When Iowa Department of Public Health officials planned their health provider flu vaccinations, they learned that many Iowa providers were above the recommended age requirements to receive the live virus H1N1 vaccination. In fact, no providers in Van Buren County were below the cut off age of 49.

Expanding insurance coverage is important, experts say, but that is only half the battle. For many Americans, particularly in rural parts of the country, access to high quality health care services could remain elusive.

“We have some serious challenges in Iowa as it relates to the number of providers that we have,” said Tom Newton, executive director of the Iowa Department of Public Health. “We do have a high percentage of our population in Iowa that is insured at this time, and I would tell you that even some of them struggle right now to get access to health care. You can’t just assume that by providing people with a source of payment that you’ve provided them with access to health care.”

As The Iowa Independent has previously reported, the Hawkeye State, like many other rural states, is coping with a plummeting number of health care professionals, including specialists, primary care physicians, nurses and behavioral health professionals.

While several factors such as perceived career stress and compensation issues are at the root of the decline, the problem is also being amplified by a rapidly aging health care workforce.

As a part of H1N1 flu response and vaccination plan development for health care providers, Newton said he spoke with a public health administrator in Van Buren County about the department’s plan to utilize flu mist, a live-virus vaccination that is delivered through the nose like a nasal spray. Because that vaccination contains a live virus, its use has been restricted to certain age groups.

“Health care providers were going to be our targeted audience for using flu mist, at least in some cases. But, in Van Buren County they do not have any health care providers that are under the age 49,” Newton said, noting that regulations prohibit anyone 49 and up from using the live virus. “That presents problems for us from a vaccination standpoint, but what does that say about health care providers in those communities? There are probably going to be some of those folks who are eligible to retire within five years.”

The alarming demographics and shrinking number of health care workers in rural areas are not just limited to primary care doctors. Other components of health care are also in short supply in much of Iowa.

“We aren’t just talking about those people that are traditionally thought of as health care providers – it’s dentists, it’s mental health and it’s even pharmacy,” said Cheryll Jones, a southeastern Iowa pediatric nurse practitioner who serves on the board of the Iowa Rural Health Association. “There aren’t necessarily huge numbers of pharmacies in rural areas. So, even if you have a provider, you may have to travel a fair distance to get your prescription filled.

“[Workforce] is a concern that we have, and not just for rural, but especially for rural. Certainly, the need for folks to have health insurance is important, and that is where a lot of the focus has been, but access to insurance does not equate to access to care.”

A declining and aging workforce is probably the most publicly visible of the challenges facing a health care system, but it is far from the only challenge for rural areas. According to Tim Size, executive director of the Rural Wisconsin Health Cooperative, his state, like Iowa, has maintained a relatively low uninsured rate.

“We are very used to dealing with rural health in an environment where most people have insurance cards,” Size said. “People having insurance cards is much better than people not having insurance cards, but it doesn’t deal with the long, long list of issues that we have to struggle with.”

As health care companies react to the current global economic recession, there will be efforts to make health care services more centralized, which isn’t always in the best interest of rural consumers or providers.

“We need collaborative ways for rural to work with rural and for rural to work with urban that maintains services available in the rural areas,” Size said. “From that respect, we have to be very concerned about the economic incentives that will come with reform. … There are a lot of models floating around out there that have tended to be developed in urban communities and we need to be very cautious about those being mandated into rural communities without any demonstrating or testing of the idea.”

When it comes to the debate over improving health care, Newton said, “It all comes down to how you define access.” For many rural residents, the definition is likely to remain too narrow to make much of a difference.

The 2010 Agriculture Appropriations Act, which passed the U.S. House on Thursday and the Senate on Friday, contains $350 million that will benefit dairy farmers. Of that amount, $60 million will be used for cheese and other dairy product purchases. The commodity purchases will be used by the government to fill food banks for struggling families that have been hit by economic hard times.

The remainder of $290 million, earmarked for direct aid to dairy farmers, will be distributed at the discretion of U.S. Secretary of Agriculture Tom Vilsack, who is expected to rely heavily on the expertise of his dairy advisory committee. The funding is not expected to resolve the long-term problems plaguing dairy farmers, but should help many producers through the current financial crisis.

