Iowa Public Television

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STATEWIDE IOWA PUBLIC TELEVISION IS CELEBRATING THE 30TH ANNIVERSARY OF "IOWA PRESS," NOW SERVING THE STATE AS IOWA'S LONGEST RUNNING PUBLIC AFFAIRS PROGRAM. WITH THIS WEEK'S EDITION OF "IOWA PRESS," HERE IS DEAN BORG.

Borg: TIMES ARE TOUGH THROUGHOUT IOWA STATE GOVERNMENT, AND ESPECIALLY FOR THE IOWA DEPARTMENT OF HUMAN SERVICES. THE CASE OF SHELBY DUIS, THE NORTHERN IOWA CHILD ABUSED-TO-DEATH A LITTLE OVER A YEAR AGO, EXPOSED WEAKNESSES IN IOWA'S CHILD PROTECTION SYSTEM. FOLLOWING THAT TRAGEDY, OUTSIDE ANALYSES INDICATE IOWA'S DEPARTMENT OF HUMAN SERVICES DIDN'T HAVE ENOUGH CASEWORKERS TO EFFECTIVELY DEAL WITH ITS CASELOAD, ESPECIALLY SUSPECTED CASES OF CHILD ABUSE. THE RHETORIC AND GOOD INTENTIONS TO REMEDY THAT SITUATION HIT A BRICK WALL OF AN ABUSED ECONOMY, REDUCED TAX REVENUES AND RESULTING BUDGET CUTS. TODAY, LIKE OTHER STATE DEPARTMENTS AND AGENCIES, THE DHS FINDS ITSELF DOING MORE WITH LESS. RESTRUCTURING, CUTTING SOME JOBS, AND ADDING OTHERS IN PERCEIVED KEY AREAS IS ON THE HORIZON. SOME SAY RESTRUCTURING WILL ONLY MAKE MATTERS WORSE. IT'S IN THAT CHALLENGING ENVIRONMENT THAT JESSIE RASMUSSEN DIRECTS IOWA'S LARGEST STATE AGENCY. WELCOME BACK TO "IOWA PRESS."

Rasmussen: THANK YOU.

Borg: WHAT AN INTRODUCTION. YOU'VE GOT LOTS OF CHALLENGES AHEAD. ACROSS THE TABLE: "DES MOINES REGISTER" POLITICAL COLUMNIST DAVID YEPSEN, AND "ASSOCIATED PRESS" STATEHOUSE REPORTER MIKE GLOVER.

Glover: DIRECTOR RASMUSSEN, YOU'VE BEEN IN THE NEWS A LOT LATELY FOR THE REORGANIZATION PLAN AT THE DEPARTMENT OF HUMAN SERVICES. WITHOUT PLUNGING INTO ALL THE DETAILS OF THAT PLAN, HOW WILL THE TYPICAL IOWAN NOTICE THE NEW DEPARTMENT OF HUMAN SERVICES?

Rasmussen: FOR THOSE THAT ARE USING OUR SERVICES, NEEDING OUR SERVICES, I HOPE THEY WILL NOT SEE SIGNIFICANT DIFFERENCES. OUR COMMITMENT IS THAT WE HAVE TO MEET OUR CORE RESPONSIBILITY, AND THAT IS GETTING SERVICES TO THOSE IOWANS IN GREATEST NEED. IN THOSE COUNTIES THAT HAVE LESS THAN FULL-TIME PRESENCE, IT WILL MEAN INSTEAD OF PICKING UP DOCUMENTS, APPLICATIONS, AND MAKING APPOINTMENTS AT OUR OFFICE, THEY MAY PICK THEM UP AT THE COURTHOUSE AND MAKE AN APPOINTMENT OVER THE PHONE SO THAT WHEN THEY COME IN, THAT'S WHEN WE'LL BE THERE TO RESPOND AND TO HELP THEM. IN SOME RESPECTS IT MIGHT BE BETTER FOR OUR CUSTOMERS, BECAUSE RIGHT NOW THEY HAVE TO COME TO OUR OFFICE, PICK UP AN APPLICATION, MAKE AN APPOINTMENT, COME BACK THE SECOND TIME. IF WE COULD FIGURE OUT HOW TO IMPROVE OUR ACCESS SO WE ARE AT WHEREVER THEY ARE AND THEY COULD MAKE THOSE APPOINTMENTS WITHOUT COMING TO OUR OFFICE, PERHAPS THEY'LL ONLY NEED TO COME TO OUR OFFICE ONCE.

Glover: THEN THE QUESTION COMES UP, WHY DIDN'T WE DO THIS SOME YEARS AGO?

Rasmussen: WELL, IT'S A DIFFERENT TIME. AND IF WE COULD HAVE FULL-TIME OFFICES IN EVERY COUNTY, EVERY COUNTY TELLS ME THEY WOULD LIKE THAT, BECAUSE THEY BELIEVE THAT THEY ARE THEN RESPONDING TO HAVING A SERVICE AVAILABLE FOR THE PEOPLE WHO LIVE IN THEIR COMMUNITY. OUR COMMITMENT TO THEM, THOUGH, IS THAT WE HAVE TO MAKE SURE THAT WE ARE USING OUR RESOURCES IN A WAY THAT WE'RE MEETING THE NEEDS OF OUR CUSTOMERS. AND WE ARE GOING TO WORK WITH THE COUNTIES TO MAKE SURE THAT OUR CUSTOMERS, THE PEOPLE WHO NEED OUR SERVICES, DO HAVE ACCESS.

Glover: AND HOW MUCH MONEY ARE YOU GOING TO SAVE?

Rasmussen: WE HAVE ABOUT $10.5 MILLION SHORT IN FISCAL YEAR '02. IT'S A COMBINATION OF STARTING OUT THE YEAR WITH LESS MONEY, THEN THE 4.3-PERCENT ACROSS-THE-BOARD, AND THEN LESS FEDERAL DOLLARS. WE MANAGED SOME IN JULY, ABOUT $3- OR $4 MILLION, BEGIN TO MANAGE BY SOME REDUCTION OF THE WORK FORCE IN OUR REGIONAL OFFICES AND IN OUR CENTRAL OFFICE. SO WHAT WE WERE FACED WITH MANAGING IS ABOUT $7 MILLION. THE LEGISLATURE IN SPECIAL SESSION GAVE US BACK $3 MILLION. THAT $3 MILLION, COMBINED WITH OUR EFFORT TO NOT HAVE TO LAY OFF ANYBODY ON THE FRONT LINE, ENABLED US TO DO JUST THAT.

