Gun permits, Medicaid dominate talk at Legislative Coffee

Legislation introduced in the Iowa Senate last week, aimed at easing restrictions on permits to carry firearms in Iowa, sparked a 20-minute conversation at the League of Women Voters of Jasper County’s Legislative Coffee Saturday at Hy-Vee in Newton.

State Rep. Wes Breckenridge, D-Newton, addressed the small group of constituents, covering a range of issues from his own efforts to introduce campaign finance reform legislation, to mental health funding and reviewing the effectiveness of Iowa’s business tax credits.

But it was the effort by the Republican Senate majority to eliminate the requirement for a permit to carry firearms in Iowa that sparked concern among the mostly Democratic-friendly crowd.

As a member of the minority party, the Newton Democrat and retired law enforcement officer said many of his concerns on the gun legislation have fallen on deaf ears at the Capitol.

“It’s challenging being in the minority,” Breckenridge said. “They don’t need me. They don’t need my vote or my expertise in this field to show how we might be able to do a better, safer way of permitting and doing this while still allowing people to have their guns, enjoy competition and enjoy that freedom the Second Amendment provides.”

Senate File 165 passed an Iowa Senate subcommittee Feb. 11. It would allow person-to-person firearms sales without a background check, if the bill becomes law, although the screening would be required if the gun is purchased from a federally-licensed firearms dealer.

The other sticking point for opponents at Saturday’s coffee was the bill goal to eliminate the requirement for a permit to carry in Iowa, joining 14 other states with similar laws. According to the language, the bill does allow Iowa gun owners to obtain a permit to carry if they’re transporting the weapon across state lines.

This comes as Republican lawmakers are also trying again to enact an amendment to the Iowa Constitution adding the right to own and possess firearms. Iowa is one of six states that does not have language in its constitution referencing gun rights; however, Breckenridge and other Democrats are concerned that the “strict scrutiny” language in the amendment goes further than the Second Amendment in the U.S. Constitution and would make it difficult to enact gun safety regulations in the future.

The amendment will have to pass through the statehouse this session and in 2020 before going to Iowa voters for final approval.

Breckenridge, a retired Newton Police Department officer, told the crowd at Hy-Vee he has a vision for firearms permits that incorporates both background checks with a mental health component and hands-on training before a permit is allowed. For the Newton Democrat, the more complex the firearm, the more hands-on hours should be required for a permit. For example, Breckenridge would like to see more required training for a semi-automatic rifle than a handgun or shotgun for sporting.

The goal of any firearms legislation, he said, should be to make prospective and current gun owners more knowledgeable about the operation of the weapon and use safe practices.

“Make sure we don’t allow one (constitutional) Amendment to override another when it comes to public safety, and that we have a process in place that affords you that Second Amendment right and not limit your life, liberty and pursuit of happiness,” Breckenridge said.

Representing large rural areas, Breckenridge said any legislation should be a compromise with Republicans and Second Amendment activists, respecting Iowa’s culture of gun ownership for hunting and sporting.

“With us being in the Midwest and that culture we have here, it’s understandable that they’re very protective of their rights. They want to pass that on to their children, and safety and being able to hunt and things like that,” Breckenridge said. “The appropriate approach is to make sure people who do own guns have the proper knowledge, safety training and mental health checks.”

Medicaid Reform

As Iowa Republican Senate and House leadership try to convince detractors that problems with Iowa’s 2016 shift to third-party managed care of its Medicaid program are beginning to subside, those in the Democratic minority like Breckenridge are still citing issues with the privately managed care organizations — specifically, low provider reimbursement rates for care and shorter duration of services covered for patients.

Saturday, Breckenridge joined many of his Democratic colleagues in highlighting a recent report by the Des Moines Register which points out Iowa Total Care, the most recent MCO to join Iowa’s $5 billion Medicaid system, is renting office space in one of the priciest commercial areas in the Des Moines metro.

“One of the most premier real estate places in Des Moines area cost per square foot is the place they have leased. For a company that is coming in wanting to provide services for individuals truly in need, to spend that much money, it seems hypocritical,” Breckenridge said.

To the possibility of the Medicaid system returning to a fully state-run system, Breckenridge told the small crowd, with Republicans controlling both chambers of the General Assembly and the Governor’s Office, it is an unlikely outcome.

“We put forth a mental health bill that would take long-term care back to the old Medicaid system to help take some of the weight off of (MCOs),” he said. “Our hope is (Republicans) will at least take a look at it to help that process.”

This is an idea State Sen. Amy Sinclair, R-Allerton, told the Newton Daily News in a December 2018 interview she would consider if it’s deemed necessary by her caucus. Sinclair, the Senate majority whip who represents the southeast third of Jasper County, suggested a hybrid Medicaid model with a not-for-profit company acting as an intermediary to manage services could be an attractive alternative to the MCOs. She pointed to Colorado, a state that has been using a nonprofit privatized system for several years.

Sinclair was invited to Saturday’s event, along with Republican Sen. Zach Nunn or Bondurant, and Rep. Jon Thorup, R-Knoxville, but all told the League they had prior engagements.

Breckenridge told the group at Hy-Vee he wants increased oversight on the managed care system, beyond questioning the leadership of the MCOs in a hearing room, on a provider to provider basis.

“To really have boots on the ground and go around the state and find out from people, are you getting paid at the same tier level you were before (managed care)? Are transportation costs the same as they were before? Have you been denied or rejected claims? And find out exactly what’s happening to find a fundamental way to fix this,” Breckenridge said.

Breckenridge cited UnityPoint Health’s announcement in November 2018 it will close its intensive care unit in Marshalltown due to a $7 million deficit at the healthcare center as a warning for rural communities like Jasper County this could be the fate of its small providers if Medicaid reimbursements don’t return to pre-privatization levels.

“If you’re not on Medicaid or don’t know someone who’s on Medicaid, don’t think this isn’t going to impact you,” Breckenridge said. “As those individuals don’t get reimbursement, those providers in Jasper County and all over the state of Iowa absorb that. ....Providers can’t keep their doors open if they continue to do this and not get give the appropriate reimbursement rate.

Contact Mike Mendenhall at 641-792-3121 ext. 6530 or mmendehall@newtondailynews.com