Governor Terry Branstad and Lt. Governor Kim Reynolds Tuesday, September 30, 2014

A HEALTHY DISCUSSION: Governor Terry Branstad and Lt. Governor Kim Reynolds Tuesday, September 30, 2014

Dr. Angela Franklin, President of Des Moines University kicked off the first A HEALTHY DISCUSSION of 2014 on Tuesday, September 30th with Governor Terry Branstad and Lt. Governor Kim Reynolds by welcoming those in attendance to DMU and discussing the University’s mission.

She then to introduced, PBH Co-chair Dr. Andy McGuire who outlined the goal of the Healthy Discussion forum as a bipartisan opportunity for the Iowa Congressional Delegation to address their position on health care and educate PBH partners and DMU Students and faculty on issues that are critical to health care in Iowa. Andy introduced the Governor and Lt. Governor and recognized Branstad for his work in health care and coverage for the Medicaid population.

Lt. Governor Reynolds spoke first and indicated the successes of the Branstad/Reynolds administration in the realm of budgeting and business growth. She also highlighted the Healthiest State Initiative and Blue Zone’s Projects as ways public/private partnerships can move the needle on health. She also discussed how important it is for our younger students to be educated in math and science. She expressed the administration’s passionate and commitment to the STEM initiative, which engages students in these areas, so they are prepared to be Iowa’s next leaders in health care.

Governor Branstad began his presentation by thanking the Partnership for Better Health and Des Moines University for hosting the Healthy Discussions program. He discussed his time at DMU and how he was proud of the accomplishments there, especially the creation of the wellness center and being the only University in the nation to have been certified as a platinum level wellness leader by WELCOA.

His comments focused on the Health and Wellness Plan compromise for Medicaid expansion and the Healthiest State initiative as his major accomplishments in healthcare over the last 4 years as Governor.

The Governor and Lt. Governor answered tough questions from PBH advocates, DMU students and faculty. When asked about tobacco prevention he indicated he was firmly anti-tobacco and proud of his efforts at the state and DMU. Any efforts in implementing tobacco control need to be evidence-based practices. He also stated his support of closing the casino loophole even though it faced long odds.

On innovation in healthcare they described a robust economy in Iowa that supports business who create new cures and treatments was essential. Branstad discussed the need for a policy community, which supports public private partnerships for innovation to prosper in Iowa. Additionally they had visited many companies engaged in this area and were excited about Iowa’s future her because of their efforts to grow the economy and the STEM initiative.

Finally, DMU physical therapy students and faculty asked questions surrounding the need to reduce patient co-pays for physical and occupational therapy. The Governor indicated he needed to learn more about this and directed them to meet with his staff to discuss options for next session, but supported the idea of providing greater access to care that reduces cost.

The first A HEALTHY DISCUSSION of 2014 was very well attended, with over 100 student, faculty and PBH partners in attendance.

______The Des Moines Register’s Tony Ley’s covered the discussion. The article can be found below and at the following link. http://www.desmoinesregister.com/story/news/politics/2014/09/30/terry- branstad-pessimistic-about-banning-smoking-in-casinos/16494845/

Branstad pessimistic about banning smoking in casinos Des Moines Register Tony Leys, [email protected] September 30, 2014

Gov. Terry Branstad reiterated Tuesday that smoking should be banned from casinos, but he warned public health advocates not to get their hopes up.

"I'm a realist. I can tell you you're up against one of the most powerful and prosperous industries," he said of the casinos. "…They have a huge amount of clout. They have a lot of money. They have a lot of impact."

The Iowa Legislature exempted casinos in 2008 when it voted to ban smoking from most workplaces, including bars and restaurants. Since then, casinos have beaten back all attempts to expand the ban. They contend that they would lose significant business if they banned smoking, which would cause the loss of jobs and state tax revenue.

Branstad recalled how he tried a few years ago to have legislators change a tax law affecting casinos. "I got clobbered," he said. "The casinos beat me."

