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State Capitol Report

February 26, 2023


This Week's Highlights


  • It's funnel week - bills have to be voted out of committee to stay alive!
  • No movement on public assistance "reform" bills (but not dead yet).
  • Senate finishes reorganization hearings, House has one more subcommittee.
  • Mental health professional loan repayment program changes safe from funnel.
  • Remote involuntary commitment hearings approved by committee.
  • House subcommittee passes bill forcing insurance to mirror state public policy.
  • House subcommittee passes bill to allow carrying of guns everywhere.
  • Health care provider "conscience" bills pass subs in Senate.
  • Senate subcommittee moves forward with foster care discrimination bill.
  • Government Oversight listens to experts in gender transition treatment.
  • HHS presents Medicaid rate review, behavioral health tops list for increase.
  • New bill restructures HHS boards and commissions (subcommittee Monday).


First Funnel Hits This Week (Week Eight)

Monday will mark Session Day 50 of the 110-day scheduled session, and by the end of the week session will have hit the halfway point.  As of Friday, February 24, legislators have introduced 1,299 bills, ranging from short one-liners to the 1,569-page government reorganization bill.

 

Monday will also mark the first day of the first Funnel Week. By close of business Friday, policy bills will need to have been passed out of their assigned committee in order to stay alive for the session.  This means the introduction of new bills is about to taper off dramatically and the intense number of subcommittee meetings over the last few weeks will be replaced with committee work.

 

After the funnel deadline, activity will switch to floor debate as both chambers try to move bills to the other chamber in preparation for the second Funnel deadline on March 31, when bills have to have passed either the House or Senate, and be out of committee in the other chamber. Essentially committee work ends after March 31, with the exception of the tax (Ways & Means) and budget (Appropriations) committees.

 

Budget work typically follows closely on the heels of the First Funnel. The Revenue Estimating Conference (REC) has set their next meeting for March 10, when they will set new revenue projections. The Legislature is required to set its budget for the coming year (fiscal year 2024) using the lower of two REC estimates (December or March). If March estimates are increased over December, the Legislature must still base its budget on the December numbers. Any funds left over just go toward the state's ever-growing surplus (which toward paying off tax cuts made in previous years).


By next weekend, you will be able to see which bills survived ("active") and which bills died (moved to the "inactive" list) in the IPA Bill Tracker.

Priority Updates

There has been a flurry of subcommittee and committee activity over the last two weeks as legislators prepare or the funnel deadline. Just a few notes on IPA priorities:


  • Fixes to the psychologist prescribing law to remove barriers is now one vote from being sent to the Governor (SF 133 is on the House Calendar ready for debate).


  • IPA successfully fought off occupational therapists trying to be added to the list of "mental health professionals" and the PSYPACT compact that weakens patient protections.


  • Mental health professional loan repayment program changes safe from funnel, but there are competing interests. The House prefers to add back prescribing professionals, but the Senate wants to just make a few adjustments to fix issues that arose during the rules process.


Here are a few other bills to note:


  • No movement on public assistance "reform" bills (HF 3 & SSB 1105), but don't count them dead yet. The bills have passed out of subcommittee, but they may just be tabled until budget discussions (then added to a budget bill).


  • The Senate has wrapped up its review of the Governor's reorganization bill (SSB 1123); it will come out of committee this week. The House has one more subcommittee meeting to review the 900+ page HHS portion of its bill (HSB 126), but it is also going to be voted out of committee before the funnel. It is unlikely they will amend it at this time but there is an amendment being worked on. The only parts that have been controversial are: moving the child advocacy board to HHS and eliminating its autonomy, the state takeover of community-based corrections (and making local boards advisory only), allowing the Attorney General to override county attorney decisions and intercede without being asked, making the Department for the Blind director a governor-appointed position, eliminating the lengthy process in Iowa Law to close or merge the School for the Deaf and the Braille & Sight Saving School (and moving them from Board of Regents to Department of Education), and the removal of director salaries from a range (allowing Governor to set them).


  • The House HHS Committee has advanced a bill (HSB 133) to allow mental health professionals to testify remotely (either video or audio) for involuntary commitment hearings for substance use disorder or mental illness.


  • A House subcommittee advanced a bill (HSB 167) that will prohibit private insurance plans from having policies that do not align with state public policy. While this is an effort to stop private insurance coverage of things like gender affirming care and reproductive care (as well as decisions to pay for services outside the state), it is written broadly and could address other types of treatment as well.


  • On the Senate side, a subcommittee has decided to move forward with a bill (SF 297) that would allow a health care provider to refuse care to someone if it is against their moral, religious or ethical beliefs. Again, while this bill is intended to address reproductive and gender affirming care, it is written very broadly and could be used as an excuse to discriminate against anyone. Likewise, another Senate subcommittee moved forward on a bill (SF 300) that bars a licensing board from taking any action against a health care professional that does not follow FDA, NIH, or CDC guidelines (again written very broadly to include any guidance).


