The end of next week marks the second funnel at the state Capitol — the deadline for bills to pass at least one chamber and the other chamber's subcommittee and committee process in order to stay alive. That means this week lawmakers are busy moving legislation. The hopeful news right now is they look unlikely to advance a series of bills before funnel that would have made it harder for vulnerable Iowans to access food and health care.

That decision turns out to be timely, too, given a federal court ruling yesterday that struck down Medicaid work-reporting requirements — like those in one of the bills — in Kentucky and Arkansas. The ruling affirmed that a fundamental purpose of Medicaid is to help states provide health insurance to their residents, and that imposing barriers that cut people off coverage is unlawful and harmful to those the program is intended to help. By choosing not to advance the bill this session, Iowa lawmakers will avoid costly and pointless litigation. 

Several budget subcommittees introduced their funding bills this week, and the House Education budget bill (HSB 248) included some good news, too. There is a $1 million increase for Early Childhood Iowa, to be distributed through the school ready grant funding formula. There is also a new appropriation of $3 million for children's mental health, to be used to establish a children's mental health school-based training and support program. Other important early-childhood programs like Shared Visions, Early Head Start and literacy initiatives maintained their current funding status.

It is very important to note that this is the House proposal; the Senate budget target for Education appropriations is $15 million lower than the House proposal. That means the increases — and even the status quo appropriations — aren't guaranteed. Advocates will need to keep pressure on their senators to protect them. 

We have not seen an actual bill for the HHS budget subcommittee, but we have seen a spreadsheet that shows no new state dollars to child care. This is highly disappointing. The feds have provided increases in funding, but our Governor and legislators did not increase child care eligibility, even though they talked about it on the campaign trail. We know in order for the workforce to grow families need child care. We'll share more information on the HHS budget when we see a bill.

Below are several other policy topics of note. 

Dr. Sharon Guthrie is the Director of Graduate Nursing Programs and Associate Professor at Mount Mercy University in Cedar Rapids. She worked as a school nurse for 8 years at Xavier High School and has led the Iowa School Nurse Organization since 2008, working to pass state legislation that supports student health. But some of those gains are now in jeopardy as SF438—a bill that would fundamentally change how student health screenings are reported to the state—gains traction at the capitol. The Center's Stephen Dykstra spoke with Dr. Guthrie earlier this week to get her take on the bill and its potential harm to Iowa students.

Do you see the role by schools and school nurses to report health data as an administrative burden?

This whole part of processing and reporting screening results is just a small part of what a school nurse does every day. I think people are blowing this out of proportion a little bit in terms of what the administration has to do—the school nurses are currently the people who do the majority of work around data reporting. Here's the other concern—I don't think anyone has actually talked to a school nurse in order to get that perspective. And public hearings on this issue are scheduled during the day when nurses are unable to leave school and attend. So, I think an important voice is missing from the conversation.

How do schools currently collect and report data? What would this change if SF438 is implemented?

Families are informed through pre-registration materials handed out by school districts, including what's required and so on. Typically, parents will return completed health forms to the school nurse who then creates a file for each kid. For those who fail to turn in the forms, the school nurse can easily and quickly identify them and follow up. In this scenario a parent might inform the nurse they are unable to afford screening services. And even though this is purely hypothetical, consider that nobody wants to be honest about that with a school administrator. Instead, they are much more likely to communicate that to the nurse, who then becomes a key resource for that family. On the flipside, this current bill would require providers—not the school—to submit data. But here's the problem: there are multiple data systems used to report health (i.e. dental, vision) data, and they don't often 'talk' to each other very well. Likewise, providers don't always screen for the same thing in students and many risk submitting insufficient data. All of this creates a gap between what should be and what actually is reported.

Are there benefits to leaving the reporting responsibility with school nurses?

Keeping the data collection and reporting local in the school district is important because that is where assistance is going to come from. And as a school nurse, if I don't have that data easily accessible it's only going to prolong the process of getting students the help they need. Gathering and accessing the data locally is very important to providing timely and helpful resources to parents and students.

