Iowa Senate Democrats

Fighting for a Better Deal for Iowans.

  • Healthy Moms and Babies Act will address growing maternal health concerns

    Iowa Senate News Release

    For Immediate Release: Feb. 19, 2020

    DES MOINES – Senate Democrats have proposed legislation to address the growing maternal health crisis in Iowa.

    “Iowa is facing a maternal health crisis that we simply cannot ignore,” says Senator Janet Petersen, the Senate Democratic Leader. “Iowa’s maternal mortality rate has more than doubled in the past three years, hospital labor and delivery departments are shuttering at record speed, and 66 Iowa counties no longer have a single OB/GYN practicing in their county.”

    The scope of the problem includes:

    • Iowa has lost 37 labor and delivery departments.
      MAP OF OB UNITS | LIST OF CLOSURES
    • Iowa has the lowest number of obstetricians per capita in the country. Two-thirds of rural Level 1 hospitals have no obstetrician on staff.
    • Compared to other states, Iowa has a high rate of cesarean births, an indicator of potential health problems for mother and child.

    “Iowa taxpayers pay for more than 40% all births in our state through Medicaid,” Petersen said. “Governor Reynolds has put a system in place that allows out-of-state companies to make a profit off of labor and delivery services while our rural hospitals are financially penalized for providing care. Iowa’s privatized Medicaid doesn’t cover the full cost of delivering babies, which hurts rural and urban hospitals.” 

    The Healthy Moms and Babies Act (SF 2062), co-sponsored by 18 members of the Iowa Senate, will address the maternal health care crisis by:

    • Adjusting Medicaid rates so that hospitals are adequately reimbursed for the care they provide.
    • Ensuring labor and delivery units use proven practices—known as “safety bundles”—that save lives during delivery.
    • Expanding home visiting services for pregnant women, new moms and babies.

    – end –

    Summary of SF 2062: “Healthy Moms and Babies Act”

    Background

    Maternal health in Iowa is experiencing a crisis.

    Maternal death rates are higher in the U.S. than in any other developed nation, and they are rising.  In Iowa, maternal mortality has more than doubled in three years.

    In addition, moms-to-be are now sicker than in the past, with increasing maternal age, higher levels of obesity and related health complications, and societal problems such as substance abuse and mental health, all playing a role.

    To compound these problems, access to care is diminishing and the provider workforce is shrinking. Iowa has seen 37 labor and delivery units in critical access hospitals close since the year 2000, and Iowa has the lowest number of obstetricians per capita in the country, according to the American College of Obstetricians and Gynecologists.

    • 64% of rural Level 1 hospitals have no obstetrician on staff
    • Iowa ranks 50th out of 50 in the number of OB/GYNs per capita
    • Iowa has a high rate of cesarean births which can lead to future health problems

    As of October 2019, 37 of Iowa’s 118 community hospitals have closed their birthing units since 2000, according to the Iowa Department of Public Health. There were two closures in 2019, down from eight closures in 2018 — the most in a single year. Since then, Mount Pleasant, New Hampton and Muscatine have announced closures.  Most of those closures have happened at smaller facilities. Hospitals are not reimbursed for the cost of the standard of care for labor and delivery so they lose money on every birth.

    About 40% of births in Iowa are Medicaid so making improvements to maternal care in the Medicaid program is key to improving maternal health and birth outcomes in Iowa. Privatized Medicaid doesn’t cover the costs for delivering babies in Iowa when health care providers follow the standard of care.

    Division I:  Medicaid Maternal and Child Health Improvements

    DHS is directed to adopt rules under both fee-for-service and managed care Medicaid, amend any managed care contracts, and apply for any Medicaid plan amendments or waivers necessary to improve care for moms and babies in all the following ways:

