CPC meets with Dr. Andy McGuire

On Tuesday May 1st, members of the Children’s Policy Coalition sat down with Dr. Andy McGuire to discuss the issues facing children and families in our state, including education, health care, and family economic security.


Pictured (left to right): Sheila Hansen, Child and Family Policy Center; Dara Madigan, Iowa Association for the Education of Young Children; Abby Patterson, Prevent Child Abuse Iowa; Charlie Bruner; Dianna Baker Hoye, Save the Children Action Network volunteer; Jill Applegate, Every Child Matters in Iowa; Barb Brenner, Polk County Early Child Iowa; Dr. Andy McGuire, candidate for Governor; Mary Nelle Trefz, Child and Family Policy Center; Lana Shope, Iowa Community Action Association and Iowa Head Start Association; Deann Cook, United Ways of Iowa; Chaney Yeast, Blank Children’s Hospital; Dave Stone, United Way of Central Iowa; Anne Discher, Child and Family Policy Center; Denise Rathman, National Association of Social Workers.

Read the full transcript of the meeting below:

Jill Applegate: Thanks everyone for being here today. The Children’s Policy Coalition is very excited to welcome you Dr. McGuire. This is our second single candidate forum of the primary season in the gubernatorial race. We are just so thankful that you have made a time to come and talk to us about the challenges that are facing Iowa’s kids and families. We all know that children’s health and safety education and general wellbeing should be a top priority and to ensure that all kids have what they need to thrive, the coalition has invited all candidates in the gubernatorial race to meet with us to talk about these urgent issues. And just to note, we don’t endorse any candidates or score them in any way. We simply just want to get the information into the hands of voters so that they feel comfortable when they go to the polls in June, that they have all the information they need to make their choice on who is the best candidate to support kids and families. And so that’s a lot of the work we do. Our purpose is to educate voters candidates, and elected officials on these urgent issues facing kids and families. And we just want to know how you plan to invest in kids and families if you were to become the next governor.

Dr. McGuire: I always say when!

Jill Applegate: Well I want to start with everyone being able to introduce themselves for you.

Dr. McGuire: That would be great, I know almost all of you.

Jill Applegate: Yeah, we’re all familiar faces. And then have the opportunity to hear a little bit from you on your campaign. So, my name is Jill Applegate and I am the program manager for Every Child matters in Iowa, and the co-chair of the Children’s Policy Coalition.

Lana Shope: Lana Shope, and I’m with the Iowa Community Action Association and Iowa Head Start. We have 17 community action agencies that serve all ninety-nine counties primarily with low-income families.

Sheila Hansen: Hi, Sheila Hansen with the Child and Family Policy Center. I’m a co-chair with Jill of the Coalition.

Barb Bremner: Barb Bremner with Polk County Early Childhood Iowa.

Abby Patterson: I’m Abby Patterson with Prevent Child Abuse Iowa.

Charlie Bruner: I’m Charlie Bruner, I’m a freelance child policy agitator—

Dr. McGuire: —freelancer. Charlie, I think you’re just, can we have a godfather over the place.

Dara Madigan: I’m Dara Madigan from the Iowa Association for the Education of Young Children.

Dave Stone: Dave Stone, Advocacy Officer with the United Way of Central Iowa.

Deann Cook: Deann Cook, United Ways the Iowa, which is the Association of all 25 United Ways that serve Iowans.

Mary Nelle Trefz: Mary Nell Trefz, Child and Family Policy Center.

Chaney Yeast: Chaney Yeast, Blank Children’s Hospital.

Denise Rathman: Denise Rathman, National Association of Social Workers.

Anne Discher: Anne Discher, and I’m also with the Child and Family Policy Center.

Dr. McGuire: And I’m Andy McGuire and I’m running for governor. No. Um, and do you want me to—

Jill Applegate: Yes, feel a little bit to talk about your campaign and your priorities.

Dr. McGuire: I’ll probably do my five-minute spiel. Before I do that, I want to say something that, you know, I go into a lot of groups like this and a lot of times I’ll know one person or I’ll have worked on one thing or something. I’ve worked with almost all of you in this room, and so, you know, this is something that comes from my heart. I have to, I have to do one thing, it sits on my desk. So, that I’ve been involved with a lot of you in different ways about kids. I have seven of my own and one grandchild. Maybe that’s why, and I talk about them every time I give a speech, so I’ll give them a little speech, but I want to know I want to first tell you all that I have seen the amazing work that each of you have done and it makes a difference.  And I this morning got the celebration for our Book Buddies. So we read to three- and four-year-olds, preschoolers. I’m over at Oak Ridge and Monica will tell you, she told me I couldn’t do that and I said, no, that’s the one thing I’m going to keep because it keeps me centered in what I’m doing and why. And it’s the celebration was just so great. And what I heard this morning too is statistically, for our Book Buddy people, those kids at third grade are ten percent above where kids who don’t get that are, so that’s what we’re doing and that’s what you’re doing. And I just love being a part of this, this whole effort. And I will always be a part of this effort, whether I’m governor or just me. I will always be a part of your effort.  So about me. I’m from Waterloo, Iowa originally. I’m from a family of eight. My mom, when my mom stayed home with us and my dad was a World War II vet came home and started construction machinery business. And I always tell people that that sort of shaped who I was, that I think about caring about others. I was taught when we’re growing up, when somebody was sick, you went and took food to them. If somebody was down on their luck, you all got together and got them better and that’s why I became a doctor, and I’m a medical doctor for those who don’t know me. And that’s why, because I could see the power of caring about somebody, especially when they’re sick or injured. And I think in kids that might be even more of a thing.  So, I’ve been going all over Iowa. I was chair of the Democratic Party. So I have had the luxury of a couple of years of listening to people all over Iowa, all ninety-nine counties. And then doing it as this campaign has gone on and I don’t hear about people caring as much as, as I think I should. A lot of people feel like they can’t get a fair shake for their families, for their kids, like they can’t get ahead. And they feel like their government is pushing, putting profits ahead of people. And I can just tell you, as someone who’s taken an oath, I will always put patients first and that means I’ll always put people first and that’s what I think your governor ought to do. And that’s why I tell people where I come from because I think it makes a difference.

