Editor's note: Nate Boulton suspended his campaign for governor on May 24, a day after the Des Moines Register published accusations of sexual misconduct from three women. This interview with Boulton was conducted in late April.
Nate Boulton is a labor rights attorney and first term Democratic state senator from Des Moines. Boulton is a ranking member on the Labor & Business Relations Committee and also serves on the Appropriations, Commerce and Judiciary committees.
In this interview he talks with IPR's Clay Masters about why he's running for governor, how he thinks the privatization of Iowa's Medicaid system should be reworked and fixes for Iowa's mental health system. A transcript of the conversation follows:
I'm asking every candidate who's running for governor just a simple question. Why do you want the job?
Well it's the same thing that got me into running for the state Senate. I've set out to improve the quality of life for working families in this state. Unfortunately this past year and past legislative session, we've seen an agenda that has gone in the wrong direction. And it really struck me, the end of the last legislative session, when I was actually taking a look at this race to decide whether I was going to get in or not I sat at my desk in the Iowa Senate and saw the Yes No buttons. And I just kind of said to myself, ‘if I'm here in 2019 pressing that no button against an agenda that I disagree with, and I think is harming Iowa's future, I'm not going to live with myself if I haven't done everything I possibly can to see us actually execute a plan for Iowa's future.’ And that really was when it really hit me that I was going to do everything I can to win this race for governor.
I remember the first time that I interviewed you was the last legislative session. There were talks in the debate process of the collective bargaining bill that took away a lot of the rights for public sector workers. And I remember thinking this guy might have some ambitions down the line maybe wants to be governor. I didn't realize that it would be the next year.
Ok so what makes you feel that you're ready for the top spot there at the Statehouse?
You know I think as you look at, you know, people that we need stepping forward I think we do need a new generation of leadership in this state. People who are looking beyond the next year or two years and starting to see what Iowa can and should be for 20 years down the road and having a plan for getting us there. I think my experience in the legislature just in this short period of time has allowed me to develop the relationships that I'll need to actually accomplish some of the things that need to be done for our state. And have given me the experience and the knowledge of not only the process but the way we can go about getting this stuff done.
And your background leading up to your time in the legislature. What do you feel from that personal experiences make you right for the job?
So I mean you look at where I grew up a small town in southeast Iowa Columbus Junction. You know I came from a rural Iowa family that I think when we start looking at bridging what has been perceived as a real divide in our state of urban versus rural. I'm someone that grew up in rural Iowa but now I represent a more urban area of the state. I think we can see that there are a lot more things that unite us than divide us in terms of our smaller communities and our larger communities. When we see underfunding of schools for example that's not a unique problem to an urban school or a rural school. When we see things that threaten our natural resources safe drinking water you know no one in rural Iowa or urban Iowa doesn't want to trust the water coming out of their tap. So those are things that I think I'm key in a key position to emphasize our shared values and what we can do to accomplish those things In terms of my work background. I'm someone that went originally to Simpson college to be a high school government and history teacher. So I care a great deal about our public schools. I student taught at Indianola High School and did some substitute teaching during my early law school years. I'm someone who has spent 12 years as a workers’ rights attorney doing everything I can to make sure people are valued and treated with dignity and respect in their workplaces. I think we can go back to those focuses and make sure that that we're doing things the right way here.
Well when you look at 2016, the last election, it was a very divisive election the way that the campaigns played out. And there were a lot of people in Iowa who felt that the message from the current president, Donald Trump, spoke to them because they felt isolated. They felt like they'd been forgotten. Working class blue collar you saw in many of these counties that went Republican for the first time in a long time even here in Iowa. How do you think those people are going to hear your message when so much of politics is just it’s so divisive?