The appropriations bill totals $121.2 billion, including $23.3 billion in discretionary spending. Although many areas and programs received reduced federal funding as a part of the appropriations bill, Congress provided no funds for the Farm and Ranch Stress Assistance Network, which was authorized as a part of the Farm Bill. Without the program, many states continue to scramble to meet the behavioral health needs of agricultural and rural workers under economic stress.

One of the areas that saw an increase in funding was the national food stamp program, which received $58.2 billion. That, when combined with stimulus monies from earlier in the year, results in a 19 percent increase from last year’s levels.

A program to assess the safety of Chinese chicken imports, heavily backed by the National Pork Producers Council, was also included in the bill. Language included in the bill allows the USDA to conduct scientific risk assessments on the safety of the processed chicken imports from China.

U.S. Rep. Bruce Braley (D-Waterloo) took part in a congressional hearing about the future of the program Wednesday. Although Braley is hopeful that reauthorization of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act will receive bipartisan support as it has in the past, he acknowledges that the current political climate could pose a challenge.

“I have to be frank and tell you that, in light of what we saw happening over August and what we saw on the floor of the House [on Wednesday when President Obama delivered an address to a joint session of Congress], it would not surprise me if there was some partisan opposition,” Braley said by phone Thursday morning. “I’m hoping that the better angels of our nature will win over and we can have a meaningful discussion on the importance of the reauthorization.”

The Ryan White CARE Act, which funds basic care, treatment, education and support services related to HIV/AIDS, disbursed more than $2 billion to states, local governments and advocacy groups during each of the past three fiscal years. Advocates say the funding is indispensable to ensuring that patients with HIV/AIDS get the care they need.

Because distribution of funds through the program can be granted to programs that provide assistance across state boundaries, it is difficult to determine exactly how much funding makes it way directly to Iowans or Iowa-based programs. According to one estimate from the Kaiser Family Foundation, Iowa received roughly $4.5 million in assistance in fiscal year 2007:

The bulk of the money directed to Iowa goes toward helping patients access HIV/AIDS medications, promoting early intervention, and providing services in underserved areas. The 2006 reauthorization of the program required that 75 percent of the funds directed to a state under Part B are spent on core medical services (i.e., medications, ambulatory services, substance abuse treatment and behavioral health services), while the remaining 25 percent could be used for support services (i.e., respite care, outreach and medical transportation), unless the state receives a waiver.

Although no Iowans testified to Congress on the first day of hearings, Prof. Donna Sweet of the University of Kansas School of Medicine and chairwoman of the board of the American Academy of HIV Medicine in Washington, D.C., provided lawmakers an inside look at one Kansas program.

“The HIV Program KU Internal Medicine Midtown provides care and treatment to 1,246 patients as of today,” Sweet said. “Of these, 40 percent would have no coverage if it were not for the Ryan White CARE Act. We provide ongoing, comprehensive care to an ever-increasing number of patients, regardless of their ability to pay. My clinic has an average annual increase of 100 new patients a year — in Kansas, not New York or California. However, we are still working off the same number of Ryan White dollars we have received since 1999. To broadly paint the picture: In the last 10 years my clinic’s patient load has doubled, and my funding has remained the same.”

In order to keep the clinic afloat, Sweet reported that she and the staff have resorted to “Girl-Scout-styled fundraising.”

“There seems to be a commonly held belief that program cuts will only affect administrative functioning and that medical services for the sick will somehow always be available through Ryan White, or Medicaid or some other program; this is a false assumption,” she said.

If the program is not reauthorized, the Kansas facility as well as other programs throughout the nation will no longer have funds with which to operate. By Jan. 1, there would no longer be funds to provide services to 40 percent of the Kansas patients or make payroll for most staff members. In addition, there would no longer be money for case workers or for prescription assistance, a service that Sweet said is used by 80 percent of her patients.

“Over the past 20 years, HIV has become a highly manageable disease with proper care and treatment,” she said.

“Without the Ryan White Program, my clinic would have never been created. Without a timely reauthorization of Ryan White, it may cease to exist. Without my clinic, my patients will not receive the care they need to manage their disease. And without that care, the disease they live with every day may unnecessarily and prematurely claim their lives.”

Braley said, despite partisan challenges and the heated health care debate before Congress, he believes that the program will ultimately be reauthorized.

“The problems that led to the passage of the Ryan White Act have not changed,” he said. “We still have significant needs in the areas of AIDS awareness and prevention, and that’s why I’m confident the bill will be reauthorized.”

