IPA Capitol Report

State Capitol Report

January 16, 2023

Legislative Session Off to Fast Start

The first regular session of the 90th Iowa General Assembly gaveled in at 10:00 am on Monday, January 9th, 2023. This marked the first day of the scheduled 110-day session, with a target adjournment date of Friday, April 28th, 2023.

First Day of Session - House (left) and Senate (right). In the Senate photo, Senator Amy Sinclair takes the Oath of Office to serve as President of the Iowa Senate.

New Legislators

The 90th General Assembly includes a total of 53 new legislators: 39 in the Iowa House and 14 in the Iowa Senate. The 39 new House members include 23 Republicans and 16 Democrats, with one of the new Republicans having come from the Iowa Senate. The 14 new Senators consist of 9 Republicans and 5 Democrats, with 4 of the Republicans and 3 of the Democrats having come from the Iowa House.

Chamber Control

The Republicans control the Iowa House by a 64-36 margin and the Iowa Senate by a 34-16 margin. This is an increase of 4 seats in the House and 2 seats in the Senate from 2022. This means Senate Republicans have the coveted "supermajority," which allows them to confirm all of the Governor's judicial, agency, and board/commission appointments without needing a single Democratic vote. Additionally, Republicans nearly swept all statewide offices, with Governor Kim Reynolds, Secretary of State Paul Pate, and Secretary of Agriculture Mike Naig all winning easily. Republican Brenna Bird was able to oust longtime Democrat Attorney General Tom Miller, and Republican Roby Smith was able to defeat longtime Democrat Treasurer Mike Fitzgerald, flipping those two offices for the first time in 40 years. The only statewide office that Democrats were able to hold onto was that of State Auditor Rob Sand.

Leadership

In the Senate, Republican Senate Majority Leader Jack Whitver remains in his role as Floor Leader of the chamber as well as Senator Brad Zaun as Senate President Pro Tempore. Senator Amy Sinclair now serves as the President of the Senate and Senator Waylon Brown is the Majority Whip. The Senate Democrats are led again by Senator Zach Wahls who is joined by new Minority Whip Senator Sarah Trone Garriott, who defeated former Senate President Jake Chapman in the 2022 election.

In the House, Republicans re-elected Speaker Pat Grassley, Majority Leader Matt Windshitl and Speaker Pro Tempore John Wills. For the Democrats, Minority Leader Jennifer Konfrst and Minority Whip Lindsay James also return to their roles, this year with an all-female leadership team to back them up. You can view the full leadership teams of each party in each chamber here. You can read the opening statements from legislators here. Note that the Democrats have listed legalization of marijuana as one of their top issues for 2023.

Condition of the State

Governor Reynolds delivered her Condition of the State address at 6:00 pm on Tuesday, January 10th, where she provided her budget and priorities for the 2023 legislative session. The main legislative highlights the Governor wishes to pursue are:

A school choice proposal that allows any Iowa student (after a 3-year phase-in) to be able to take the $7,598/year that would have gone to their public school, instead using it to pay for private school tuition.
Major new restructuring of state government that will reorganize the duties of 37 executive branch entities and shrink cabinet level offices to 16.
Put a moratorium on any new administrative rules until a four-year review is completed.
Big investment in health career pathways (apprenticeships) - adding $12 million more to the $3 million already appropriated to encourage high school student to get into mental and behavioral health jobs, nursing, and direct support professions.
Enhancing penalties (zero tolerance) for manufacturing and distributing fentanyl laced products, and improve access to naloxone by allowing fire departments, EMS, police, schools, health care providers (including behavioral health providers), county health departments, and state agencies to distribute it.

The Governor's budget increases state spending by 3.3%, but only spends 88.2% of available revenues (far below the 99% limit). The total $8.487 billion budget leaves a projected $2 billion ending fund balance, about 23.5% of the state's budget. The Governor's budget includes:

$15 million increase for Medicaid to increase rates paid to 430 nursing homes. Medicaid is expected to have money left over at the end of the budget year (June 30, 2023) – about $322.7 million will be unspent. The Governor’s budget will bring that down to $104.2 million at the end of June 2024.

$7.2 million increase to help DHS pay for changes at state institutions, some to comply with the Department of Justice agreement (but the funds are flexible and can be used as needed by DHHS).