Well I think it's got to be paired two things together right? Our frustrations but also our hope and our vision for the future. And I think that's the lesson that comes out of 2016, is that going forward yes we need to recognize that people do see certain things in their communities, in their lives that need to be respected as very real concerns that that should be discussed. But it's not just pointing out the negative. It's also sharing the positive. And that's I think the thing that our campaign has focused on the most is pointing out the things that have been done in this last two years and the legislative process that have held back and taken away from a quality of life of working Iowans that we want to see protected and promoted. But then also sharing that vision of what would I do with the same opportunity that Governor Branstad and Governor Reynolds have had the last two years. You know, when we look at Iowa's long term future we don't get to the place we want to be by accident or by default. We have to be intentional. We have to have a plan for how we achieve those successes of a future Iowa. If we want the next generation of skilled workers to choose to stay in or come to this state, one of our biggest threats for the long term future, we have to offer what they should come here to enjoy. And if we're deteriorating the quality of our schools, if we are struggling to provide health care including mental health care to Iowans, if we’re not offering wage growth and an increase in some of the benefits that workers are searching nationwide to find, things like my paid family leave bill, we're missing that opportunity. So when we look at the way we want to build our state the right way we have to lead and show that vision of how we can get there. And I think that's what voters are looking for.
So let's talk about some of these issues. Health care we're seeing becoming a big issue in this race already. We look at Medicaid and the privatization of the management of that program. That was something that former Governor Terry Branstad did without legislative approval in 2016. It was seen as a way to contain costs. What is the answer to making Medicaid a more sustainable program within the state?
Right. When we look at what's happened with our Medicaid system it really is a tragic story. It was a system that was forced into place with little notice and little preparation. We had people falling through the cracks immediately in a rushed transition period. And then, since it's been placed in effect, we've seen more and more complex problems and long term problems. These aren't problems that will just go away. When Governor Reynolds said in her Condition of the State address, “mistakes were made in going into this system,” there's been nothing done to actually address those mistakes. Leadership is about not pointing out the problem, but offering a solution to it. I have co-sponsored with the other Democrats and one Independent in the Iowa Senate a proposal that would cancel the MCO contracts and get us through a six months transition to actually getting Iowans taking care of Iowans again. Because that's what's missing right now. We're seeing delays and denials in services that are being provided. Well that's not only affecting the patients who are struggling to get the services they need. But we're hearing from providers that, you know, almost half of them have admitted that they're going to have to scale back the services they provide based on this current, private managed care system that we are in. Well that doesn't just affect Medicaid recipients. Now you're threatening the health security of every Iowan. So when we hear from the managed care organizations themselves that without bailouts they can't survive this system, and we've already had one leave altogether, we have to admit this is not a sustainable approach. We have to go back to the drawing board and primarily make sure it's Iowans taking care of Iowans in this process, because right now we have a lot of money going out of state and it's resulting in fewer and fewer people getting the services that they need.
And just a side definition here, but MCO managed care organization. These are the private insurance companies that have taken over the management of Medicaid in the state. I'm also curious though there's a lot of talk about, the old fee-for-service model under the state is not sustainable. Do you say otherwise?
Well I think that we have seen by proof that there are certainly ways that we could have improved the fee-for-service model. But going into a wholesale change of privatizing the whole works is not sustainable either. And we were having people get the services that they needed through the fee-for-service model. So we have to go back to the drawing board, and I think get us back to, you know, hit the reset button and then find the approaches from there. But this to me was done in a reckless way. It was a go-it-alone plan from the Branstad and Reynolds administration. Governor Reynolds was in the perfect position. She had a golden opportunity from day one when she was sworn in to show she was different, to show she was going to lead on this, to show she would do more than recognize the mistakes, but take action and do something about it, because it wasn't the legislative process that brought us this system. It was the governor's office. And instead we didn't see action. We saw more explanation than action.
Sticking with health care, there was a bill that was signed into law that got bipartisan support over mental health. What was your take on that bill? Was it a good bill to get signed into law?