Things have changed quite a bit since then, as the spotlight has shifted to lenders and their behavior during the boom. States and cities continue to aggressively pursue subprime lending discrimination suits, and judges across the country are signaling a willingness to move forward with some cases. As the lawsuits wind their way through the court system, more details and allegations about the inner workings of the subprime world are emerging. And as startling as some of the charges already have been — a former loan officer for Wells Fargo testified in one affidavit that employees regularly referred to minority borrowers as “mud people” and called subprime mortgages “ghetto loans,” — there’s even more ahead, said David Berenbaum, executive vice president of the National Community Reinvestment Coalition.

“The ’smoking guns’ are coming out,” Berenbaum said, referring to possible evidence that lenders targeted minority communities and borrowers for higher priced loans. “And I expect more and more of these smoking guns to become apparent.”

In the latest development, a Superior Court Judge in Los Angeles recently certified a 2005 lending discrimination lawsuit against Wells Fargo as a class action case. The suit contends that area managers at the bank refused access in some minority neighborhoods to a software program that allowed for discounted prices on mortgage loans. Barry Cappello, a partner with Cappello & Noel in Santa Barbara, which represents some 10,000 to 20,000 borrowers in the suit, said he believes it is the first subprime lending discrimination suit in California to be classified as a class action.

According to Cappello, Wells Fargo introduced a program in 2002 called “Loan Economics,” which gave loan officers the authority to offer discounts to loan applicants. The savings on lower fees and interest rates could be significant, ranging from $500 to as much as $10,000 per loan. The suit claims that the Los Angeles area Wells Fargo manager refused to allow loan officers operating in certain minority neighborhoods to offer the program. Borrowers in predominantly white neighborhoods were given access to the software.

Cappello said the suit stemmed from complaints by black and Hispanic loan officers for Wells Fargo, who said they asked to use the software in their branches but upper management refused.

Wells Fargo is fighting the suit and has denied all the charges. In a statement, the bank said, “We are disappointed in this ruling and intend to vigorously defend this matter as the case proceeds. The decision does not indicate the court believes the underlying allegations have any merit. We feel the allegations represent a complete mischaracterization of our long-standing commitment to responsible lending and the pricing practices and tools we use. The policies, systems and controls we have in place ensure race is not a factor in the pricing or products we offer.”

The case could go to trial in about a year, Cappello said.

More lawsuits are expected in the near future over the treatment of Hispanic borrowers in Arizona and Texas, who were offered high-cost loans they didn’t understand at misleadingly low teaser rates, then refinanced into even more expensive loans than their initial mortgages, Cappello said.

Wells Fargo, the nation’s largest home lender, also has been a target of lawsuits elsewhere. Last month, Illinois Attorney General Lisa Madigan sued the lender, alleging that blacks and Hispanics were sold high-cost subprime loans more frequently than white borrowers with similar incomes. The suit contended loan officers were offered incentives by the bank to steer borrowers into the more expensive loans, and that white borrowers generally received the lower-cost prime mortgages.

Some borrowers thought they were getting prime loans from Wells Fargo Home Mortgage, the suit also charged. But their loans actually came from Wells Fargo Financial, the bank’s subprime unit.

In Iowa, two watchdog groups charged this week that minority homeowners in Des Moines were three times more likely to receive high cost subprime loans from Wells Fargo than white homeowners.

In June, the New York Times reported on affidavits from a 2008 lawsuit by the city of Baltimore against Wells Fargo over subprime lending, which charged that the bank targeted blacks in Baltimore and suburban Maryland for high-interest subprime loans. Former loan officers testified in affidavits about using terms like “mud people” and “ghetto loans.” The bank also had an emerging markets unit that pinpointed black churches as fertile ground for selling subprime loans, according to the former officers. And in March, the NAACP filed suits in federal court in California against Wells Fargo and HSBC, alleging minority borrowers were more likely to be issued higher rate subprime loans than white borrowers with similar credit scores and qualifications. Both banks have strongly denied the charges. The NAACP also has pending litigation against nearly a dozen other banks and lenders over subprime lending discrimination.