Some of the things I talk about, and I’ll kind of shorten this up because I’d much rather talk about what specific to you, but I think some of these things, well, most of these things actually intersect with you because, I mean, Charlie [Bruner] and I talked about, if it’s not about the kids, what is it about? And we don’t spend enough time focusing on them. So I talked a lot about healthcare. If you don’t have your health, especially with a child, you don’t have anything. So healthcare is a right, not a privilege. I’m a doctor, I believe that strongly, but what we’re doing right now in Medicaid is really limiting access to healthcare for six hundred thousand Iowans. Many of them young children and moms. We shouldn’t be doing that. They didn’t know what they were doing. Those who don’t know my background, I did run a Medicaid company, it was a voluntary for moms and babies, and it’s nothing like what they’re doing now. And we actually doubled prenatal care. We doubled immunization rates, we took care of kids and we took care of those moms and we had a good result. So I know they didn’t know what they were doing when they did this and they still don’t know what they’re doing and it’s hurting kids. Just two quick stories: special needs dad. So Dad, who has special needs kid and he’s kept him at home. They’ve done fine as a family. It’s not been easy, but they’ve done fine because they’ve had a little Medicaid help. They’re now cutting back on that help enough that they don’t think they can keep their child at home, they’re going to have to put them in an institution that’s not good for the child’s health, that’s not good for their family.  It’s not even financially responsible, it’s the wrong direction and that’s some of the things that’s happening with this privatization and so we have to reverse it. Also talked to a mom who has a disabled child. She has to drive an hour and a half to get her daughter care. That’s not the kind of access we should have for our disabled children. So, I would bring that back in at this point because I think it’s done, I think it’s been done so badly that I’m worried about patients, about kids at risk and so I would bring it back into the state to stabilize it and then we could decide and I would also tell you I have the expertise to do that since I’ve worked in Medicaid, I am a doctor. I know how to do that and I would get that done. I also talked about mental health, substance abuse and addiction and I was, it’s intriguing, I’ve been talking about since the beginning because it’s personal to me. I’m going to guess every one of you know, somebody who’s suffering, but when we talk about kids, so fifty percent of mental illness can be diagnosed by the age of fourteen. We have got to talk about schools and education and how we get hold of helping those kids before they act out and then become part of our justice system. We also have to stop treating mental illness as a character flaw and started treating it as an illness. It is an illness and we don’t put people diabetes or broken legs in jail, but we put people with mental illness in jail. So I have a mental health plan, a seventeen pages long, so I do not print it because I like trees. But please go to my website and if you have any feedback on it, it’s just a start.

It is not a, you know, you can’t do the comprehensive. We’re going to have to keep working on this, but it is a start on had to tackle beds, how to tackle more providers. We’re fiftieth in mental health beds and forty-seventh in providers and this honestly helps us take it out of the hands of law enforcement, which is really where we’ve put it right now. So that’s something I’d love to talk about. And then, I talked a lot about public education. I’m a product of public education. I’m going to guess most of you are and it’s why most of us are successful. It’s the greatest thing about this country and the state is that anybody, I don’t care who you are and you guys know this. Anybody, any child can be successful because of what we have in public education. And that’s why, to starve it, which we have done for eight years. So if you want to do the statistics, from 1973 until the last eight years, we averaged more than four percent growth. Averaged. Think about that. Farm crisis, everything else. Averaged more than four percent. Last eight years we’ve averaged less than two. Almost one. That’s not even keeping up with cost of living and we can’t do that and expect to have world class schools. And if you don’t have world class schools, I don’t know what you think the future’s going to look like because that to me is the future. I do talk about that I’m a scientist and so I believe in science and I believe in the way science gets things done. So climate change is something I talk about and having clean air and clean water because I think that’s the birthright of children.

And lastly, why do I, why am I doing this? I’m doing this because I have seven kids and one grandchild and I want my kids and grandchildren and your kids and grandchildren to be able to stay right here in Iowa and be successful. And that’s what I’m so glad about what you’re doing because this is every kid, every kid who grows up in Iowa ought to have every advantage, so they can be what they, what is successful. And that might be different for different people. But I just think it’s really important that we let kids be the success that they can be. So that’s what I talk about and I’m very excited about talking to you because this would be an absolute priority for me because it’s been a priority for me for a long time. 

So I’m a founding member of WLC [Women’s Leadership Connection] and I’m very proud to be and I’ve been involved in it ever since then. You know, we helped get, at least the early childhood education that we have now. We’ve worked on all kinds of things to get that done. And I think there’s a lot of work left to do, but I’m always very proud of that we have moved the needle, all of you have. And when Prevent Child Abuse Iowa, I worked on that board for many years and you know, I know what you struggle with and I know sometimes it doesn’t seem like we make enough progress, but we have made progress and I would tell you under my governor leadership, we would make more progress. So that gives you a little sense of me.

Jill Applegate: Yeah, well I think it makes sense to maybe to start talking about health and wellbeing. So Chaney and Mary Nelle, if you would like to, talk about that topic a little bit.

Chaney Yeast: Well thank you for already highlighting a lot of what we were hoping you would highlight. So, access to well child visits to determine ongoing health and the mental health needs is critical to a child’s development. One in five Iowa children suffer from a mental health condition in their childhood and adolescence yet only about under two percent actually access services to help mitigate that impact. We talk about Iowa lacks a children’s mental health system, meaning what a child receives in one area of the state is very different than the services and supports that the child and family receives in another area of the state. And then to top that off, we’d throw Medicaid into the pot. So out of our six hundred thousand Medicaid members, half of those are kids. Yet we tend not to talk about kids in terms of Medicaid because they’re the least costly members.

Dr. McGuire: Yes. They sure are. That was, I always laughed at that because yeah, eighty percent are the moms and babies and yet twenty percent of the cost so no one cared.

Chaney Yeast: So our specific question for you is, what actions will you take to ensure access to services, to address the developmental, emotional, and mental health needs of infants, children and young adults?