Branstad, who was not governor when the smoking ban passed, was responding to a question at a health care forum at Des Moines University. The question came from Stacy Frelund, government relations director for the Iowa Heart Association. Frelund recounted how previous proposals to ban smoking in casinos have died in the Iowa House of Representatives, which is controlled by Branstad's fellow Republicans. She asked if he would help push the House to pass such a bill in next year's session.

The governor said he would continue to speak out on the subject, and he said the public supports banning smoking in casinos. But he added, "I'm not optimistic."

Frelund said afterward that it's unfair for casino employees to face the health risks of working in smoky environments when workers in other businesses have been spared. She said other states, including Illinois, have banned smoking in casinos, and she expressed hope that Iowa would join them someday.

Frelund said she appreciated Branstad's support but wished he could persuade legislators to change their votes. "He's not our problem," she said, agreeing with him that the casino industry holds tremendous power in the Statehouse. "It's like fighting the 500-pound gorilla."

In an interview after the forum, the governor said some people falsely think he can order legislative leaders around. "Just because they're the same party doesn't mean that I can necessarily get their support on everything," he said. He predicted that the most likely way to pass a casino smoking ban would be to include it in a bargain with the industry.

"If there's something they really want, maybe it can get done," he said. But he said he wasn't sure what that bargaining chip would be.

Iowa Gaming Association President Wes Ehrecke said later Tuesday that the 18 commercial casinos in his organization provide "state-of-the-art ventilation" to minimize the smoke. He said they also have smoke- free restaurants, shops and meeting spaces, and most offer smoke-free gambling areas. But he said banning all smoking from Iowa state-regulated casinos would make them lose customers to tribal casinos and other states' casinos. "States who have banned smoking in their casinos have seen revenues drop up to 30 percent," he wrote in an email to the Register. "That would mean a decrease of gaming tax revenue to be allocated by the Iowa Legislature of $60 million to $90 million."

A spokeswoman for Iowa House leaders declined to comment on the issue.

The casino-smoking issue was one of the few negative notes in Branstad's appearance. He spent most of his time at the forum touting his administration's health care successes, including passing a version of an expanded Medicaid program and making progress toward his goal of making Iowa the healthiest state in the nation.

His Democratic opponent, Jack Hatch, is scheduled to make a similar appearance at Des Moines University at noon on Oct. 10. Democratic congressional candidate Staci Appel is to make an appearance there at noon Friday. Her Republican opponent, David Young, is slated to speak there at noon Oct. 13.

A HEALTHY DISCUSSION: Staci Appel, Candidate for Iowa’s 3rd Congressional District Friday, October 3, 2014

On October 3rd, the second A HEALTHY DISCUSSION of 2014 welcomed Staci Appel, candidate for Iowa’s 3rd Congressional District. Dr. Angela Franklin, President of Des Moines University, greeted the audience and discussed the University’s mission. She then introduced PBH Co-Chair Dr. Andy McGuire. McGuire introduced Staci Appel and recognized her leadership in the Iowa Senate.

Appel presented herself as a mother and formal financial consultant. She noted her passion for supporting middle class families, seniors, and education. Appel detailed her accomplishments in the Iowa Senate, noting that 26,000 students now attended pre-school in Iowa, compared to just 5,000 prior to the legislation she spearheaded. She called Iowa’s state smoking ban the strongest indoor and outdoor ban in the nation and spoke of her role in helping Iowa become the first state to require equal work for equal pay.

After Appel’s introduction, she answered a variety of questions from the audience. About 50 students, professors, and PBH partners attended the program.

Appel acknowledged the importance of addressing health issues at a young age. She promoted initiatives that improve nutrition and exercise in schools, as well as preventing poor health choices, like teenage smoking. Among the list, she recognized Tom Harkin’s legislation to provide fresh fruit in schools.

Though she was not willing to give her full support, Appel mentioned she was willing to further discuss a federal law that allows medical uses of a cannabis oil extract. Appel would support more funding for research into other innovative treatment for chronic diseases.