$6.5 million increase for mental health/disability services regions as planned (as regions spent down balances, state funds were needed to fill that gap). That brings the total to $141 million.

$82.8 million to public schools (2.5% increase) and $106.9 million for private school scholarships (this would fund scholarships for 14,068 students).

You can read more about the Governor’s budget and policy priorities below:

IPA & Governor's Priorities

There are quite a few details in the Governor's proposal to highlight:

Government Restructuring will include moving all professional licensing from DHHS to the Department of Inspections and Appeals. We do not know details on this yet, but one thing government restructuring requires is re-writing rules (so not sure how that comports with the moratorium on new rules the Governor signed last week).

The Governor expands her registered apprenticeship program to create more career pathways to go beyond nursing, and include EMS and direct support professionals. She also wants to incentivize behavioral health providers to create career pathways and apprenticeships for community health workers, behavioral health counselors and substance abuse counselors. The Governor asks for a total of $15 million (an increase of $12 million) to expand this effort.

The Governor is also recommending improving specialty care in rural areas by expanding her "Centers of Excellence" initiative that partners large health systems with small rural hospitals to focus on maternal health, cancer treatment, and surgery. The additional $575,000 will add two additional centers of excellence (bringing total to four). The Governor also plans to pass legislation to allow designation of rural emergency hospitals, which brings with it additional federal funds to stabilize emergency outpatient services in rural areas.

The Governor also leant her support to medical malpractice tort reform, asking legislators to move ahead with capping non-economic damages ("pain and suffering") for injuries, disability, or death caused by medical errors.

The Governor has put a focus on state investments, including IPERS retirement funds. She wants to pass legislation that prohibits any investment firms that manage the state's money from boycotting fossil fuel energy or firearms companies and divest any holdings in companies that engage in ESG (environmental, social, governance) strategies.

Finally, the Governor's education reform package includes a parents rights component that she says will create “culture of transparency” and “set boundaries to protect Iowa’s children from woke indoctrination.”

MH/DS Regions Report

Iowa’s mental health and disability services regions pay for core services, including crisis services, for those that are not eligible for Medicaid. They also pay for services that are not covered by Medicaid. Over the last two years, the state changed the way the system is funded, moving away property taxes to being 100% state funded.

Iowa Department of Health & Human Services (DHHS) has released a report on the regions and has included some recommendations. The report found:

Services are not consistent across the state.
Services are not defined and put in place in the same way across regions.
Governing boards need to include more stakeholders and fewer county supervisors.
Data needs to be integrated so tracking can be consistent.

The report recommends:

Limiting county elected officials to 49% of the governing board membership.
Increasing voices of other stakeholders on governing board, including law enforcement and judges.
Allow regions to keep 10% of their budgets in the bank, so they can cover expenses while they wait for state reimbursement (they are currently only allowed to keep 5%).
Add community-based competency restoration to the list of core services that a region is required to fund. This service helps people found incompetent to stand trial in the community, instead of relying on MHIs.
Eliminate unnecessary quarterly reporting (annual reports are still required).

The report has a lot of detailed information in the report:

· You can read the report and recommendations here.

· You can see a map of the regions here.

IPA Bill Tracker

With the Governor’s address in the rear view mirror, the Legislature will now spend the next seven weeks introducing bills by the truckload. Legislators have until February 10 to request bills, and until March 3 to get them out of their committee of origin (the infamous "first funnel" that kills off bills not making forward progress).

The IPA bill tracker is the best place to find updates on where bills are in the legislative process. Bills are added daily, and bill status is in real-time, so you can always know where a bill is in the legislative process.

There are already bills that:

Fix Iowa's prescribing psychologist law to eliminate restrictions that a person complete their program within five years of asking for a license, require residency supervision by a board-certified physician, and allow prescribing only to people whose primary care provider is a physician. This is IPA's bill; we support!
Create new hoops for people to access public assistance (including Medicaid).
Prohibit gender identity and sexual orientation instruction in grades K-3.
Prohibit schools from accommodating gender non-conforming students (and require teachers to "out" them to their their parents). IPA is opposed.
Enacts PsyPACT (IPA remains opposed).
Creates a Professional Counselors Compact (IPA supports).
Changes the mental health professional loan repayment program.
Prohibits non-compete contracts with mental health professionals.
Conduct a study on the impact of technology on student cognitive abilities (IPA is "undecided" in order to request that a psychologist be part of this study).