Dubuque Telegraph Herald . April 17, 2016
In life-and-death battle against heroin, Dubuque needs more help.
Today’s extensive front-page report examining the scourge of heroin - its use, abuse and toll on lives - has been weeks in the making. It could not have come soon enough.
Alicia Yager’s report was in the final stages of editing when we learned that a leading local crusader against heroin, Vicki Allendorf, had lost sons to heroin overdose.
You read that correctly: sons.
Two of Allendorf’s sons, 31-year-old Zachary J. McPoland and 27-year-old Terry T. McPoland, succumbed to their heroin addiction on the very same day.
Few among us have come anywhere close to experiencing such a devastating loss, and for her to suffer it as a single mother - the young men’s father died in 2014 - and after a protracted, courageous life-and-death battle against the insidious grip of addiction, challenges our limits of comprehension.
Friends, family and the community can only express their sympathy and support. No, that’s not correct. There is more that can - and must - be done, and it must involve more segments of society than this community.
Even before the McPoland brothers’ death, many of us were aware - through our reporting here and other sources - of the skyrocketing threat of heroin, particularly in Dubuque County. The double tragedy served to put a “face” on the crisis, and no doubt contributed to attendance and interest in the previously scheduled town hall session in Dubuque conducted Wednesday evening.
If you didn’t attend or watch the event broadcast on THonline.com, we encourage you to watch the archived video of the event on our website. It puts the dangers, the toll and the challenges into focus. As Sgt. Gary Pape, of the Dubuque Drug Task Force, put it, “Heroin is our most tragic drug by far.”
The meeting also made it clear that there is no single, silver-bullet solution. It will require involvement and commitment from many segments of society, including medicine, government, law enforcement, judiciary, treatment centers and the community at large.
If one fact became clear at the town hall, it is this: Dubuque County is fighting this epidemic with one hand tied behind its back. It lacks sufficient resources.
Dubuque County recently came into additional money to ramp up treatment programs, but it needs more. Dubuque County - this region, in fact - lacks space for people needing in-patient attention.
The addictive nature of opioid painkillers puts many patients at risk of becoming drug-dependent, which can lead to addiction to the painkillers and, later, heroin. Many of the tragic stories we’ve heard lately start out with issuance of a prescription for painkillers.
It’s time to re-examine the pressures on doctors and hospitals - especially in a competitive health care marketplace and litigious society - to take a hard look at contemporary thought that patients should, at virtually all costs, have a pain-free medical experience.
That look is underway. The Centers for Disease Control and Prevention last month released guidelines intended to limit prescriptions for opioids. Note, however, that the guidelines are only voluntary.
The heroin epidemic is like an earthquake - striking with little warning and with devastating impact - and Dubuque is an epicenter. If we’ve learned anything the past week, through the double tragedy and the town hall session, it is that this community needs more help to combat it.___
The Des Moines Register. April 17, 2016
A ’smooth’ Medicaid transition, governor?
Gov. Terry Branstad succeeded in implementing his wildly unpopular plan to privatize Medicaid. The state officially turned over administration of the $4.2 billion program to for-profit insurers on none other than April Fool’s Day.
About 72 hours later, the governor characterized the transition as “smooth.” It “went off without any major disruptions to Medicaid patients or the providers that have been serving them,” he said during a press conference.
Few Iowa health providers would describe any aspect of privatization as smooth. And the extent of disruption to patients remains to be seen. No one knows whether their health insurance works until they try to use it. Hundreds of thousands of Iowans will begin doing that this month.
Understanding their experiences with managed care companies so far means relying on anecdotes, including those shared with associations, the newspaper and on social media. One Facebook post garnering much attention comes from Melissa Gentry, a physician’s assistant in Oskaloosa. When she posted a message directed to “Iowa Medicaid MCOs” about an unnamed patient, she had no idea it would be shared by thousands of people.
Gentry acknowledged managed care companies were working through “kinks” in the initial days, but her patient is in no position to navigate them. He has schizophrenia. Daily life is a struggle. His medication allows him to go out in public, maintain relationships and even work part-time.
“For the first time in a really long time, he feels like a worthwhile human being,” wrote Gentry. “But you just said that his “specialty medicine” has to come from your approved specialty pharmacy. So I sent his prescription to your specialty pharmacy and do you know what they told me? It will take 24-48 hours for approval from the insurance company. Once it’s approved, they will call my office to set up delivery. At which point, the medication will be shipped from the pharmacy in Orlando, Florida to my office in Oskaloosa, Iowa, which may take 5-7 days.”