When asked about public health issues, Appel referenced the Ebola virus outbreak. She said she recognized the need to put more funding in the CDC to contain and treat diseases. After mentioning her work on the 2007 Iowa Smoking Ban, Appel said she would love to work on opportunities to ban smoking nationwide.

Appel was asked a number of questions by current and future doctors. When asked about the aging population of rural doctors in Iowa, Appel noted the need for a loan forgiveness program for doctors. Appel was also questioned about doctors leaving Iowa for states that offer higher Medicare and Medicaid reimbursement rates. She indicated the need for higher reimbursement rates to help keep physicians in state.

Appel said her top health-related priority is to allow Medicare to negotiate drug prices with pharmaceutical companies. Overall, Appel called for more certainty in the health care field for patients and providers alike.

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The Des Moines Register’s Tony Ley’s covered the discussion. The article can be found below and at the following link. http://www.desmoinesregister.com/story/news/politics/2014/10/03/staci-appel-speaks-at-des- moines-university-health-care/16661649/

Appel says government can do more to promote health. Tony Leys, [email protected]

Democratic congressional candidate Staci Appel pledged Friday to support a range of programs to help Americans improve and maintain their health.

"There's a lot of things we can do," Appel said at a health-care forum at Des Moines University.

The former state senator from Ackworth is running for Iowa's 3rd Congressional District seat, which is open because Republican Tom Latham is retiring.

Appel, who served one term in the Iowa Senate, touted her work on a successful 2008 bill to ban smoking in most workplaces, including bars and restaurants. "We have the strongest indoor and outdoor smoking in the nation. That was not an easy task to do," she said.

Appel acknowledged later that anti-tobacco activists are pressing to tighten the ban further by eliminating an exemption for casinos, as some other states have done. But she said that the outdoor limits in Iowa's ban make it tougher than any other state's. (The American Lung Association gives A grades to Iowa and 25 other states for their smoking bans.)

Appel said that if she's elected to Congress, she would pursue more measures to discourage smoking, including among teens. "That's something that once you get started, you can't stop," she said of smoking.

She also pledged to push for more physical activity and better nutrition in schools. She said she wants more support for public-health agencies, such as the Centers for Disease Control and Prevention, to combat outbreaks such as the Ebola virus. Iowa has never sent a woman to the U.S. House or Senate. Appel suggested changing that pattern could help families and children. "When we elected more women to the state Senate we passed quality preschool, we passed the statewide smoking ban, we passed the texting ban," she said.

In response to several questions from the audience, Appel indicated she didn't know details of proposals but was willing to talk about them. One was from an activist for the Epilepsy Foundation, who asked the candidate if she would support changing federal law to allow medical uses of a marijuana extract. Proponents say such extracts help control seizures and don't make users high.

Appel said she had mixed feelings about the issue. "This is hard, because as a mom, I'm not supportive of legalizing marijuana in any fashion," she said. "But when you start talking about using it for medical things, if I had a child who needed it I'd probably move heaven and earth to get what my child needed. So it's something I'd willing to talk about and look at."

Appel's Republican opponent, David Young, is scheduled to speak at Des Moines University at noon Oct. 13. Democratic gubernatorial candidate Jack Hatch is to speak there at noon Oct. 10. Gov. Terry Branstad spoke there Tuesday.

A HEALTHY DISCUSSION: Jack Hatch, Gubernatorial Candidate for the State of Iowa Friday, October 10, 2014

On October 10th, the Partnership for Better Health and Des Moines University hosted the third A HEALTHY DISCUSSION and welcomed Jack Hatch, Gubernatorial Candidate for the State of Iowa.

Des Moines University President Dr. Angela Franklin introduced the audience of over 70 to Senator Hatch. Dr. Franklin spoke of Hatch’s 30 years as a businessman, but also listed his efforts as a member of the Iowa legislature. Specifically, she referred to Hatch’s assistance to victims of the Iowa floods of 2008, as well as his strong involvement with the Affordable Care Act.

