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Editor’s note: Zachary Pendroy is a human resources generalist, of Monroe, running for the Iowa House District 28. He is one of two Democrats seeking the party’s nomination in the June 5 primary. The top Republican and top Democrat will compete for the state seat up for grabs in November. The following is the last of four Q&As with the State House candidates. The full Q&As can be found on our Election Central page at newtondailynews.com.
1. What do you see as the biggest issues facing constituents in your district? If elected, how will you address this issue?
The most pressing issue constituents face is access to mental healthcare. Mental healthcare is the cornerstone of a healthy and productive life and must be at the forefront of thought in our district and our state. This issue is especially dear to me, as 1 in every 5 individuals in the U.S. utilizes mental healthcare — in fact, I utilize mental healthcare. In addition, according to the CDC, farmers and ranchers are the No. 1 occupational group to commit suicide. Considering our district is a relatively rural area dominated by farming, this is a scary statistic that must be addressed. The lack of mental healthcare in the state of Iowa must be addressed by creating new facilities, training and retaining psychiatrists, emphasizing community care and investing in new, innovative technology and research to deliver care and find long-term solutions to mental healthcare.
The Former VA campus in Knoxville is the perfect facility to purchase and renovate into a state-of-the-art headquarters for the state’s mental healthcare program that can be used for treatment, education and research. I believe the state can purchase the 1,300-bed facility and partner with the University of Iowa Health Care system to treat patients with mental healthcare needs, educate psychiatry students, as well as provide needed research for agencies like the National Institutes of Health and Department of Health and Human Services. Funding for this facility would be created in part by taxes upon employer-sponsored benefit plans (specifically medical insurance), federal funding provided by the Substance Abuse and Mental Health Services Administration and its affiliated federal agencies, as well as by partnerships with private entities, such as Wellmark BCBS, hospitals and businesses – all of which are key stakeholders in addressing the mental healthcare crisis in our state. The six facilities that Governor Reynolds has proposed would serve as regional support facilities that will coordinate with the main facility in Knoxville to ensure operational efficiency and easy transfer of medical records, research and coordination of ongoing care between the institutions.
Building facilities is useless without being able to staff the facilities with psychiatrists who can provide necessary care. With a critical shortage of psychiatrists nationwide (especially in our state), Iowa must work, in the short-term, with federal officials to increase the amount of H-1B Visa permits available for foreign psychiatrists to practice in the state of Iowa. In the long-term, the state must create a pipeline for the overabundance of psychologists to receive accreditation in medicine to be able to practice psychiatry. Finally, Iowa must offer student loan forgiveness or reduced/free tuition for psychiatry students who practice or wish to practice in Iowa for a specific number of years.
For patients who need ongoing care, but don’t need to remain committed for long periods of time, community care is an essential tool that will need to be developed. Community care involves the creation of a support network in the community that helps individuals with mental healthcare needs and serves as a preventive tool to minimize the risk of an individual relapsing to a higher need of care. As part of community care, I suggest the creation of support groups that would mirror the Alcoholics Anonymous support groups. Individuals would be free to attend these sessions where professionals would be available to address questions or concerns and guide individuals to available resources. Additionally, community care involves education for the community, such as church groups, social clubs and the K-12 system to help spread awareness of the issues associated with mental healthcare and how best these groups and individuals can help from a community perspective.
Lastly, Iowa needs to invest in new and innovative technology and research that focuses on long-term solutions to mental healthcare. Specifically, I propose investing in better access to technological systems, such as “Dr. On Demand,” which is a video-phone conference that puts patients in direct contact with a doctor to be able to give immediate care to a person in need.
Mental healthcare must be addressed in Iowa. Through the creation of new facilities, training and retaining of psychiatrists, building community care, as well as investing in new technology and research, I believe our state can become the forerunner in mental healthcare and become a model for the rest of the United States.
2. How would you address the state’s Medicaid crisis? Problems, including late payments, have led one MCO to pull out of Iowa and another said it can no longer accept new customers. Several prominent Democratic lawmakers have called for the state to go back to the previous system, which was run by the state of Iowa. Do you believe there’s an opportunity to return to the state-run system, or does the state need to find a way to make the MCO-based system work? Do you believe the system is working effectively for rural Iowans?