Should the charges in the lawsuits be proven, it would amount to massive violations of the Fair Housing Act, the Equal Credit Opportunity Act, and other fair housing and lending laws, Berenbaum noted. Enforcing fair lending laws has been “an issue the government has failed to address over the past decade,” he said. Lenders could face criminal penalties from the government for violating fair housing laws, and they could be subject to punitive damages and fines from government lawsuits.

Big lenders like Wells Fargo and HSBC are obvious targets for suits because of their size and the amount of lending they did. In addition, many other lenders and originators of subprime loans have gone out of business, complicating efforts to address allegations of lending discrimination through lawsuits.

That leaves a major question regarding all the lending still unanswered, Berenbaum said: Where has the U.S. government been? The Federal Reserve reported in 2005 that an analysis of federal mortgage data found that blacks and Hispanics were more likely to receive higher interest rates on mortgage loans – and that it intended to examine the practices of 200 lenders as a result.

But nothing’s happened since that announcement, Berenbaum noted. Instead, as the years go on, and the government takes no action, allegations about price differences in mortgage loans based on the race of borrowers and their neighborhoods continue to grow.

Mary Kane covers the economy for the Washington Independent, a Center for Independent Media site.

Boswell had been hesitant to support a public option in health care reform legislation previously, telling a crowd in Sigourney earlier this month that he still hasn’t decided whether he could support a government competitor to private insurance companies.

A week and a half later, it appears Boswell has warmed up to the idea, reports Radio Iowa’s Kay Henderson:

“I’ve come to the conclusion over these last several years that we need some kind of a public option,” Boswell said, to applause and cheers — and a few jeers from others in the crowd who don’t share his opinion. “I also realize that it’s got to be constructed very carefully.”

Boswell, a member of the fiscally conservative “Blue Dogs” in the U.S. House, had said previously that a public option could “be something I can’t vote for.”

King scored a 96 out of 100, losing out on collecting the group’s “Defenders of Liberty” award due to his vote last year to override President George W. Bush’s veto of the $307 billion farm bill. The entire Iowa delegation voted to override.

Iowans were not completely shut out of the group’s awards, though. Rep. Dave Loebsack, D-Mt. Vernon, received the “True Liberals” award for voting against all 25 of the bills used to determine the rankings, scoring a perfect zero.

Rep. Tom Latham, R-Ames, scored an 88 percent, losing points for supporting an expansion of the State Children’s Health Insurance Program (SCHIP) and tax credits for alternative energy sources. Rep. Bruce Braley, D-Waterloo, scored a 4 percent, voting against the group’s position on 24 of 25 issues (he initially voted against the financial services bailout but supported a later version). Rep. Leonard Boswell, D- Des Moines, also scored a 4 percent (he supported a bill permitting D.C. residents to own firearms in response to a Supreme Court decision).

In the Sentate, Republican Charles Grassley scored a 76 percent and Democrat Tom Harkin scored scored a 4 percent.

The 25 bills which the group used to compile its ratings reflect a cross-section of issues, including taxes, energy, climate change, unions and culture topics like abortion and gun ownership.

The ACU has issued its rankings every years since 1971, providing a numerical indicator of how much  lawmakers agree with the group’s conservative ideals. The group was founded in December 1964 following the defeat of Republican Barry Goldwater in that year’s presidential election. It is probably best known as the sponsor of the Conservative Political Action Conference.

The Iowa Republican called the National Council of La Raza a “pro-amnesty organization” and said “the last thing Congress should be doing is handing out cash to apologists for immigration law breakers.”

“American taxpayers do not support La Raza’s agenda or its position in support of amnesty for illegal aliens,” King said in a statement.

La Raza has been a focal point of conservative criticism over the years, ranging from claims that it encourages illegal immigration to the United States to accusations that it is exclusionary in its approach to civil rights.

In an open letter to the public entitled “The Truth about NCLR,” the group’s president tried to put those rumors to rest, pointing out that immigration legislation La Raza has supported in the past, the McCain-Kennedy Immigration Bill, called for comprehensive reform, including improved border security.

The money in the omnibus bill is for “nationwide community development activities,” according to Taxpayers for Common Sense, a group that has combed through the bill and listed all the earmarks it contains.

La Raza points out that any federal money it receives for housing and community development projects is directed to its subsidiary, the Raza Development Fund. That organization’s job is to bring private capital and development assistance to local organizations serving Latino families in areas such as affordable housing, primary health care and educational facilities. No money from earmarks goes to advance La Raza’s public policy efforts on immigration.

