Mental health care solutions pitched by Iowa gubernatorial candidates at forum

DES MOINES - Among the myriad policies, programs and ideas to provide better mental health care in Iowa, nearly all of the 13 candidates for governor agreed on one thing.

Administration of the state's $5 billion Medicaid program should return to the state.

At a forum hosted Tuesday evening by Des Moines University and organized by the Des Moines Register, 13 candidates for governor fielded questions on how to improve Iowa's mental health care system. Roughly 400 people attended, organizers said.

The only candidate not in attendance was incumbent GOP Gov. Kim Reynolds, who is on a family vacation this week and sent a video statement.

Reynolds is a staunch defender of Iowa's privately managed Medicaid program, but that delivery system was on the chopping block Tuesday.

'To fix this problem, first end the privatization of Medicaid,” said John Norris, one of the seven Democratic candidates for governor, each of whom attended. 'Commercial (managed care organizations) will never be motivated for health care first. Need to admit failure. The governor needs to admit failure. That's a part of being a leader.”

During her video statement, Reynolds said the state's regional system is providing more mental health services in modernized and community-based settings.

Reynolds recently defended the Medicaid system after one of the three companies paid by the state to manage care dropped out and one of the two remaining said it cannot handle additional patients - leaving the third to absorb about 200,000 patients.

'It's not perfect. I've never said it was perfect,” Reynolds told reporters in November. 'I'm willing to put the time and the effort into making sure that Iowans get the care that they deserve in a managed and coordinated and more modern delivery system. I'm not going back.”

That puts her at odds with most of the candidates at the forum, including independent, Libertarian and even Republican candidates.

'I also believe that the reversal of the privatization is a key issue here,” said GOP candidate Steven Ray of Boone.

Candidates also discussed the need for more mental health care beds after the 2015 closure of two state-run mental health institutions, although the field was divided over whether those facilities should be reopened or recreated.

Democratic candidates Cathy Glasson of Coralville and Nate Boulton of Des Moines said the mental health institutes should be reopened, as did independent candidate Brent Roske of Des Moines. The other candidates were less committed to reopening the facilities, or said a shift to community-based care was appropriate.

'I'm sure many of you that work in the field know, this is a complex issue,” said Democratic candidate Andy McGuire, a Des Moines physician who practiced medicine for nearly 30 years before getting into politics. 'Acute care beds are not the only beds we're talking about here. There are transition beds, there are long-term beds. And we have a real problem right now with - we don't have enough acute care beds - but honestly we don't have anywhere for people to go who can't go home after they're done with their acute care and their medicines haven't quite worked yet. ... This is a cascading issue.”

The candidates were asked how they would pay for the myriad solutions they presented.

Most said they would allow local governments to raise their property tax levy to help pay for more mental health services. Some were critical of the current status of the state budget. Ron Corbett, a Republican candidate and outgoing mayor of Cedar Rapids, said reducing administrative costs would help.

Glasson and Roske said their campaign calls for a universal health care system would provide more mental health care services.

'It's not OK to shrug your shoulders and say, ‘How are we going to pay for it?' and have that make the problem go away,” Roske said. 'We need to look at this as something that we expect, just like police and fire (departments), K-through-12 (public education).”