Iowa Republicans Want to Shield Pesticide Firms From Cancer Lawsuits
Growing up on a cattle ranch in Clarinda, Iowa, Tatum Watkins wanted nothing more than to be outside, help out on the farm, and run freely through the fields like other kids in the farming community. Instead, she spent much of her childhood driving to medical appointments out of state. Watkins was born with a birth defect known as gastroschisis, in which her abdominal organs were outside of her body. Angry and confused as she sat on the sidelines, Watkins often wondered why she was different. By the time she was 10, she had a hypothesis.
Every summer, Watkins's father would plant grapes on the ranch around the same time her neighbors sprayed pesticides on their crops. Every summer, the grapes would die. When a young Watkins made the connection, she began to wonder if the pesticides—a simple 'fact of life' in Iowa—could also have caused her gastroschisis. Her best friend, who suffered from a similar abdominal wall defect, also grew up on a working farm.
Years later, research found that excess exposure to Atrazine, a herbicide created by the pesticide giant Syngenta, is indeed associated with an increased risk of gastroschisis. Watkins will never know for sure if that's what caused her condition, but she wishes she and her family had access to this research a decade ago. 'Had people had the data to go forward with a lawsuit back then, I think that would have been a brilliant thing,' Watkins said.
Iowa has the second-highest rate of cancer cases and the fastest-growing cancer rate in the country. It's also one of the top states for pesticide use. Thousands have sought and won legal battles against the handful of pesticide companies that dominate the market, and litigation has been a crucial tool to help Iowans pay for the health care they need. But now, facing billions in legal fees, pesticide companies are lobbying to block litigation against them with the introduction of Senate File 394.
The bill, which recently passed 26–21 in the Iowa State Senate and will be voted on in the House this month, would prevent Iowans from bringing lawsuits against a pesticide manufacturer for failing to warn them of health risks, as long as the product includes a label approved by the Environmental Protection Agency. The votes to pass the bill came exclusively from Senate Republicans, although six Republicans also joined Democratic colleagues in opposing the measure.
'This bill would essentially make the federal labeling requirements sufficient legally, as far as whether they are adequate to warn consumers about potential harms from using that pesticide,' said Dani Replogle, a staff attorney at Food and Water Watch who has been following the bill closely. So if a person is diagnosed with cancer, and they suspect their illness is linked to pesticide exposure (as a growing body of research suggests), the person could not sue the company for so-called 'failure to warn' if their label follows EPA guidelines.
'I think the groups who are most at risk are farmers, and particularly migrant farm workers, who are already in a very hazardous line of work,' Replogle said, adding that children, pregnant people, and the elderly are also at risk. Eighty-nine percent of Iowans oppose S.F. 394, according to polling from the Iowa Association for Justice.
Dubbed the 'Cancer Gag Act' by critics, the bill is part of a larger nationwide push from the pesticide manufacturer Bayer to reduce its litigation costs. Similar laws have been introduced in eight states, as well as at the federal level. Over the last decade, Bayer has faced more than 167,000 lawsuits related to the use of its herbicide Roundup, a weedkiller originally developed by Monsanto and a product that forever changed the productivity of American farming; its use is practically synonymous with the country's industrial food system. When Bayer acquired Monsanto in 2018, it also acquired billions in litigation and settlement fees. The company has set aside more than $16 billion to deal with Roundup-related lawsuits, and has already paid out more than $10 billion in settlements. Just last week, the company was ordered to pay one of its largest payouts yet: a whopping $2.1 billion to a Georgia man who claimed that excess exposure to Roundup caused his cancer and that the company failed to warn of this possibility. Bayer did not respond to a request for comment.
Roundup contains glyphosate, a synthetic herbicide that's been classified as a 'probable human carcinogen' by the International Agency for Research on Cancer, a research arm of the World Health Organization. Its use is banned in Belgium, France, the Netherlands, and other countries. The EPA however, has found that glyphosate is 'not likely to be carcinogenic to humans,' a finding that pesticide companies argue exempts them from having to warn of Roundup's health risks.
The Modern Agriculture Alliance, a coalition of agriculture stakeholders founded by Bayer as part of its lobbying efforts, argues that glyphosate is an essential tool for crop yields in Iowa to ensure the state has 'a robust and affordable domestic food supply,' and that the bill to shield pesticide companies from lawsuits is crucial in ensuring farmers' long-term access to Roundup. The Modern Ag Alliance declined to comment on the record for this story, but pointed to a statement after the bill passed in the Iowa State Senate. 'If farmers lose access to key crop protection inputs due to meritless litigation,' said Modern Ag Alliance executive director Elizabeth Burns-Thompson in the statement, 'it will cripple their ability to compete and cause food prices to go even higher. That's why the overwhelming majority of Iowans support legislation that protects farmers' tools, and not the trial lawyers and radical, anti-ag activist groups that want to 'end capitalism' and put our farms at risk.'
