- Associated Press - Monday, May 18, 2015

Sioux City Journal. May 13, 2015.

Iowa faces budget challenges, but …

Sometimes, perspective is in order.

Take, for example, the state budget in Iowa.

While it’s true the budget for fiscal 2016 remains a work in progress as overtime continues for the split-control Legislature, creating frustration, if not angst within some quarters of the state, it’s important for Iowans to remember this: According to the Legislative Services Agency, the state treasury will close the current fiscal year with almost $700 million in its cash reserve and economic emergency funds and its general-fund balance will show a surplus of about $352 million. No general fund tax increases or big reductions in spending for specific departments or programs will be necessary.

That’s an enviable fiscal position nearly half of the states across America only can dream about.

An Associated Press story published in the May 10 Journal reported 22 states face budget deficits for next year. Nine states face budget shortfalls of $1 billion or more (Illinois tops the list with a projected deficit of $6 billion).

Governor Terry Branstad and both Republican and Democratic lawmakers in the Legislature share credit for budget leadership. Sometimes it’s difficult to get to a final product in Iowa’s budget negotiations, but the end result is, by and large, responsible. We expect the same will hold true this year. In neighboring South Dakota and Nebraska, the story is much the same.

Want more positive numbers? For the fiscal year beginning July 1, state revenue in Iowa is forecast by the Revenue Estimating Conference to rise by 6 percent over this year. In its most-recent rating of how well the 50 states are run (the rating was released in December), 24/7 Wall Street ranked Iowa number four. The annual review is based on a comprehensive study of data on financial health, standard of living and government services.

We do not diminish budget challenges faced by Iowa, but putting them in proper perspective tells us the overall fiscal picture here at home is, well, pretty good.

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Waterloo-Cedar Falls Courier. May 17, 2015.

Seeking strategies to slow brain drain of Iowa youth

Our public and private universities and colleges do a fine job in educating young people and getting them ready for the global workforce.

It would be nice if more of our own higher education graduates remained in Iowa long after commencement. For years, Iowa’s leaders have decried the so-called “brain drain” - the exodus of graduates of Iowa’s colleges and universities to seek employment in other states.

Last week, a panel of Cedar Valley job placement experts convened at a public forum at The Courier to discuss how the state can retain more educated young people.

Studies by the University of Northern Iowa, University of Iowa and Iowa State University were cited.

Reports show about half of Iowa and ISU respondents reported no longer living in Iowa six months after leaving school. About 85 percent of UNI respondents still lived in Iowa. UNI has a higher percentage of in-state enrollment than the other state schools.

With an eye toward economic growth, it is our hope discussions like these can lead to strategies to keep more of Iowa’s best-educated people in Iowa. However, on a personal level, we cannot begrudge a young, educated Midwesterner who is afflicted with a case of wanderlust. It’s a normal condition found in a significant portion of graduates.

Rachel Dozark Judisch, regional vice president for Blue Stone Therapy Solutions in West Des Moines, said she got involved with the “brain drain” problem because she deals with it on a daily basis.

“In my little world, we can’t find enough educated, qualified professionals,” she said.

However, Judisch, a former member of the Generation Iowa Commission, did note that research shows that by about age 32 a significant portion of former Iowans come back to the state. With that in mind, perhaps one strategy could be a more aggressive outreach to Iowa alums who have been working elsewhere for a number of years.

When raising a family becomes a consideration, former Iowans seem to recall the quality schools and other family-friendly environments they were once so familiar with. Iowa companies can certainly benefit from those who have developed other perspectives from other locations.

Meanwhile, we can also work on outreach to students while they are still making their way through school.

“There’s a lot of great high-end engineering, tech-oriented opportunities out there,” said Danny Ludick, talent solution director at the Greater Cedar Valley Alliance & Chamber. “It’s not just about educating students, it’s about educating those who educate the students.

We simply don’t buy the “there’s nothing to do here” refrain. No, we don’t have ocean beaches (although we do have water available to use) and our winters can be uncomfortable for some. Making a living through a quality career is a top priority for educated young people, but your social and leisure lives are what you make of them - no matter your geographic location.

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The Des Moines Register. May 17, 2015.

Iowans wait for drugs, insurers to respond

If you live in Iowa and your doctor writes you a prescription for a particular drug, it could be several days, or even a few months, before your insurer responds to a request for prior-authorization of coverage for the drug.

That would not be the case if you lived in, say, California . or Louisiana . or Massachusetts . or any one of several states that require insurers to respond to prior-authorization requests within two to three days.

In Iowa, most health insurers can take as long as they like to respond, which has left some policyholders struggling with serious, untreated symptoms.