Yepsen: LET'S BACK UP FOR A MOMENT AND PLUNGE INTO SOME OF THOSE DETAILS. WHAT IS IT THAT YOU'RE DOING? GIVE US A VIEW, KIND OF A THUMBNAIL VIEW OF WHAT IT MEANS WHEN WE TALK ABOUT DHS REORGANIZATION.

Rasmussen: WE DID THREE THINGS. FIRST OF ALL, WE SAID THAT OUR FIRST COMMITMENT IS MAINTAINING FRONT-LINE WORKERS BECAUSE THEY ARE THE ONES THAT CONNECT OUR CLIENTS WITH THE SERVICES. SO WE SAID WE ARE GOING TO TAKE A DISPROPORTIONATE HIT IN OUR MANAGEMENT, MIDDLE-MANAGEMENT, ADMINISTRATIVE ACTIVITIES. SO THE FIRST THING WE DID WAS, IN CENTRAL OFFICE, WE TOOK A 25-PERCENT REDUCTION IN THE WORK FORCE IN ORDER TO OFFSET ANY IMPACT ON THE FRONT LINE IN THE FIELD. THE SECOND THING WE DID IS IN TERMS OF OUR MANAGEMENT IN THE FIELD OPERATIONS, WE STRIPPED IT DOWN FROM 42 MANAGERS TO 8, AGAIN KEEPING OUR EYE ON THE FRONT LINE. AND THEN THE THIRD THING WE DID IS WENT TO LESS THAN FULL-TIME OFFICES IN 40 COUNTIES. WE'VE HAD THREE COUNTIES FOR ABOUT TEN YEARS THAT HAVE BEEN OPERATING WITH LESS THAN FULL TIME, AND WE ARE ADDING 37 MORE.

Yepsen: GO AHEAD AND FINISH YOUR --

Rasmussen: AND THAT LAST BIT REALLY ALLOWS US TO CO-LOCATE OUR WORKERS, AND THAT'S GOING TO BE CRITICAL. WHEN WE HAVE FEWER SUPERVISORS -- WE TALKED EARLIER ABOUT NEEDING MORE SUPERVISORS. BUT WHEN WE WERE GOING TO HAVE FEWER SUPERVISORS, WE NEED TO HAVE OUR WORKERS LOCATED TOGETHER SO THEY CAN HAVE MORE DIRECT CONTACT WITH THAT SUPPORT.

Yepsen: WHEN IT'S ALL SAID AND DONE, HOW MANY POSITIONS WILL YOU ELIMINATE THROUGH LAYOFFS OR ATTRITION, DISMISSAL, EARLY RETIREMENT?

Rasmussen: ACTUALLY THE LAYOFFS WILL BE ABOUT 116 FEWER POSITIONS BY THE TIME WE GET DONE, IN THE FIELD OPERATION. WE ALSO HAVE LAYOFFS IN CENTRAL OFFICE AND IN OUR FACILITIES, BUT IN OUR FIELD OPERATIONS.

Yepsen: AND DEAN MENTIONED SHELBY DUIS IN THE OPENING. WHAT IS THIS REORGANIZATION? WHAT ARE ALL THESE CHANGES GOING TO MEAN FOR OUR EFFORT TO FIGHT CHILD ABUSE IN IOWA? IS THAT JUST OFF THE RADAR SCREEN NOW?

Rasmussen: I CERTAINLY HOPE NOT. IN FACT, ONE OF THE THINGS THAT WE LEARNED IN THAT STUDY WAS THAT OUR FRONT-LINE WORKERS IN CHILD PROTECTION, CHILD WELFARE, DIDN'T HAVE ENOUGH CONTACT, DIRECT CONTACT WITH SUPERVISORS, NOT TO CHECK ON THEIR WORK BUT TO PROVIDE THAT CONSULTATION IN VERY DIFFICULT DECISIONS. AND BY GOING TO LESS THAN FULL-TIME OFFICES AND PULLING MORE OF OUR STAFF TOGETHER, THEY SHOULD HAVE MORE DIRECT CONTACT WITH THE SUPERVISORS. THEY WILL ALSO HAVE PEERS. WE HAVE MANY OFFICES THAT ONLY HAVE A COUPLE -- THREE OR FOUR PROFESSIONALS WORKING IN THAT OFFICE. THEY'RE ALL BY THEMSELVES MAKING VERY TOUGH DECISIONS. BY PULLING THEM TOGETHER, NOT HAVING AS MANY FULL-TIME OFFICES OUT THERE, THEY WILL HAVE THEIR PEERS TO DO PROBLEM SOLVING WITH. SO WE THINK THAT PART WILL BE BETTER. I AM ACTUALLY MORE CONCERNED ABOUT THE BUDGET CUT IN TERMS OF OUR PROGRAM DOLLARS THAN I AM RESTRUCTURING.

Yepsen: WHAT DO YOU MEAN BY BUDGET CUT?

Rasmussen: WELL, RESTRUCTURING IS REALLY IN RESPONSE TO NOT HAVING THE DOLLARS AROUND OUR OPERATIONS, WHICH IS THE PEOPLE WHO DO THE WORK. THE PROGRAM REDUCTIONS ARE THE DOLLARS WE NEED TO PAY FOR SERVICES. AND IN CHILD WELFARE, WE'RE GOING TO HAVE ABOUT $12 MILLION LESS IN FISCAL YEAR '02. THAT'S A COMBINATION OF THE 4.3-PERCENT ACROSS-THE-BOARD AND A LOSS OF FEDERAL DOLLARS. I AM MORE WORRIED ABOUT NOT HAVING THE DOLLARS TO PURCHASE SERVICES FOR THIS POPULATION THAN I AM ABOUT THE RESTRUCTURING.

