Gov. Branstad recently said that, in his fight against licensure laws in Iowa, he is “up against very organized and powerful special interest groups that have a lot of money, and they work very hard to get these restrictions into law. And they’re interested in protecting themselves more than they are in protecting the public.”
Actual facts reveal something much different: Educational requirements protect professions by keeping out those without the education and capability to perform the job. In most cases the protection and restriction of certain professions is in the interest of protecting the public.
The Board of Behavioral Sciences and the Board of Social Work exist “to ensure the integrity and competence of” licensed mental health professionals “and investigate complaints for unprofessional conduct.” Both boards’ websites maintain a list of sanctions that have been brought against unethical professionals throughout the years. This oversight is a benefit to both the profession and the public. The people on these boards have a professional and personal interest in maintaining high standards for the practice of behavioral therapy and client treatment.
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Currently, if you share something damaging with your therapist, unless they have a duty to warn, meaning that safety is at risk (homicidal, suicidal threats, imminent harm to a child), the therapist cannot tell anyone else without your express, written permission. With no board in place, this code of ethics and the sanctions which would follow such a breach of confidentiality become harmless to the practitioner. This would decrease trust in the profession but, more importantly, would decrease clients’ sense of safety in sessions and their ability to benefit from services.
The boards also ensure that a therapist practices within the scope of their training. This ensures safety for the client, as well as a measure of accountability to other professions in related fields. Without a board to oversee and sanction therapists, giving advice to clients which falls outside the scope of practice will be largely without recourse, for the client or the other professionals impacted by this behavior.
The most directly damaging aspect of this action by the governor to Iowans would probably be the loss of client’s ability to bill their insurance for these services. This would certainly benefit Gov. Branstad, as it would serve to make his Medicaid privatization less of a catastrophe, but most Iowans receiving therapy would no longer have access to insurance covered mental health care and would have to pay out of pocket for therapy, or simply go without. This may also burden the court and child protection systems, as they may need to surrender taxpayer funds for therapy and evaluations that would have previously been paid by their insurance.
Going without mental health care for severely mentally ill Iowans will run up both health care and public safety expenses, as these Iowans may frequently end up in emergency rooms or the criminal justice system. Both of these options are suboptimal and expensive.
The licensure boards, contrary to the governor’s claims, are self-sustaining. They are housed under the Division of Professional Licensure, which is supposed to be 100 percent fee supported, costing the state nothing. And the licensure fees that help support the board, contrary to what some may claim, do not appear to keep women and minorities out of the profession — about 90 percent of the therapists under these boards are female. The boards do not keep race or disability status on record, and it is unclear where the governor got this information for Iowa.
Speaking of money, therapists are not a rich special interest group. Licensed Marriage and Family Therapists split the cost for their lobbyist with mental health counselors. Social workers as a group are not known for their deep pockets. Nor do other licensed professions likely have lobbies that rival the Koch brothers.
If the governor does want to talk about powerful special interest groups and expensive lobbyists, however, Americans for Prosperity and other Koch-brothers-funded groups have long backed the elimination of licensure. Mark Holden, senior vice president of Koch Industries, said in 2015 of the rally against licensure, “We don’t constrain ourselves by a budget. If there’s something that makes sense to do, we’re going to look at it and do it.”
Recently, Koch Brothers lobbyist Drew Klein publicly circulated a photo of himself shaking the governor’s hand after the governor signed the bill changing collective bargaining for public employees — an otherwise private event. We are fairly certain that the “powerful, well organized” social work lobby lacks such access to the governor.
Additionally, the day that the bill HSB 138 was introduced to the Legislature by the governor’s office, the State Ombudsman’s office issued a report which was highly critical of the state boards. This report was confidential and the office reported that they were unable to identify the boards examined in the study, but that “We believe at least some of the weaknesses we identified here are likely to exist with other state licensing boards.” Making such a generalization based on an examination of 14 percent of the state’s roughly 36 licensing boards is pretty slick, but far from honest. This report is brief, poorly written, and contains only anecdotes. It contains no actual data. The fact that this report came out the same day as HSB 138 brings some very serious questions to mind, as does the governor’s introduction of HSB 174, a bill which would have also abolished licensure, the day after HSB 138 was killed.
This is not how an honest government functions.
The ombudsman’s report says, “A government agency that purports to exist for the benefit of the public but refuses to explain its work invites deep suspicion and distrust. Such is the case with Iowa’s licensing boards, which have displayed an obvious preference for secrecy over transparency.” This is said in a report that investigates five of 36 boards, does not identify which boards were studied, and makes a broad generalization about all Iowa Board functioning based on this secret, limited sample.
The report also does not make a specific recommendation, stating: “We are not making a specific legislative recommendation at this time, as we recognize there may be valid policy arguments for and against opening licensing board records.” To be clear, this report did not recommend abolishing any of the boards.
Removing licensure for therapists would affect both public safety, and Iowan’s ability to access this care using their insurance. This determination on the governor’s part does not appear to be in the best interest of most Iowans.
Ian Kerns, North Liberty, and Jillian Polaski, Coralville, are licensed marriage and family therapists.