Dr. McGuire: And I come at this from a doctor angle, from a medical angle. The best thing you can do in medicine is prevent. I’m a public health person for that very reason. My husband always laughs about it, he’s an orthopedic surgeon. He says, I fix broken bones. You make sure the ladder is okay so you don’t fall off and break your bone. Okay. That’s the difference. I’m about prevention and it’s so important when we’re talking about our kids, if they can get access and get the right medical care, which this is, this is pennies, this is pennies. So early childhood, and I would even say in utero prenatal because if you can take care of a mom and get her to have a healthy baby, you’re halfway home. And it also goes to all the problems of the circles of poverty. If the baby’s not doing well, the odds that that mom and that baby or getting out of any kind of poverty situation are almost zero. So if we can get that baby to be born healthy, we can get that mom to understand how to do the preventive care, immunizations. It’s not easy. And I’m, I hope you don’t mind. I’m going to kind of jump around because honestly, it’s not a straight line, because some of the things we found when we doubled immunization rates was, how do you do that? Well, first, if someone doesn’t have enough to eat or they’re worried about their house and not having a roof over their head, they don’t really want to talk to you about getting an immunization. It is, you know, they’re trying to keep a job that doesn’t usually have benefits. Sometimes there’s two jobs or three jobs and they’re trying to balance it all. The idea of getting their kid to the doctor is not the first thing. So what you have to do is those social determinants, you have to first take care of making sure that those social determinants are okay, they have, they know they’re safe, they have a roof over their head, they have food, then you can talk to them about their health.  But if we can get kids to have the preventive care they need and you know that means more than even immunizations. But it does mean talking to them about their home life. And I’ve done a lot of work on ACEs and if we can talk about adverse childhood experiences and what that impact is having and understand early on because you know, the antidote is to have a strong relationship with that child by an adult. If we can do that, there is so much we can do with kids. So it’s bigger than just, you know, the immunizations and those kinds of things. It’s about making sure that kid isn’t abused. And I always, as a doctor, I will tell you, at Prevent Child Abuse Iowa, we did a lot of this. We have become much more aware of emotional abuse, physical abuse, sexual abuse and understanding how to diagnose it and how to take care of it. But all of that comes from being able to prevent it. So what you have to do is you have to make sure first of all, Medicaid is working like it should because if it works like it should, it will pay for these sorts of services, but right now it’s not working like it should.

You have to make sure you’re also doing it in relation with the providers. Right now we’re not paying providers either. One of the things we did with my company was we pay providers more for things that we wanted done. So we incented them over what Medicaid did. So that’s why we got immunizations done. That’s why we got the preventive services done, zero to two, because we incented that. There’s a way to make Medicaid even more efficient at doing that and it’s really important. It sounds like, well of course, but you know, immunization rates in Medicaid are not great. So we’ve got to keep working at that. So that’s the sort of things I would do, is I would incent it and make sure that that system is there first of all, and then incent the positive behavior, and I know it can work. We doubled those immunization rates, doubled in prenatal care, if you help and work with the providers, you can do it. But right now I talked to a provider, actually Lutheran Services, they’re almost a million dollars behind in what they’re getting paid. So you certainly can’t do that because then providers are not working with you. So I think it’s about getting the patient there and making sure that they’re socially okay so they can get their healthcare taken care of, making sure that they, the providers are in and then being fiscally responsible with that so that the program can keep going. But right now we’re sending, you know, profits to another state. So I think that’s really a doable thing. So that’s sort of the preventive care way I would look at it. And you’re exactly right about mental health though. And it’s something we probably don’t do enough of is just having that conversation with children about how they’re doing because yeah, fifty percent [at] less than fourteen [years-old], and we, I just think of all the angst, kids gets into substance abuse or addiction, acts out and gets in the judicial system, that we could save if we could start talking to that kid at an early age and say, okay mom, we think we’ve got some problems here. And there’s medications, there’s therapy. We can do things with this and not have to wait for them to make the mistakes they make.

Jill Applegate: I think you also brought up safety and security in your own home. So I’ll turn it over to Abby from Prevent Child Abuse Iowa to talk about that as well.

Abby Patterson: In 2015, 8,298 children were found to be victims of abuse or neglect and 5,918 were placed in foster care. Iowa has some of the highest national averages for neglect and abuse rates and foster care placement. Child Welfare services are intended to prevent and respond to abuse and neglect and provide safety, permanency and well-being of children removed from their homes. Yet too many children enter or remain in foster care and don’t have permanency in their lives. When children age on foster care, they have major barriers to success and our current investments put a lot more emphasis on placement versus prevention. Additionally, the recent deaths of Iowa youth adopted from the foster care system and the investigation followed have raise concerns about the capacity of our child protective services. So what actions would you take to reduce the number of children who are subject to abuse and neglect and how would you ensure that youth aging out of the foster care system have a promising future?

Dr. McGuire: Those are big ones and it’s something I worked on with Prevent Child Abuse Iowa. What I would first talk about, I think is this, DHS [Department of Human Services] has over one thousand less employees in the last eight years and yet they have more work to do. You can’t do something with nothing. This isn’t tightening our belt folks. This is cutting the bone and then some. And I talked to a DHS worker who no longer works there and he told me at the end of the Culver Administration they had brought in a consultant and he does pretty high acuity casework on case management. And he said he was having eighteen cases on his case load. And the consultant said, you know, really with that acuity, you should probably be at thirteen cases just to make sure that you’re doing the right thing. He told me they’re up in the sixty to eighty range now. You can’t do that. Any of you that understand, I’ve managed case managers, they’re worth their weight in gold. They will save children and money all the way, but you can’t have them do what they can’t do because then they’re just checking the box. They’re calling, they don’t get an answer, they’re putting the phone back down. You can’t ask them to do something they can’t do. So you have to put resources there. And now people say, well how are you going to do that? Well, I think our tax structure right now is giving away money before we ever see it. So our money, our revenues in Iowa go up two, two and a half percent a year, but what happens is we give away a lot of that in tax breaks and tax credits that we don’t need to be doing. That’s not why people are coming to Iowa. That’s not why they’re successful here. If we took that and put it into those thousand people in DHS and made them more efficient by giving them better software and computers, because I know when I worked with DHS, we were a lot paper based and that’s just not a good thing to do. You have to invest in being smart technologically. So if we did that, if we took that money that you know, some people talking about four hundred million, five hundred million dollars, that’s sitting in those tax breaks that I, and I’m not against all tax breaks, some tax breaks are great, but I want to make sure that we’re giving a dollar and we’re getting back lots of value for that. And when we’re not, like those four hundred million, let’s put that for kids. Let’s put that in our priorities. Because I always say we don’t have a revenue problem, we have a priority problem, and so that’s what, what I would do first, is make sure DHS is there for those kids.

