SIOUX CITY | My ancestors came from Ireland, a place President Trump might have called a "s***hole" country in the 1840s.
The Gallaghers and Floods fled starvation and economic collapse during the Potato Famine, which killed 1 million Irish and sent another 1 million desperate men, women and children in search of hope. They washed up on U.S. shores poor, often sick, weak and largely unwanted. "NINA" signs greeted them: "No Irish Need Apply."
With the help of others, those Floods and Gallaghers busted their backs on farms and railroads, in factories, and, well, even at a newspaper in Emmetsburg, Iowa.
They had to eat. They had to survive. They aimed to make life better for their children, or, as Rep. Steve King would put it, "other people's babies," who ultimately enriched Iowa communities such as Brooklyn, Osage and, generations later, Storm Lake and Moville.
Those thoughts stirred on Thursday as I listened to newcomers from El Salvador describing lives they left in coming to the U.S.
President Trump, who on Friday denied using the profanity in a meeting a day earlier with members of Congress, had earlier in the week called for phasing out the Temporary Protected Status for an estimated 200,000 Salvadorans who were allowed to live and work in the U.S. in the wake of 2001 earthquakes that displaced more than 1 million people.
Prior to 2001, the Central American nation endured civil war for 13 years. Subsequent gang warfare and high homicide rates have El Salvador rated as the world's third most dangerous country, according to the World Economic Forum.
Gang members murdered the maternal grandparents of Salvadoran Oscar Rodriguez, of Sioux City. An uncle, he added, was shot eight times before he died. The murderers then chopped off the man's head and his arms.
"I see on Facebook at least five deaths each day from gang members," said Rodriguez, who was granted asylum in the U.S. 16 years ago. He came here as a 10-year-old, unable to read or write. The 2011 West High graduate is now fluent in Spanish and English and works as a member of his brother's roofing crew. They completed their first roof of 2018 on Monday in Vermillion, South Dakota.
"We work as far away as Brookings, South Dakota," said Rodriquez, who is married and the father of two children. "We work on homes and businesses in Akron, Le Mars, Sioux City. In the summer, work from 6 a.m. to 10 p.m., sometimes 110 hours per week."
Rodriguez, who told me he pays sales taxes, income taxes, Social Security taxes and property taxes via his rent payment, downed three papusas prepared by Gloria Romero, a native of El Salvador who came to the U.S. in 1999, sponsored by a family member who lived in Los Angeles. Romero and her husband, Jorge Romero, and their three sons, settled in Sioux City in August of that year.
The Romeros worked for Sara Lee and Tur-Pak Foods and became U.S. citizens. In 2008, they opened California Papusas & Bakery on Sioux City's west side. Gloria opens her shop six days per week, serving customers who raise families while producing for firms such as Tyson Fresh Meats, Curly's Foods, and Beef Products Inc., among others. Jorge died of cancer in 2012.
"The people I know from El Salvador are scared," she said of those who have Temporary Protected Status. "They have their lives here in Sioux City."
A man from Storm Lake, Iowa, said he knows of at least 35 to 40 Salvadorans who work with him at Tyson Fresh Meats, slaughtering hogs in demanding jobs that keep food on the table for us and their growing families. The man and his wife, parents of two children, don't wish to identify themselves for the newspaper.
"My friends at Tyson are really feeling sad about it," he said of Trump's order. "They think they'll lose everything they have. They don't know if they have any other way of extending their stay here."
The man, who owns a home, said he's heard of friends who are considering a sale of their home and autos, fearful they may lose them anyway in their day of reckoning.
An immigration attorney suggested Salvadorans meet with a lawyer to examine options for possible work extensions. They have time as their Temporary Protected Status, which, as the title suggests, is temporary, would extend until September 2019. Homeland Security officials said conditions in El Salvador have improved since the earthquakes, thus making the Temporary Protected Status no longer applicable.
The man at Storm Lake disagreed. He said he knows of a Salvadoran who was deported last year and killed two days after setting foot back in his home country. The perception there is that if you came from the U.S., you have money.
"I also had a cousin who was 15 years old," he said. "He was picked up from school by gang members, taken to another town and killed."
Rodriguez, a refugee, knows of other tragedies. "I can't go back to El Salvador," he said. "I don't want to go back."
Whether or not President Trump described it as a "s***hole" country, it's where he, if he gets his way, will send 200,000 tax-paying U.S. workers and their children.
If he were president in the aftermath of the Potato Famine, I likely wouldn't be here. I probably wouldn't have been at all.
DES MOINES | Many nursing homes in Iowa — particularly in rural areas — are struggling to make ends meet.
A big part of the problem, nursing home officials say, is that payments from a government health care program are insufficient and sometimes not timely.
And the state’s privately managed Medicaid system adds another layer of stress to nursing home budgets, officials say, because of the management companies’ appeals process and administrative burden.
More than 400 nursing homes in Iowa accept patients who pay through Medicaid or Medicare, government-run health care programs for the elderly, disabled and poor, according to a federal database.
Many of those facilities, industry officials say, are feeling a budget pinch, in large part, because Medicaid reimbursement rates are too low and payments often are delayed as claims are contested.
Medicaid is jointly funded by the federal government and states, which can set their level of payments to providers within federal guidelines.
States, including Iowa, must be thoughtful when setting Medicaid payment rates as the program continues to chew up a large share of the state budget. At $1.3 billion, Medicaid spending comprises 18 percent of Iowa’s general fund spending; that is second only to public education funding, according to the state’s nonpartisan legislative agency.
For states, that high price tag must be balanced with creating a payment system that is sufficient for health care providers to deliver adequate care to patients who use Medicaid.
A growing number of nursing homes are finding the payments too low, officials say.
Iowa’s state budget is experiencing its own struggles, with shortfalls that have led to spending cuts in each of the past two years.
Although the state has not cut Medicaid spending among its budget cuts, the Medicaid reimbursement levels are “inadequate,” said Brent Willett, president of the Iowa Health Care Association, which advocates on behalf of more than 700 long-term care facilities in the state.
Willett said long-term Medicaid residents in nursing homes are underfunded by an average of $30 per day, or $10,950 per year. He said because many nursing homes operate on profit margins of less than 1 percent and many at a loss, those costs are passed on to residents with private insurance in the form of higher rates.
Willett said often those residents with private insurance are then forced to spend down their savings, more quickly putting them in a position to need Medicaid, creating what he called “an unsustainable cycle.”
Rural facilities feel that pressure even more, Willett said, because they have more Medicaid patients than urban facilities, and thus fewer private patients to absorb the impact of low Medicaid payments. While more than a half of residents in Iowa long-term care facilities are covered by Medicaid, dozens of facilities have at least roughly two-thirds of their patients covered by Medicaid, Willett said.
And smaller, rural facilities do not have the resources to shoulder increasing costs, he said.
“This places rural facilities in an extremely precarious position: as state and federal Medicaid reimbursement continues to fall further and further behind the cost of care, and with fewer private pay residents to pass the costs along to, finding ways to absorb the losses becomes increasingly challenging,” Willett said.
Nursing homes closed last year in Charles City, Le Mars and Storm Lake. The Charles City facility cited financial constraints as the reason for closure; the Le Mars facility had received poor service ratings from federal regulators.
Iowa’s privately managed Medicaid system is compounding the problem for nursing homes, Willett said.
While the private companies that manage the state’s $4.7 billion Medicaid program do not set payment rates, they oversee claims and payments. Sometimes payments are denied and wind up in an appeals process; Willett said this can put financial stress on small nursing homes that do not have the resources to cover the loss of that payment while it is in the appeals process. He said some facilities are forced to take out loans to cover payroll costs while waiting for Medicaid payments from the managed care organizations, or MCOs.
“We continue to work with the managed care organizations to advocate for the development of more consistent managed care claims payment systems,” Willett said. “These denials — most of which subsequently enter an appeals process — are growing across the state and have resulted in providers accumulating large accounts receivable balances as they await approval for services rendered and costs incurred.”
A spokesman for United Healthcare, one of the two companies managing Iowa’s Medicaid program, said the company works closely with doctors and health care providers, and pointed to a recent state report that said 100 percent of medical and pharmacy claims were administered within 30 days, and that providers are reimbursed at the full Medicaid rate.
SIOUX CITY | Woodbury County takes a place in Iowa electoral history Tuesday.
A special election for a state House seat will be the first test of the state's new voter ID law.
Democrat Rita DeJong and Republican Jacob Bossman, both of Sioux City, are competing in the district, which includes Sioux City's Morningside neighborhood and some areas in northern and western Woodbury County. The seat was recently vacated by Jim Carlin, who won a special election for a state Senate seat last month.
Woodbury County poll workers have been trained on the new photo-ID requirement and are ready for implementing it in Tuesday's election, said Pat Gill, the county's top election official. Polls will be open from 7 a.m. to 9 p.m.
"Most voters will see very little difference in the amount of time it takes to process them as they cast their vote," Gill said.
Gill said workers will expand the use of electronic poll books, where most county voters are already accustomed to scanning their driver’s license as a look-up tool to facilitate the process.
Gill noted there is some flexibility in the implementation of the voter ID for 2018.
"Since this year is the first year of the requirement, it is considered a soft rollout. If the voters do not have the required ID, they will simply be asked to sign an affidavit that informs them of the requirement and they acknowledge that they are the person they say they are, as they exercise their right to vote," Gill said.
House File 516 was passed by the Republican-controlled Legislature and signed into law by former Gov. Terry Branstad, despite concerns from Democrats and civil rights groups that the law’s true intent was a thinly-veiled attempt to suppress turnout by Democratic-leaning voters.
Besides requiring ID and signature verification at the polls, the law also ends straight-party voting and shortens the period for early voting from 40 to 29 days.
Iowa Secretary of State Paul Pate in December began mailing ID cards to about 123,000 registered voters who do not already have a valid Iowa driver’s license or state identification card.
The cards are free and will be sent automatically to roughly 6 percent of Iowa’s registered voters. Pate, who serves as the state's elections commissioner, said the process is designed to ensure all registered voters in Iowa have an identification card to use when voting in 2018.
“It should be easy to vote, but hard to cheat, and that’s what this new law ensures,” Pate said in a statement. “We are taking the unprecedented step of mailing free voter ID cards automatically to every registered voter who does not already have an Iowa driver’s license or non-driver’s ID. Only those Iowans will receive these cards. I encourage them to be on the lookout for the Voter ID cards in the mail, and when they receive their card, open it, sign it and keep it.”
Registered voters who have a valid driver’s license or a non-operator identification card from the Iowa Department of Transportation will not receive a free card. They will need to take their current state-issued ID with them to the polls, according to Pate’s office.
Gill said Pate's office has been good to work with in getting information for training poll workers. However, Gill spoke against the need for the new law, as he had for years when Republicans brought it up unsuccessfully.
"I have never witnessed any activity that I felt would warrant the implementation of a voter ID requirement. That being said, my office will comply and fulfill the requirements of the law in a fair and competent manner that most voters will find unobjectionable," Gill said.