Glover: AND WE'RE TALKING ABOUT THIS BUDGET YEAR. WE'RE GETTING READY TO START A LEGISLATIVE SESSION FOR THE NEXT BUDGET YEAR, FOR A CONSIDERABLE BUDGET THERE. IS THERE ANY REASON TO THINK THE BUDGET IS GOING TO BE ANY DIFFERENT FOR THE NEXT BUDGET YEAR, OR ARE THINGS JUST GOING TO CONTINUE TO BE JUST AS TOUGH?

Rasmussen: RIGHT NOW WE'RE ALL FEELING THAT IT'S GOING TO BE JUST AS TOUGH. THE BUDGET THAT WE SUBMITTED FOR FISCAL YEAR '03 HAD VERY LITTLE GROWTH IN IT. WE ASKED FOR MORE DOLLARS IN TWO AREAS: IN MEDICAL SERVICES, WHICH IS ESSENTIALLY AN ENTITLEMENT; AND IN CHILD WELFARE. WE HAD HOPED TO GET $5- OR $6 MILLION IN CHILD WELFARE TO OFFSET WHAT WE WERE GOING TO LOSE IN FEDERAL MATCH. THOSE ARE THE ONLY TWO AREAS THAT WE ASKED FOR ANY SUBSTANTIVE AMOUNTS OF MONEY. I'M NOT EVEN SURE AT THIS POINT WE WILL HAVE ANY DOLLARS AVAILABLE FOR INCREASES.

Glover: MORE LAYOFFS COMING?

Rasmussen: I'M NOT HEARING AT THIS POINT IN TIME THAT THERE WILL BE, BUT I THINK, AS I UNDERSTAND IT, THE ECONOMIC FORECAST THAT CAME OUT IN DECEMBER SHOWED A LITTLE BIT MORE POSITIVE INFORMATION. BUT I THINK, OVERALL, WE'RE ALL EXPECTING THAT WE'RE GOING TO HAVE LESS DOLLARS AVAILABLE.

Borg: IN THE LESS DOLLARS, I THINK YOU'RE ALREADY RUNNING A DEFICIT IN MEDICAID.

Rasmussen: YES.

Borg: ARE IOWA'S POOR IN DANGER OF GOING WITHOUT MEDICAL SERVICES?

Rasmussen: WELL, I THINK WHAT WE HAVE TO TALK ABOUT IN MEDICAL SERVICES IS THE FUNDAMENTAL QUESTION: DO WE TRY AND GET A CORE SET OF SERVICES TO AS MANY IOWANS IN NEED AS POSSIBLE, OR DO WE OFFER A MORE ROBUST PACKAGE OF SERVICES FOR FEWER IOWANS? AND THAT'S THE STRUGGLE WE'RE HAVING RIGHT NOW IS HOW TO DEAL WITH THE IMMEDIATE 4.3-PERCENT CUT IN THE MEDICAID SERVICES.

Borg: SO YOU MEAN MORE SERVICES FOR THE VERY POOREST, BUT THOSE THAT ARE ABOVE THAT CUTOFF LINE WOULDN'T GET ANYTHING.

Rasmussen: WELL, ACTUALLY I THINK WHAT WE HAVE TO LOOK AT IS WHAT WE'RE OFFERING IN TERMS OF THE PEOPLE WHO ARE ELIGIBLE BECAUSE OF THEIR INCOME RIGHT NOW. CAN WE CONTINUE TO OFFER -- WE CALL THEM OPTIONAL SERVICES IN OUR JARGON. THE STATE GETS TO CHOOSE WHAT THEY COVER. THERE ARE SOME THINGS THE FEDERAL GOVERNMENT MANDATES, BUT THERE ARE MANY THINGS THAT WE GET TO CHOOSE. THINGS LIKE OPTOMETRIC CARE, CHIROPRACTIC CARE, PODIATRY, DENTAL CARE, THOSE ARE ALL OPTIONAL SERVICES, AND WE HAVE TO SAY, "CAN WE CONTINUE TO PROVIDE COVERAGE FOR ALL THOSE OPTIONAL SERVICES." THE OTHER IS A TOUGHER DECISION. WE ALSO HAVE A CHOICE ABOUT WHAT GROUPS WE COVER, AND THE STATE COULD SAY WE'RE NO LONGER GOING TO COVER ALL THE GROUPS THAT WE ARE TODAY.

Yepsen: WELL, YOU TALK ABOUT -- DEAN MENTIONED THE MEDICAID PROGRAM HAS A CORE -- THERE'S CERTAIN SERVICES YOU'RE MANDATED TO PROVIDE. YOU HAVE SOME OPTIONAL SERVICES YOU CAN PROVIDE. YOU ALSO PROVIDE SERVICES TO MEDICALLY-NEEDY PEOPLE, WHICH IS SORT OF THE NEAR-POOR IN IOWA.

Rasmussen: YES.

Yepsen: NOW, YOU'RE TALKING ABOUT DOING AWAY WITH THAT PROGRAM.

Rasmussen: YEAH, AND THAT'S WHAT I WOULD CALL THOSE OPTIONAL ELIGIBILITY GROUPS. WE HAVE CHOICES ABOUT WHETHER OR NOT WE WILL COVER PEOPLE LIKE THAT WHO MAKE A LITTLE BIT MORE THAN WHAT THEY NEED TO BE ELIGIBLE FOR MEDICAID BUT THEY HAVE SO MANY MEDICAL BILLS THAT THEY'RE POOR. BY THE TIME THEY PAY THOSE MEDICAL BILLS -- ACCORDING TO EXISTING CODE, WHEN MONEY IS TIGHT, THEY HAVE PRIORITIZED WHICH GROUPS MUST BE ELIMINATED FIRST. THAT'S WHY THERE'S ALL THIS CONVERSATION ABOUT MEDICALLY-NEEDY, BECAUSE THEY'RE THE FIRST, ACCORDING TO LAW, TO BE ELIMINATED.

Glover: IOWA IS NOT IN THIS BATTLE ALONE.

Rasmussen: RIGHT.

