U.S. Rep. Steve King

Rep. Steve King, R-Kiron, has been identified as one of four members of Congress who are improperly receiving a homestead tax deduction, according to the Capitol Hill newspaper Roll Call.

The exemption allows people who own homes in Washington, D.C., to receive a $67,500 reduction on the assessed value of their home. The deduction also caps increases on the assessed value of homes at 10 percent above the previous year’s tax assessment. It is not supposed to be available to those who claim residency in another state even if they have a home in the District.

King, who bought a one-bedroom condominium in D.C. in 2005 for $325,000, told Roll Call he believes “the D.C. tax department made a mistake.” A King spokesman declined further comment to Roll Call.

In 2005, an investigation found that 22 senators were receiving the tax break. District officials blamed a computer glitch and have since audited the program to purge those unqualified to receive the tax break and collect back taxes owed.

At the time, several observers questioned how lawmakers could not know they were receiving the exemption since it is noted on the property tax bills homeowners receive twice a year, including a calculation of any savings.

Pete Sepp, spokesman for the National Taxpayers Union — a longtime King ally — told Roll Call that accepting the deduction amounts to “tax avoidance.”

“More than the law here is the appearance,” Sepp added. “Constituents already tend to feel that lawmakers spend too much time in Washington and not enough time at home, so how is this going to help improve that image?”

One group upset with King is supporters of allowing the nation’s capitol voting rights in the U.S. House. Earlier this month, the Iowa Republican helped stall a bill granting those rights by attaching an amendment gutting the city’s gun laws. District-based blog DCist chided King for his misstep.

King comes out looking worst of the bunch — not only is he seemingly cheating on his taxes, but he also helped stall the recent D.C. voting rights bill. Tsk tsk.

Others named in the Roll Call story were Rep. Tom Petri, R-Wis.; Rep. Phil Gingrey R-Ga.; and Rep. Mike Rogers, R-Ala.

Update: Washington, D.C., officials confirmed King’s story.

Red pins represent Iowa hospitals that do not offer obstetrical services. Green pins are Iowa hospitals that continue to offer such services. Click image to access interactive Google map.

This month, the Mitchell County Regional Health Center in Osage became the 14th Iowa hospital in as many years to stop offering obstetrical services. Families in Osage expecting a child will need to travel to neighboring cities for final prenatal exams and delivery in hospitals that offer those services or seek other options.

Births in Iowa’s hospitals have increased by nearly 10 percent in the past 10 years, but access to obstetrical services has declined in rural Iowa, as hospitals discontinue labor and delivery services.

It’s a trend that is impacting rural areas not only in Iowa but across the United States.

A 2008 report from the Iowa Department of Public Health notes that of 181 OB/GYN physicians identified in the state, only 46 practice in rural counties. The vast majority of the physicians are located in Iowa’s population centers — Polk, Linn, Johnson, Black Hawk, Dubuque and Scott counties.

The same holds true for family practice physicians. And one county, Taylor, has neither a family practice physician or an OB/GYN physician listed.

The reason Mitchell County Regional and other rural hospitals say they can no longer offer these services is a lack of physicians.

While there is no doubt that rural areas are experiencing physician shortages, officials say that doctors need more than an invitation and short-term incentives before they will begin a long-term practice in a rural setting. While Iowa continues to pursue incentives like loan forgiveness programs, the legislature and Iowa’s rural communities have yet to address the root causes of the shortage, including the state’s dismally low Medicare/Medicaid reimbursement rate and the lack of encouragement and incentives for young rural Iowans to take the plunge into medical school.

Physicians Alone Aren’t Enough

“It takes more than a doctor to deliver a baby,” said Gloria Vermie, director of the Iowa Department of Public Health’s Office of Rural Health. “Sometimes when a hospital or a doctor stops offering [obstetrical care] it isn’t necessarily any one issue, but a culmination of issues.”

Vermie, who formerly served with the Kansas Department of Health, said the Sunflower State has made strides in training and retaining primary care physicians in rural areas with a specialized residency education program.

“In a mid-sized town called Salina, they have the Smoky Hill Family Medicine Residency Program,” she said. “It was specifically for residential, rural-health physicians. A high percent of the doctors who go through that program end up serving rural areas.”

The philosophy of the Kansas program, she said, could be summed up as “grow your own,” because a high percentage of doctors who chose to take part were natives of rural areas. Following completion of the program, Smoky Hills boasts a 92 percent placement in rural settings.

“It’s a very wise thing for communities to begin doing,” she said. “They can start to look at their existing students when they are in junior high to see who might have that potential. They should think: ‘What can we do for these students right now to ensure that they can get to medical school and then come back home?’”

The “grow your own” approach is something that excites University of Iowa professor Kelley Donham. He teaches a course in rural health and agricultural medicine through the university’s College of Public Health. Donham has also  advocated, unsuccessfully, for the school to begin a full-fledged training track that would focus on rural health care, priming doctors to work in areas outside major cities.

“It’s quite clear what it takes to get people who want to go into primary care medicine and into rural areas,” Donham said. “That is, you get people who are oriented toward primary care who are from rural areas. Better yet, these individuals need to have spouses that are from that area. They have to have rural mentors and have a rural experience. They need to have a sociological connection to that population.”

Vermie believes that offering loan incentives to medical school students is key to increasing the number of Iowa’s rural doctors. Such loans are often forgivable if the student agrees to spend a certain amount of time practicing in an underserved community. The loans are important, she said, but they aren’t the solution for retaining doctors in rural areas.

“Communities may need a higher level of education and training to do the recruitment and retention,” she said. “We can’t mandate that a physician stays in [a particular community], but if those local leaders know all the right strategies to bring those doctors in and assure them that the community will support them and that certain amenities are present, then they may have a higher success rate.”