  • Senate and House committees approved a comprehensive "educational flexibility" bill (SF 391, HF 327) that include a provision that would no longer require schools to incorporate information about AIDS in human growth and development curricula. Earlier versions of these bills also eliminated instruction on HPV and the availability of HPV vaccines, but those were added back in at the last minute (so they remain a requirement for schools).


  • Everywhere Carry might as well be the name of HSB 173, which got the approval of a House Public Safety Subcommittee. The bill allows people to keep guns and ammo in their cars as long its out of sight at a jail and correctional facility; prohibits any public or private employer from prohibiting an employee, volunteer, or contractor from having firearms and ammo in their cars (but can prohibit if its a company car) as long as they are in a lockbox and out of sight (and makes the employer immune from any damages from the firearm being onsite); allows carrying on state fair grounds, at schools (if its during pickup/dropoff), on snowmobiles and ATVs; and gives casino managers the option to allow employees or patrons to carry on the property.


You can find updates to these bills and other bills introduced daily in the

IPA bill tracker.

Medicaid Rates & Gender Affirming Care in Committees

The Iowa Department of Health and Human Services (HHS) presented its "Improving Medicaid Program for Members" report last week during a House-only Health & Human Services Budget Subcommittee meeting. A large part of the review outlined how the state needs to develop a better, more cohesive, more transparent home and community based services system (as an alternative to higher-cost facility-based institutional options). The report did also highlight Medicaid rate structures and found:


  • Need to set a regular, fact-based review process for rates.
  • The two areas "most ripe" for increases are physician and behavioral health rates.
  • Residential substance use disorder treatment should be covered, increased.
  • You can see the benchmarking of rates here.


HHS also announced it would be maximizing state Medicaid dollars by adding a new intergovernmental transfer that allows them to tax MCOs as they do private insurers, then giving those funds back through contracts (which are then matched by federal funds). It basically allows the state to draw down more federal dollars without adding any additional taxpayer funds. That bill (HSB 177, SSB 1167) passed out of the House HHS Committee and is scheduled to come out of the Senate HHS Committee this week.


Switching committees, the House Government Oversight Committee heard from two health professionals about gender-affirming care (Dr. Katie Imborek, co-director of the UI LGBTQ+ clinic, and Dr. Dave Williams, chief medical officer of UnityPoint). They provided members of the committee, plus a packed room that included other legislators, with the steps that transgender youth and their parents must go through before receiving treatment.


As Dr. Imborek said, "It is a long, arduous and methodical process by which our providers, in collaboration with mental health providers, like psychiatrists, psychologists or counselors...provide parents and their children information about risks, benefits and alternatives, so parents have the freedom and liberty to make the decision that is best for their minor child."


Right before the committee, Speaker of the House Pat Grassley acknowledged he is considering allowing legislation this year to ban such care to transgender youth. Five other states have already passed legislation (Alabama, Arkansas, Florida, South Dakota, Utah). It's clear that legislators are going to advance something out of the 19+ bills already introduced, a record number according to One Iowa.


So far the only bill that has passed committee and through the funnel is HF 180, prohibits schools from accommodating a student's gender identity and bars teachers from withholding information about a student's expression of gender from parents (or encouraging parents to accept it). IPA is registered opposed.


The following bills have either not been assigned a subcommittee or the subcommittee has said they will not meet, and won't have the time to make it through the Friday funnel:


  • HF 190 & HF 325 remove gender identity from civil rights protections.
  • HF 290 requires government documents reflect gender on birth certificate.
  • HF 229 & SSB 1164 enacts the "religious freedom restoration act."
  • HF 401 eliminates required diversity and bias prevention in law enforcement training.
  • SF 129 includes inaccurate "findings" about gender dysphoria and bans treatment.
  • SF 335 requires K-12 students to use bathroom coinciding with biological sex.
  • SF 348 makes it illegal for a parent to bring their children to a drag show.


The following bills may still be considered, but will have to make it out of committee this week:


  • HF 367 protects schools from lawsuits for employee, contractor, and volunteer failure to use preferred name and gender pronouns. (no recommendation from sub)


  • SF 159 bans gender and sexual orientation school instruction in K-8, changes human growth and development curriculum from grades 1-12 to 9-12, and other "transparency" and "parents rights" reforms. (passed subcommittee)


  • SF 212 looks like a non-discrimination bill that bars discrimination against foster and adoptive parents based on religious beliefs, but it actually allows discrimination by permitting foster care and adoption providers to refuse to place a child in the care of someone whose lifestyles are in discordance with the provider's religious or moral beliefs. (passed subcommittee - and likely to be brought up in committee this week)


  • HSB 112 requires schools post curricula on website for parent review, and a process for parents to report violations. (passed subcommittee)
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