Glover: YOU HAVE A SITUATION WHERE THE ECONOMY IS SLOW, STATE TAX COLLECTIONS ARE DOWN, DEMANDS ON YOUR SERVICES ARE HIGH BECAUSE UNEMPLOYMENT GOES UP. THAT'S HARDLY AN UNFORESEEN CIRCUMSTANCE. SHOULD THE STATE BEGIN TO BUILD A CASH RESERVE TO DEAL WITH THESE SWINGS IN THE BUSINESS CYCLE, AND SHOULD YOU TAP INTO THE STATE'S RAINY DAY FUND TO BAIL IT OUT RIGHT NOW?

Rasmussen: WELL, THAT'S REALLY A POLICY DECISION THAT'S MUCH BIGGEST THAN MY AUTHORITY AS THE DIRECTOR OF THE AGENCY.

Glover: BUT YOU MAKE RECOMMENDATIONS ON THOSE THINGS.

Rasmussen: PROBABLY NOT ON WHETHER OR NOT THEY GO INTO THE RAINY DAY FUND OR USE RESERVE FUNDS. BUT IT DOES SEEM THAT THIS OUGHT TO BE AN OPPORTUNITY FOR US TO SAY HOW ARE WE GOING TO RESPOND TO THE VERY CONUNDRUM YOU'VE JUST POINTED OUT WHEN WE HAVE LESS MONEY AVAILABLE AS A STATE, WE HAVE MORE PEOPLE WHO NEED OR SERVICES. AND WE KNOW THIS IS GOING TO HAPPEN EVERY ONCE IN A WHILE. SHOULD WE NOT PLAN FOR IT? I THINK IT'S A WORTHWHILE POLICY DISCUSSION TO HAVE.

Borg: HAVE YOU AT ALL DISCUSSED WITH THE GOVERNOR DIPPING INTO THE RAINY DAY -- AFTER ALL, YOU ARE THE ADVOCATE FOR THE POOREST IN IOWA, AND IF YOU DON'T ADVOCATE DIPPING IN, WHO IS GOING TO?

Rasmussen: WELL, THERE ARE A FAIR NUMBER OF FOLKS WHO PROVIDE SERVICES AND ARE ADVOCATES FOR THIS POPULATION WHO SORT OF FORMED THE RAINY DAY COALITION. AND MANY OF US FEEL IT'S NOT ONLY RAINING, IT'S POURING. AND IT'S PARTICULARLY HARD ON THOSE THAT ARE MOST VULNERABLE. I GUESS THE POLICY DEBATE FOR THE LEGISLATORS ARE DO THEY DIP INTO THAT RAINY DAY FUND OR DO THEY TAKE IS FROM SOMEPLACE ELSE.

Yepsen: THE REPUBLICANS RUNNING THE LEGISLATURE SAY THAT THEY'RE NOT GOING TO DIP INTO IT, AND THE GOVERNOR HIMSELF HAS NOT MADE IT CLEAR WHAT HE'S GOING TO DO, BUT HE'S INDICATED HE MAY NOT. I WANT TO GO BACK TO MIKE'S QUESTION, THOUGH. YOU KNOW THIS IS GOING TO HAPPEN AGAIN. THIS HAS HAPPENED BEFORE WHERE WE GO INTO HARD TIMES, TAX REVENUES DROP, DEMAND FOR YOUR SERVICES INCREASES. WHY DON'T YOU -- WHAT IS YOUR PROPOSAL TO THE POLICYMAKERS NOW FOR DEALING WITH THE PROBLEM OF THE RECESSION OF 2008 OR '09, OR WHENEVER THE NEXT RECESSION COMES? WHAT ARE YOU DOING ABOUT THAT?

Rasmussen: WELL, WE WILL HAVE AN OPPORTUNITY TO HAVE ANOTHER DISCUSSION AROUND THE REAUTHORIZATION OF THE BLOCK GRANT FOR ECONOMIC ASSISTANCE. AND MANY PEOPLE ADVOCATED, WHEN IT FIRST WAS AUTHORIZED ALMOST FIVE YEARS AGO, THAT WE SET ASIDE SOME DOLLARS FOR THIS VERY REASON. DON'T SPEND ALL OF YOUR BLOCK GRANT. WHAT HAPPENED WAS THAT WE ACTUALLY STARTED GETTING THE MESSAGE ABOUT TWO YEARS AGO: HURRY UP AND SPEND ALL YOUR MONEY BECAUSE REAUTHORIZATION IS COMING UP, AND IF YOU HAVEN'T SPENT IT ALL, THEN THE FEDS ARE GOING TO THINK YOU DON'T NEED IT ANYMORE AND CUT THE BLOCK GRANT. I THINK WE SHOULD AGAIN, AT THIS TIME AS WE'RE ABOUT READY TO ENTER INTO A NEW FIVE-YEAR GRANT ON ECONOMIC ASSISTANCE, HAVE THAT DISCUSSION NOT ONLY AT THE STATE LEVEL BUT AT THE FEDERAL LEVEL.

Yepsen: SO THERE'S NO INCENTIVE FOR YOU TO SET ASIDE DOLLARS FOR YOUR OWN RAINY DAY --

Rasmussen: THERE WASN'T THIS FIRST TIME AROUND. AND THERE WERE MANY OF US THAT DID ADVOCATE FOR THAT. AND I THINK THAT BOTH THE STATE AND THE FEDS NEED TO COME TO SOME AGREEMENT THAT THAT'S A REASONABLE THING TO DO.

Glover: LET'S STEP BACK AND TAKE A LOOK AT THE BIG PICTURE, IF WE COULD, FOR A SECOND. FOR A LONG TIME, SHELBY DUIS, CHILD ABUSE WAS A HOT TOPIC IN THIS STATE. FOR A LONG TIME DHS REORGANIZATION WAS A HOT TOPIC IN THIS STATE. IT SEEMS LIKE SINCE SEPTEMBER 11, THERE'S BEEN NO OTHER HOT TOPIC OTHER THAN TERRORISM. HAVE YOUR ISSUES GOTTEN KNOCKED OFF THE RADAR SCREEN?

Rasmussen: I WOULD CERTAINLY HOPE NOT. THE COMMUNITY DISCUSSION ABOUT THE DEATH OF THE CHILD, WE SHOULD KEEP THAT GOING BECAUSE IT IS A COMMUNITY RESPONSIBILITY TO TRY AND FIGURE OUT HOW WE'RE GOING TO DO OUR BEST TO PREVENT THE DEATH OF CHILDREN OR ANY HARM TO CHILDREN. WE'VE BEEN TRYING TO SHARE WITH PEOPLE THAT OUR CASELOADS ARE UP IN EVERY PART OF OUR WORK. AND SEPTEMBER 11 ACTUALLY CREATED ANOTHER BLIP IN OUR MENTAL HEALTH DEMANDS FOR OUR SERVICES.