Aging out, there are some programs that have been done in other states to help kids who are aging out of foster care. It’s hard to know what works, but I think it’s really important that we try to work with those kids. A lot of it is, what’s the plan? So there are lots of job skills that you can get in high school even, the community college’s come in, so that someone could have basically a job that pays well with good benefits coming right out of high school. That’s one option for kids. If they want to get into school, we need to help them with, if that’s they want to do a four-year school, we need to make sure that those scholarships are available for those kids. And the problem is it’s almost like a special category because they really don’t have much.  And so you can’t say, well, we’ll pay for school, but you’ll have to figure out the rest. You have to help them understand what work study and what they could do and help lace it together for them, like a parent would. I think in this case the state has to be that parent for them when they age out at 18. There are other states that are doing that and it’s working really well. So I think it’s really, to drop them at eighteen when we’ve watched them for that long, I think is a bad use of our talents all the way along. We need to make sure that they get on the way. And lastly, and I can’t even think of what I was going to say. Oh, lastly, we got to make sure that in schools, that where these homeschooling, I’m not, I’m for choice in school. I just think public money should go to public schools, but homeschooling I think should have some oversight and we’ve not done that. We’ve kind of taken that off and I think it’s important that there’s oversight. So we make sure that the kids always have an advocate, someone who sees them and knows what’s happening and what’s not, because that’s a lot of what happened with the deaths. And you know, Charlie, you’re wonderful. We used to say, we’re going to kill children if we keep doing this. We’re going to lose children. And I think people looked at us and probably a lot of you like, you’re just sounding the alarm. No, we’re losing children and we can’t do that. Not a not a state I would be a governor of.

Jill Applegate: Well you touched on something very important which is budgeting and taxes for our priorities here in Iowa. So I will turn it over to Charlie to talk about that, how we’re going to budget for Iowa’s priorities.

Charlie Bruner: Thank you. I’m kind of a tax policy, is kind of my hobby.

Dr. McGuire: Good for you!

Charlie Bruner: We know that seventy percent of our general fund budget really is directly to the health safety, education, economic security and development of kids. While the federal government plays a role, it really is at the state level that decisions are made around how we make our investments in kids. Over the last twenty years Iowa’s experienced several budget crises and across the board budget cuts affecting children and some of those have yet to be restored such as in Early Childhood Iowa, and in some of the child welfare services and supports. And state budget growth overall is, I think you mentioned, has lagged far behind growth in the state’s economy as lawmakers have enacted and often phased in tax cuts which have made it difficult to maintain, let alone enhance, existing programs. So kind of the question is what is your plan to tackle tax policy issues that do ensure statewide adequate state general fund to pay for Iowa’s priorities and particularly children’s health, safety, education, security and development?

Dr. McGuire: Well first of all would it be a priority and that’s different than it is now. One of the things they’re doing right now is they’re talking about this tax cut. You know, I’ve heard a lot of different numbers thrown around, but 1.7 billion dollars over six years, that’s just, we don’t have enough money right now to do the services we need done with the tax breaks we’re giving away. And we’re going to do another 1.7 billion dollars out of a 7.4-billion-dollar budget that, I mean, I took math. That doesn’t make any sense. It doesn’t make any sense. So the first thing you got to do is say we need to put money to where our priorities are. And we’ve talked about this for years, Charlie, we don’t always do that. And then when the cuts come along, I always think it’s the people who can’t scream. And a lot of times that’s our people. That’s children, especially children who are in poverty. It’s moms in poverty. Those are the people who don’t have, they certainly don’t have a lobbyist except for maybe Charlie and, and that’s what we need is we need some, we need a governor who is willing to say, I hear those kids and I hear you and I’m willing to put the priorities there. Now how do we do that? First of all, we don’t do this tax cut. We do not have the resources to have a tax cut right now. And frankly, I will tell you, I’ve gone all over the state, all ninety-nine counties. I haven’t heard one person say, if we don’t get a tax cut, I don’t know what we’re going to do you know? I mean the economy is doing okay and people really want services. They’re more worried about what you said, the two kids who died. They’re are more worried about our education system and, are we doing what we’re supposed to do with that? They’re more worried about the healthcare system. So the tax cut is a is a nonstarter.

Then I think you’d go back to what I was saying before is you look at the whole budget and you say, okay, it’s going up two, two and a half percent a year. Where are our priorities and where do we put that money? Where we don’t put it? We don’t put it on tax credits that aren’t really returning anything anymore. And I will tell you that I’m, like said there are good tax credits and if you’re going to give me one hundred dollars in value back for my dollar, I’m going to do it every time. Because that helps all of us. But there are lots of tax credits that we never looked back on and so we give them a dollar because we think we’re going to get that back, we’re not getting the value back and we’re not taking the dollar back. We need to be very, you know, like a scientist, very into metrics. So when someone says they need a tax break and we go, this would really help us. Great. We’re going to monitor it and if it’s not helping us, we’re taking that money back. That’s a good deal for us. And that’s where we ought to be doing it so that we can put our money where our priorities are. And that should be on healthcare. That should be on education. So to your point, I think there’s money there and I think those priorities, the seventy percent, that’s probably what it should be. When you take education and healthcare into there, it probably should have been at least that or more. And we, I guess the last thing I would say is I’m not sure we have the money to not do this now. I mean, I look at some of the things, preventive care, if we did the pennies it would cost to make sure that our Medicaid system is working well or any system was working well for preventive care. That saves money down the line. When we’re doing things with the foster care, if you do that right, it saves money down the line. Mental health, substance abuse and addiction. Great part in my mental health plan is if we’ve diverted people before they even got into the system who have a substance abuse problem, if we diverted them, didn’t even get them in the system so they don’t have the box, got them into drug treatment, you know, nonviolent just with a disease, a substance abuse disease, it’s one sixth of the cost that it is to put them in prison, which is where are going to go. So think about that. It has ten times the success rate and it’s one sixth the cost. They do it in other states. So in a lot of ways, Charlie, we can’t afford to wait on these because we will save money that then we can put back into our Medicaid, into our children’s services. The other thing I will tell you I will never do, and it’s always bothered me, is we would save money in something in children, in Medicaid, and the money would go into the general fund. No. If we save money the money ought to go back to helping the people that had saved in that program, that’s where the money ought to go. So I think we ought to talk about, instead of it going into a general fund and people don’t know where it goes, when we save money, we had an earmark it for going back into helping people that need it. And that’s my priorities. Does that, does that answer your question. You want more specifics? I certainly—

Charlie Bruner: No, we have other questions to get to.