It was a good bill, and I was proud to vote for it. And we had a couple of good steps in the right direction on mental health, you know, in terms of acute care access as well as helping make sure our teachers in our schools are recognizing when they need to intervene with a student that may be at risk of taking his or her own life. I think those are things that were positive steps in the right direction. But we can't pat ourselves on the back right now and pretend like mental health has been solved for Iowa's future. We see still real threats to the system. I've introduced legislation that would force reopening two of our state’s four mental health institutes that this administration shut down in another go-it-alone policy. The House and Senate had funded those facilities and those funds were vetoed and those facilities were shut down by the action of this administration. What the real consequence was, we had more Iowans going without mental health services, particularly the ones with the most severe mental illness in our state were forced to go through a transition that did not go well. I talked to a man who was in the Clarinda facility when it was shut down. Within three weeks his brother, who was taking care of him, was dead because the only place to go was a nursing home. That's unacceptable to have Iowans struggling like that with mental illness and it puts stress on the rest of the system. When you have those that need 24/7 supervised care and services being put down the next rung of the ladder, it makes it harder for people to get the placements that they need. Our two existing facilities right now, I've toured Independence and Cherokee. They will get calls in a single day that if they kicked everybody out and brought in all the intakes that they had a need for, they still wouldn't have room. So we've got a real crisis here. It's going to take more than just a couple of pieces of legislation to promote acute care. We need a Children's Mental Health Network. We need the long term services at those care facilities re-established. We need a lot of different things going on in our system. And right now, we're not seeing much action. And I think Iowans are going to be suffering in the long term future because of it.
Can the state afford to take on more responsibilities? I mean, a lot of times the argument you hear for, I mean with Medicaid or you name it, from the Republicans, is that, you know, having private sector help with paying for some of these things is a way to innovate. Can the state afford to do these kinds of things under its own umbrella?
The state cannot afford any longer to abandon the services that Iowans need in our communities. We have a lot of times private organizations, for example, that are struggling to get the resources they need through this managed care system. I mean, when you look at the facility I toured in northwest Iowa in the Jackson Recovery Center, for example, a facility in the Sioux City area that's providing resources for substance abuse and other critical issues in that community. That they're at a point now where if they stay in a system that has this private managed care, they are looking for how they're going to sustain themselves. Because if that facility has to shut down because they can't get their bills paid, which is unfortunately a reality for a lot of rural Iowa hospitals and other health care facilities, those services are gone. So now, not only have we lost 200, 250 jobs in that community, we've lost access for thousands of people for substance abuse treatment. Well those people that aren't getting substance abuse treatment now are going to have a harder time succeeding in our economy because they are going to continue to have substance abuse problems that interfere with their productivity. So the consequences are not just the immediate effect of that individual's health care, but it's the ripple effect that really does impact the quality of life and in a community that really needs to see a better path forward.
We've seen the Revenue Estimating Conference regularly change how much money is coming into the state. What kind of sign and what kind of signal does that show you as to what kind of work would need to be done with the state budget?
Well I'm on the Appropriations Committee in the Senate so I think about the budget quite a bit. In fact, we're at a point right now where we should have a budget set and known for this next year. But we don't. In fact, we have had end-of-the-year budget cuts thrust upon places like the University of Iowa, Iowa State and our community colleges without any idea how, in the next 90 days, they're going to have the ability to fulfill the next year's obligations. So this budgeting process is a disaster and it’s fiscal irresponsibility that got us to this point. I mean, we are now spending the equivalent of $600 million a year in tax exemptions, credits, giveaways to corporations that are making it harder and harder to forecast the budget. That are making it harder for us to make ends meet. We are at a 17 year low in unemployment. There is no excuse for this state to go through mid-year budget cuts, to raid emergency funds and do emergency fund transfers to make permanent budget cuts in these budgets when we should have the sun shining and the economy growing. I mean when revenues are up year-to-year we should not be going through these reckless cuts that are compromising critical things that a lot of times are revenue generating and positive impacts in our community. When we underfund DHS when we underfund mental health care when we underfund our schools, we're not only making effective cuts to this year and an impact this year. But some of those things have a 30 year impact for our state. We have to get a handle on the cause and effect of this budget crisis. And until this administration gets serious about talking about the overextension of those tax credits, exemptions, giveaways we're not going to see responsible budgeting practices. To add to the irresponsibility, to introduce all kinds of different ideas of how you're going to eliminate revenue going forward? I mean the proposal that we've seen come out this week $100 million in tax cuts that are going to benefit by 80 percent the wealthiest 5 percent of Iowans? That's the last thing we need to be doing in this state. We have to be taking care of our education system. We have to be improving access to health care. We have to have real economic development for the long term. Those things aren't going to happen if we continue to drive ourselves down to a low wage, low skill state economy based on transactional what I call corporate coupon economics. Where we're going to give you something if you come in here for a set period of time and then allow that employer to go shake down the next state when that transactional period is over.