    1. Provide reimbursement in an amount that appropriately covers the entire standard of care costs for labor and delivery;
    2. Provide the same reimbursement for maternal-fetal medicine services and comprehensive maternity care when provided in person or via telehealth (covering both facility and professional fees);
    3. Allow continuous Medicaid eligibility for a woman for a 12-month postpartum period (compared to 60 days currently);
    4. Provide comprehensive maternity care which includes the basic number of prenatal and postpartum visits recommended by ACOG (American College of Obstetricians and Gynecologists), any additional prenatal or postpartum visits that are medically necessary, necessary laboratory, nutritional assessment and counseling, health education, personal counseling, managed care, outreach and follow-up services, and treatment of conditions which may complicate pregnancy;
    5. Provide reimbursement for doula care;
    6. Reimbursement for breastfeeding supports, counseling, and supplies including the standard cost of breast pumps and electronic breast pumps;
    7. Reimbursement for transportation to all prenatal and postpartum care appointments; and
    8. Reimbursement for all postpartum care products such as breast pads, period pads, comfort products, pain relievers, and other similar products.

    Division II:  Maternal Best Practices/Safety Bundles and Hospital Requirements

    Licensed hospitals that provide labor and delivery services shall be required to do the following:

    1. Adopt and implement the current best practices or safety bundles recommended by ACOG and the Alliance for Innovation on Maternal Health; details here https://www.medpagetoday.com/obgyn/pregnancy/74631

    These maternal safety bundles include action measures for:

    • Obstetrical Hemorrhage
    • Severe Hypertension/Preeclampsia
    • Prevention of Venous Thromboembolism
    • Reduction of Low Risk Primary Cesarean Births/Support for Intended Vaginal Birth
    • Reduction of Peripartum Racial Disparities
    • Postpartum care access and standards
    1. Provide information to the public, including but not limited to maternity and neonatal level of care status and the meaning of that status;
    2. Provide cesarean birth statistics;
    3. Provide statistics on the number of vaginal births after cesarean (VBAC) and vaginal births after two cesareans (VBA2C);
    4. Provide rate of exclusive breastfeeding upon discharge;
    5. Provide all moms and babies receiving labor and delivery services with information and assistance in applying for services and health care coverage including but not limited to Medicaid; AEA agencies; WIC; and home visiting programs; prior to discharge from the hospital; and
    6. Have a comprehensive labor and delivery unit closure plan in place that includes a plan for future births and pregnancies and the capacity of other providers to absorb the services in case of unit closure.

    Division III:  Expanded Home Visiting Services

    DHS is directed to seek federal approval for any state plan amendment or waiver necessary in order to collaborate with the Department of Public Health and the Department of Education to expand maternal and infant home visiting services under Medicaid that:

    • promote healthy pregnancies;
    • positive birth outcomes; and
    • healthy infant growth and development.

    The departments shall design a home visiting approach that maximizes coordination and blending of programs and funding, reduces duplication of efforts and ensures that the services provided meet federal evidence-based criteria. Home visiting should start prenatally and include mental health services.

  • Rural Iowa’s Maternal Health Crisis: A Doctor’s Perspective

    By Senate Intern Kylie Spies, University of Iowa MSW student

    Women in Henry County soon will have to travel an hour to Iowa City or Ottumwa to give birth. In labor and delivery, every minute can be critical. Sarah Ledger of Mount Pleasant, a physician with Henry County Health Center, talks with State Sen. Rich Taylor about the consequences of closing obstetrics units in rural Iowa.

    Rural Iowa hospitals are struggling to keep their doors open, and family practice doctors are on the front lines. Dr. Sarah Ledger, D.O., visited the State Capitol to tell legislators about the challenges Iowa families and doctors are facing.

    Dr. Ledger provides prenatal care to southeast Iowa women at Henry County Health Center in Mount Pleasant. HCHC will close the doors to its maternity unit in June, leaving another Iowa community without a safe place to have a baby.

    Henry County Health Center is a Top 100 Critical Access Hospital in the United States. Critical Access Hospitals are small rural hospitals at least 35 miles from another facility. They have 25 beds or fewer, and must offer 24/7 emergency services. In rural Iowa, these hospitals may be a matter of life and death in a crisis.

    Dr. Ledger says that because of the way Medicaid providers pay hospitals for maternity services, they are sometimes forced to close their labor and delivery units to keep the rest of the hospital afloat. It takes a lot of staff and hospital resources to be ready to deliver a baby at any time. If Medicaid payments don’t cover the costs or aren’t made quickly, rural OB units suffer.