This bill has elevated the conversation around the important role school nurses play in our schools. What are ways we can help nurses better serve students?

First, implement the recommendations regarding student health screenings we outlined in the SF475 work group I was a part of last year. The legislature requested those recommendations, and I think there are a lot of great ideas for improvement that can be done without this harmful bill. Also, I hope people will take the time to learn about the role school nurses play in student health. This is not about putting on Band-Aids and handing out ice packs—school nurses do so much more. We help kids find enough food to get them through the weekend; we organize food drives, make sure students have warm clothing during the winter months and provide an immense amount of mental health support. I think if people start to recognize the actual role school nurses play in their communities, they'll realize it makes no sense to remove them from data reporting process.

What's the link between child health and learning? Why is student health so imperative?

We all know as adults if we don't feel well, we certainly don't perform as well at work—we're not as productive. The same is true for students. If a kid comes to school not feeling well or didn't get enough sleep, they're not going to learn as well. If I'm a student who's worried because my parents got in a fight last night, my mind is going to be focused on that instead of what the teacher is presenting in class. This is the harsh reality for many of our kids in Iowa. Here's another thought—if I'm a parent with a sick student but if the school nurse is busy running around between multiple buildings and can't see my kid that day, I'm forced to keep my kid home from school. And we know student learning is hurt when kids miss days of school. Attendance improves drastically when there's a health care provider present at the school building.

Any parting thoughts for fellow advocates and concerned Iowans?

I'd encourage Iowans to avoid making assumptions about how health care works in schools. Reach out and make a connection with a school nurse—ask them about their day. What are their challenges? Another point is that policy should be based on evidence and facts. As a health care provider, I need to practice with evidence-based methods. We should expect the same from our policymakers—they should provide evidence that serves as a basis for their policies. Finally, I'd stress the importance of not making assumptions about students and the circumstances they face. In an ideal world all students would be healthy, but that's simply not a fact of life. So just because my kid doesn't have specific problems doesn't mean others aren't facing challenges of their own. Until you put yourself in their shoes, you don't realize how challenging it can be.

New podcast: Helping foster youth transition to adulthood

There are approximately 6,500 youth in the foster care system in Iowa—and nearly 1 in 4 are over age 14. Placement in the system is difficult kids, especially for those in or nearing their teen years. According to data from the Annie E. Casey Foundation, 40 percent of foster youth in Iowa ages 16+ will "age-out" of the system when they turn 18. This often leaves youth to fend for themselves as they transition to adulthood. 

Both Taylor Barry and Carol Behrer play an important role in helping youth at risk of aging out of the foster system reach better outcomes. Barry works with the National Youth in Transition Database (NYTD), a federal initiative that tracks outcomes for foster youth using regular surveys. She also helps youth connect with valuable resources. Behrer is the executive director at Youth Policy Institute of Iowa, which works on policies that relate to vulnerable and under-represented youth. Her organization works extensively with foster care data in Iowa—and supports programs like the Iowa Aftercare Service Network that support youth beyond the foster care system.

On this week's podcast the Center's Anne Discher sits down with Barry, Behrer and policy associate Angelica Cardenas to dig into foster care in Iowa: what's working, what's not and how we can ensure every youth has a smooth transition to adulthood. Listen here.


Property tax cap limits would hurt local services

Fast-growing cities, depopulating rural communities, local governments recovering from natural disastersall would be particularly hurt by a proposal at the Legislature to impose an annual 2 percent cap on the growth of local property tax levies. Such a move would represent "unprecedented state control over the budgeting decision of local democratically elected city councils and county boards," according to a new Iowa Fiscal Partnership brief authored by Iowa Policy Project research director Peter Fisher and Iowa State University economist David Swenson. Read it here


Bill tracker

Want to go deeper? Curious about the status of key bills? The Center maintains a bill tracker to outline the specific legislation we are following this this session. 

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