Creative Commons photo by jimmywayne via Flick

If Senate File 2028, the government reorganization bill, is passed as written, only state-approved psychiatric medications will be readily available to individuals on Medicaid. Medications that do not appear on the approved list will only be paid for if a physician requests and receives a waiver on behalf of the patient.

Although Iowa has utilized a preferred drug list for some time, the state has also granted exceptions for specific conditions that tend to require the most complex — and often most expensive — medications. Iowans on Medicaid who have mental illness, Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS) or cancer, as well as those who have undergone a transplant, have been granted exceptions under the preferred drug list, and their physicians have been free to prescribe whatever medication has worked best without needing to obtain prior state authorization.

Language in the government reorganization bill removes all such protections for “drugs prescribed for mental illness” and, advocates argue, is setting the stage for small immediate savings, much larger long-term expenditures and the potential of massive human suffering.

“Mental illness is a very complex and individualized,” said Carol Porch, an Iowa City mental health advocate. “What works for one person may not work for another, or may cause side effects in one person and be perfectly fine for another. There are even differences between brand name drugs and generics that have the same active ingredients because the non-active parts, or fillers, can create a situation where the drug can be more quickly or more slowly absorbed by the system. When dealing with psychiatric medications, all of this is a factor that determines the overall health of the person and their place in society.”

Even for the most mild mental illness, finding the most helpful and well-tolerated medication and dose can be difficult — often requiring multiple trials because effectiveness and reactions can vary from individual to individual. At least as early as 2004 the American Psychiatric Association’s Office of Healthcare System’s and Financing warned against limiting access to psychiatric medications because even those that have similar overall effectiveness also have specific mechanisms that can affect each person differently.

Upon completion of a study specific to schizophrenia, the National Institute of Mental Health concluded that “families and physicians need more, not fewer, choices” of prescriptions because, in part, “to say the medications are equivalent is not to say they are identical.”

Margaret Stout, executive director of the Iowa chapter of National Alliance on Mental Illness (NAMI), understands that the budget is tight, and that legislators need to make cuts that will save money.

“Over time, this policy will end up costing the state much more money than it would have paid for psychiatric prescriptions,” Stout said. “Our national organization has already given Iowa a D when it graded the states’ systems for serious mental illness. I know — and I’ll even predict — that if this is passed that our state will see increased homelessness and more people entering the criminal corrections system.”

The situation in Iowa, where the state is considering closing its only dual-diagnosis care center and there have been waiting lists for last-resort, state-funded care, is especially dire, she said. Even if the state fulfills its aim of closing the Mount Pleasant facility and maintaining the existing number of available beds, the previous need already out-weighed the existing services.

“We are headed in the wrong direction when it comes to caring for those with mental illness,” Stout said.

The overall economic climate in Iowa and subsequent across-the-board cuts mandated by Gov. Chet Culver has also resulted in Medicaid providers being paid less by the Iowa Department of Human Services. Under the proposed preferred drug list change, physicians who believe their patient will benefit from a medication not on the list would have to appeal to the state for authorization to try to the drug. Advocates wonder how many physicians, already underpaid by Medicaid, would be willing to go that extra distance for low-income patients.

“I really worry that we are setting ourselves up for two different standards of care,” Stout said. “One for those who have, and another for those who don’t.”

Porch is also focused on those who utilize the Medicaid program and may not be in a position to offer their own voice and experiences to legislators.

“What really is at stake here is that this change in policy has the potential of creating a lot of human suffering. That is just not acceptable,” Porch said.

Senate File 2088 has been passed by the Committee on State Government and is currently before the Senate Appropriations Committee for further review.

Republicans vow bipartisanship during 2010 legislative session, as long as they get their way.

Corps of Engineers assurances on the small likelihood another record flood will hit Cedar Rapids during the next 50 years doesn’t seem to be comforting Cedar Rapids.

250,000 Iowans will lose Sinclair stations at midnight unless a deal can be struck.

Political endorsements don’t carry much value in Iowa, unless they do.

Gov. Culver heading to Tempe, Ariz., for the Insight Bowl, and no doubt he’ll once again be paying his own way.

Apparently, the only public notice for the hearing was tacked up on a bulletin board inside the State Capitol, and the only person who noticed and actually showed up was a nonpartisan capitol staffer. The method used to advertise the meeting does meet the minimum standards under state law, which only calls for the public notice to be tacked up 24 hours in advance.

Dick Oshlo, the state’s budget director, said he didn’t expect many people to turn out anyway.

From The Register:

Oshlo said Wednesday’s hearing was meant “to take public comments.” It’s required by the Iowa Code, but it’s usually considered a formality, he said. “Historically, few people have ever come,” he said. “We followed the same process as we have in the past.”

Asked how notice of the hearing was published in previous years, Oshlo said: “The type of structure for the hearing and the notice have been the same for the last four, five, six years.”

A new meeting has been scheduled for Monday.

Iowa’s track record in government openness has been less than stellar over the years, to say the least. One study backed by the American Society of Newspaper Editors, Freedom of Information Committee and Society of Professional Journalists ranked Iowa 31st in government openness nationally. The 2009 General Assembly considered a bill to bolster Iowa’s open-meetings and open-records laws, but after several re-writes it still sits in committee.

Culver’s office is calling the e-mails “draft documents,” which it says aren’t required to be disclosed under Iowa law. The Register doesn’t agree with that assessment.