    Critical Access Hospitals are supposed to receive higher rates of payment for their services because they are so vital to the community. But profit-driven private Medicaid providers have squeezed hospital budgets so tightly that they can no longer serve Iowans.

    “You abandon OB to keep your hospital open,” says Dr. Ledger. “We’re running into the same thing with our EMS services. We run into the same thing with some of our inpatient care units. You have to cut back on the services that you provide to keep your hospital open. And we’re seeing hospitals that are still closing.”

    Dr. Ledger says women are at higher risk of health problems like high blood pressure and premature births than they were 20 years ago. She sees patients living with violence and hunger, and many without a vehicle for traveling to appointments.

    Good prenatal care is crucial for the health of moms and babies. Regular appointments during pregnancy allow doctors and midwives to monitor patient health, educate moms, and prepare them for labor and newborn care. Without access to prenatal care, Iowa women and their babies face serious health risks.

    “These women come in and we have no idea what the potential complications are going to be. It increases the cost of health care overall because we’re not prepared. We haven’t taught these moms how to take care of their babies. We haven’t taught these moms how to take care of their bodies. You see more complications with that.”

    Women in Henry County soon will have to travel an hour to Iowa City or Ottumwa to give birth. In labor and delivery, every minute can be critical.

    “It is much safer to deliver these babies in a stable OB unit with a trained OB clinician, rather than an ER, in the back of an ambulance, or in a personal vehicle on the side of the road,” says Dr. Ledger.

     The shortage of maternity units in rural Iowa puts moms and babies at risk.

    Iowa ranks 50th out of the 50 states in the number of OB-GYNs per capita. Two-thirds of Iowa counties don’t have a single OB. Combined with the 34 closures of rural Iowa maternity units since 2000, Iowa has a serious care crisis. Dr. Ledger is asking the Legislature to fix Iowa’s Medicaid mess to protect rural hospitals.

    “We need more support with our Critical Access Hospitals. We need more money, unfortunately we need higher reimbursement,” she says.

    “We pay a lot of money to these private MCOs, and we are getting less and less.”

    Sources

    www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Health-Disparities-in-Rural-Women?IsMobileSet=false

    www.hchc.org/

    www.ruralhealthinfo.org/topics/critical-access-hospitals

    www.arcgis.com/apps/webappviewer/index.html?id=52284a7453eb46b79149c1571d2d5e1b

  • Senate Republicans vote to take away women’s rights

    TRANSCRIPT:

    Ladies and Gentleman of the Senate, on the opening day of the Legislative Session, I said,

    “Iowans shouldn’t have to worry that their human and civil rights are on the line when the Legislature is in session.”

    But here we are…

    Today, Senate Republicans, under the leadership of Senator Schneider and Senator Whitver, are pushing a Constitutional Amendment designed to strip away the freedom of Iowa women, girls and their families.

    President Schneider and Leader Whitver – this debate calendar for today is one for the history books – one you will both be remembered for.

    First, you celebrate the 100th anniversary of women’s right to vote.

    Then, on the same debate calendar, the only other piece of legislation you put forth is a Constitutional Amendment to strip women and girls of their basic human rights.

    You’ve chosen today to push an extreme agenda with the ultimate goal of an all-out abortion ban in Iowa –with no exceptions granted under any circumstances, instead of focusing on real problems facing young Iowa families in our state.

    Iowa women and girls need MORE access to safe health care close to home, NOT LESS.

    But that doesn’t seem to faze you.

    Never mind that Iowa is facing a maternal health crisis facing our state.

    Never mind that Iowa’s maternal mortality rate has more than doubled in the past three years.

    Never mind that 66 Iowa counties don’t even have a single OB/GYN.

    Livestock in our state has better access to doctors than Iowa women and girls, but I guess that doesn’t matter to you.

    Never mind that Iowans are losing labor & delivery departments and safe places to go for decent reproductive health care at a dangerous and deadly pace.
    ¬
    Iowa families represented by Senator Sinclair have lost three labor & delivery departments in Chariton, Knoxville and Leon.