That's inconsistent with polling showing that a majority of Iowans oppose the bill. Those who do support the bill, physician and Iowa State Representative Megan Srivinas said, may also be under a mistaken impression of how it would work in practice. 'There are a lot of half-truths to try to scare people into passing this,' Srivinas said. For example, though much of the bill's debate focuses on the effects of glyphosate, Srivinas pointed out that the legislation includes lawsuits related to 'any pesticide, herbicide or fungicide, whether it exists today or ever in the future.'
A number of other harmful chemicals would therefore be exempt from failure to warn lawsuits should the bill pass. Exposure to paraquat, a weed-killing chemical manufactured by Syngenta (parent company ChemChina), has been linked to Parkinson's disease. A 2022 report from The Guardian revealed that Syngenta 'insiders feared they could face legal liability for long-term, chronic effects of paraquat as long ago as 1975.' Syngenta also invented Atrazine, the herbicide linked to gastroschisis. The company did not respond to request for comment.
'There are so many carcinogens out there, and we need to understand all the different impacts so we can actually combat this cancer epidemic in our state,' Srivinas said. Both Srinivas's mother-in-law and father-in-law, who are farmers, have been diagnosed with cancer at some point in their lives. 'We need to give people the ability to get treatment, to understand what's going on, and to be able to make the choices for themselves, right?'
But fighting pesticide use in an agricultural state like Iowa isn't easy. If you're urban or rural, whether you use pesticides on your crops or not, you've likely been exposed to pesticides in some form or another, said Rob Faux, an organic farmer in northeast Iowa. He's been farming for more than 20 years, and though he doesn't use pesticides on his vegetables, his property is surrounded by soy and corn row crops that are regularly sprayed. Like many Iowans, Faux is a cancer survivor, and he relentlessly ponders whether he got sick just because of his profession.
'It's a common acceptance in rural Iowa that we're probably being poisoned, but we don't want to know about it because we're not sure we can do anything about it,' Faux said.
Over the last year, Faux has opposed S.F. 394 through his work at the Pesticide Action and Agroecology Network, a coalition that seeks to end the country's reliance on pesticides. PAN, along with a number of other advocacy groups, including Food and Water Watch, has led opposition efforts across the state. In February, more than 150 people rallied in the Capitol against the legislation.
It's important but exhausting work, Faux said. 'This is not what I do by nature. I prefer to grow things, or I prefer to educate people, which are the two things that I've done more of my life,' he said. Still, he thinks advocacy is needed nationwide. In addition to similar legislation being close to passing in Georgia and North Dakota, the attorneys general of Nebraska, Iowa, Alabama, Arkansas, Georgia, Indiana, Louisiana, Montana, North Dakota, South Carolina, and South Dakota have also filed a petition to amend a federal law that would make it harder to sue pesticide companies.
In Iowa, the bill has until April 4 to pass at least one committee in the House, but its lifetime could be extended through an appropriations process. Advocates are hopeful that representatives will prioritize the health and well-being of Iowans over corporate profit.
'I know people often get tired and frustrated, and they don't feel like they're making a difference,' Faux said. 'But I need to remind everybody that, believe it or not, you do make a difference if you come with integrity, if you come with the right intention.'