Medicaid is a massive program in the state of Iowa, comprising about 19 percent of the state budget. When MCOs were solicited to manage the state Medicaid program, the state was promised many features, including cost savings of up to $232 million in FY 2018, faster reimbursements and better, more efficient services. The exact opposite has occurred. I believe Medicaid privatization must be repealed, with control given back to the state of Iowa for the short-term until a long-term solution can be created that may or may not include MCOs for the following reasons:
MCO contracts are strongly biased in favor of the MCO, Claims are being denied at high rates, and Medical provider administration costs have ballooned.
MCO contracts are strongly biased in favor of the MCO. This is most evident in the terms and services provided by the MCO surrounding what is medically necessary. Medical necessity under the state-administered program consisted of what a medical provider determined was medically necessary for a patient. Under the MCO contracts, medically necessary services were not defined by the state and were left up to the MCO itself. This is causing many claims to be denied because an out-of-state provider was reviewing the claims and determining the services were not medically necessary without knowing or meeting a patient. These denied claims were then being challenged and are now being determined by administrative law judges who, again, do not know the needs of the patient as the provider does.
As mentioned, claims denial is a serious problem. While MCOs are processing claims in a timely manner with 99 percent of claims being processed within the first 7-10 days, claims are being denied 28 percent of the time or suspended 32 percent of the time, according to the Davis Brown Law Firm. Recent articles by the Des Moines Register have highlighted the fact that MCOs are consistently denying claims for disabled Iowans, who require the most care, but is for whom Medicaid is designed.
The difficulties of MCOs do not stop at patients -- it also affects medical providers. Administrative costs of medical providers have ballooned because each MCO has a different process for billing and reimbursements, as opposed to the prior process. This has caused medical providers to add administrative overhead to bill for services. In turn, this reduces the dollars available to actually treat and care for patients.
Medicaid privatization has done the exact opposite of what was promised. Favoring MCOs in contracts, denying medically necessary services and adding administrative overhead are byproducts of a rushed transition. Iowa must transition back to the state-run program and take time to develop a long-term solution to Medicaid administration that focuses on the overall goal of Medicaid -- providing healthcare for low-income families.
3. Earlier this year the Senate considered a law that would allow “Constitutional Carry” in Iowa. If passed, this law would have allowed Iowans to carry a concealed weapon without a permit. It would have also loosened restrictions on the sale of firearms in the state. Some Senators have said they plan to take up the issue when the next legislative session begins. Do you support this legislation? Why or why not?
I support legislation that allows for Constitutional Carry in Iowa. Legal gun owners, like myself, should have the right to carry open or concealed weapons without needing a permit.
4. Gov. Reynolds signed a water quality bill into law this session responding to calls to provide funding to the state’s voluntary nutrient reduction strategy, incentivizing farmers to use cover crops, terracing and no-till farming to reduce the amount of run-off from Iowa’s farms going into lakes, rivers and streams. Democratic lawmakers have criticized the law for redirecting money for existing programs instead of creating new revenue, while some in the Ag-industry and environmental community think there is not enough money for farmer education and oversight. Do you think Iowa needs to invest more in water quality to fix this issue? Do you think the state should provide more oversight or guidance to ensure nutrient reduction is being implemented properly?
Farming is a way of life in Iowa, including for my family, but our farming practices are not sustainable. As our state has begun to understand the need for water quality monitoring, it has made strides to address these problems associated with the lack of sustainable farming practices. However, these solutions are often under-funded or, worse yet, rob Peter to pay Paul in the state budget. I believe Iowa must invest more in water quality and provide more guidance to ensure water quality improvement strategies are being implemented.
Iowa needs to invest more in water quality. This does not mean robbing from one program to invest in another, but creating new revenue streams to ensure water quality programs continue for the long-term. Specifically, investment needs to focus on creating opportunities for small farmers to upgrade property, plant and equipment. My family owns a small farm with 180 acres of cropland and grazing land. We don’t have the funds necessary to upgrade our equipment to a no-till planter or invest in cover crops, which is where Iowa should focus its efforts. In addition, there has to be more education regarding resources available for water quality improvement projects that translate the benefit to farmers. Educational programs should focus on what improvement projects are available, what grant monies are available, as well as the cost-benefit analysis of the projects in question.
In addition to investing capital, the state needs to invest as a partner in any projects that farmers want to implement. Partnering with farmers and using a mentorship-coaching approach will help show farmers the government is committed to supporting these projects throughout the implementation process while also providing oversight without using the carrot-stick method that is less beneficial for everyone.
Investing in water quality is critical for Iowa. Creating new revenue streams and investing as partners with farmers will help realize Iowa’s goal to address water quality.