Dr. Franklin then introduced Gubernatorial candidate Jack Hatch, who began by giving brief remarks on his participation in health care as a policy maker. Hatch told the audience his decision to enter public administration came as a result of the dramatic impact public policies have on communities and individuals.

Hatch recounted the extraordinary opportunities his last 12 years as a legislator has given him, particularly related to health. Hatch worked with the White House on the development, passage, and execution of the Affordable Care Act. In this role, Hatch headed a task force of state legislators who discussed the legislation on a weekly basis. Hatch called the Affordable Care Act a success in improving the cost and quality of health care, and hopes to implement the act to the fullest as Governor. According to Hatch, all Iowan adults and children should have insurance, and all providers should be able to practice medicine the way they want.

In addition to his work on the affordable care act, Hatch created the Community Health Center Incubator Program and the Iowa Collaborative Safety Net Provider Network to increase the number of adults with access to health care, as well as the number of community health centers in the state. Hatch has also been committed to providing health care insurance for children, working to make Iowa the state with the largest percentage of insured children in the nation.

If elected governor, Hatch described his wishes to rearrange state government to centralize health care by moving Medicaid from the Department of Human Services into the Department of Health. As a result, all health decisions, safety net providers and health information would be contained in one location. Hatch believes unifying health care would allow Iowa to focus on improving the health of citizens, as well as better educating state legislators. Hatch would also pursue a strong health insurance marketplace exchange, to give people more options on their insurance.

Hatch fielded a question from a physical therapy student who voiced his concern on the insurance classification of professionals like physical and occupational therapists as specialized care. As a result, patients are forced to pay higher co-pays in comparison to other physicians. In response, Hatch expressed his support of ensuring physical therapists are included in the Affordable Care Act reimbursement and payment system to ensure they receive the reimbursement they need.

Senator Hatch articulated his concern about the lack of direct care workers that are licensed. Consequently, skilled workers in this field are paid poorly, while unqualified workers have no limits to the work they can do. He highlighted his initiative to create a professional career ladder for direct care workers to create a registration and licensing system for the occupation. As Hatch said, this ladder would improve the direct care field and make qualified health care workers more accessible to people at home.

Hatch believes a single payer health care system, which is now used in Vermont, would not be possible to enact in his lifetime due to political constraints. As a result, he said he would focus on improving the efficiency of the current healthcare system. Particularly, Hatch would like to improve our health care technology to help citizens receive their medical records in a fast, inexpensive manner.

According to an audience member, providing one school nurse for every 750 students is recommended in Iowa, but not enforced. Hatch said he would bring together the Department of Health and the Department of Education to increase health care providers in schools. Hatch would also aggressively support the use of medical cannabis for chronic illnesses, as well as using health impact assessments to set a standard for health in Iowa.

In closing, Hatch recognized the opportunity for Iowa to truly be the healthiest state in the nation. According the Gubernatorial candidate, however, the title of ‘healthiest state’ has to be earned by creating policies that ensure every Iowan has access to high quality health insurance.

Hatch: Iowa should allow medical marijuana distribution. Tony Leys, [email protected]

Iowa should set up a practical program to help patients with legitimate needs obtain medical marijuana, Democratic gubernatorial candidate Jack Hatch said Friday.

"We need to grow it here, dispense it here and regulate it here," the state senator said in a health-care forum at Des Moines University.

Last spring, the Legislature passed a law decriminalizing possession of a marijuana extract for treatment of severe epilepsy. But the new law provides no way for families to obtain the extract legally.

Hatch voted for that law, but he sees it as just a first step. "As good as it was, it's impossible to implement," he said.

His Republican opponent, Gov. Terry Branstad, signed the bill, but has indicated he doesn't want to expand the law anytime soon. Hatch said Friday that it should be broadened to let people with other diseases use medical marijuana if there is scientific evidence the drug could help them. Afterward, he said examples could include cystic fibrosis, multiple sclerosis, cancer and chronic pain.