Hashtags

Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles


Axios
33 minutes ago
- Axios
Medicaid work rules' bureaucratic nightmare
Republicans insist that Medicaid work requirements will weed out people who shouldn't be on the safety net program's rolls in the first place. The reality is that the red tape and bureaucratic hoops to jump through will have far broader effects, according to health policy experts. Why it matters: Coverage losses stemming from work rules will be a key focus in the Senate this month as lawmakers debate the sweeping GOP budget bill that contains the most significant changes to Medicaid in the program's history. What's inside: The bill, which passed the House in May, includes a new federal requirement for those ages 19 to 64 to work or participate in 80 hours of community engagement per month to keep their Medicaid coverage. The requirement was supposed to take effect in 2029, but the House Freedom Caucus insisted the timeline be moved up to Dec. 31, 2026 — which would generate around $50 billion more in savings per year. Senate Republicans, even the more moderate members, have expressed support for the work requirements, including moving up the timeline. The White House contends that 4.8 million able-bodied adults are choosing not to work and said this week that work requirements "will strengthen the system to better help those most in need of assistance." House GOP leadership this week also cited recent statistics from the American Enterprise Institute that state Medicaid recipients who don't report working say they spend 4.2 hours watching TV and playing video games (compared with 2.7 hours for recipients who work). State of play: Most able-bodied Medicaid recipients work full or part time. Some states have already imposed work requirements, resulting in thousands of people either losing their coverage or finding it very difficult to sign up. Arkansas implemented a work requirement in 2018 that lasted less than a year and left 18,000 fewer people covered, or about 25% of the eligible population, per KFF. A court eventually ruled the program violated Medicaid law. Work requirements began in Georgia as part of a Medicaid expansion in June 2023, and as of January, only 6,500 adults had enrolled — a fraction of the 25,000 the state expected would sign up in the first year, KFF says. New Hampshire also tried to launch work requirements but stopped after a month, after only 8,000 of the 25,000 people subject to the requirement had complied. The Congressional Budget Office this week estimated that 4.8 million people could become uninsured by 2034 due to the Medicaid work requirements measure in the reconciliation bill. How it works: States would have to build systems to track all of the enrollees and their work statuses, likely adding significant costs to their program budgets. Then, enrollees would have to contact states, which could be required as often as once a month, to show that they're working or participating in another eligible activity like caretaking. Enrollees would have to submit paperwork proving a disability, substance abuse disorder or other criteria to qualify for an exemption. One concern is that the envisioned system doesn't account for informal arrangements, such as whether a person is paid in cash for domestic work, seasonal jobs in agriculture or even being self-employed. It also assumes that covered people would be aware of the work requirements and would try to comply. What they're saying: "The experience in Arkansas was that the people who lost coverage because of the work requirements for the most part became uninsured," said Jennifer Tolbert, deputy director of the Medicaid program at KFF. "There was no increase in the share of those working." "In all of these states, we see time and again that the people hurt include workers who are supposed to be exempt, including people with disabilities who are supposed to be exempt," said Leonardo Cuello, a research professor at the Georgetown University Center for Children and Families. The bottom line: Work requirements don't appear to encourage people to work, and the large savings in the budget bill are likely to appear because of people losing their health coverage. "The argument is that this is about waste, fraud and abuse. That's not how this bill produces savings," said Ben Sommers, a health economist at Harvard who studies work requirements. "These are savings from kicking eligible people out of Medicaid who should have that coverage, who need it for their health care, because they can't navigate this big bureaucratic mess that the bill creates," he said.
Yahoo
42 minutes ago
- Yahoo
Planned Parenthood provides basic health care. If they close, where will many women go?
When the Trump administration suddenly froze federal funding to more than 100 Planned Parenthood clinics this spring, the organization's Michigan branch was already deep into hard discussions about its finances. 'The leadership team and our board had been scenario planning for months to try to fill those gaps to see how we could continue providing care,' said Ashlea Phenicie, chief external affairs officer of Planned Parenthood of Michigan. The only option was clear. Michigan's 14 Planned Parenthood clinics serve tens of thousands of women. In order to save clinics around the state that were either busier or in places where women had few other options, the team would have to close multiple clinics, including the only one in the state's Upper Peninsula, a large, isolated and mostly rural area surrounded by a stretch of Lake Michigan. In Ann Arbor, home of Michigan State University, the city's two clinics would be combined. It's a reality playing out across the country. At least 20 Planned Parenthood clinics have closed or will close within the year. For decades, the health care organization has been squeezed by the same pressures choking nearly all U.S. providers –– low insurance reimbursement rates, blocked Medicaid expansion, understaffing and rising costs of providing medical care that have forced hospitals and health clinic closures throughout the country. Uniquely, Planned Parenthood, a nonprofit that serves more than 2 million patients nationwide every year, many of them uninsured, underinsured or who qualify for Medicaid, has also become the target of pointed funding cuts that started under the first Trump administration. 