Glover: HOW SO?

Rasmussen: THERE IS AN INCREASED UTILIZATION OF THE EMERGENCY ROOM. AND WE WERE JUST HEARING A REPORT FROM THE FOLKS WHO MANAGE OUR BEHAVIORAL HEALTH CONTRACT, AND THEY WERE SAYING THEY WERE EXPERIENCING THIS INCREASE IN THE USE OF THE EMERGENCY ROOM, PARTICULARLY SINCE SEPTEMBER 11. IT'S THE ANXIETY THAT TENDS TO PLAY ON PEOPLE WHO HAVE MENTAL ILLNESS OR HAVE A LOT OF STRESS IN THEIR LIVES. SO THAT ALSO HAS PLAYED INTO AN INCREASED DEMAND FOR OUR SERVICES. AND I THINK WE DO TRY AND KEEP THIS ON THE FRONT BURNER, AT LEAST FOR THOSE THAT ARE CONCERNED ABOUT THESE ISSUES.

Yepsen: WHAT IS THAT INCREASE IN SERVICES GOING TO COST YOU? ANY PRICE TAGS FOR WHAT THIS MENTAL HEALTH THING IS COSTING THE STATE?

Rasmussen: WELL, LET ME SAY IT'S HAPPENING IN ALL PARTS OF OUR BUSINESS. IN ECONOMIC ASSISTANCE, WE'VE HAD SOMEWHERE BETWEEN A 6- TO 7-PERCENT INCREASE. IT'S THE FIRST TIME IN SEVERAL YEARS WE'VE HAD AN INCREASE IN OUR CASELOADS IN ECONOMIC ASSISTANCE. YOU KNOW, WE HAD WELFARE REFORM. WE WENT FROM 40,000 CASES DOWN TO LESS THAN 20,000 CASES, BUT NOW WE'RE SEEING AN INCREASE AGAIN. THAT'S GOING TO COST US ABOUT $7 MILLION IN FISCAL YEAR '02.

Yepsen: IS THAT DUE TO SEPTEMBER 11?

Rasmussen: THAT'S REALLY DUE TO THE ECONOMY.

Yepsen: WHICH IS RELATED TO SEPTEMBER 11.

Rasmussen: SURE, SURE. AND MEDICAL SERVICES, WE'VE HAD ALMOST A 12-PERCENT INCREASE IN THE DEMAND FOR MEDICAL SERVICES, MORE PEOPLE NEEDING HEALTH CARE AND SIGNING-UP FOR MEDICAID. THE SHORTFALL WE'RE FACING IN MEDICAID IS DUE TO THE FACT THAT THERE'S ABOUT 25,000 MORE PEOPLE THAN WE PROJECTED THAT HAVE SIGNED UP FOR HEALTH CARE. I THINK IT'S A REFLECTION OF THE ECONOMY. WE'RE ALSO SEEING ANOTHER LITTLE SPIKE AFTER SEPTEMBER 11.

Yepsen: I WANT TO FOCUS ON THE MEDICAID QUESTION. PROVIDERS, PEOPLE WHO PROVIDE SERVICES TO POOR PEOPLE, DOCTORS AND MEDICAL PEOPLE. YOU'RE PROPOSING TO CUT THE MONEY THAT THEY'RE PAID. NOW, IF YOU DO THAT, WHAT'S THE INCENTIVE FOR THEM TO KEEP PROVIDING THESE SERVICES? ISN'T THERE A DANGER THAT THEY'RE JUST GOING TO SAY TO HECK WITH THESE PEOPLE?

Rasmussen: IT'S A VERY GOOD POINT. IT'S ONE WE HAVE TO CONSIDER. WE ALREADY DID A 3-PERCENT ACROSS-THE-BOARD REDUCTION IN RATES FOR ALMOST ALL OF OUR MEDICAID PROVIDERS JULY 1, AS PART OF OUR BUDGET MANAGEMENT. AND IF WE CUT ANY DEEPER, WE HAVE TO ASK OURSELVES, ARE WE GOING TO LOSE ACCESS FOR A LARGE NUMBER OF OUR MEDICAID CLIENTS. PEOPLE WHO PROVIDE OPTIONAL SERVICES LIKE CHIROPRACTIC CARE WOULD SAY RATHER THAN ELIMINATE A TOTAL SERVICE, LIKE CHIROPRACTIC CARE, JUST DO ADDITIONAL ACROSS-THE-BOARD PROVIDER RATE REDUCTIONS. OTHERS WOULD SAY, NO, YOU SHOULD GO AND ELIMINATE THE MEDICALLY-NEEDY COVERAGE. THAT'S A FEWER NUMBER OF PEOPLE. IT RAISES A LOT OF SAVINGS. THIS IS NOT AN EASY CONVERSATION TO HAVE.

Yepsen: WELL, I WANT TO ASK YOU ABOUT THAT MEDICALLY-NEEDY PROGRAM. THIS IS THE NEAR-POOR. NOW, IF YOU GET RID OF THAT PROGRAM, WHICH THE FEDERAL GOVERNMENT PAYS TWO-THIRDS AND YOU PAY A THIRD OF THEIR HEALTH CARE COST SAYS, IF YOU GET RID OF TO SAVE YOUR THIRD, IT'S MY UNDERSTANDING THAT MANY OF THOSE PEOPLE WILL WIND UP ON WHAT'S CALLED THE STATE INDIGENT CARE PROGRAM WHERE THE STATE PAYS IT ALL. ISN'T THAT KIND OF SILLY?