When Karrie Anderson of Grimes was diagnosed with multiple sclerosis five years ago, she waited three months for her insurer to respond to a prior-authorization request.

“They weren’t saying ‘no,’” she says. “They weren’t saying anything at all. So we were just stuck in limbo, and I wound up spending every other day on the phone with the insurance company trying to find out what was happening.”

When Bill Crawford of Des Moines was diagnosed with cancer two and half years ago, he waited more than eight weeks for prior-authorization of the prescribed cancer drug that doctors said might extend his life another five years. His widow, Mary Ann Crawford, says the delay may have contributed to Bill’s death just five months after the diagnosis.

“When you’re diagnosed with one of the most rapidly growing cancers known to science, you don’t want a lot of delays in the treatment,” she says. “To go home and wait a week, two weeks, a month, two months, knowing that this cancer is growing - well, it’s just devastating.”

Last year, state lawmakers tried to address the problem by approving legislation that would have required insurance companies to respond to a prior-authorization request for medication within 72 hours.

Unfortunately, that provision of the bill was vetoed by Gov. Terry Branstad, who stated, “I believe time requirements are best implemented through the administrative-rules process under the Iowa Insurance Division.”

Initially, the division came up with rules that closely mirrored the legislation, right down to the 72-hour deadline. Then, for reasons that still aren’t clear, the proposed rule was revised and the response deadline was changed to 15 days for non-urgent claims and three days for urgent claims, which led to protests from the Iowa Medical Society, patient advocates and others.

The proposed rule doesn’t define “urgent.” It also leaves open the possibility that an insurer could meet the requirement by simply acknowledging receipt of a prior-authorization request without making a decision that would enable policyholders to either begin receiving their medication or begin the process of appealing a denial.

Thankfully, state lawmakers recognize that a 15-day deadline is not in the public’s interest, and so they have once again taken up this issue. Last month, the House voted 95-0 in favor of the 72-hour rule, but the bill has stalled in the Senate, where it is opposed by Express Scripts, the nation’s largest pharmacy benefits manager and one of the companies that would have to comply with the deadline.

It’s not unreasonable to expect an insurer to respond within 72 hours to a prior-authorization request. After all, Medicaid has 24 hours to respond to such requests, and typically does so within three hours, according to Iowa Medicaid.

Without deadlines, patients are left waiting days or weeks to get an answer to their prior-authorization requests. That’s not just inconvenient. Timely access to medication alleviates pain and suffering, while unnecessary delays lead to costly additional treatment and hospitalizations.

The 72-hour deadline deserves the support of the Iowa Senate and the governor.

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The Hawk Eye.

A thousand cuts: Fatal crash renews Amtrak debate

This week’s fatal Amtrak derailment in Philadelphia raised troubling questions about safety.

The cause hasn’t been determined officially, but the train was traveling dangerously at twice the speed limit on that stretch of track.

The crash clearly hurt the struggling passenger service’s reputation. What the crash that killed at least eight people did not do is justify attempts by Amtrak-hating lawmakers to abolish the nationwide government subsidized passenger system.

Recovery crews still were hunting for missing passengers in the wreckage when two disturbing things happened on the political level.

By coincidence, in Washington a House panel was trying to cut $250 million, or roughly 20 percent, from Amtrak’s federal budget in the fiscal year that begins in October. That would leave Amtrak $1.13 billion to use for operating costs but not one cent for infrastructure. President Barack Obama had requested a notunreasonable $2.5 billion for Amtrak next year.

The Republicanorchestrated budget cut is unacceptable, even unconscionable given Amtrak’s role -after cars and airplanes - as the third wheel in the nation’s commuter and long-distance transportation system.

The Philadelphia accident also became a convenient opportunity for Amtrak supporters to revive debate about improving railroad infrastructure. Most experts say America’s rail lines require tens of billions of dollars in safety upgrades.

Also by coincidence, a bipartisan group of state and bigcity officials were due to arrive in Washington Thursday to lobby Congress to spend more on Amtrak, not less.

They will meet heavy opposition from Republicans who control Congress and have been trying to kill Amtrak for years under the false assumption private railroads companies will assume the service.

All but a handful of railroad companies dumped passenger service 50 years ago because moving freight was more profitable - with none of the baggage or responsibilities that go with accommodating people instead of inanimate objects.

Amtrak trains run mainly on private railroad tracks that weren’t designed for highspeed trains. That must change.

This week’s tragic crash aside, Amtrak routes are in trouble everywhere. In western Illinois, the popular daily commuter train from Quincy to Chicago that stops in Galesburg and Macomb may fold because Gov. Rauner wants to cut the state’s share of the route’s subsidy.

That is just one of many reasons for Americans to demand Congress and their state legislators stop killing Amtrak by a thousand cuts.


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