Dr. McGuire: Well and Charlie and I have talked. I will say he’s taught me a lot of this. So, we’ve been friends over the years because I like what you guys do.

Jill Applegate: Well, I think the flip side of what the state does with that budget would be family economic security. And so I think I’ll have Lana talk a little bit about that.

Dr. McGuire: Perfect.

Lana Shope: We have about fifteen percent of our kids living in poverty. We have a lot more that are right on the edge living in families that are struggling to make ends meet. And we know that kids who come from low income families aren’t given equal opportunity for lots of developmental chances in their lives. We know that strong work support program and policies that help these families are key to their ongoing success. So what actions would you take to reduce multigenerational poverty and ensure that all children have access to equal opportunities to achieve success?

Dr. McGuire: I think it starts with supporting $15 an hour minimum wage because that’s a floor and I don’t probably talk about that as much as some of the candidates because I really think that’s a floor. As you guys taught me, that’s not a living wage. We know $15 an hour is not a living wage, but it’s a lot better than seven and a quarter where we are now. So, and if you ever thought about living on seven and a quarter an hour, you can’t do that. Now I would tell you it’s hard to raise any kind of family and having any kind of life on $15. But we got to get there and then we can start to talk about, because really is what we need to talk about is good paying jobs with good benefits for everyone. Some of the programs I’ve been involved with, this is mostly United Way, is the idea that if we can help people get more education, this was child care workers. We got their wages up, we got them more education. It helped them because these were lots of times single moms. So it helped them get a job that then had better wages and better benefits. But it also helped the child care facility because now they had better educated care givers. So there’s programs like that. And again, these are pennies compared to what you spend if a child is going to be incarcerated or child’s going to be sick. So we spend those pennies, we can get people better paying jobs, now it has the ripple of, it helps the daycare, but it also helps the family and I just, I love when we can do several things at the same time.

But I think it, also right now jobs are not as much the problem. When I go all over, there’s a help wanted sign everywhere you go. It’s wages that are the problem and so we have to get wages up. Some of that will happen with unemployment going down, but I think we have to foster an attitude of the floor of $15, but then getting to a good benefits, good wages with good benefits. That’s another thing I think we have to have a bully pulpit for us is good benefits. We need to have healthcare for everyone, especially with the ACA [Affordable Care Act] doing what it’s doing in our state, where we’re putting out this, I don’t even have a good word for what this is that they put out, the Farm Bureau/Wellmark sort of kind of insurance. It’s not insurance. It’s actually getting around every regulation of the ACA and it’s going to hurt people. It really is. It’s going to bring back preexisting conditions, going to bring back not having mental health, not having maternity care. It’s going to bring back really not covering some of the stuff. It’s, it’s bad. And people will know what’s bad. So that’s the other thing is I do think having good benefits at the workplace is something we need to do work on.

Jill Applegate: Well, and all of us here now with the importance of early education as you just touched on. So I’ll ask Barb and then Dara too, if you want to add, you know, your experience in, feel free, but a Barb to talk about early education and child care.

Barb Bremner: That’s, it has been something that I think we’ve all worked collaboratively on. The accessibility and quality childcare in Iowa to help parents earn and children learn.

Dr. McGuire: I like that!

Barb Bremner: I think, I didn’t make it up.

Dr. McGuire: Then I can steal it!

Barb Brenner: In Polk county, unlike about twenty-four percent of the area of Iowa that has child care desert. We don’t, we’re not necessarily in a desert, but we do struggle having child care that’s affordable and accessible for families and that’s really working. We have through work with co-funding with United Way, supporting child care centers that accept child care assistance kids, but we’ve seen an overall trend here in the state a reduction of about forty percent of child care providers who will accept child care assistance. We have a corporate child care company coming in from Minnesota, that’s going to have five spots in the metro area and they’ve determined that they can’t afford to enroll the child care assistance kids because of the fact that the state will not reimburse at market rates.

Dr. McGuire: They’re at 2004 rates last time I checked.

Barb Bremner: So we have this kind of knotty ball that we cannot untangle because of the low rates to providers, which then impacts their bottom line, which impacts the wages they’re able to pay their employees. So how, the question is, how will you support affordable child care and access to quality care for Iowa’s families?

Dr. McGuire: Well, I think you’re exactly right. We can’t talk about quality when we can’t even, they can’t even afford to do anything. And I, we used to do some of this with United Way where I would go in and they would be changing the diaper right next to the sink and it’s that, you know, people think quality, yes it’s about early childhood education and all that. It’s also about the safety of having a child changed right next to the sink and that’s where the food is. So we’ve got to get on, to a point where they at least can think about quality because they’re not thinking about the dollar every day. We’re, we’re at 2004 prices. I mean that you can’t expect, just like education, you can’t expect people do nothing with, do something with nothing. So I would raise that and, but I will tell you something, I don’t know that you know, but when I go around, somebody asked me in a forum the other day, what’s the one subject that no one’s talking about that we should be talking about?  And it’s childcare. We’ve got dual income families all over Iowa. And the thing I hear about, I think Iowa Falls was the first place I heard about it was, I don’t think I can go help at our dairy farm because I can’t get the kids in daycare because the only, there’s only one, I’m not sure it’s very good. And when a person said, well, their recommendation was, well, nothing bad happened there when my kids were there. That’s not exactly a rounding, you know, this is your child, this is the most important thing in the world. So she’s not working on the dairy farm because she’s staying home with her child. That’s not something that helps us. So we need to have more oversight into getting the quality up in all those daycare facilities. But you can’t do any of that if you don’t pay them, certainly from the state, what they need to be paid. And you’re exactly right. It’s going to be harder and harder and harder to get people to take that.