King is not alone in his criticism of certain earmarks in the omnibus bill. Many conservative lawmakers are calling on President Barack Obama to demand the extra spending be eliminated from the bill now before the U.S. Senate, but Democrats are quick to point out Republicans have requested their fair share of earmarks, too.

Taxpayers for Common Sense counted more than 8,500 earmarks in the bill with a cost of $7.7 billion, up 3.4 percent from last year. Democratic leadership estimates that the total earmark value is about $3.8 billion. In the Transportation/Housing & Urban Development portion of the omnibus bill, which is where the La Raza earmark is included, King has requested nearly $2.3 million worth of earmarks, mostly for road and bridge projects in his western Iowa district.

While King’s only public statement on the omnibus bill has been critical, his House Republican counterpart, Rep. Tom Latham of Ames, released a statement Thursday praising the bill for including millions of dollars for a “wide range of projects at Iowa State University,” which is located in his hometown.

And, according to Iowa Secretary of State Mike Mauro, there were few problems associated with the new way of registering.

“Overall, the process went very smoothly and (Election Day registration) was handled efficiently and expeditiously,” said Mauro. “Training of county auditors and precinct election officials was a crucial factor in making this process work.”

In 2007, Iowa became the eighth state to allow voters to register at the polls. The law took effect in January 2008, and last November was the first general election when it was in force.

Same-day voter registration laws have been criticized for making elections more vulnerable to fraud, but supporters have argued that the benefit of increased political participation outweighs the potential risk of a few more fraudulent votes.

Sen. Barack Obama campaigns in Cedar Rapids, 7/31. (Photo: John Deeth)

70 percent: Obama’s winning percentage in his best county, the People’s Republic of Johnson County. Obama exceeded a local Lyndon Johnson record of 68 percent from 1964. The dusty old canvass books may tell if Obama’s margin breaks any sort of FDR record. Johnson County had by far the biggest Obama percentage in the state.

Other counties that traditionally go heavily Democratic, such as Des Moines, were just over 60 percent. Obama had an unusual hot spot on the Minnesota border, topping 60 in Winneshiek, Worth, and in his second best county, 63 percent in Howard. Democrats picked up highly targeted state House and Senate races in Winneshiek, so the extra effort may have been a factor.

81 percent: McCain’s winning percentage in his best county. One guess… yeah, Sioux County.

30,069: Obama’s Johnson County winning margin. Local Democrats set a goal of 25,000 months ago, and far exceeded John Kerry’s 19,000 margin.

4,173: John McCain votes in Iowa County.

4,173: Barack Obama votes in Iowa County, giving Iowa County the Golden Hanging Chad Award for close results. Cedar County got national attention in 2000 with an election night tie, but less attention for a final count that gave Al Gore the county by two votes.

55.2 percent: The percentage of Johnson County’s vote that came in as early ballots. Yes, more people voted before Election Day than on Election Day. Statewide, 533,967 voters had returned absentee ballots through midday Tuesday, 16 percent higher than 2004. Absentees postmarked by Monday, Nov. 3 can still be counted, which might affect a couple of the races listed below.

62.6 percent: Senator Tom Harkin’s winning margin. Some polls showed low-profile Republican Christopher Reed breaking 40 percent, but he landed at 37.4. That can now be marked as the official baseline for Republican votes in Iowa, a few points above Democrat Art Small’s 2004 loss to Chuck Grassley.

O. Kay Henderson at Radio Iowa reports that Reed has still not called to congratulate Harkin, but then, neither has Jim Ross Lightfoot, who lost to Harkin 12 years ago.

35.7 percent: Republican Dave Hartsuch’s count in the 1st Congressional District, lowest among the ten major party nominees. Rob Hubler made the deep red 5th District as competitive as any of the others, with 37.3 against Steve King.

42.2 percent: Republican Kim Schmett’s percentage, making his race against 3rd District Democrat Leonard Boswell, surprisingly, the closest in the state.

0: Iowa women elected to Congress or governorship, as Iowa remains in the club with Mississippi. Democrats had high hopes for Becky Greenwald in the 4th, but Tom Latham held her under 40 percent.

Likewise, the Iowa Republican blogosphere was convinced, without any neutral indications to guide them, that Mariannette Miller-Meeks in the 2nd District was the sleeper candidate of the entire nation. But she only pulled 38.9 percent to Democrat Dave Loebsack’s 57.1, with the remaining 4 points going to two other candidates.

