Legislators, community discuss mental health topics

by Lissa Blake

Is the United States a nation where it is easier to gain access to guns than to mental health treatment?
Larry Sells of Decorah says "yes".
Sells was one of four area residents with “lived experience” responsible for organizing a community legislative forum on mental health Friday, March 22 in the Decorah City Council Chambers. "Lived experience" is a term used to describe individuals who have lived through the experience of being given a mental health diagnosis and of being a ‘client’ or ‘consumer’ within the mental health system.
Co-organizers of the event included Mark Warden of Postville, Janel Clarke of Waukon and David Prochaska of Cresco. Attending the forum were State Senator Mary Jo Wilhelm, State Representative Patti Ruff and State Representative Roger Thomas.
Also on hand to help answer attendees’ questions about Iowa’s role in expanding Medicaid, the Affordable Care Act, Mental Health and Disability Services regionalization and funding of the system were Rick Shannon from the Governor’s Developmental Disabilities Council and Jan Heikes, coordinator for Mental Health services for Winneshiek and Allamakee Counties.

MEDICAID IN IOWA
One of the key discussion topics included possible expansion of Medicaid in Iowa. Since the meeting, Democrats in charge of the Iowa Senate approved a major expansion of Medicaid coverage, which will help at least 100,000 Iowans, despite objections from Iowa Governor Terry Branstad.
Senators voted, 26-23, to offer Medicaid services provided for by President Obama’s federal Affordable Care Act for adults between the ages of 19 and 64 with income up to 138 percent of the federal poverty level and for foster care children up to age 26, beginning January 1. Income guidelines range from $15,856 for a single person to $32,488 for a family of four.

THE DISCUSSION
During the meeting, Shannon explained that through the expanded Medicaid program, the federal government is promising to pay 100 percent of the additional cost of the program for the next three years. This amount would then decrease incrementally, ending at 90 percent after 10 years.
“A lot of states have concerns about the federal government’s ability to live up to that promise, including Governor Branstad, who is concerned if the government can’t live up to its financial obligation, it will end up costing money we can’t afford,” said Shannon.
Last week, before passing the plan, Senators approved a compromise amendment that would allow the State to opt out of the expanded Medicaid program if the federal government fails to meet its financial obligations. “Another of the Governor’s concerns everyone has heard of is the ‘woodworking effect’ - people coming out of the woodwork to apply for help,” said Shannon.
Wilhelm said she thinks the Medicaid expansion is a “good opportunity for Iowa.” She expressed concerns about the Governor’s alternative plan, to expand IowaCare, a health care program that provides limited services for people who are not otherwise eligible for Medicaid. The purpose of IowaCare is to provide some health care coverage to people who would otherwise have no coverage.
“The services provided by IowaCare are not as good as I think they should be. People end up going to Iowa City anyway. We’re not talking about people who can just put $50 worth of gas in their car to go somewhere else. These are people who struggle,” said Wilhelm.
Wilhelm said while she appreciates the concern the Governor has voiced about the federal government not living up to its responsibility, “How do you know unless you try?”

MEDICAL HOME
Thomas said in an expanded bill, he would like to make sure each person has a ‘medical home.’
“If you go to a clinic in Decorah, you should be able to get care. You don’t have to travel to Iowa City and get sent to an emergency room. It’s the only way you’re going to be seen in a short period of time. As I well know, if you have a gall bladder attack and it's bad, you need immediate attention,” he said, adding another of his concerns about Medicaid is that it doesn’t pay for name brand prescriptions.
Ruff said she thinks change is needed for those individuals who don’t qualify for Medicaid or cannot afford insurance.
“They tend to end up at the emergency rooms at our local hospitals and they have to accept them, see them and treat them. This is putting a financial burden on our hospitals and individuals. They’re not able to pay their bills… When a local hospital is strapped financially, it’s harder for them to stay open,” she said.

MEDICAID ADVANTAGE
Wilhelm said she thinks the Governor’s IowaCare program offers “less service for less people that costs more. And it’s not going to help people with mental health and disability services,” she said.
Heikes added IowaCare makes it difficult to get preventative care. “Under IowaCare, people have to travel to Dubuque for any care of chronic illness. Sometimes there is a three-month waiting list,” said Heikes.
“The present plan has been dysfunctional for years,” added Wilhelm.
Ann Bunn, a consultant for Prairie View Senior Living in Fayette, said while she thought the discussion was wonderful, “if we think Medicaid expansion is going to take care of everything, I think we’re fooling ourselves. It’s the counties who take care of people who fall through the gaps. Some people don’t fit into the government’s columns.”

MENTAL HEALTH
REDESIGN
Heikes next explained some changes taking place locally as part of the State’s mental health reorganization. Through an organization called County Social Services, Winneshiek and Allamakee counties will become part of a 21-county region.
While some counties will receive less per patient as part of the reorganization, Heikes said both Winneshiek and Allamakee are in good shape. “We’re okay in both of these counties because a lot of our services were Medicaid already. Some other counties are not okay,” she said.
The group next discussed “transition funding” applied for by 31 counties in Iowa, amounting to $11.6 million, and whether or not additional funding for staff would be available. “We don’t know if there’s going to be an additional salary bill. What we do know is that under Branstad’s plan, there would be no mental health plan,” said Thomas.

AUDIENCE FEEDBACK
Sells then said, “It’s easier to get access to a gun than it is to get access to mental health treatment.” He also lamented the lack of access for minors. “If we lose our children, we lose ourselves,” he said.
Lula Tesvi, a peer support specialist, said, “If we have a healthy society, we are able to contribute. People have these problems, not because they choose this. No one wakes up and said I want to be mentally or physically disabled, or brown or yellow. We’re all human. We have so much money to spend for weapons and all of this stuff, why can’t we fight for all of us?”
Thomas said as legislators, they have a lot to learn. “We, as legislators, are kind of these 100-day wonders. We think we know everything, but we don’t. Before I came a legislator, I was a farmer, a mechanic and a bus driver. The average person can always become a policy maker and someone who advocates for other people. But I’ve learned more here today, because I haven’t had the time otherwise. There is a time element for us to be able to do that,” said Thomas.
Clarke said she encourages a “connection between the Legislature and those of us out here… Anyone who has had a mental issue and has come through it - and it does happen that some of us do get through it and want to tell our story and do it appropriately to people who want to hear it.”