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The governor and our current Legislature have failed to protect public health in the state of Iowa. One day when the focus changes to safeguard our public health, I’ll drink to that.
What’s an Iowa doctor to do? Recently I was invited with a group of other physicians for an evening of drinks and hors d’oeuvres with Gov. Kim Reynolds and the first gentleman as a member of the Volunteer Physician Network. When I received this, I recalled the recent bravery of Iowa high school graduates who spoke out when receiving a scholarship from the governor. Alarmingly, we in Iowa have observed as the governor and Republican-controlled Legislature pass regressive laws that affect teaching, privacy, reproductive options, medical decision making, reading materials, the public funding of our schools, and a lack of firearm restrictions.
I knew as a physician who works with disenfranchised populations — including people of color and members of the broader LGBTQ community — that I had a responsibility to take a stand and speak out myself.
According to the CDC Foundation: “Public health is the science of protecting and improving the health of people and their communities. … Overall, public health is concerned with protecting the health of entire populations.” Let’s look at how our state under our current governor and Legislature fares:
Ban on gender-affirming health care
Reynolds signed into law Senate File 538, banning transgender youth from accessing gender-affirming care, which in many cases is medically necessary treatment. Even when a counselor, doctor, and family know that this treatment can be life-saving, the ban features no exceptions for an already at-risk population. Further, from the Register on May 18: “Senate File 496 requires educators to notify parents and guardians if a student is transgender, and prohibits the teaching of gender identity and sexual orientation to students through sixth grade.” Our schools need to be affirming of all our students and to make sure they know the facts of sexual identity, orientation, and gender expression.
Government reorganization zaps health board
Under Senate File 514, the State Board of Health is eliminated. It had existed in Iowa for almost 150 years, providing informed regulations and oversight over health facilities and public health across the State. Some of the Board of Health duties are simply eliminated (preventing the spread of disease, promoting health behaviors, and advocating for the importance of public health standards) while others are shifted to a new Council on Health and Human Services that requires only one health professional to serve instead of a majority.
SNAP and Medicaid restrictions ramp up
Senate File 494 imposes a new asset limit for the Supplemental Nutrition Assistance Program, or food stamps, and increases income monitoring requirements for both SNAP and Medicaid. It has been estimated that millions of state dollars will be spent to kick thousands of Iowans off these benefits as a result of the bill, leading to heightened food insecurity and more uninsured Iowans that will only negatively impact the overall health of Iowa. Reynolds has not yet signed the bill.
Health and Human Services budget bill with no maternal health investments
Senate File 561 failed to address significant challenges facing maternal health in Iowa. Republicans refused to consider extending Medicaid postpartum coverage following pregnancy, which 44 other states have already accomplished. Extending postpartum coverage clearly leads to more positive health outcomes following pregnancy. Reynolds has not yet signed the bill.
Iowa seeks abortion restrictions
Reynolds has continuously fought for the courts to reinstate a ban on abortion in Iowa after six weeks of pregnancy, following the overturning of Roe v. Wade. If Reynolds is successful, 98% of abortions may be banned in the state. As we know from other states, abortion bans do not prevent all abortions, but instead push pregnant women to seek abortion in less-safe environments. One hopeful area is the governor’s continuing push to allow over-the-counter dispensation of birth control pills. When that is approved, we need to ensure that insurance such as Medicaid will continue to pay the bill. Preventing unwanted pregnancies and subsequent abortions must be a common focus for all members of our government.
Firearms in Iowa unchecked
A National Public Radio report on May 12 said that “firearms are the number one cause of death for kids and teens … and play a huge role in suicide as well.” In Iowa, military-style weapons are readily available and legal to openly carry; the need for a permit to carry a concealed weapon has been phased out. Public health requires us to legislate against the sales of further offensive guns, as well as high-capacity magazines. We must take action before a mass shooting occurs in Iowa and to prevent shootings in our schools and other areas where teens, students, and the public hang out. We need to legislate and get beyond “thoughts and prayers.”
The conclusion
No. I will not attend the May 31 evening of drinks and hors d’oeuvres at the governor’s mansion, and I encourage my invited Iowa physician colleagues to do the same. The governor and our current Legislature have failed to protect public health in the state of Iowa. One day when the focus changes to safeguard our public health, I’ll drink to that.
David E. Drake, D.O., provides remote psychiatric services to indigent Iowans and in private practice. Contact: drakeoffice@gmail.com.
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