The other thing I talked about in that forum was the cliff and I, it irritates me beyond belief that we still have a child care cliff. And I talked to a guy from the government, this has been a ways back with United Way and I said, why do we have a cliff? And you know, why wouldn’t we say, okay, if you’re going to get a fifty-cent raise, this is what we want. We want people to be successful in their job, get a promotion. She, there’s a fifty-cent raise, why are we then going to ding her by taking away four thousand dollars’ worth of child care benefits? I mean it, so she doesn’t take the raise. And we talk about the circle of poverty, we just smashed her back down. So that’s not right. Well, so the guy said, well, what do you want to do? And I said, well how about if we graduate it? So if you get to this, you get seventy-five percent of the benefits. If you get to here, you get and, as it is, we should raise the, our cap is way too low in Iowa. We should raise that first of all. But then, you know, seventy-five percent, if you get to this level, then you get only seventy-five percent of the benefits so that we basically make it so you get a raise. But some of it’s going to go to child care, that’s a reasonable thing to do. That’s what the rest of us would do. That’s what we ought to do as a state. He told me we didn’t have the computing power to do that. I’m pretty sure my phone has the computing power to do that. So that’s ridiculous in this day and age. But back to paper, if we’re a paper place, we might not have the power to do that. We need to get where we can have people tell us what their paycheck is. We can tell them, okay, then you qualify for this. That should be done. Should be easy. So a couple of things there. Raise the 2004 rates from that. Raise the how much per child care that the cap is for, what I think is 145%, I think of the federal poverty level, that’s got to be higher. So, and if you look at the states around us, they’ve all done it higher, so got to raise that and then we’ve got to make sure that we don’t have the cliff anymore because, that’s a way to do it. The other thing, I do like the program where we train people that are single moms to, you know, get more education so they get better jobs that we can now pay them for and then they can help with the child care center. I do think programs like that where you get the double bang for your buck really help.

Jill Applegate: Yeah. Well and a similar issue to child care is after school because kids, you know, even as they age, they still need care when their parents are at work. So I’ll have Sheila talk about afterschool needs.

Sheila Hansen: Before school, after school and summer learning programs support working families by filling the gap between work and school schedules. They provide additional learning opportunities for youth beyond the classroom. And they keep children safe. Seventy-five percent of Iowa parents actually support the funding but, support this funding but the funding does fall short. What, the question is, how would you ensure that all children and youth have access to high quality before and after school and summer programming?

Dr. McGuire: I think we sometimes think of those as extras. They’re not extras at all, especially for a working mom and like, I go back to, what do we want? We want the mom to become self-sufficient so she can support her family, but what’s she supposed to do after school? Then that just makes a barrier. And especially the transportation issues, we run into this with early childhood education, the transportation, it’s just we’ve got to be more mindful of who are you speaking to especially, and who are you speaking to when you’re speaking to a mom who’s just barely getting herself out of poverty. That’s the person we should be thinking of. Not the everyday mom, but the mom who’s just getting her kid out, just getting herself out. How do we help her keep that step up? So, I think we have to fund those. And now I’ve said it probably six times and people are going make fun of me, but those pennies, that’s an investment in that child. If you think about the, I always think of arts, but the recreation, getting exercise, getting good food so they’re not hungry and hangry. That’s what we have to do. So I talked to a principal in a rural school and he said that on Monday mornings about 10:00 they, he was a math guy, so he said, I plotted all our disciplinary problems and Monday at 10:00 was like the big time because they were hungry and they hadn’t been fed as much over the weekend. And so he started instilling a program where you could come get breakfast in the morning even if you weren’t eligible and cut that down immensely. So I think we have to have this thought about, how do we invest in our kids so that then we don’t have the problems that costs us money anyhow. So we have to be, sort of back to that to that preventative care and using that pennies of investment in our kids. This is our kids. Is there anything. I mean, I don’t know if you all have kids, but nothing changes your life like having a child. It, everything becomes about that child and that future and that’s what you ought to have a governor thinking about when they’re thinking about funding and not about profits for somebody and not about some big lobbyist. I said everything I do as a governor will be about Iowans. It’ll be about what we need right here. Not what somebody wants from Wisconsin. I won’t go there, but it’s not that. It should be about problems Iowans have, and Iowans have this difficulty and it is pennies. So I think we ought to be talking about this instead of some of the tax breaks and lobbying things that go on right now. And certainly this 1.7 billion dollar tax cut. That’s not a good idea.

And can I just add one thing? I think people don’t realize the power of arts, but then also a physical education. Getting kids to be able to walk and have good education and understand maybe their nutrition a little better, which a lot of times before and after school is what that does, has a lifelong effect. If you can get a kid to think that walking or running or being active is a good thing, you can take, you can take years off their life, or onto their life, so we got to get to think about the ramifications of what that is. It’s not someone babysitting a kid after school. It’s actually giving them the skills to have a greater life.

Jill Applegate: Absolutely. Well, we just have one set topic I want to talk to you. We’ll shift gears and I’ll ask Denise to talk about human trafficking.

Dr. McGuire: Oh good.

Denise Rathman: Yes. We’ll stop there. Our last question will be a bit of a difficult one. So in 2017, forty percent of victims in reported human trafficking cases in Iowa involved my minors. According to the National Center for Missing and Exploited Children, there are several factors that make children particularly vulnerable to trafficking, and that includes a history of abuse, patterns of running away, unstable home life or involvement in the child welfare system. Perpetrators target children because it’s their age make them more vulnerable, easier to manipulate. Yet human trafficking is still a largely hidden problem. It requires heightened awareness to understand the warning signs. Human trafficking can happen anywhere at any time and look different each time. So our question for you on this topic is how would you address the issues of human trafficking and ensure the broad based training needed to educate all Iowans that serve, teach, protect, respond, or utilize our natural resources.

Dr. McGuire: Tough subject. I will tell you, I don’t think I’m, I’ve been made aware of this more in the last several years. And really the first time I heard about it, I was kind of like, no. And the more you dig into it, yes, this is exactly, it’s exactly those vulnerable kids. A lot of times they’re the ones that end up, and it is, it’s a much larger problem than I think any of us even wants to acknowledge. So the first thing I think you do, and I don’t pull the bully pulpit out very often, but I do on this one. I think the first thing you have to do is have a leader who says we have a problem, and this is what happens, because I think the more people we can have at a Kum and Go or a Casey’s that looks at a kid and says something’s not right here, I think that’s our best prevention for this. I mean our law enforcement obviously in that, and you brought up training. So if we’re all more aware of what happens, I think that that arms us all with, because nobody wants this to happen. But that arms us all with, maybe we should be back to the see something, say something. We should be more aware. Second, training. I think training in a large way. I don’t want to ever dump anything on teachers, but teachers are our best way to get to understanding. They know when things are happening. But then we talked about DHS where you don’t have those thousand people. If we had those thousand people, I think a lot of this, you’re talking about kids who are, a lot of times being overseen by a DHS worker, if the DHS worker weren’t so handicap for having so many cases they could do more. But I also think the training to understand, wow, this kid is really at risk. You know, even if you’re talking about ACEs for physical health, but those kinds of things that talk about, this person’s really at risk for having, for being involved in that and how do we make sure that those foster parents are aware of it and are keeping a tab and knowing where things are. I think that awareness and then that training is exactly what you do. I’m not sure I have a solution to this problem. I was stunned when a person told me that Iowa is really bad for this and the reason he thinks is because of Interstate 35 and 80 where you can just get the heck out of here. That makes me so upset, that we would have that. So, I think making it a bigger priority is a huge, because it’s not something most people talk about it and we should because no one wants this.  So I would love to tell you, I could wave my wand, but I think more, it’s having the attention to that and having the leadership to say it’s wrong and even maybe pointing out to people where we can get involved and get people off of this. I have been involved with some people who have come out of trafficking and you didn’t really ask that question, but that’s another whole problem. We’ve done this with the United Way, is figuring out how to help people who are coming out of trafficking because they really have some significant issues that need to be handled. And so that’s sort of the next part is now that once we tackle this, we’re going to have that next problem of people who have been abused in this and we have to make sure that we take care of them and their needs. Because it’s kind of PTSD [Post Traumatic Stress Disorder], mental health, abuse structure that really needs to be, and there’s some states that are doing a good job of that. We’re doing okay, but I think we need to do even better.