Different topic. Water quality is something that we see pretty much becoming more and more of an important issue in the state every year. There was a bill, the governor said that she wanted it to be the first bill that she signed, and it was the first bill that she signed. It allocates more money for water quality projects to be done in the state to clean up Iowa's rivers, lakes and streams. Does it go far enough?
No. It doesn't. And my frustration with this water quality bill is we heard in the Condition of the State address Governor Reynolds said she was going to push through a monumental water quality bill. Well we're still waiting for the monumental water quality bill. What we got were the leftovers from last session that were not advanced because they didn't do enough. This is actually a very expensive way to do very little for water quality in this state. It doesn't have monitoring. It doesn't have a watershed approach. I've introduced legislation that actually gets us to where we should be in terms of doing the thing that voters asked us in 2010 to do. With over 60 percent of the vote, voters said here's the solution we want. We want real meaningful action on this. We want an Iowa Water Land Legacy Trust Fund with a dedicated revenue stream to deal with water quality and land management. And that wasn't urban versus rural. You look at where the votes came in on that. Iowans said this is a priority, we want it funded. And it's something that offers a sustainable approach. When we talk about threats to agriculture in our future, you know topsoil runoff is one of those top of mind threats because it's not just nitrates that are going into our waterways. It's not just, you know, the pollutants that we're worried about, it's the topsoil itself that's going down the Mississippi River. So we have to worry about the future of agriculture the quality of life in terms of rural Iowans in terms of hunting and fishing. I'm very proud of the work my wife Andrea does. She's the statewide trails director for the Iowa Natural Heritage Foundation helping communities acquire biking trails, hiking trails, water trails. Think of the economic development that can happen if we really did have a monumental approach to water quality and land management in this state. I'm proud to have introduced legislation to actually fund the Water Land Legacy Trust Fund and I think we can get to a real solution that way.
What is an example of, in your short short time in the Iowa Legislature, that you have worked with a Republican and found some kind of common ground?
Well we have been in a historically partisan environment and I don't think that's going to be news to any of your listeners out there. But despite that I have gone out of my way to have lunch or set up times to meet with and talk with each of the Republicans that I was elected with to the Iowa Senate to get to know them as individuals to start our careers together. I've gone out of my way to work with Republican legislators to improve legislation. While I may disagree with where it's headed to find some of those unintended consequences and limit the harmful effects that legislation would have. Despite having a D behind my name, I've had my name on three different amendments that have been passed. It may not sound like a big deal to a lot of your listeners, but there haven't been a lot of Democrats with their names on legislation that is moved anywhere in this legislative process.
And what are some of the examples?
One example that I think is a key example of how we can improve bipartisan cooperation was a bill dealing with volunteer firefighters that also serve as city council members. And it was a bill dealing with double compensation for them. If you were on a fire call and also serving as a city council member, not to cost the city more than, you know, the one payment. The way it was drafted I had a concern that the only person that would be without the benefit of coverage for an injury on that fire call would be someone who answered the call of public service twice. So Senator Guth a Republican from North Iowa, a very conservative Republican, was the floor manager of that bill and he and I co-sponsored an amendment that addressed that concern. And it, of course, passed unanimously because we did that. I could have sat back and said nothing and then pointed out the harmful effect of their legislation and how they got something wrong. But instead I reached across the aisle to make sure we offered a solution to a very real problem. And I've done that with other amendments that have had unanimous support. And I'm proud to have done that.
All right. Senator thank you.
I've enjoyed the time and I look forward the next 40 days as we go through this primary election process. But feel like we're in a good spot and looking forward to the rest of the campaign.