A week without medication can be catastrophic for someone with schizophrenia. A little paranoia may be followed by not showering, fear of eating, hallucinations and time in the hospital, wrote Gentry.
The head of the Iowa Pharmacy Association said she has heard it is taking a week or more to obtain certain drugs for some people with mental illness. “The patient then has to get a new prescription and get it through mail order,” said executive vice president and CEO Kate Gainer.
Fortunately, Gentry had a sample on hand she could provide her patient. In fact, three patients in two days needed such samples. She got on the phone to get medication quickly delivered. The problem “isn’t about one medication for one person on one day,” she said this week. And some patients, including those who are elderly, frail or suffering from mental illness, may not have providers able to spend the time navigating the new bureaucracy on their behalf.
Amy McCoy, spokeswoman for the Iowa Department of Human Services, said it didn’t seem many patients are facing obstacles in obtaining drugs, and workers are quickly resolving problems. The state has a comprehensive plan to monitor compliance and outcomes going forward, she said, and hopes the news media also focuses on the “good news” stories.
Except the editorial board hasn’t heard any yet.
We did, however, hear from Amie Ford of Davenport. Her 2-year-old son Brayden has cerebral palsy. He receives seven to eight hours a week of therapy, which she credits for his progress. The switch to private Medicaid has meant changing primary care providers. Based on a handbook from the insurer, she has calculated about four weeks of therapy each year will be covered. When she called the insurer to find about increasing that, she was told to check the handbook for the answer.
“We don’t know what is going to happen,” she said.
Kevin McNee of Marion, who receives Social Security for physical and medical disabilities, said he had received no insurance card or booklet from his private insurer by April 1 - three months after privatization was originally supposed to be implemented. So he had no valid card when he went to a doctor’s appointment early this month, but was told there would be no charge. A few days later, he found out the person assigned to handle his financial affairs had received the packet from the insurer at an address on file with the Social Security Administration.
“This worries me because I have no idea who or what agency passed my information along to the MCO,” he said. On Thursday, McNee received in the mail a $233 bill for the April 4 doctor’s appointment.
Lynne Vonderohe of Mason City has been her 28-year-old daughter’s legal guardian for a decade. The state had a record of this when it managed Medicaid. But the MCO doesn’t. When she called the insurer Tuesday to select a primary physician for her daughter, the insurer wouldn’t talk to her. She said they wouldn’t accept her guardianship orders and instead would mail a release form for her daughter to sign.
“My daughter is nonverbal and cannot legally sign any documents,” Vonderohe told an editorial writer last week. “I’m so angry right now. In addition to all the other crap we have to fight, now we have to fight this.”
Then there are the Iowans willing to share their stories but not their names because they’re embarrassed to be enrolled in Medicaid. Among them is a Des Moines woman who understands insurance after working in the industry for 25 years. She now relies on the government insurer and has repeatedly asked for a basic handbook detailing her benefits. She said she was told by both the state and the private insurer they would not mail one. Her options: printing it at the library, which would cost about $17, or downloading it onto a flash drive, which she doesn’t have. She also doesn’t have Internet access at home.
What other problems are Iowans encountering? How many are unable to obtain drugs or see their regular doctor? As of last week, fewer than 70 percent of health providers who had been previously serving Iowa Medicaid patients had signed contracts with all three private managed care companies, according to DHS. Lawmakers say they’re hearing from dozens of constituents with problems.
But according to Iowa’s governor, the transition to his “modernization” of Medicaid has been smooth. Apparently he’s not talking to his constituents.___
Quad-City Times. April 17, 2016
Up or down, Congress owes Central States pensioners a vote.
Give them a vote.
Congress owes that much to the 400,000 retirees set to have their Central States Pension Fund (CSPF) benefits slashed next month.
Thousands of Central States pensioners rallied Thursday at the Capitol in Washington. The private pension fund, like hundreds of others, was mismanaged for decades by trustees. Union bosses were AWOL throughout, turning their heads as the risky investments piled up. With a value of just $1.8 billion, Central States has more than $42 billion in liabilities.
Then, in 2014, Congress got involved. Lawmakers hoped to shield the federal insurance agency that backs private pensions from the coming wave of failing private funds. Inserting a tiny clause, empowering Treasury officials to reduce pension payments in the event of a fund’s pending collapse, did just that. The massive change, potentially altering the lives of 40,000 Central States pensioners in Iowa and Illinois, breezed through Congress with little to no discussion. That’s the beauty - and the farce - of jamming voluminous budget bills with tangential policy.
