Andy McGuire is a physician and health care management executive. She was also chair of the Iowa Democratic Party in 2015 and ‘16 and oversaw the last Iowa caucuses. Now, she’s running for her party’s nomination for governor.
She spoke with IPR's Clay Masters on Wednesday May 9, 2018 at her campaign office in Des Moines. A transcript of the conversation follows:
I'm asking everybody who's running in the primary why they want to be governor?
Well that's a good question. I think the biggest part of it is… I come from Waterloo originally, Waterloo, Iowa and -- big family. My dad was a World War II vet, came home, started a construction machinery business. My mom stayed home with us and I learned about caring about other people and it's always carried through with me. If someone was sick, we went and helped them out. If somebody was down on their luck, the whole community got together and got them back on their feet. And that's why I became a doctor. I'm a medical doctor by training and that's why I became a doctor, because I could see the power of caring about somebody especially when they are sick or injured. But for the last couple of years as I've gone all over Iowa, I've been to all 99 counties, been sitting listening to people. They don’t feel like, their government certainly, but that they’re cared about. They don't feel like they can get ahead for their families. They don't feel like they can, they've had a fair shake. And honestly, they feel like the government especially is putting profits ahead of people. Well, I'm a doctor so I took an oath to put patients first. I will always put patients, or people first and I think that's important because I think you want a governor who cares about every Iowan’s success, and the people being successful. Not necessarily a special interest or a corporation, but people in Iowa being as successful as they possibly can be. So that's the kind of governor I want to be, and that's why I'm running.
Health care has become a pretty big issue during this race, for the primary race. In the Iowa Legislature, we've seen former governor Terry Branstad handed over management of Medicaid to private companies. We've even had the governor say that there were mistakes that were made. In your eyes, what is a way to proceed with Medicaid when many people say that the old model, referred to as fee-for-service, was not sustainable? Do you say otherwise?
Well, I was involved in Medicaid. I've been in health care my whole life. But I actually ran a voluntary Medicaid company. So I understand Medicaid as very different than what they're doing now. But it's complicated. What I would do is, because I have heard from so many patients about how they're really getting hurt by this. I mean, they really are getting hurt. I've heard from a special needs dad, so dad of a special needs kid. He has to probably put that son in an institution because of the cutbacks that Medicaid is making, that denial of services. I talked to a mom who has to drive an hour and a half to get her child care. That's not what we need in Medicaid. And so what we're doing right now is really hurting patients. And what, I feel like because it's hurting patients, and I'm always centered on patients, we have to bring it back into the state to stabilize it. It is really unstable now, and we have to make sure we're taking care of patients. We also have to make sure we're paying providers. I've talked to some providers that are almost $1 million behind on their payments. We can't have that kind of, that won't sustain for very long in this state. And we're not saving any money as everyone has said. So bring it back into the state. To your point, fee-for-service, there was some management when it was with the state and I worked with them. I think there can be some management with the state, but more importantly stabilize it, make sure patients are taken care of, make sure doctors and providers are getting paid, our rural hospitals, and then make sure that we're fiscally responsible. And then start to put in some programs to help patients be healthier. One of the things we don't talk about enough is, as a doctor what you want to do is, it's not about denying services. That's not how you save money in the long-term. How you save money is by keeping people healthier. We doubled immunization rates when I ran our company and we doubled prenatal care. Those sort of actions to keep people healthier, so they have healthier babies, so they can have better health. Then they can be more productive. But they also require less health care dollars because down the line, they're not in the hospital and that's what really costs people. So if we can keep people healthier we can actually address the fiscal responsibility while we're still paying providers and taking care of patients and making them healthier. So that's the way I would look at Medicaid.
What was the company that you were running?
And when you're talking about making people healthier so they're using the system less. I mean that's one of the reasons that people a lot of times talk about the MCOs and managed care organizations. But it doesn't, you don't see it working that way?
It's exactly what they say managed care should be, that you invest in patients by investing in getting, making sure you get your preventive care done, making sure that you're doing the kind of things to keep yourself healthier. And in the long run you will control costs that way. That's what managed care is. What we're doing right now is not managed care. They may say it is. It's denial medicine. They're saving money by denying services, not by keeping people healthier. What I would do is, want to do programs that might help people get healthier. But the first thing we've got to do is stabilize this program, make sure patients are taken care of.
Are there other models or states out there that you think are doing a good job?