Jill Applegate: I mean, I think we can easily say all of these issues are connected, right.

Dr. McGuire: No way!

Jill Applegate: We have, you know, a few minutes left, so I do want to open it up to see if any members have additional questions or if you Dr. McGuire have any questions for us that are experts.

Dr. McGuire: Well, I think you said something very powerful there. Is some people go, well, you know, what’s your expertise? Why are you best to do this as governor? One of the things is I do know health and health is complicated. As you know, it’s really not an easy field and it has so many tentacles. If you talk about Medicaid, talk about mental health, talk about women’s health. You talk about clean air and clean water. Talk about even up to nursing homes, not your thing, but the other part, you talk about all the things that have to do with health. That’s why as someone who comes from health I have such expertise, but education is intertwined with health. The idea that you can somehow take those two away from each other. Absolutely not. So we have to make sure we’re funding education, especially early childhood and then making sure that we’re getting that with the health structure. Nurses, which not even everybody has nurses like they should. I want to have one person in every district who is about mental health and substance abuse. That’s not enough, but it’s a start because we know we have parents who know there’s a problem, but not sure what to do. We have teachers who absolutely know there’s a problem, but they don’t know what to do. And of course right now we don’t have the resources to take them to. So first we have to have the resources for them to take them to. But then you need to have somebody who can take it away from the teacher and say, I will help get this child the help they need. So I think there’s so many ways that we intertwine. And I also tell people that go, well, but it’s about jobs and economic development. I’ve got news for you, every business I’ve ever talked to, and I ran a business. It’s going to go, do you have good healthcare? Do you have good education? Because otherwise we’re not coming there. So don’t kid yourself. That is the bedrock. Those are the kitchen table issues. And so I think what you’re doing is so important. But I do think it’s all interrelated and I just, I really commend you for what you do and I’m not, like I said, I’ve been a part of, I’ve been with almost all of you in some different capacities. So I just really appreciate what you’re doing.

Jill Applegate: Thank you.

Dr. McGuire: Do you have any other things we haven’t talked about?

Jill Applegate: Does anyone have other questions you’d like to, yeah, Dara.

Dr. McGuire: Go for it.

Dara Madigan: I’ll just piggy back off Barb’s question. You kind of address the quality and accessibility of child care as far as parents and families and like the program quality is concerned. But can you also talk about how you can address the needs of the child care workforce and the quality of that workforce?

Dr. McGuire: Well, and that’s this, at least this program we’re doing, I think we have to have better quality care providers, but we can’t pay them at seven and a quarter an hour or eight, which is about what, you can’t do that and expect to have this. So I think the $15 really helps with that because it says, okay, but then you go, well, how are you going to pay for? Well you got to raise the amount that the state pays, which would really help to get to that level. But then you have to make sure that you try to invest in people who, you know, need to, would love to do it, but need help going to the community college and getting that, those resources, getting that education so they then turn that around and go back and plus they have a good job with good benefits. So it’s that kind of tripling itself. I just, we’ve done it with United Way and it is fabulous. I’ve gone to some of those graduations, those moms are so proud of themselves and they’re usually moms, usually single moms, and they’re so proud of themselves because they’ve gotten an education, they’ve gotten some schooling, they feel very accomplished. I don’t think you can underestimate how great that is and they turn around and give that back to the kids. So I think there’s a synergy there, but it can’t work without resources. You can’t do something with nothing. But, and I said, I don’t think this is a hard thing to do. I just think it’s a priority thing to do and I think we have the money to do it. So if that tells you what I’m thinking and I think that goes, I know there’s a lot of angst about the quality ratings and where we go with all that.  I’ve been in those meetings forever and people not wanting certain qualities because then they don’t even want to apply for them if they’re not going to get a five and all those. I know all those issues. I think we have to work on those issues together, but more importantly we need to get better qualified, better educated child care workers, but we can’t do that until we get the payment at a level where that supports that. And when we can this is a great group of people. This is doing, they’re doing, they’re taking care of our future, so we’ve got to make sure that that’s a priority.

Anne Discher: I’ve got a question sort of looking at opportunity with a little different cut. At the Child and Family Policy Center, we are the Iowa grantee for the Annie E Casey Foundation’s Kids Count initiative and so we’re all about collecting data on child wellbeing, right? Lots of different indicators. And every year the Casey Foundation puts out a book that ranks Iowa compared to other states. And we always look real good, you know, three or five or six. But you know, a few years ago they decided to take a different cut at that process of looking at data of well-being on kids and families. They decided to disaggregate it by race and ethnicity and do a similar cut, looking at how Iowa compares to other states and you know, we’re used to feeling pretty good about how Iowa looks on these kinds of rankings and we don’t actually look very good when you disaggregate data by race and ethnicity, and actually even white kids in our state don’t rank as high, but our rankings for kids of color when you look at indicators of well-being are really quite poor and the disparities between white kids and kids of color are some of the worst in the nation.  So I would love your thinking about what you as governor would do to really try and make sure every kid has access to opportunity.

