over the cruelty and fear.
We would add: Does it affirm life to deny children and the elderly food stamps? Is it pro-life to ignore that people cannot afford health insurance? What is pro-life about the elderly not being able to afford prescription drugs?
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