Rep. Cheri Bustos, D-East Moline, says she approved the massive spending package to avoid a government shutdown. Slighting 400,000 retired delivery drivers and truckers wasn’t her goal when she became the only Quad-Cities lawmaker to back the last-minute funding plan, she said. To make her point, Bustos is co-sponsoring legislation to bail out Central States, saving retired Eagle Foods employee Terry Weeks, of Davenport, from a 58 percent slashing of the pension he paid into for more than 30 years.
Central States admits the proposed bailout is unlikely. The House’s continued slide to the right precludes the bailout from conservatives’ purity test, Central States argues on its website.
Even further, the increasing rarity of private pensions, in a 401(k)-invested economy, feeds anger among non-union taxpayers who snarl at the word “bailout.” Add to that, the inherent politicization of the Senate draft - sponsored by insurgent Democratic presidential candidate Bernie Sanders - and Sanders’ bailout is probably doomed to inaction.
Treasury officials have set a May 7 deadline for a decision. Congress is in session through April 29 before a planned week off.
A congressional side-step would be nothing short of shameful cowardice. The clock is ticking.
The GOP-run Congress, after all, inserted itself into this issue with its 2014 federal funding bill. Yet, lawmakers appear to lack the spine to openly debate the political principles that probably doom the bailout to the dust-collecting pile.
A floor debate followed by a vote is the least Congress can do for the 400,000 Americans facing financial upheaval.
There’s a compelling conservative argument against bailing out Central States. The bank bailout in 2010 still enrages the masses, who aren’t likely to much care about the distinction between hedge fund managers and retired truck drivers. The bill could set a precedent that would cost taxpayers for decades. Up to 200 private pensions could go bust over the next two decades, says the Pension Rights Center. The U.S. government could find itself on the hook for billions, year after year.
But the 400,000 people reliant on the sinking Central States pension were made a promise. Pay in for so long and enjoy a secure retirement. They’re victims of poor management and union indifference. And they’re facing personal catastrophe.
Congress pulled a fast one on more 40,000 Iowans and Illinoisans. True to form, the ruse was well hidden, only rearing its ugly head when Central States pensioners started receiving notices in the mail.
There’s merit to both sides of the Central Fund bailout debate. And congressional Republicans are always willing to make some statement about government spending.
If Republican lawmakers truly believe their mantra, they’ll have the courage to apply it to real people facing real personal disaster.___
Fort Dodge Messenger. April 17, 2016
Water quality gets a major boost.
Keeping water everywhere in the Hawkeye State as free of contaminants as possible is an important goal. Consequently, it’s very good news that additional grants have been approved by the Iowa Department of Agriculture and Land Stewardship to strengthen and broaden the state’s Urban Conservation program.
Late last month Iowa Secretary of Agriculture Bill Northey announced that $919,149 in funding had been authorized for 13 urban conservation water quality initiative demonstration projects. In addition to the state monies, $2.59 million in matching funds will be devoted to these projects. There will also be a variety of in-kind contributions from various parties, according to information provided by IDALS.
“We continue to be encouraged by the response we are seeing both in rural and urban areas to the Iowa Water Quality Initiative,” Northey said in a statement issued March 23. “Iowans are very engaged and these 13 new urban projects, along with the 32 demonstration projects already in place, will allow us to continue to expand the effort and get new water quality practices installed.”
The communities where the 13 new initiatives will take place are Amana, Ankeny, Arnolds Park, Bloomfield, Cedar Rapids (two locations), Davenport, Des Moines (two locations), Lake View, Sioux City, Storm Lake and West Des Moines.
The conservation measures being supported will include efforts to handle runoff from storms occur in ways that minimize degradation of water quality. Reducing flooding from runoff also will be addressed.
The Iowa Water Quality Initiative is an especially noteworthy government program because it puts a strong emphasis on partnerships between governmental bodies and the private sector. According to IDALS it was established “to help implement the Nutrient Reduction Strategy, which is a science-and-technology-based approach to achieving a 45 percent reduction in nitrogen and phosphorus losses to our waters.”
The Messenger welcomes these new conservation projects. Northey’s championing of the Water Quality Initiative deserves applause. This important undertaking will benefit our state far into the future.___
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