He said he would have the state government strictly limit who could grow and sell medical marijuana. It should only be available in a few dispensaries, so authorities could keep close tabs on the distribution, he said.

Hatch made his comments about marijuana in response to a question from the state leader of the Epilepsy Foundation, which is lobbying for greater access to the drug for people who have documented need for it.

Hatch has said he wants to see how states such as Colorado fare with legalized recreational marijuana before considering allowing that in Iowa. Branstad opposes any move to legalize recreational marijuana.

Friday's forum was part of a series of such appearances organized at Des Moines University by the Partnership for Better Health. Branstad participated in it last week. Hatch, the longtime co-chairman of the main legislative committee overseeing health care, spent much of his appearance Friday touting his work on reforming Iowa's health-care system and on helping form and implement the federal Affordable Care Act. "What the federal government did, and what the state did will go down as probably one of the greatest public-policy initiatives of this century," he said.

He said the new federal law "certainly needs some work," including the creation of a state health insurance exchange so Iowa officials would have more control. But he said the law is already making the American health-care system more efficient and effective. Hatch denied critics' allegations that the Affordable Care Act is "socialized medicine." He noted that instead of having the government run the health-care system, the new law relies on private insurers and hospital systems.

An audience member asked if Hatch would support a single-payer health-care system, in which a government insurance plan similar to Medicare would cover everyone. Hatch said he sees the appeal of that idea, but it's politically impossible. "It's not going to happen. Not in my lifetime," he said.

He said that if he's elected governor next month, he would push to improve implementation of the Affordable Care Act, not seek to replace it with a single-payer system in Iowa or nationally.

A HEALTHY DISCCUSSION: David Young, Candidate for Iowa’s 3rd Congressional District Monday, October 13, 2014

The final A HEALTHY DISCUSSION of the 2014 was David Young, candidate for Iowa’s 3rd Congressional District.

Des Moines University President Dr. Angela Franklin presented David Young and spoke of his background, including his native Iowa roots and seven years spent as Senator Chuck Grassley’s chief of staff. Franklin noted Young’s work alongside Grassley to prevent government overreach, waste and abuse of power.

Dr. Franklin then introduced congressional candidate David Young, who began by introducing himself to the audience. He praised his Iowa upbringing for fostering the work ethic that put him in the position to be able to serve his state. Young called working with Grassley a blessing, noting it gave him an opportunity to see Washington D.C. up close, and discover what works in government. Young said his time in Washington showed him how to listen to constituents, watch government and work across the aisle. He told the crowd he would continue to do so if elected.

Young listed three major deficits he sees in government: budget deficit, job deficit and trust deficit. To solve these issues, Young called for the development of bipartisan efforts, accountability, and certainty. Despite the challenges he saw and continues to see in Washington, Young called himself an optimist.

In regards to the Affordable Care Act, however, Young named himself a realist. He said the law was too partisan and created uncertainty, but will not be repealed or changed comprehensively. As a result, Young said he would work to simply improve the law.

Young told the crowd he is in favor of the current health care market, but wants more transparency from providers, saying citizens should know the cost of their care up front. He said this transparency would create more competition between providers and drive prices down.

In response to the current high student loan debt, Young said he would be in favor of loan forgiveness programs for students that enter certain occupations or work in certain areas. Young also called for more certainty on reimbursement rates for physicians to create more certainty in the medical community.

When questioned on his opinion to set term limits for elected officials to eliminate the career politicians, Young said he believes seniority for politicians resulting from more terms in office helps smaller, more rural states like Iowa to have a larger voice.

When asked about legalizing the use of medical cannabis, Young said he is sympathetic to the situation faced by the ill and parents of ill children. He would look to the FDA to ensure the treatment is safe and effective. Young made sure to note a clear distinction between the approval of legalizing cannabis treatment and legalizing drugs.