    The families Senator Miller-Meeks represents have lost three labor & delivery departments in Bloomfield, Keosauqua, and Fairfield.

    Moms-to-be in Senator Rozenboom’s district lost their labor & delivery department in Centerville.

    Young families who are represented by Senator Segebart lost access to three labor & delivery departments in Audubon, Manning, and Sac City.

    Senator Waylon Brown – young families in your district had already lost labor & delivery services in Osage. Now you can add New Hampton to the list of places that won’t serve moms-to-be in your district anymore.

    Moms-to-be represented by Senator Johnson no longer have a labor & delivery department to deliver their babies in Oelwein and Independence.

    Senator Johnson was assigned the Healthy Moms and Babies Act to help address the maternal health crisis facing Iowa. But Senator Johnson hasn’t scheduled a subcommittee on the bill yet.

    Senator Edler: you promised the families in your district more access to health care. But Marshalltown because the Iowa community to lose a Level 2 labor and delivery department.

    Iowa parents-to-be that Senator Costello represents no longer have labor & delivery departments in Clarinda and Hamburg.

    Families Senator Sweeney represents lost labor & delivery departments in Iowa Falls and Eldora.

    Families Senator Whiting represents lost labor & delivery departments in Sibley and Rock Rapids.

    Parents-to-be and families living in Anamosa, Corning, Dyersville, Estherville, Guttenberg, Hampton, Humboldt, Ida Grove, Jefferson, Keokuk, Maquoketa, Washington, Webster City – all lost labor and delivery departments.

    Mount Pleasant is soon to shutter its labor and delivery program. And NONE of these hospitals that closed their labor and delivery departments are required to make sure other communities can take on the additional patient load, or that women have safe transportation to get to distant hospitals.

    So, even if your senate district hasn’t lost a labor and delivery department, your constituents health care is compromised as well. Access to a labor and delivery room matters.

    And the problem is getting worse.

    We know we’re likely to see an additional 10 labor & deliveries close down in the near future. A significant number of OB/gyns and family practitioners are planning to retire soon. And, we are starting to lose family practice residency programs in the state.

    These, my friends are real issues.

    BUT instead of making Iowa a safer place to have a baby, or help women get health care to regulate problematic periods, and address period health care issues that impact their ability to go to school and work, or improving access to family planning services so parents can choose when to have kids, and safely space their pregnancies, or choose not to have kids.

    Instead government is intruding on their lives.

    You have chosen to take away freedoms from Iowans.

    Instead of dealing with real problems that can truly be life or death problems for women and girls in our state, you have chosen to ram your power into women’s bodies once again.

    Wasn’t it enough, when you banned thousands of Iowa women from getting their reproductive health care from Planned Parenthood, Unity Point and the University of Iowa Hospitals and Clinics…while you still enjoyed your taxpayer funded health insurance that allowed you, your spouses and your kids to access those providers and even get the same services you denied to the women you represent?

    Women are getting tired of you making your political statements with our uteruses.

    It’s time to quit punching women and girls in the uterus with your policies, and pretending it’s for our own good.

    This Constitutional Amendment steals the rights away from Iowa women and girls by taking away our ability to make personal decisions about what is best for our bodies, our future, our families, and our pregnancies.

    I can’t think of a single body part that is regulated more than the UTERUS.

    Not a big toe.

    Not eyes.

    Not even the penis, which is responsible for 99% of all rapes and 100% of all unintended pregnancies in our country, according to facts and science.

    To my Senate Republican colleagues – it is time for you to quit treating Iowa women and girls as second-class citizens whose rights and opportunities are inferior to your own.

    I don’t like to be mansplained on what human rights are.

    This constitutional amendment is written with the sole purpose of banning access to safe abortion care in Iowa.

    Don’t let the misleading language in this amendment confuse you.

    This amendment is not designed to protect women.

    The intent of this constitutional amendment, and the politicians behind it, is to make sure Iowa can ban abortion without exception.

    When you take away access to safe, legal abortion care, and maternal health care, you do not protect women and girls – you put their lives at risk.