Rasmussen: IT IS A POSSIBILITY THAT ABOUT THEIR ONLY OPTION WOULD EITHER GO TO THE STATE INDIGENT CARE PROGRAM OR TO GO TO THE COUNTIES FOR GENERAL ASSISTANCE, WHICH IS SOMETHING THAT THE COUNTIES ARE VERY CONCERNED ABOUT. AGAIN, IS IT A GOOD SITUATION TO CUT OFF THE MEDICALLY NEEDY? NO, IT IS NOT. THESE ARE PEOPLE WHO TRULY NEED ACCESS TO HEALTH CARE. THEY ARE PEOPLE WHO, IF THEY DON'T GET THESE MEDICATIONS, THEIR LIVES ARE IN DANGER. AND YOU'RE RIGHT, IF WE CUT THEM OFF -- THEIR NEEDS ARE STILL THERE. JUST BECAUSE WE STOP PROGRAM DOESN'T MEAN THEIRS NEEDS GO AWAY. WHERE ARE THEY GOING TO GO AND ARE WE GOING TO END UP PAYING MORE FOR IT IN ANOTHER PROGRAM? IT'S A VERY LEGITIMATE QUESTION. OPTIONAL SERVICES PROVIDERS WOULD SAY THE SAME THING. IF YOU SHUT OFF CHIROPRACTIC CARE, THEY'LL JUST GO TO THE DOCTOR FOR THEIR BACK PROBLEMS AND IT WILL COST YOU MORE.

Yepsen: BUT YOU'VE GOT NO MONEY INSIDE YOUR EXISTING BUDGET TO SOLVE THIS PROBLEM.

Rasmussen: NO, I DON'T.

Yepsen: THIS MONEY IS GOING TO HAVE TO COME FROM CUTTING SOMEBODY ELSE ELSEWHERE IN STATE GOVERNMENT, RIGHT?

Rasmussen: RIGHT. IT MEANS THAT ARE WE GOING TO SAY THAT PROVIDING HEALTH CARE FOR PEOPLE WHO ARE POOR IS ONE OF OUR TOP PRIORITIES FOR THE USE OF STATE DOLLARS.

Glover: ONE OF THE TOPICS MUCH IN THE NEWS LATELY IS IMMIGRATION. THERE'S BEEN A LOT OF IMMIGRATION, A LOT OF ISSUES AROUND IMMIGRATION. TELL ME WHAT SORT OF PRESSURES THIS INCREASE IN IMMIGRATION HAS BROUGHT ONTO YOUR AGENCY.

Rasmussen: I CAN'T SAY THAT WE FEEL A GREAT DEAL OF PRESSURE FROM IMMIGRANTS COMING INTO THE COUNTRY. IN TERMS OF THE REFUGEE PROGRAM, THERE'S SUCH A WELL-PLANNED MANAGEMENT OF THAT, THEY'RE USUALLY IMMEDIATELY HOOKED-UP INTO JOB OPPORTUNITIES AND THOSE KINDS OF ACTIVITIES. IMMIGRANTS THAT ARE COMING IN SOMETIMES NEED OUR SERVICES TEMPORARILY UNTIL THEY CAN GET SITUATED AND GET A JOB. BUT I CAN'T TELL YOU THAT WE FEEL A STRONG HIT IN OUR SERVICE NEEDS AS A CONSEQUENCE OF THE IMMIGRANTS.

Glover: DO YOU HEAR FROM LOCAL SOCIAL SERVICE PROVIDERS ABOUT IT?

Rasmussen: NO. THE BIGGEST THING WE'RE FEELING RIGHT NOW IS SIMPLY DUE TO THE ECONOMY.

Yepsen: ANOTHER ISSUE THAT GETS DISCUSSED A LOT IS WHAT ARE CALLED FAITH-BASED INITIATIVES, RELIGIOUS ORGANIZATIONS DOING SOCIAL WORK. IS THIS A SOLUTION FOR SOME OF THE PROBLEMS THAT YOU FACE? I HEAR FROM MANY CONSERVATIVES WHO SAY THAT PEOPLE OF FAITH CAN PROVIDE A LOT OF HELP TO PEOPLE IN NEED AND, IF THEY GET A LITTLE HELP FROM GOVERNMENT, THEY CAN DO A LOT MORE. DO YOU SEE THIS AS A SOLUTION? WHAT'S THE ROLE FOR FAITH-BASED INSTITUTIONS IN IOWA?

Rasmussen: THERE IS NO QUESTION THERE IS NO GREAT MORE IMPORTANT TIME THAN NOW FOR US TO REACH OUT TO THE ENTIRE COMMUNITY AND TRY AND FIGURE OUT HOW WE'RE GOING TO RESPOND TO NEEDS OF PEOPLE WHEN WE HAVE LESS RESOURCES. THERE ARE MANY PEOPLE, HOWEVER, IN THE FAITH-BASED COMMUNITY WHO TELL ME THAT THEIR WELLS ARE CLOSE TO EMPTY, THAT THEY'RE ALREADY RESPONDING TO AN INCREASED DEMAND FROM PEOPLE THAT NEED ASSISTANCE. AND THEY'RE A LITTLE CONCERNED ABOUT WHETHER OR NOT GOVERNMENT MIGHT DUMP ON THEM AND EXPECT THEM TO DO WAY MORE THAN WHAT THEY CAN DO. BUT HAVING SAID THAT, I THINK WE HAVE TO REACH OUT, NOT ONLY TO THE FAITH-BASED COMMUNITY, BUT OTHER COMMUNITY ENTITIES -- THE SCHOOLS, NEIGHBORHOOD ASSOCIATIONS -- AND BEGIN TO PLAN, AS THE COMMUNITY, HOW WE'RE GOING TO RESPOND TO THE NEEDS OF PEOPLE WHEN WE DON'T HAVE VERY MANY RESOURCES.

Glover: ANOTHER CHRONIC COMPLAINT YOU HEAR IN IOWA IS THE MEDICARE PROGRAM, PROVIDING HEALTH CARE FOR THE ELDERLY. IOWA IS 50TH IN THE NATION IN MEDICARE REIMBURSEMENT. LONG BEEN A COMPLAINT. IS THERE ANYTHING YOU CAN DO ABOUT THAT, AND WHAT ARE THE PROSPECTS OF IMPROVING IT?

