It's called passing the buck.
Let's be up front, HF 2456, now headed to Gov. Kim Reynolds' desk, is a notable step forward in righting the state's mental health crisis. County sheriffs championed it. Lobbyists for the hospital industry supported it. Advocates for the mentally ill lauded it.
And yet, it's bound to become a cash-bleeding yoke around local government's neck. If only Republicans in the Legislature weren't so dead-set on election-year tax cuts.
Among other things, HF 2456 would create six regional "access centers" boosting beds for those not in need of hospitalization. Iowa suffers from one of the nation's most severe bed shortages for mental health patients, according to federal reports. Former Gov. Terry Branstad only exacerbated Iowa's bed problem when he shuttered half of state's treatment center. Jails, such as Scott County's, were never intended to serve as de-facto treatment centers for addiction and psychological disease. But, in recent years, that's increasingly been the role of local sheriff's offices.
So, yes, the goal of HF 2456 is warranted. And yet, just like when Iowa shuttered its clinics, the legislation foists the burden on local governments. It's an unfunded mandate all in the name of under-construction income tax cuts that are little more than election year pandering.
For all its upside, there's no immediate way to pay for these new "access centers." Jerry Foxhoven, director of the Iowa Department of Human Services, recently told a group of county supervisors that local property taxes would comprise the primary funding mechanism, reported Des Moines Register. Medicaid, however, would obviously be a funding source for treatment, he said.
But Iowa's Medicaid system is a veritable dumpster fire since its privatization almost two years ago. There's no reason to believe that the new access centers will be treated any differently from the hundreds of providers getting short-changed by the for-profit firms running the $4 billion health care networks.
Nor does the bill begin to rectify the structural failings rampant within the state's, and the nation's, broken system of health care. Treatment is hugely expensive. Medicaid funds a massive share of mental health treatment and yet, unacceptably low reimbursement rates remain a barrier to expanded treatment at health care facilities, both public and private. Perhaps of greatest significance, Iowa suffers from a severe shortage of physicians and clinicians specializing in treating mental health, experts told us. And medical school is hugely expensive.
Nothing in HF 2456 will change any of this. Nor can it amid Iowa's self-made budgetary free fall.
Iowa's counties will continue to struggle with a growing epidemic until Iowa incentivizes mental health care providers to work here through student loan repayment programs. County taxpayers will bear the brunt of the crisis until Iowa's failed Medicaid privatization system is rolled back and lawmakers cease passing the cost down the ladder to save face.
More beds are certainly a start. Yet, it's at best disingenuous to consider HF 2456 anything more than a feckless half-measure — a mere fragment of anything resembling a legitimate, holistic approach.
Lawmakers are actively discussing reneging on a promised backfill to local governments, as state revenues continue to flag. Iowa's regent universities face yet another mid-year budget cut, this time $11 million, under legislation passed Wednesday. Health and social services programs were axed by another $3.4 million. And both Legislative chambers have made clear that they are on board with Gov. Kim Reynolds' call for further tax cuts.
Iowa's broke and its services are being actively gutted as an offering to the false god of supply-side economics. Iowa Senate's cult-like devotion to trickle down is precisely what destroyed Kansas and Oklahoma, where Republicans are now hiking taxes just to keep schools open. Gov. Kim Reynolds less egregious version is a close cousin to that which has yet to bolster economies in Indiana and North Carolina, the latter facing a $1 billion shortfall by 2019, according to that state's economists.
Iowa lawmakers passed a laudable bill, one that could alleviate the pressure on packed county jails never designed to act as mental health clinics. But HF 2456 remains nothing but a half-measure until lawmakers pony up some cash.