31-19: The new Iowa Senate margin. Democrats gained three Senate districts. Swati Dandekar won an expected victory in open District 18 in Marion, and Mary Jo Wilhelm knocked off GOP incumbent Mark Zieman in District 8 in the northeast corner. Steve Sodders took open District 22 from the GOP in Marshall County. But two incumbent Democrats went down in defeat: Jeff Danielson in Waterloo’s District 10 and Frank Wood in the Quad Cities District 42.

6: State Rep. Wes Whitead’s lead in House District 1. Not percentage lead, vote lead. Six (6) votes, the state’s closest. Seesaw results and conflicting reports kept the Iowa House in question during the night. For a few hours, Rep. Elesha Gayman was shown as losing, but the highly-targeted Democrat held on once the absentees were added in.

160: Democrat Larry Marek’s winning margin in House in House District 89 for a Democratic gain. Marek won with a big margin in the Johnson County part of the district, the same way Becky Schmitz carried the corresponding Senate District 45 two years ago.

56-44: The new Iowa House margin, with six Democratic gains. In addition to Marek, the pickups were open district 16 in the northeast (John Beard) and 13 in Mason City (Sharon Steckman). Kerry Burt knocked off ex-TV anchor Tammy Weincek in Waterloo’s District 21. Gene Ficken defeated incumbent Dan Rassmussen in District 23 in Buchanan and Black Hawk counties. Phyllis Thede, who narrowly lost a Senate seat to Hartsuch two years ago, beat incumbent Jamie Van Fossen in Davenport’s District 81.

But Democrats lost three seats, including two in two northern Linn County. Nick Wagner beat Gretchen Lawyer in open District 36 (Dandekar’s old seat), and Renee Schulte bashed first term Rep. Art Staed over the head with a flowerpot (a frequent ad theme) in District 37 by 47 votes, which is within the provisional ballot and late absentee ballot margin.

Incumbent Democrat Mark Davitt appears to have lost in House District 74, though the Des Moines Register reports that Davitt’s campaign gathered different numbers and says they won.

If all results hold (Staed and Whitead may not), that’s a Democratic gain of three from the last session, but only a gain of two over the 2006 election results. In perhaps the most frustrating result for Democrats, party switcher Dawn Pettengill held on in Benton County’s District 39.

60.8 percent: The narrow winning margin for the $20 million Johnson County conservation bond. The issue got off to a roaring start with 70 percent of the absentee, but saw its margin drop through the night. Two vote No committees fought the measure, but by the time they got started many votes were already in the box. (Like mine–making their two robocalls asking me to vote no pretty much moot.) Local Republicans were urging a No vote on their headquarters answering machine, while the Democrats formally endorsed a Yes vote. With so many Democrats voting early, the election day pool of voters leaned more GOP than average. The measure won the Election Day vote in Iowa City by 60-40 but lost by the same margin in the rest of the county. Janelle Rettig of the Land Water Future vote Yes committee calculates the winning margin at 486 votes.

44: Barack Obama, 44th President of the United States. Obama frequently credited Iowa for the Jan. 3 caucus win that sent him on the road to the White House, and that should help Iowa keep its place in the front of the line for the 2012 and 2016 nomination process.

Editor’s note: Some of these numbers could change before results are certified, so take them with a grain of salt.

“I think this is the type of year where that is possible,” Culver said in an interview at Obama’s Friday rally. “It could be like 1964. We (Democrats) literally had people on the ballot in 1964 who didn’t even know they were on the ballot.”

In Iowa’s Fifth District, Democrat Rob Hubler of Council Bluffs is challenging three-term U.S. Rep. Steve King,. R-Kiron.

“Perhaps the people of the Fifth District want a change,” said Culver, a Democrat.

While King is considered the decided favorite by all logical measures, Culver said Democratic momentum, turnout and early voting are off the charts — all factors that could sweep Hubler past a stunned King.

Obama’s visit to Des Moines in the final days of the campaign helps candidates up and down the ticket across the state, Culver said in an interview with Iowa Independent following Obama’s speech to an estimated crowd of 25,000 in downtown Des Moines.

“The fact that he’s here is really going to help us down the stretch as far as getting everyone to the polls,” Culver said.