Bobbi Buckner Bentz is director of the Primary Care Office in IDPH’s Bureau of Health Care Access. One of her duties is to review site applications for the National Health Service Corps, a federal program that offers scholarships to medical professionals who agree to practice in underserved areas. Since 1994, Iowa has offered a similar program through the Bureau of Health Care Access that is called PRIMECARRE.

Due to increased marketing and recently approved federal stimulus funds, the federal program should see significant increases this year. Bentz has already reviewed 16 and is expecting several more before the March 27 cut-off date.

Medcaid/Medicare rates key to stopping “doctor drain”

County-by-county listing of obstetric and primary care physicians in Iowa. Click to view larger graphic.

But loan programs aren’t enough to address the many other factors that challenge doctors who practice in rural areas. In Iowa, the state’s extremely low Medicaid/Medicare reimbursement rate, the ongoing nursing shortage, increased liability issues and even limited rural broadband access all create an environment that can make doctor retention difficult, observers say.

Christian Fong is vice-chairman of the Generation Iowa Commission, established by the state to attract and retain young professionals in the state. He believes that the loan forgiveness program doesn’t offer enough incentive for medical professionals to give up the pay increases they can obtain in neighboring states with much higher Medicaid/Medicare reimbursement rates.

“The loan forgiveness program, which has been the traditional way of trying to keep [physicians] in rural areas, has been, for the most part, a failure,” Fong said. “For medicine, sometimes you are dealing with $250,000 of debt. But what is that much debt when you can make $50,000 more a year by moving to Minnesota? The economics no longer works out for loan forgiveness.”

The other piece of the puzzle, according to Fong, is what happens to a community when the physician meets his or her commitment and moves on.

“If they leave, the community is often left with this huge hole,” he said. “And it can be very difficult to re-recruit to those rural areas. So, an OB/GYN that comes into a community begins to assemble a support system. It’s no longer just a single doctor, but it is all the support networks that go into having that doctor available. If that OB/GYN leaves, the hub of that network is gone. What are the other people who were hired as a part of that support system supposed to do?”

Last year, the Generation Iowa Commission indicated that the solution to Iowa’s “doctor drain” was increasing Medicare/Medicaid reimbursements.

“That’s going to be extremely difficult in this budget environment,” Fong confessed. “But, until we make a commitment as a state to do it, we are going to continue to see ‘doctor drain’ out of our state — and particularly out of rural areas.”

U.S. Rep. Tom Latham, R-Alexander, who has been a significant voice in the ongoing conversation about Iowa’s nursing shortage, believes at least some of the burden placed on physicians and hospitals can be alleviated with technological advances. Latham secured $95,000 in funding for the Newborn Monitoring Initiative, a first-of-its-kind telemedicine technology that has been spearheaded by Gunderson Lutheran Health System and Gunderson Clinic in Decorah.

The system allows physicians to send real-time data from rural clinics to medical center specialists. The data can help facilitate consultations, improve coordination of care and give women and babies in rural regions access to specialists that might otherwise not be available without extended travel. Such advances can also help a family practitioner in a rural setting from feeling isolated and overburdened.

Vermie, meanwhile, says that economic development strategies currently employed by communities for potential business recruitment and retention could be modified to apply to medical professionals.

“There needs to be a local discussion on how the communities can appeal to these medical professionals — especially the young ones,” she said. “How do you entice them? How do you appeal to them? How do we cultivate the support services that will ensure this doctor will have a good practice without being overburdened?”

Sen. Chris Dodd signed books and stumped after announcing that he was moving a large portion of his staff here.  Gov. Bill Richardson campaigned around Iowa, emphasizing his pro-gun record in rural areas (and wearing an American flag lapel pin).  Sen. Hillary Clinton rode her new bus, “The Middle Class Express,” across the state.  Sen. Barack Obama continued his criticism of Clinton’s Iran vote in a series of speeches here, which received mixed reviews in terms of style.  Former Sen. John Edwards highlighted his opposition to the Iraq War on his “Take a Stand” tour.  And Sen. Joe Biden held an event with Republican candidate and Sen. Sam Brownback to highlight their Iraq plan at the end of the week.

On Tuesday, most in the Democratic field announced that they would take steps to remove themselves from the Michigan primary ballot because Michigan’s primary date violates the Democratic National Committee’s rules.  Most notably, Clinton did not, opting to stay on the ballot.  Rep. Dennis Kucinich attempted to remove himself but was unsuccessful.  Sources told Iowa Independent that the move was an attempt by other campaigns to damage Clinton’s standing in early states like Iowa.

Obama’s and Edwards’ criticism of Clinton intensified.  At the end of the week, Biden and Richardson squared off in an aggressive series of dueling press releases attacking each other’s plans for Iraq.  There were also many state legislative endorsement announcements from several campaigns.  And it was revealed that Edwards would receive an endorsement from the SEIU’s Iowa Local on Monday.  As the weather cooled down, the Democratic campaign heated up.

On the Republican side, Sen. Sam Brownback, who made a joint appearance with Biden to tout their plans for Iraq, said that he must win fourth place in Iowa if he is to stay in the race.  Gov. Mitt Romney launched a new TV ad attacking jihad, although he has only spent three of the past 60 days in the state.  Sen. John McCain rode the Straight Talk Express across the state.  And Rudy Giuliani received the support of former candidate and Wisconsin Gov. Tommy Thompson.

Republican Party State Co-Chair Leon Mosley confirmed speculation that the GOP supports a Jan. 3 caucus date.  Influential columnist David Yepsen seemed to support splitting caucus dates for the two parties, although others disagreed.  At this point, conventional wisdom is that the caucuses will be either Jan. 3 or Jan. 5, but the issue is far from settled.