'What is different this time around is that it's much more sweeping. It's a deeper and broader cut that will affect both more clinics and more people,' said Farzana Kapadia, a professor of epidemiology and population health at the New York University School of Global Public Health. In March, the Trump administration withheld funding by excluding many Planned Parenthood clinics from the Title X family planning program, a federal grant program that funds family planning and reproductive health care. Then, in late May, House Republicans delivered another enormous blow, voting to end funding for Planned Parenthood as part of the reconciliation bill. Federal law already restricts federal funds from being used for abortion, except in cases of incest, rape or if a mother's life is in danger, through a law called the Hyde Amendment. But if passed, the reconciliation bill would cut off Medicaid reimbursement to any nonprofit that primarily offers family planning or reproductive health services, provides abortions beyond the Hyde Amendment exceptions and received more than $1 million in Medicaid reimbursements in 2024. As a nationwide organization, Planned Parenthood does all three. If the bill passes in the Senate, it would block Planned Parenthood clinics from billing Medicaid for any health services at all, including cancer screenings, wellness exams and birth control. It's unclear if the new legislation would apply to Planned Parenthood nationally or on a state-by-state basis. Over half of Planned Parenthood patients are covered by publicly funded health programs like Medicaid and in 2023, about 36% of all Title X services were provided by Planned Parenthood clinics. Eliminating these sources of funding would cut hundreds of millions of dollars from Planned Parenthood's care costs every year. Targeting federal funding for any type of care for Planned Parenthood clinics is a way opponents of abortion rights can attempt to shut down clinics that do provide abortion, even if they also offer other care. Phenicie said Republican lawmakers appear to understand that cutting off Planned Parenthood from Title X and Medicaid reimbursement will put the clinics that perform abortion in peril, even if these funds can't cover the procedures. The slashed funds could affect all Planned Parenthood clinics whether they offer abortion services or not. 'They know so much of our patient base is on Medicaid or needs Title X to pay for their care, they know that cutting this off will allow them to cut off access to abortion and they are willing to make that trade,' she said. Before the cuts, Planned Parenthood was already operating on thin margins. Now, clinics are struggling to operate at a loss. 'The numbers are so devastating that there are really no options other than closing some centers and consolidating others, and then investing in our virtual health centers that can serve people across the state,' Phenicie said. At least 1 in 3 women say they have gone to a Planned Parenthood clinic for care, as well as 1 in 10 men, according to a recent KFF Health poll. Nearly half of Black women have gone to a Planned Parenthood clinic, the poll found. Abortions, the main reason the Trump administration has ended support for the clinics, account for just 4% of the services Planned Parenthood provides, according to a 2024 annual report. The vast majority of Planned Parenthood's services involve basic health care for women, including diagnosing and treating urinary tract and yeast infections and screening for cervical cancer and breast cancer. Some locations offer vaccination against HPV, hepatitis B, Covid and influenza. More than half of care is related to testing for sexually transmitted infections and treatment. Another 25% is providing access to contraception, often at low or no cost. Cancer screenings and other non-abortion services make up 18%, the report showed. Those important medical services haven't swayed opponents of the clinics. In January, Sen. Rand Paul, R-Ky., introduced a bill that sought to ban Planned Parenthood from federal funding in the same ways the federal reconciliation bill would. The bill is called the Defund Planned Parenthood Act. 'My commitment to protecting life isn't just personal, it's rooted in both science and principle. Life begins at conception, and I've spent my time in the Senate fighting to protect the right to life,' Paul said in a press release. About 40% of Planned Parenthood's funding comes from government health care reimbursements and grants. Many locations offer a sliding scale payment option for people who can't afford health care. That money comes, in part, from government programs that are now being cut. 'Cutting this funding is really about cutting access to care for people who are not insured or who are underinsured to allow for tax breaks for people who can afford their medical care,' NYU's Kapadia said. Wendy Stark, president and CEO of Planned Parenthood of Greater New York, said that even when a patient has private insurance, 'the reimbursement rates are just not meeting the costs of primary care. 'The U.S. health care system pays a tiny amount of health care dollars into primary and preventative care,' Stark said. 