    That’s why the American Medical Association and the American College of Obstetricians and Gynecologists oppose efforts to ban abortion.

    Iowans – not politicians – should be in charge of our own personal medical decisions.

    Make no mistake about it – this Constitutional Amendment is part of an extreme abortion ban agenda pushed by Republican politicians here in Iowa and across the country – designed to do one thing. End access to safe abortion care, no matter what the cost to the lives of women, girls and families living in our country.

    President Schneider, you chose to use the power of the Senate Presidency to have the Iowa Senate celebrate women’s right to vote today. And then in the very same day, you allowed a debate on an ultra-extreme Constitutional Amendment that strips women and girls of their basic human rights.

    Isn’t it ironic, don’t you think!

    President Schneider, I am glad you don’t have the power to take away women’s RIGHT TO VOTE that our grandmas and great grandmas fought for more than 100 years ago because I know WOMEN intend to use that right.

    I urge a no vote.

  • Improving health for Iowa moms and babies

    Maternal health in Iowa is experiencing a crisis. Maternal mortality has increased at an alarming rate in recent years. Maternal deaths went from fewer than 15 in 2008 to almost 50 in 2019, according to Dr. Stephen Hunter, co-director for Perinatal Care at the Iowa Department of Public Health.

    A big part of the problem is Iowa’s shrinking health care options and workforce:

    • Iowa has seen 34 labor and delivery units close since 2000.
    • Our state has the lowest number of obstetricians per capita in the country; 64% of rural Level 1 hospitals have no obstetrician on staff.
    • Iowa has a high rate of cesarean births, as a result, which can lead to future health problems.

    About 40% of births in Iowa are covered by Medicaid, but privatized Medicaid doesn’t cover the costs for delivering babies if health care providers follow the recommended standard of care, so hospitals lose money by providing labor and delivery services.

    That’s why we are proposing the Healthy Moms and Babies Act (SF 2062), which will:

    • Adjust Medicaid rates so that hospitals are adequately reimbursed for the care they provide.
    • Ensure labor and delivery units use proven practices—known as “safety bundles”—that save lives during delivery.
    • Expand home visiting services for pregnant women, new moms and babies.

    Changes to reproductive health care have real consequences

    During a recent visit to the State Capitol, former State Senator Chris Brase of Muscatine shared his daughter’s devastating pregnancy experience during the summer of 2019.

    Sen. Brase’s daughter experienced a loss of amniotic fluid at around 24 weeks, meaning that her baby’s lungs and other vital organs would be harmed and her baby would not survive birth.

    Because of legislation approved by the Republican-controlled Legislature and signed by the Governor in 2017, she was forced to continue the pregnancy, risking her own health, while knowing that her baby would suffer after birth.

    She was only able to receive the medical care she needed when sepsis set in and her life was at risk.

  • Committee remarks on SJR 21

    Prepared opening remarks to the Senate State Government Committee on SJR 21 by State Sen. Claire Celsi, D-West Des Moines

    SJR 21, Constitutional Amendment: legis.iowa.gov/legislation/BillBook?ga=88&ba=SJR21

    Good morning and welcome to all Iowans who’ve traveled here today to witness this meeting and those who are listening online.

    For many Iowans, this proposed Constitutional Amendment by the Republicans may seem like its coming out of left field.

    Let me assure you. This Iowa bill is just a small part of a coordinated effort to overturn Roe vs. Wade at the national level – and if the Supreme Court kicks the decision back to the states – it’s an effort to weaken the protections of the Iowa Constitution.

    Republicans know that once the Iowa is weakened, if their plan succeeds – then they can go back to the bad bills they’ve tried to pass and get them all out of the trash heap of history and pass them without fear of the Iowa Supreme Court overturning their laws.

    Let’s review. They’ve passed telemedicine abortion bans, a 72-hour waiting period and a 6 week heartbeat bill. Each attempt to limit Iowans’ rights to a safe, legal abortion was more extreme, medically inaccurate and insulting than the one before.

    All of these extreme laws have been nixed by the courts. In the 72-hour waiting period case, the Iowa Supreme Court had enough and the majority opinion went into great detail as to all the ways that Iowans’ constitutional rights had been usurped.