Rasmussen: THERE ISN'T ANYTHING THAT I CAN DO AS A DIRECTOR OF OUR STATE AGENCY EXCEPT TO JOIN LEGISLATORS, GOVERNOR, LIEUTENANT GOVERNOR, IN LOBBYING THE FEDERAL GOVERNMENT TO REEVALUATE THE MEDICARE SYSTEM AND TRY AND ADDRESS THE INEQUITIES IN OUR SYSTEM. IT IS CLEAR THAT RURAL STATES, LOWER POPULATION STATES LIKE IOWA, HAVE BEEN DISPROPORTIONATELY HIT BY THE MEDICARE RATES.

Glover: AREN'T YOU GOING TO GET THE SAME ANSWER THAT YOU'RE GIVING, IN ESSENCE: "THE ECONOMY IS SLOW, THE TAX COLLECTIONS ARE DOWN, WE'VE GOT TO SPEND SOME MONEY TO FIGHT TERRORISM." IS THERE A REALISTIC CHANCE OF GETTING THE MONEY TO FIX THIS?

Rasmussen: I'M NOT TERRIBLY OPTIMISTIC. AND I WILL TELL YOU IT'S LESS ABOUT ECONOMY AND MORE ABOUT THE FACT THAT THE BIG STATES, LOTS OF POPULATION, WHO ARE GETTING THE HIGHER RATES KNOW THAT IF WE TRY AND EQUALIZE THE MEDICARE DISTRIBUTION, IT'S GOING TO COME OUT OF THEIR POCKET.

Yepsen: SO LET ME PIN YOU DOWN ON THIS A LITTLE BIT. IS THIS A FAILURE OF OUR CONGRESSIONAL DELEGATION? I MEAN THIS IS AN ISSUE OF REIMBURSEMENTS FROM THE FEDERAL GOVERNMENT FOR THE MEDICARE PROGRAM. IT'S NOT MEDICAID, IT'S MEDICARE. AND THIS ISSUE HAS BEEN AROUND FOR A LONG TIME. WE TALKED ABOUT IT FOR YEARS IN THIS STATE. NOW, IS THIS A FAILURE OF OUR CONGRESSIONAL DELEGATION NOT TO BRING HOME THE BACON, IF YOU WILL, IN TERMS OF GETTING A FAIR REDISTRIBUTION FOR IOWA'S INCOME. THESE GUYS LIKE TO TALK ABOUT ALL THE CLOUT THEY HAVE IN WASHINGTON. WHERE ARE THEY?

Rasmussen: I THINK THAT THEY HAVE AGGRESSIVELY GONE AFTER THIS IN A BIPARTISAN WAY TO GET OUR FAIR SHARE TO IOWA. THEIR STRUGGLE IS THE COMPETITION WITH THE BIGGER STATES WHO ARE GETTING TO HIGHER RATES OF INCOME BECAUSE, UNLESS WE CAN FIND MONEY OUTSIDE OF THE SYSTEM TO ADD TO IT, YOU HAVE THE SAME AMOUNT OF MONEY GOING INTO THE MEDICARE SYSTEM AND IT STILL GETS DISTRIBUTED THE WAY IT IS.

Glover: THE BOTTOM LINE IS THERE'S JUST NOT MUCH CHANCE OF GETTING THIS FIXED.

Rasmussen: I WOULDN'T GIVE UP ON IT. AND I THINK OUR CONGRESSIONAL REPRESENTATION HAS BEEN FIGHTING HARD TO GET THIS CHANGED. IT ISN'T OVER YET BUT IT'S GOING TO BE A TOUGH BATTLE.

Yepsen: WELFARE REFORM?

Rasmussen: YES.

Yepsen: HAS IT WORKED?

Rasmussen: YES, IT HAS WORKED. LIKE I SAID BEFORE, WE'VE GONE FROM OVER 40,000 CASES DOWN TO LESS THAN 20,000 CASES. AND WE'VE HAD A COMMENSURATE DROP IN THE AMOUNT OF MONEY THAT WE'VE SPENT ON IT. THE TEST ABOUT WELFARE REFORM WORKING IS NOW. WHEN THE ECONOMY IS IN A SLUMP, IS WELFARE REFORM GOING TO WORK? RIGHT NOW IN IOWA, MOST OF OUR PEOPLE ARE EITHER WORKING OR THEY ARE IN JOB TRAINING, SO I WOULD SAY THE EXPECTATION FOR THEM TO GET OFF PUBLIC ASSISTANCE IS STILL WORKING.

Yepsen: WE'VE HAD WELFARE REFORM AROUND FOR A WHILE. AS YOU SAY, WE'RE IN A DIFFICULT TIME FOR IT. WHAT ELSE DO WE HAVE TO DO TO FIGHT POVERTY? I MEAN SURELY YOU'VE LEARNED SOME THINGS IN YOUR CAREER ABOUT HELPING THE POOR. WHAT SHOULD WE BE DOING THAT WE'RE NOT DOING TO HELP THESE 20,000 PEOPLE YOU JUST TALKED ABOUT?

Rasmussen: I THINK IT IS A MULTIPRONGED RESPONSE. ONE RESPONSE IS WE WOULD QUESTION WHETHER OR NOT THE PAY THAT FOLKS GET IS ADEQUATE. SO ONE RESPONSE WOULD BE DOES MINIMUM WAGE NEED TO BE RAISED. WE HAVE A SIGNIFICANT NUMBER OF PEOPLE WHO ARE WORKING FULL TIME SLIGHTLY ABOVE MINIMUM WAGE, AND THAT'S NOT ENOUGH TO SUPPORT THEIR FAMILY. AND THEY'RE STILL ELIGIBLE FOR THE SERVICES THAT WE PROVIDE. THE SECOND PRONG IS TO LOOK AT WHAT HAPPENS TO OUR CHILDREN IN THE VERY EARLIEST PARTS OF THEIR LIVES. WE KNOW THAT QUALITY EARLY CHILDHOOD EDUCATION MEANS KIDS ARE MORE LIKELY TO BE SUCCESSFUL IN SCHOOL, MORE LIKELY TO GRADUATE FROM HIGH SCHOOL, MORE LIKELY TO GET JOBS AND BE PRODUCTIVE CITIZENS. SO I THINK WE HAVE TO LOOK AT THE OTHER END OF THE SPECTRUM, MAKE SURE THAT WE ARE INVESTING IN THOSE EARLY YEARS SO KIDS GET OFF TO A GOOD START. THE THIRD THING IS REALLY LOOKING AT OUR ADOLESCENTS AND TARGETING THEM FOR JOB TRAINING SKILLS, JOB OPPORTUNITIES THAT ARE GOING TO LEAD THEM TO JOBS THAT PAY WELL. AND FINALLY I WOULD SAY THAT IN OUR PUBLIC ASSISTANCE POPULATION, I THINK WE HAVE TO REALLY PUSH OUR RECIPIENTS TO THINK ABOUT JOB OPPORTUNITIES BEYOND THE TRADITIONAL JOBS. AND IF YOU TAKE A SURVEY OF MANY PEOPLE ON PUBLIC ASSISTANCE, PARTICULARLY WOMEN, THEY WILL SAY WHAT THEY WANT TO DO IS BECOME A SOCIAL WORKER. AS MUCH AS I WANT SOCIAL WORKERS, THE TRUTH OF THE MATTER IS THE PAY IS NOT REAL GOOD. WE NEED TO DO A BETTER JOB OF CONNECTING OUR RECIPIENTS WITH THE JOBS THAT ARE GOING TO PAY WELL ENOUGH TO ALLOW THEM TO BE INDEPENDENT.