Dr. McGuire: Yep. No, and it is, there’s a lot of statistics like that, that when you roll it down, it’s not good and we’re not addressing it. We’re ignoring it more than anything. I have a lot of people of color that I’ve spoken to about this and that are helping me with this because, first thing I understand is you need to be in that community and see what they need. I don’t, I really bristle at one size fits all. I’ve learned from going all around Iowa, one size does not fit all. There are different, you know, you think, oh, Iowa’s pretty like, no, actually it’s, it’s different and they have different needs and I do think we always need frameworks and structure and, and kind of the framework of what we need to do. But I think you should let a lot of local help that. And so one of the things we’ve done, the Black Caucus is a part of the Democratic Party and we’ve gone around and done workshops in most of the, the more urban areas. Though we did one rural, which was very interesting. So Hispanic and African American, we need to talk to them about what they need. That’s what we do in health disparities is trying to understand, why are you not coming to the doctor, why are you not getting your children, you know, this sort of thing. What’s the driving force? Because lots of times it is a driving force. In medicine is lots of times that there’s a cultural barrier. And that’s true LGBTQ, it’s true of a lot of things that doctors don’t relate to the culture that someone has. And that’s something we’ve been doing in medicine. That’s something I would foster even more is to have that feeling. But I think it’s an education too, it’s understanding where those kids come from and where they need to go. And that’s one of the reasons early childhood education, you all know, but I’m going to say it anyhow, if you have them ready to learn when they hit kindergarten, you know, it’s half the battle done. So, but they’re not and they’re not getting the childcare they need, we have this voluntary and it’s not, it’s better than it was, but it’s not as good as it could be. I would have mandatory, well, what’s a better word than mandatory, but you know, I would have every kid be able to have a preschool, mandatory preschool, because I think getting those kids ready to learn, especially when they come from homes, a lot of times, you know, not all people of color, but a lot of people of color, also has the poverty in there, so we’ve got to make sure we get them ready to learn because it’s so important. So this preschool I was at this morning, it’s all, it’s very diverse and those kids, the progress they make when we put some effort into it is unbelievable. So we can tackle this problem. We have the resources to tackle this problem, but we’re not putting much light on it. And we do like to say we’re number one at things. So I think you’ve got to look at how that works. And the other thing I would do is in my cabinet, in my government, I would have it look like Iowa. And that I would have people of color. I would have people from different cultures because I think that’s a good way for that to be sitting at the table. Those people will be sitting at the table understanding some of the nuances of their culture. I found that out with suicide, and the Black Caucus, there was a much different discussion than I had had normally and I would not have known that except they told me. So I think we’ve got to get more into everybody’s feeling, I talked a lot about everybody being successful in Iowa and that means different things to different people and it should. And so I want everyone to feel like they can be successful, not just certain people and so that means getting down into culture and communities and making sure that they feel like they have what they need to go forward. So that’s the kind of things I think about.

Jill Applegate: Great, well if you have any closing remarks you’d like to say.

Dr. McGuire: Closing remarks, sure! Terri Caldwell Johnson this morning said, me? Microphone? Sure! Well, I just, and I’m not, it might seem like pandering except that I’d done a lot of these forums and lot of times I don’t know anyone at the forum, so it’s not pandering, it’s real. I believe as Charlie’s taught me and Sheila and Denise, I mean, I believe that if we don’t do it right for our kids, we’re not going to have the state we want. I talk all the time about world class education. If we want our kids to be successful, if we want the state to be successful, that’s the future. You have to have world class education and you have to pay for that education. It’s important. I also think if you don’t have healthy kids, the rest of it kind of goes by the wayside as well. So you’ve got to talk about their health and make sure that, and that’s every child. That’s not some children, that’s not most of the children, that’s every child. And that’s not easy, but it’s something we ought to be doing. And you got to make sure that they’re listened to. And, we’ve had this battle before where nobody’s talking for the kids and there’s a lobbyist standing up for whatever cause it is. We’ve got to make sure that whenever we do things, we think, is this a good thing for Iowa’s children? And I know Charlie will be at my door telling me that, but that’s what you’ve said all along, is this good for Iowa’s children? And if it’s not, why are we doing? So I think there’s a way to do that. And people think, well, you can’t fund everything. Actually, I’m pretty sure we can. I really am pretty sure we can. With what we’re giving away in tax breaks, I’m pretty sure we can get to taking care of kids and I think if we do that we’ll be actually fiscally more conscious down the line than we are now. But we’ve got to invest in our kids and then it will have, in high school graduation, in less people going into the judicial system, it will prevent that and help us fiscally later on. But more important we’ve got to do it for our kids. And I will always be about my kids, your kids, our grandkids. That’s kind of a wrap.

Jill Applegate: Thank you so much.

Dr. McGuire: Thank you. And if I think we have the literature, if you have any questions because I know how I am, what about this or something more specific than this, please let me know. I would love to answer your questions. The other thing is please, if you have, and I think we’ll give a card out, but if you have something, you know, I wish you talked about this or you should look at this or send me, Charlie sends me stuff all the time. I have lots of folders from Charlie. If you have information that you think I should have. I’m a student. I’m a scientist. I love information. So, and I’m a data geek, to your point. So I would love any information you have. Don’t think, oh, she probably already knows this. No, let me know this. And I’ll tell you what else, as governor, I’ll be the same way. I’ll be listening to you as governor. Alright?

Jill Applegate: Yes. I appreciate that sentiment. And likewise, if you ever feel like we can be helpful for you, feel free to reach out to the Coalition or to any of our organizations. But yes, on behalf of the Coalition, thank you so much Dr. McGuire for being with us this morning. We’re very happy to hear your perspective.

Dr. McGuire: Do you all know what this is? Because I went around and did talks for early childhood education. We were first doing Women’s Leadership Connection and you have to have good quality, to your point, good quality early childhood education and that’s interactive. And one of the things we talked about was, you know, it’s not just you watching a video or sitting, it’s interactive learning is so important and that’s what this is. Is when you have positive stimulation, I give you a ball, we say ball, we toss it back and forth and we’re both doing that. That’s interactive. When you don’t have that, parts of your brain don’t wire as well and that’s a lifelong problem and it usually means you become much more instinctual. So your fight and flight and you don’t have the reasoning power to say, I shouldn’t run out of the room or I shouldn’t start to hit you. And that’s a real problem in adulthood. So it’s so important to you to do so. Yeah. That’s, and we built a very successful Women’s Leadership Connection because people understood how important it was. So, I love this.








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