    Republicans complain of activist, unelected judges making these decisions on behalf of Iowans. But what’s ironic is that Republicans in Iowa and nationally are working to stack the courts with judges that will rule in their favor on the issue of abortion.

    A Constitutional amendment is the most extreme action that can be taken a democratic political body. The Republicans are sick of the courts standing up for Iowans’ rights. They want to make sure they have the final say.

    Since this bill has been introduced, I’ve heard from women from all over Iowa. Women who have had life threatening conditions such as preeclampsia that have killed their baby and nearly killed them, too. I’ve heard from Iowans who had an aunt, mother or grandmother who had an illegal abortion and died. I’ve heard from retired nurses from Western Iowa who worked in rural hospitals that provided safe yet illegal abortions to women who had the means and access to the procedure.

    I’ve talked to women whose sisters went to college, tried to self abort their pregnancy in a bathroom, and never came home.

    I’ve talked to women who lost babies much wanted babies at 8 weeks, 12 weeks, 24 weeks for various reasons.

    Thanks to Iowa’s law that limits abortion after 20 weeks – “except for the life and health of the mother” some women have had to wait until they were septic before having a life-saving D&C.

    Some Republicans in the Iowa Senate are determined to weaponize our Constitution to eliminate rights that we currently have. Today, my Democratic colleagues and I are standing up against that overreaching concept.

    Instead of focusing on Iowa’s maternal health crisis, Republicans choose instead to ignore those problems and go the most extreme route possible.

    On behalf of my constituents and the millions of Iowans who support safe, accessible and legal reproductive healthcare – I take great offense to this completely unnecessary bill.

    Thank you Mr. Chair.

  • Statement on constitutional amendment on women’s health

    Read and track Senate Joint Resolution 21

    State Sen. Claire Celsi’s prepared remarks for subcommittee meeting on SJR 21

    January 16, 2019

    Good morning, and welcome to all Iowans who came to express their opinions here today. This is the one and only time that a public expression of opposition or support of an amendment to our constitution will be allowed.

    It speaks volumes to me that the notice for this meeting was requested from my clerk barely in time to meet the 24-hour notice Senate handshake agreement. But the notice was not received through the normal channels by Senate staff, the lobby or the public due to a technical malfunction. When asked to move the meeting to a more amenable time so that more members of the public – those who would be affected most by this law – the suggestion was rejected by the majority.

    It’s a sad day for us when we have four large public meetings for sports betting here at the Capitol, and one poorly noticed public meeting in a small room for such a consequential one here today.

    The Iowa Constitution has been updated a number of times in our state’s history. In every circumstance – it was to update and modernize, right a wrong, or expand the rights of our citizens. This amendment would take rights away. And that is the wrong direction for Iowans. Public poll after public poll affirms that our constituents trust pregnant Iowans to make decisions about their own bodies with the advice of their physicians, their partner and their God.

    In contrast, if approved, this Constitutional amendment seeks to take away a right to bodily autonomy and privacy. The Supreme Court recently elevated its recent decision to include the phrase “strict scrutiny to applies to the right to an abortion.” That means that this right is so important that any attempt to diminish this right should be considered a very serious encroachment on individual rights.

    Some Republicans in the Senate are determined to continue this war on pregnant Iowans – to stand directly between an individual who is making a serious and consequential decision for themselves and their family. These senators want to metaphorically gown up and come right in to the surgical suite and tell that trained physician and the person giving birth and their family that THEY KNOW BETTER. They get to make those decisions.

    My Senate democratic colleagues and I are standing up to say – No way. Not on our watch.

    We have a serious maternal health crisis on our hands. More than 30 labor and delivery departments have closed around our state. There are serious shortages of obstetricians around the state. Options for prenatal care are shrinking. Instead of focusing on these solvable problems, Republicans are choosing instead to focus on a long odyssey of restricting rights through a constitutional amendment and a public vote.

    Iowans deserve public servants who listen to their needs and respond. Iowans from all over the state are asking me to maintain their rights.

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