Glover: YOUR AGENCY HAS COME UNDER CRITICISM IN THE PAST FOR ITS USE OF CONSULTANTS. IS THAT ISSUE BEHIND YOU?

Rasmussen: OH, I THINK SO. THERE ARE TWO THINGS THAT HAVE HAPPENED. WE'VE CERTAINLY TRIED VERY HARD TO MAKE IT CLEAR TO PEOPLE THAT WE'RE FOLLOWING ALL THE RULES IN TERMS OF GOOD MANAGEMENT OF CONTRACTS AND CONSULTANT WORK. THE OTHER THING IS SIMPLY THE REALITY OF THE DAY; WE HAVE VERY LITTLE MONEY TO DO THOSE KIND OF ACTIVITIES.

Glover: LOOK INTO THE CRYSTAL BALL AND TELL US ABOUT YOUR FUTURE. DO YOU SEE YOURSELF LONG-TERM HEAD OF THE DHS?

Rasmussen: MY COMMITMENT HAS ALWAYS BEEN TO CHILDREN AND FAMILIES, PARTICULARLY THOSE THAT ARE MOST VULNERABLE. I WILL ALWAYS DO THAT WORK, WHETHER IT'S WEARING THIS HAT OR ANOTHER ONE. I HOPE I AM HERE LONG ENOUGH TO CONTINUE TO MAKE SOME REAL DIFFERENCES IN WHAT'S GOING ON.

Borg: WITH THAT, WE HAVE TO CLOSE. THANK YOU VERY MUCH FOR TAKING TIME TO BE WITH US TODAY.

Rasmussen: YOU BET.

Borg: DURING THIS 30TH ANNIVERSARY YEAR FOR "IOWA PRESS" ON IOWA PUBLIC TELEVISION, WE'RE CLOSING OUR WEEKLY PROGRAMS WITH CLIPS FROM OUR ARCHIVES. THE CAMPAIGN OF 1984 FOUND EIGHT CONTENDERS SEEKING THE DEMOCRAT'S PRESIDENTIAL NOMINATION. AMONG THEM, CALIFORNIA SENATOR ALAN CRANSTON. IN HIS CRITICISMS OF THEN-PRESIDENT RONALD REAGAN, CRANSTON EXTOLLED HIS CREDENTIALS AS A PEACE CANDIDATE, CALLING REAGAN'S INTERVENTIONS IN LEBANON AND GRENADA MILITARILY ILL-ADVISED, POLITICALLY ADVENTURESOME, AND ILLEGAL. I'M DEAN BORG. THANKS FOR JOINING US TODAY.

WELL, THE PRESIDENT VIOLATED THE WAR POWERS ACT WHEN HE WENT INTO LEBANON WITH THE MARINES. AGAIN, I MET WITH HIM IN THE WHITE HOUSE RIGHT AFTER HE MADE THE DECISION AND HE TOLD US ABOUT IT. AND I AND OTHERS THERE SAID, "MR. PRESIDENT, YOU SHOULD REPORT TO US UNDER THE WAR POWERS ACT, WHICH REQUIRES THAT WHEN YOU SEND TROOPS TO FOREIGN SOIL BEARING ARMS INTO HOSTILITIES OR IMMINENT HOSTILITIES, YOU MUST REPORT TO CONGRESS FORTHWITH AND GET THEM OUT WITHIN SIXTY DAYS, UNLESS WE APPROVE THE OPERATION." THE PRESIDENT'S AIDE SAID, "NO, WE DON'T EXPECT HOSTILITIES." THEY WERE WRONG. WE'VE HAD HOSTILITIES. OVER 200 MARINES HAVE BEEN KILLED. MANY MORE WOUNDED. AND THE PRESIDENT SHOULD COMPLY WITH THE WAR POWERS ACT. HE HAS NOT. THE WAR POWERS ACT WAS WRITTEN AFTER VIETNAM. AND THIS ISN'T A PARTISAN MATTER. IT WAS LYNDON JOHNSON, A DEMOCRAT, WHO TOOK US INTO THAT WAR BY HIS OWN DECISION, DESPITE THE FACT THE CONSTITUTION GIVES THE CONGRESS THE POWER TO DECLARE WAR. WE WROTE THE WAR POWERS ACT SO THAT PRESIDENTS WOULDN'T GET US INTO WARS ON THEIR OWN INITIATIVE, BUT PRESIDENTS HAVE BEEN IGNORING THE WAR POWERS ACT. I THINK WE HAVE TO TIGHTEN IT UP. NOW THAT YOU GET INTO A COUNTRY AND THE FLAG IS ASSAULTED AND AMERICANS KILLED, IT'S HARD TO WITHDRAW. SO I AM NOT ADVOCATING AN INSTANT WITHDRAWAL. BUT I THINK WE SHOULD NOT STAY THERE ANY EIGHTEEN MONTHS AND WE SHOULD MAKE CLEAR WHAT OUR GOAL IS, AND THE PRESIDENT HAS NEVER DONE THAT.

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