Young was not in favor of standardizing social security or changing Medicare to allow negotiation with pharmaceutical companies. On both issues, Young cited Iowa seniors’ approval of both programs. He also called for the strengthening of safety net programs like Medicare and CHIP (Children’s Health Insurance Program.)

When referring the current Ebola outbreak, Young called for more funding to the CDC as well as research programs at hospitals. He would also like to see more communication between the CDC and public health officials at every level.

In closing, Young ensured the crowd he takes his job seriously and recognized the efforts of those in the medical field. The discussion was well attended with an audience of about 70 students, faculty and PBH partners.

______The Des Moines Register’s Tony Ley’s covered the discussion. The article can be found below and at the following link. http://www.desmoinesregister.com/story/news/politics/2014/10/13/david-young-obamacare- affordable-care-act-des-moines-university/17211629/

Obamacare is “here to stay,” GOP candidate Young says. Tony Leys, [email protected]

The Affordable Care Act is a bad law, but it's not likely to be repealed, Republican congressional candidate David Young said Monday.

Young, who is running for Iowa's Third District seat, said it might be possible to make "some tweaks here and there. But I think this law is going to be here to stay. … The president is not going to allow his keystone legislation to go by the wayside. So we're going to have to work to make it better."

Young was speaking at a health care forum at Des Moines University. He noted that some other politicians are vowing to repeal the Affordable Care Act, also known as Obamacare. He said he agrees with that sentiment. But he said at this point, it would be more productive to focus on what's possible, and to reach out to members of both parties to find compromises. "I'll be at the table trying to fix it," he said.

He said he favors using market forces and transparency, including on health care prices, instead of increased government regulation. But he said the country also needs a "strong safety net," to help people who fall through the cracks of the health care system. "I think it's always going to be a public/private partnership," he said.

He also pledged to keep a close eye on new regulations still coming out of the Affordable Care Act, to make sure they're not too burdensome on patients, health care providers or employers.

Young is the former chief of staff for U.S. Sen. Chuck Grassley. He said he learned from Grassley how to be an effective member of Congress.

"You hear a lot of partisanship out there on both sides; a lot of people banging their fists and screaming. That's not me," he said. "…I don't want to blow up the government, but I've got a stick and I like to whack it here and there."

He also said the current threat of the Ebola virus illustrates the need to fully finance public health agencies, including the Centers for Disease Control and Prevention.

He pushes for balanced budgets, but he said, "I could think of some other departments to go after." For example, he said, billions of dollars are being lost to fraud and waste in the Defense Department budget.

Young's audience Monday included Sally Gaer of West Des Moines, a Republican who helped lead the fight last spring to have Iowa pass a limited medical marijuana law. Gaer's daughter has a severe form of epilepsy, and the family wants to obtain a marijuana extract to help control her seizures. She noted that it's next to impossible for Iowans to use the state's new law, partly because of federal laws still banning almost any use of marijuana products. Gaer asked Young what he thought the federal government should do for people who have legitimate medical needs for the drug.

Young replied that he wouldn't support broad legalization of marijuana, but he said the government could take steps to have families like Gaer's. For example, he said, Iowa families with proper state permission should not be punished for obtaining the drug in another state and trying to bring it home. "We need to make sure you're not feeling like some kind of renegade when you're picking it up," he said.

He also said he would ask the Food and Drug Administration to study the issue of medical marijuana and make recommendations to Congress.

After the forum, a spokesman for Young's Democratic opponent, Staci Appel, accused Young of changing his stance on the Affordable Care Act now that he's in a general-election campaign. In an email, Nick Galbraith quoted from a Young Facebook entry from 2013, in which he said the Republican declared Congress should "rip out" the law. Now, Galbraith said, Young is saying he wants to fix it.

Young spokesman Tim Albrecht responded by saying that the Republican candidate has repeatedly said President Obama is unlikely to accept repeal of the Affordable Care Act. "David Young would work within the system to change this terrible piece of legislation, while Staci Appel continues to champion Obama's government takeover of our health care system," Albrecht wrote.