'We are sitting in a micro version of that.' Earlier this year, Planned Parenthood announced it was selling the building that housed its only Manhattan location. Planned Parenthood locations are also shuttering throughout the Midwest and in other states that have historically voted in favor of abortion rights, including Vermont. In late May, Planned Parenthood announced it will close four clinics in Minnesota within a year. The state was the first to codify the right to abortion into law after the Dobbs decision overturned Roe v. Wade, but only one of the closing clinics performed abortions. Four of the six Planned Parenthood clinics in Iowa, including one in Ames, where Iowa State University is located, will also be shuttered. Four Illinois clinics, none which performed abortions, stopped operating in March. In April, three locations closed and two were consolidated in Michigan, where the right to abortion is enshrined into state law. Two Utah locations closed in May after losing a significant amount of funding as a result of the Title X freeze. 'We are subsidizing almost every visit we do, even with insurance,' Stark said. 'We also have a great deal of our patients who come who do not have insurance.' The decision to sell the Manhattan clinic was a strategic but difficult decision, she said. The revenue from the sale could help keep other clinics in the state operating. Both the patients and staff of the Manhattan clinic can be absorbed by Planned Parenthood's other New York City locations, which can minimize the impact the closure will have. 'When we consolidate in certain locations, we look at the whole area. Can we funnel patients to our next closest health center, are there other clinics that patients can be sent to?' Stark said, adding that this is more difficult to do in rural areas that already have extremely minimal health care options. 'If we face further erosion of our finances, we will have to make more hard decisions,' she said. Several state-level laws banned Planned Parenthood from receiving Title X funds in the decade preceding the sweeping federal exclusions. Robin Marty, the executive director of WAWC Healthcare, formerly West Alabama Women's Center, in Tuscaloosa, said these states can provide a picture of what health care may look like in states that have more recently faced Planned Parenthood closures. 'We exist as kind of a lesson to people of what resources are like if there is not a Planned Parenthood,' she said. Planned Parenthood operates just one brick-and-mortar clinic in Alabama, in Birmingham, but offers telehealth throughout the state. There are just two in Louisiana and one in the Florida Panhandle. There are no physical clinics in Mississippi, which has the highest teen birth rate in the nation. Alabama and Louisiana rank in the top seven, according to Centers for Disease Control and Prevention data. Mississippi also has the highest maternal mortality rate. Louisiana comes in second. Alabama is fourth. 'There aren't places for people to go for free birth control or STI screenings or maternal care,' she said, referring to sexually transmitted infections. WAWC Healthcare is one of the only providers in Alabama, outside of federally qualified health centers, which are run by states or counties, that does. Already, Marty said, the clinic relies heavily on nongovernmental grants in the absence of access to Title X, though the clinic does accept Medicaid. 'Every time I apply for a grant, I know I have only about a 10% chance of getting it, but I do it anyway because that's the only way my patients can get care,' she said. Other than grants, 'we rely on donors who each donate about $50 each time we contact them.' Marty said other clinics that provide some of the same services as Planned Parenthood, which are already operating on razor-thin margins, if not at a loss, will be further strained by closures. This strain will be passed onto patients. 'You are talking about individuals who are living at or below the poverty level who already can't afford health care on their own and then you are eliminating a major source of their health care,' Kapadia said. The GOP megabill, which blocks Planned Parenthood from being reimbursed with Medicaid dollars, among other Medicaid cuts, is awaiting its fate in the Senate this week. For now, Title X funding is frozen for Planned Parenthoods in 20 states. If the 'Big Beautiful Bill' passes, another 200 of the roughly 600 Planned Parenthoods will be in danger, according to Planned Parenthood. When Title X funding was cut off to Michigan Planned Parenthood between 2019 and 2021, the number of people seeking preventative care at its locations dropped 75%, Phenicie said. Although there are other health centers that can pay for visits using Title X funds, they could not absorb the patients Planned Parenthood could no longer see, she added. In the month leading up to this year's closures, Planned Parenthood Michigan kept the four closing clinics open to honor all the appointments that had already been made, and spent hours trying to help patients line up care at other clinics or through telehealth with Planned Parenthood. 'Even if they would like to continue care, if they can't be covered under Title X and they can't use Medicaid, their options will be limited,' Phenicie said. This article was originally published on
Yahoo
42 minutes ago
- Yahoo
Republicans' new Medicaid red tape will push Missouri to the brink and block healthcare for millions