There are some states that are doing a better job. One of the things we did here that was just unconscionable was, we did this in four months. I was involved in this. This is an 18 months, at least, project you have to do to turn this over at all. Now, I don't know another state that did all of their Medicaid. Medicaid is a big program. It involves 600,000 Iowans, a lot of them in long-term care, disabled, what I call moms and babies. There’s are a lot of different people. And what you have to do is, you have to make sure that you can take care of all of them. And what we did was put the whole thing into managed care. That is unheard of anywhere else. And honestly, we didn't know what we were doing. And one of the reasons I think it's important that we have a governor who understands health care is, this is 600,000 Iowans, a fifth of our expenses and another $2 billion plus from the federal government. We need someone who has this experience and can get this right and get it turned around. That's what we didn't have before. That's why I think it's so important that I have the healthcare expertise to be governor.
There was a lot of controversial legislation that was debated, some of which was passed during the 2018 legislative session. One of the bipartisan bills that did come out of the legislature had to do with mental health. This is something that every candidate I've spoken to has said this is something they're hearing about on the campaign trail – urban, rural. Do you think that legislation was good? And what other directions do you think the state should be going when it comes to mental health care in the state?
I've been talking about mental health since the first day that I got on the trail and talked to people, because it is a big deal and every candidate is talking about it. And as a health care provider I really understand with mental health, substance abuse and addiction, which I put all three. And what we did in this legislative session was certainly good to talk about mental health, and to start down a direction of doing better for mental health because right now we're 50th in mental health beds 47th in providers. And I talk to sheriffs all over that, they're the first line of mental health protection right now in this state. So we did a good job of bringing it up, but there is not funding to actually get the programs accomplished. So I'm glad that we're talking about it. We should be talking about it. We should be trying to destigmatize it, and to talk about the disease that these conditions are, but we've got to actually put in priorities and funding to make sure we can do the programs that we talk about.
On the topic of the legislative session, the state budget and tax cuts were two of the last things to get resolved. You have the advantage, I guess, than the other candidates that I've spoken to, in that the legislature has adjourned. Do you think the tax cuts that were passed were a good thing? Do you think they bit off more than they should have? Would you have been a proponent as a governor to have certain tax cuts put in place this session?
You know what I hear from people all over Iowa, and I've been listening for several months here. I don't hear about them needing a tax cut as much as they need mental health services. I hear about them needing Medicaid fixed. I hear about women's health. I hear about nursing home oversight that has been cut back because we didn't have the resources. I hear about clean water and clean air and not having the resources to clean up our water and air. That's the things I hear about. And so I'm, I just can't imagine why right now we would take away that much revenue when we don't have enough money to do the services that people really need right now. So I would’ve been functioning more on what services people need, and make those a priority. Make people a priority rather than a tax cut that goes predominantly to richer people and corporations and special interests. So, I don't think that was the way to go. I would have concentrated more on services for people.
You said you're hearing from people about water quality issues. What are you hearing from people? And there was legislation, that was the first bill that the governor signed, allocating more funds for water quality projects in the state.
You know, certainly the fact we're talking about water quality is good. But again, there was very little money in there to really do the things we need to do. We need to make this a priority. I'm a scientist by training. So, I'm a chemist and then a medical doctor. And I would approach this as science would, which is, we need to know where we are, need to measure, and know where we are. We need to know where we want to go. We need to get everyone at the table and we need to talk about the metrics and accountability that we need in order to make that happen, in order to get to that solution. That's the way I would approach it. That's going to take some revenue and we did not even give a, enough drops to do the revenue we need for this.
Are there other environmental concerns you feel that are not being talked about?
Well I am a believer in climate change, since I am a scientist and it's a scientific fact. So, I think we should be doing more to try to address climate change. We need to put our Climate Change Action Committee back in. Once the Branstad administration came in, they did away with that. We need to know how we can decrease greenhouse gases over time. This is something that's hurting us right now. It's hurting us with these storms we have that are very localized. We have more asthma and allergies. We have more and flea-borne and mosquito diseases. Those are all things that happen because of climate change. So, I think it's something that our state needs to hit head on.
The way that I have been interviewing you in the past was when you were the party chair for the Iowa Democratic Party. 2016 was a very divisive year, both in the general election and in the primary election. You saw the president as a candidate do well with connecting with rural, blue-collar voters who had felt that they had been left behind or forgotten, saw that here in Iowa. What do you think is something that can unite people in the state that have felt, you know, the way that they did during 2016? And what kind of lessons can you take away from 2016, and that you have and that you're taking on the campaign trail?
You know, I think listening to people. Listening to their struggles. Understanding where they are. I have been to all 99 counties. And when you sit and listen to people, when I was talking about they don't feel like they're getting a fair shake or getting ahead, they really don't. And I think as not just Democrats, but as leaders in this state, we have to talk about how do we help people feel like they can get ahead in the rural areas? Some of that is economic development, making sure that we help our small manufacturers that are in a lot of our rural town, making sure that we can get them connected with the community colleges, because I think that's a way to really help get some economic development in our rural towns. We also have to talk about housing in rural areas. We need to talk about childcare in rural areas. I also, with my mental health plan that I have on my website, we talk about how to get younger people, that's kind of a way to hit a lot of different things, but get younger people to go back to areas. We’ll say Iowa Falls, if a person wants to go into social work, which is something that's needed with our mental health providers, needed all over the state as underserved. If they want to go to University of Iowa or Iowa State and get social, or you know UNI, get a social work degree, go back to somewhere that's underserved like Iowa Falls, practice for five years and that we will help forgive some of their college loans. So that they can help with their college debt. They can do the job that they really want to do, a passion job without worrying about college debt and how they're going to pay for it. And we can help repopulate some of our rural areas with jobs that we really need there. I think we could do that with a lot of jobs, teachers that sort of thing, so that we make sure we are helping repopulate. But we've also got to have some of the amenities that they need like housing and childcare.
Education is a unifier for rural and urban communities. Do you feel like we're doing an adequate job as a state in funding our schools? We have seen reports that Iowa is doing better than other states.
I certainly don't feel that way, and I don't talk to many people who feel that way. When I was growing up, we were the best and we were very proud of it. I talk to people, how did we recruit doctors? When I first came to town and they said, ‘well we didn't have mountains and we didn't have coast, but we had the best education and people care about their kids.’ I honestly wouldn't be a doctor except for a 10th grade science teacher who told me I was good at math and science and he thought I could be a doctor. And he pushed me and pulled me and got me to be more than I ever would have thought I could have been on my own. And so that's what teachers do. You know, teachers are amazing and we need to respect them. So our public school teachers, and we need to make sure we give them the resources they need to teach our kids. And we are, right now, not doing that. If you think about this, allowable growth since 1973 to the last eight years, we were averaging more than 4 percent growth. Now, those were lean years, good years, over 4 percent average. For the last eight years, we've averaged less than 2 percent growth, and we're headed towards 1. That's not even keeping up with inflation. When you think about those buses and the gas and, you know, how you pump your car every day. So that's not right. That's not making education a priority. And if we want to be a world class state, we've got to have world class education. So I think that's a very big priority. And I think it's someplace that when we see some of these corporate tax credits and tax cuts that we're giving away, I think we need to put that money on to education and make sure that's a priority.
So given the state of the economy right now, and when you look at how do you fund things, like providing more funding for education… You're saying that kind of the the whole picture needs to be reexamined and priorities need to be changed?
Absolutely. I don't think we have a revenue problem. I think we have a priority problem. And the revenues go up. You know, even our budget went up 3, little over 3 percent this time. Revenues go up to two-and-a-half at least a year. And that's most years, we have revenue that goes up, but we're giving it away before it ever can get to the services of people, health care, education. So I think what you have to do is, you have to look at every tax credit. Now I will tell you, and some of my opponents don't say this, but not all tax credits are bad. Some of them are very good. If I give you a dollar and you give me back value that's worth ten, hundred times that, that's a good thing for Iowa. And a lot of our tax cuts do what we want them to do, but we need to look at them all. We need to look at them all the time, so when we set them up we need to have metrics to say at 12 months where will you be? What will you be doing that gives back that value? Then we need to look again and again and make sure that every time we be fiscally responsible for that dollar and make sure every time it's giving back the value it should. And I will tell you, there are hundreds of millions of dollars that we could put towards education and healthcare that right now are not giving us back that value.
What are some examples of good tax credits?
Wind, some scholarships that are really good that help kids who, you know, then go on to be great taxpaying citizens in our state. I think there's a lot of ways that we're fostering exactly what we want with tax credits. And that's why I do think we should be talking about that. But there are so many that, and it's funny but I don't think this is a fault thing. I think this is people have a good idea, they think it's going to return value. It's not, or it's not anymore. And we just have to be really honest about when we have to be fiscally responsible. When I give you a dollar, I want to make sure I'm getting value for those taxpayers back.
If you were to take over as the governor in the next legislative session what would be priorities for you as governor? Looking at what has happened the last couple of legislative sessions, are there priorities that you would be putting at the top of that list? How would you, as I said, you have the added bonus of having the 2018 legislative session over as we're talking right now.
Yes. Well I think Medicaid privatization, reversing that, bring it back into the state and stabilizing it for patients and for providers. I think that's number one, because you can do it with an executive order. Now it will take a while to get done because you want to make sure you keep patients safe. But that would be one of the first things I would work on. I would work on actually making some differences in mental health, substance abuse and addiction because I think it's an area where we can have almost immediate impact if we put the funds behind it. Women's health would absolutely be a priority for me. I would get the funding back to Planned Parenthood and I would not have these restrictive laws that limit a woman's ability to, comes between a woman and her doctor. Those would not be under my administration. And then I think education, you have to get funding to education so we can do the world class job we need to do.
All right, Andy McGuire thank you.