Iowa’s open-records law does not include an exemption for draft documents. However, the Iowa attorney general’s office has said that it believes the Legislature never intended to make preliminary documents, such as drafts of speeches, open to the public.

This isn’t the first instance of the state’s largest newspaper and the governor disagreeing on what constitutes a public document. In August, Culver’s staff refused to release a draft report that outlines Iowa’s housing recommendations after the floods.

In early December, Culver’s staff refused to release a list of recommended budget cuts given to the governor from state departments.

Iowa Attorney General Tom Miller said Tuesday he would work to better enforce open-records and open-meetings laws.

Both The Des Moines Register’s Jason Pulliam and Radio Iowa’s O. Kay Henderson were listening in, but when it came time to write a story, both came to very different conclusions about what it is the two Democratic mayors actually were saying.

The Register’s headline said “D.M., C.R. mayors ask Grassley to back Obama on economy,” and opened with “The top elected leaders from Des Moines and Cedar Rapids have called upon Iowa’s congressional delegation to support President-elect Barack Obama’s economic recovery plans.”

At Radio Iowa, the headline was “Mayors of Des Moines, Cedar Rapids praise rather than rebuke Grassley,” and opened by explaining that the conference call was set up to bash Grassley but the mayors ” seemed conciliatory.”

While both stories make it clear the mayors are supportive of Obama’s plan and think Grassley should support it, Radio Iowa’s focuses almost entirely on how the two Democratic mayors seemed to want to avoid getting into it with Iowa’s senior senator and highest ranking Republican. There was no mention of “seeming conciliatory” in the Register’s account, as a much more combative tone was presented.

The Cedar Rapids Gazette and Associated Press accounts are very similar to The Register’s and probably a lot closer to what The Campaign for Jobs and Economic Recovery Now, the organization that set up the conference call, were hoping for. It’s up to the reader to determine who is right (or who they trust) since the audio of the call is not available on the group’s Web site, but it’s always nice to see events coverered differently by competing media and it’s another example of why a more diverse media landscape is always better.

But with her recent spot-on predictions on the highly visible presidential campaign stage, this Des Moines pollster can make as strong a claim for clairvoyance as any earthly being today.

Selzer Co., the Des Moines Register’s pollster of record, called the Iowa caucuses for U.S. Sen. Barack Obama and former Arkansas Gov. Mike Huckabee only days before Iowans made her call official.

In the days before the caucuses, Camp Clinton trashed the poll that ended up being right.

Then, just days ago, working for the Detroit Free Press, Selzer called Michigan for former Massachusetts Gov. Mitt Romney before voters there proved her correct yet again.

“I wish there were magic and mystery to it, but it is basic science,” Selzer said.

So what does this Kansas girl turned Iowa poll company president see that others don’t? Why was she so right and her colleagues in New Hampshire so dead-in-the-street wrong only days later?

“People like to look at past events to predict future events,” Selzer told the Iowa Independent.

That can be treacherous in polling. Using 2000 and 2004 turnouts in Iowa to predict this cycle would have been terribly misleading. So she didn’t. Selzer compared what she was seeing with the Iowa electorate to a famous “M.A.S.H.” episode in which Hawkeye Pierce (Alan Alda’s character) staged a mess-hall rebellion of “we want something else.”

Obama and Huckabee best represented that, according to the data Selzer collected.

Selzer said the Clinton campaign was based on a collection of issues, not an overall theme, as was Obama’s.

Many voters were tired of the enmity between the Republicans and Democrats – something that Selzer saw in polling and that was borne out on caucus night,as large numbers of independents and Republicans voted for Obama. In terms of the gender gap difference between Iowa and New Hampshire, Selzer said she is at something of a loss to explain it.

Obama did well with women in Iowa, but suffered as a gaping gap opened to Clinton’s benefit in New Hampshire.

“She didn’t really run as a woman here,” Selzer said.

Iowa has never elected a woman to Congress or as governor. Did that play a role at all in the Iowa vote?

“I’m rather stymied by Iowa’s failure to elect a woman,” Selzer said. She chalks it up to lack of strong candidates of that gender so far rather than any deep-seeded sexism among Iowa natives.

Her bigger-picture explanation for the Obama-Clinton split in Iowa and New Hampshire is the compressed window of time between the two events.

“He (Obama) got some of this bounce, but it wasn’t a firm grip,” she said.

A native of Topeka, Kan., Selzer, who earned her master’s and Ph.D. at the University of Iowa in communication research and theory, now lives in Des Moines. On caucus night, as she drove past sites and large turnouts, she saw the first game-night evidence that her predictions were about to be right.

“That made me feel pretty good,” Selzer said. She said friends gave her a wide berth that night so she could either field press calls or “throw up” when the results came in after the caucuses.

“You’re either golden or a goat, and you don’t want to be a goat in public,” Selzer said.

Taking a long-term view, she sees Obama’s win as a boost for the integrity of the Iowa caucuses.

“It sort of in my mind calms the concerns about minority representation in Iowa,” Selzer said.

Eric Alva (left) and Antonio Agnone (right) speak out against “Don’t Ask, Don’t Tell” in Des Moines

Pictured from left to right: Eric Alva, Antonio Agnone, Alexander Nicholson, James S. Taylor, and Jarrod Chlapowski