New paperwork and work rules for Medicaid will impose new burdens on state government systems (Getty Images). This week, Senators have started their consideration of President Trump's big tax bill, which was passed by the U.S. House of Representatives in May. Missouri U.S. Sen. Josh Hawley was clear in his priorities for the legislation, writing in early May that 'slashing health insurance for the working poor is … both morally wrong and politically suicidal.' President Donald Trump was blunter, telling lawmakers not to 'f**k around with Medicaid.' The bill passed by the House, does not pass their test – it does not, as Trump and Hawley claim, contain 'NO MEDICAID BENEFIT CUTS.' Instead, it will kick millions of people off of Medicaid by piling on new red tape. And it will bury under-resourced state Medicaid offices in so much paperwork that they will be at risk of collapse. Together, these forces will mean that eligible Americans in Missouri and around the country will not have access to their Medicaid. Many will be left without health care as they prepare to bring a child into the world, face a new cancer diagnosis, or manage a chronic illness. In other words, if this bill passes, Medicaid will be cut for Missourians when they most need it. The House bill imposes new bureaucratic requirements on Medicaid beneficiaries, forcing them to file piles of new paperwork about their jobs, schools, disabilities, or sick family members to keep the health insurance they are already eligible for under the law. These so-called 'work requirements' do not boost employment as advertised – experiments in other states have repeatedly failed to do so. This is, in part, because the vast majority of Medicaid beneficiaries who can work already do. That makes sense – you can't buy food and pay rent with a health insurance card. The reason this bill reduces the cost of Medicaid by billions of dollars is that it assumes regular people will get tangled in the red tape of proving they are eligible for Medicaid. Experts project that over 10 million eligible people will lose their health care because of all the paperwork, including over 180,000 Missourians. But we believe that even this prognosis is too optimistic. Most analyses only consider the difficulty that people will have proving that they are entitled to Medicaid under the law, but not the difficulty states will have in administering the new paperwork requirements. We have spent the last several years modernizing the systems that deliver benefits to millions of Americans, including Medicaid. What we have learned is that state Medicaid systems, including MO HealthNet, are already on the brink – and lack the resources and resilience to take on the onslaught of requirements and deadlines about to hit them. Trump's tax legislation, the new requirements it imposes, and the lightning-fast timeline it requires, are setting Medicaid up for a collapse. Here's how it could play out. States are responsible for determining Medicaid eligibility. They allow people to enroll in one of four ways – by mailing in documents, enrolling online, applying over the phone, or walking into a physical office. Each of these pathways is already at a tipping point. Medicaid agencies around the country have staff vacancies as high as 30 percent, which means there are already too few workers to open mail, process applications, answer the phones, and staff walk-in centers. As a result, even under the current system, eligible people can see their Medicaid lapse because their paperwork is not processed in time. Missourians have recent experience with the effects of an overburdened Medicaid system. By law, Medicaid applications are supposed to be processed in 45 days, but as of last May, Missouri missed that deadline 72% of the time – the worst record in the nation – causing the federal government to step in to help for the second time in two years. The wait time on the Medicaid call center was 56 minutes in February 2024. The House bill will immediately explode the workload for state Medicaid offices. Medicaid beneficiaries will need to prove their eligibility twice a year instead of annually. And then it piles on the new paperwork rules. Missouri will have to figure out how to verify that a beneficiary is working, going to school, or meeting the new requirements some other way. They'll need to send out millions of paper notices, emails, and text messages to notify enrollees about the changes and train staff to handle the deluge of documents that will flood in. Just hours before the bill passed, Congress quietly moved up the deadline for states to make these changes, requiring implementation by the end of 2026 or sooner. And all this new bureaucracy rests on technology that is already failing. We've seen just how broken states' health care infrastructure is – Luke helped uncover state software errors that improperly terminated coverage for nearly 500,000 eligible kids across 29 states after the pandemic. The added strain imposed by this legislation will crash websites, jam call centers, and trigger even more software errors – trapping working people in the chaos. Under these conditions, failure isn't just likely — it's inevitable. We don't need to guess at how this plays out. When Arkansas tried to implement Medicaid work requirements in 2018 the results were disastrous. People received confusing instructions about how to prove they were working and many never knew about the requirement. The state's website repeatedly crashed. In the end, more than 18,000 people lost coverage, employment rates did not budge, and the state wasted $26 million on a failed experiment. In some states, that will mean lines around the block at overwhelmed county offices. In others, dropped calls, system outages, and piles of unprocessed renewals. These challenges compound. When the website breaks, you call. When your call drops, you drive to the office. Attrition will spike as the overmatched Medicaid staff are increasingly under siege, overtime is mandatory, and time off is cancelled. Smaller and smaller numbers of staff will bear larger and larger workloads until the system collapses. And, eligible Americans – working adults, kids, seniors, students, and adults with illnesses and disabilities – will still have no Medicaid. Hospitals will provide more uncompensated coverage, putting some – especially rural hospitals and children's hospitals – at risk of failure. This bill sets up state Medicaid agencies to fail at their most basic task – ensuring that eligible people have health insurance. It doesn't matter to a pregnant mom why her Medicaid is cut, she is going to miss prenatal visits and skip her toddler's check-up. If Hawley wants to stand up for over one million Missourians who rely on Medicaid, he should oppose this bill. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX