Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.

Paragraph: A University of Iowa study shows the state’s contribution to the Gulf dead zone spiked 47 percent to 618 million pounds in 2016, based on five-year running annual averages. “Just based on water quality data, I think we can say we’ve not made much progress over the past 20 years in terms of nitrogen,” said Chris Jones, a research engineer at the UI’s IIHR-Hydroscience & Engineering. Environmentalists say the study raises new questions about the effectiveness of Iowa’s approach to improving water quality and its reliance on voluntary ag compliance. “We’ve been pouring state and federal money into cutting nutrient pollution for decades, and this highlights the fact that the voluntary approach is not working,” said Jennifer Terry, executive director of the Iowa Environmental Council. “We’re not headed in the right direction. ... We need to follow the lead of other states and pass some environmental laws that will actually reduce loads and result in cleaner water,” Terry said. The Des Moines Register reports that the news comes as Iowa marks the five-year anniversary of the Iowa Nutrient Reduction Strategy, a plan designed to cut by 45 percent the nitrogen and phosphorus levels that leave Iowa and feed Gulf hypoxia — or the dead zone. Oxygen levels within the zone are so low that marine life can no longer survive, threatening the Gulf’s seafood industry. Most of the nutrient losses come from farming, although the strategy also targets losses from urban wastewater and industrial operations. Last year, Iowa invested $420 million in those water quality improvements, including helping farmers plant cover crops, build terraces and tackle other conservation practices that hold nutrients in place. But farmers expanding their drainage tile systems — along with increasing hog, cattle and chicken feeding operations, which provide manure to fertilize crops — likely outweigh those conservation efforts, UI scientists say. The nutrient reduction practices “being implemented are a tiny, tiny portion of what needs to be done, and it’s occurring in a system that’s changing,” Jones said. “We appreciate all that is being done with nutrient management and conservation farming. Unfortunately, we’re just impacting too few acres with too few practices,” added Larry Weber, executive associate dean for UI’s College of Engineering. Jones wrote the study with Weber and Keith Schilling, another UI research engineer. Increased nutrient pollution in water creates problems for people and animals beyond the dead zone. High phosphorus levels can lead to toxic algae blooms that can befoul lakes, rivers and streams, potentially killing pets and making people ill. And the federal government limits the amount of nitrates in drinking water to 10 milligrams per liter. Higher levels can be fatal to babies under 6 months old. Increased levels translate to higher costs for utilities for nitrate removal. “We need a dramatic increase, a rapidly-scaled up increase in conservation practices and more funding,” said Cindy Lane, the Iowa Environmental Council’s water program director. Schilling said the study shows that targeting nutrient reduction investment in Iowa can have a significant impact downstream. “Iowa has a dominant role in this Gulf hypoxia issue,” Schilling said. “Let’s invest the resources here, where we really need it. “If we solve Iowa, we solve the Gulf,” he said. The UI study gives Iowans new information in the fight to reduce the nitrogen levels that flow from the state into the Mississippi and Missouri rivers, which make their way to the Gulf of Mexico. Looking at Iowa Department of Natural Resources data from 23 monitoring stations, the study shows Iowa on average over the past 18 years contributed 29 percent of the total nitrogen headed to the Gulf from the Mississippi-Atchafalaya river basin. The river basin is a massive watershed that includes all or part of 31 states. Iowa’s nitrogen impact was even greater in other watersheds. The state averaged 45 percent of the nitrogen levels going into the Upper Mississippi River basin, and 55 percent of the nitrogen going into to the Missouri River basin. “When you look at the entire Missouri (River) watershed, our land comprises 3.3 percent of the total area ... and Iowa contributes nearly 12 percent of the water,” Jones said. But “we contribute 55 percent of the nitrate,” he said. “The way that pencils out is that the amount of water coming from Iowa has seven times more nitrates than the rest of the Missouri River watershed,” Jones said. If Iowa’s contributions were removed, the Missouri River would have little nitrogen contributions in some years. “We really need to take seriously the Missouri River’s contribution as a driver for Gulf hypoxia,” Jones said. The growing concentration of livestock feeding operations in western Iowa might account for Iowa’s large contribution to the Missouri River nitrate levels, the scientists said. “People tend to dismiss livestock influences, but maybe there’s more to it than people give credit it for,” Schilling said, adding that it would require more study to determine the impact. Iowa’s nitrogen levels, based on running five-year annual averages, have been above the 2003 value for 10 consecutive years, the study says. The scientists say 2003 was the first year the five-year rolling average could be calculated, with data that starts in 1999. The goal of the Gulf Hypoxia Task Force, made up of federal, state and tribal leaders, “will be very difficult to achieve if nitrate retention cannot be improved in Iowa,” the report said. The task force, with Iowa Agriculture Secretary Mike Naig as chairman, seeks to reduce the dead zone to 1,900 square miles by 2035. The deadline was extended from 2015. Last year, the dead zone set a record, which, at 8,776 square miles, was more than four times the goal size. The report says about 90 percent of Iowa’s nitrogen levels “can be sourced to the 72 percent of the state’s land area that is in crop cultivation.” Iowa, an agriculture powerhouse, is a national leader in corn, soybean, pork, egg and beef production. “This intense production of carbohydrates and protein has resulted in the state being a leading contributor” to the nitrogen loads and Gulf hypoxia, the report said. Naig said farmers understand the important role they play in improving water quality and are scaling up efforts across the state “as we move from demonstration projects to larger, watershed-scale implementation projects. “We recognize that there is still a lot of work to be done, but we are on the right path,” said Naig, who adds farmers are working with more than 250 partners in 65 rural and urban demonstration projects. The UI scientists doubt that increased cropping is the reason for the increased nitrogen impact. Iowa’s cropped area has increased only 4 percent over the past 18 years, while other states’ farmed land has climbed 21 percent, particularly in Minnesota, North and South Dakota and Kansas. About 85 percent of Iowa’s acres are farmed, making it the fifth-highest in the nation, based on the 2012 U.S. Agriculture Census, so there are few acres left that can be brought into production compared with other states. “Iowa’s decline in the share of the region’s soybean area was especially pronounced, dropping from 18.6 percent in 1999 to 14.5 percent in 2016,” the report said. “One would expect our (nitrogen) contributions relative to the other areas would be diminished,” Jones said. “But the opposite has occurred.” Jones said it’s led the scientists to consider other factors. The scientists doubt that Iowa farmers are using significantly more fertilizer. “When we look at nitrogen sales data, it might change a little year over year. But on a per acre basis, that hasn’t changed a lot since 1990,” he said. And with little increase in corn and soybean acres, the scientists speculate that Iowa’s increased nitrogen levels could be coming from more drainage tiles. Or farmers could be using more manure as fertilizer from animal feeding operations. Without Iowa, the Gulf’s overall nitrate loads would have declined 43,400 tons over 18 years, based on five-year running annual averages, the scientists’ data show. Instead nitrate loads grew by 52,000 tons. “It’s pretty clear these loads from the Ohio basin have to be declining,” Jones said. “A lot that is coming from Indiana.” That state’s high level of cover crop adoption by farmers could be the reason, he said, and should be studied. Cover crops such as cereal rye slow the rate of water runoff, reduce erosion and improve soil fertility. Iowa also needs to honestly discuss the impact that drainage tiling has on nitrogen losses, Jones said. Iowa doesn’t collect data on how much underground drainage runs through the state, although officials estimate about 9 million acres are drained through tile. Environmentalists believe the number is much higher. Underground drainage tile helps improve yields by quickly removing excess water from fields. Iowa’s tiling system consists of a network of drainage lines that feed into large pipes. The massive network, first constructed in the 1920s, ’30s and ’40s, turned once swampy lands into some of the nation’s most productive farmland. But water quickly carried away by the tiling system misses cleansing that would naturally occur by filtering through soil or the roots of trees, shrubs and grasses in riparian buffers along streams. Des Moines Water Works unsuccessfully sued drainage districts in three north Iowa counties in 2015, claiming underground tiles funneled high levels of nitrates into the Raccoon River, a source of drinking water for 500,000 central Iowa residents. “We acknowledge that it’s important to track implemented conservation, and we encourage that,” Jones said. “But we also need to have the courage to talk about these things that drive the system in the other direction.” Terry said Iowa is “one of the most heavily tiled states in the nation,” and its 110-year-old law regulating the practice does little to protect water quality. ___ Information from: The Des Moines Register, http://www.desmoinesregister.com Claim: Study: Iowa nitrogen pollution in the water is getting worse.
Nitrogen pollution flowing out of Iowa to the Gulf of Mexico has grown by close to 50 percent over nearly two decades, a new report shows, despite hundreds of millions of dollars spent to stem nutrients entering the state’s waterways.

Paragraph: Republican Gov. Charlie Baker administered oaths to the 40-member Senate and 160-member House in ceremonies signaling the start of the 191st term for one of America’s oldest legislative bodies. Formally known as the General Court, the Legislature traces its roots to the Colonial era. The first order of business in each chamber — both firmly controlled by Democrats — was the re-election of presiding officers. Rep. Robert DeLeo, of Winthrop, already the longest-serving House speaker in the state’s history having first taken the gavel in 2009, returned for another two-year term. Ashland Democrat Karen Spilka will serve her first full term as Senate president after first assuming the post in July. Speaking in the ornate Senate chamber, which reopened Wednesday for the first time in more than 18 months following a $20 million renovation, Spilka called for several “bold” initiatives in response to what she said were demands from Massachusetts residents to move beyond “small ideas and incremental change.” Spilka said her priorities would include legislation to better control health care spending by reining in the high cost of prescription drugs and redistribute state education funding to better serve children who live in poorer school districts. Recalling the untreated psychological trauma her father suffered as a result of his military service, the Senate leader also appealed for a broad expansion of mental health services throughout the state. “We simply cannot end the epidemic of addiction or solve the problems of chronic homelessness and unemployment, child abuse and neglect, veteran and first responder PTSD, childhood bullying, or repeated incarceration, without first addressing the underlying issue of mental health,” said Spilka. While not specifically calling for tax increases, Spilka said the state would need to “capture new revenues” to support new and existing programs. Spilka, a liberal Democrat, was widely expected to stake out a progressive agenda that could meet resistance in the House, which is also controlled by Democrats but is seen as more conservative than the Senate. Baker, a moderate Republican who remains opposed to any broad-based tax hikes, could also prove a stumbling block. In brief comments following his re-election on Wednesday, DeLeo declared that “no one’s rights will be infringed upon in Massachusetts,” an apparent swipe at the policies of President Donald Trump and other Republicans in Washington. DeLeo generally waits until a few weeks into a new session before outlining his legislative priorities. Sen. Bruce Tarr, of Gloucester, and Rep. Brad Jones, of North Reading, will again serve as the minority leaders in their respective chambers. There are 32 Republicans in the House and only six in the Senate, with the GOP having lost a handful of legislative seats in the November election. Claim: State Senate leader outlines agenda as lawmakers sworn in.
The Democratic leader of the Massachusetts Senate promised Wednesday to work for lower prescription drug costs, expanded mental health services and a reform to the state’s education funding formula as she laid out an ambitious agenda at the start of the Legislature’s new two-year session.

Paragraph: "Doctors’ offices, already burdened by federal billing bureaucracy, will soon find themselves pecked to death by new rules, Texas congressman Ted Poe says. New diagnosis codes required for reimbursement are so specific, he told Fox Business Network host John Stossel, there are a set of them just for injuries caused by turkeys. ""Whether you run into a turkey or the turkey runs into you, you're pecked by a turkey or you're bitten by a turkey, there's a difference between being pecked and being bitten,"" he said in an interview April 25, 2013. ""So they have nine codes for turkeys."" Poe, a fifth-term Republican who’s a member of the Tea Party Caucus, argues doctors shouldn’t have to face the expense of complying with new rules or penalties for screwing up. ""Do they need to go through this much detail to get information to the federal government? I don’t think they do,"" he said. We had to know: Do new Medicare billing guidelines include ""nine codes for turkeys""? Outdated codes First, a little background about this code thing. It’s not just a U.S. system — it’s international. (And in case you were wondering, it has nothing to do with Obamacare.) The ""new"" set of diagnosis codes that Poe talked about is known as ICD-10. ""ICD"" stands for ""International Classification of Diseases."" It’s published by the World Health Organization, then adapted for use in the United States. The United States now uses ICD-9, which is more than three decades old. Doctors’ offices use the codes to fill out Medicare and Medicaid claims, among other things. Their billing and practice management software is based on them. Their employees are trained to use them. The American Medical Association says that depending on the size of the medical practice, it’ll cost $83,290 to more than $2.7 million to switch. Doctors are dealing with so many other expensive regulatory changes, the association has begged since 2011 to delay or give up on the switch altogether. Other countries have charged ahead. They started to adopt the ""new"" set of codes nearly 20 years ago, and most developed countries now use it, according to the Centers for Medicare and Medicaid Services. CMS will require American doctors, indeed, any organization covered by the 1996 health care law known as HIPAA, to switch by Oct. 1, 2014. The federal government says the United States needs to upgrade partly because ICD-9 has outdated medical terms and not enough detail for accurate claims processing. Claims for two different injuries might seem like duplicate filings if you couldn’t specify right vs. left hand, for example. As Poe suggested, the new system does have far more diagnosis codes than the version developed in the 1970s — 68,000 instead of 13,000. (Poe, in his Stossel interview, said the new system has 140,000 codes, but that’s only if you group both diagnosis and procedure codes — not a direct comparison with 13,000.) How much detail are we talking? The codes allow doctors to specify not just injuries from turkeys, but from parrots, macaws, ducks and geese. There’s a different code for being ""struck"" vs. ""pecked"" or suffering from ""other contact""— with specification for the first time, an unlucky repeat or even worse, ""sequela."" (That would be some ""negative afteraffect"" resulting from your turkey encounter. Headaches! Panic attacks!) Poe’s office pointed us to this: W61.4 Contact with turkey W61.42 Struck by turkey W61.42XA initial encounter W61.42XD subsequent encounter W61.42XS sequela W61.43 Pecked by turkey W61.43XA initial encounter W61.43XD subsequent encounter W61.43XS sequela W61.49 Other contact with turkey W61.49XA initial encounter W61.49XD subsequent encounter W61.49XS sequela If you’ve seen TV ads about the need to prepare for a bright new career in medical billing and coding — this is part of the reason why. Our ruling Poe said doctors face a new regulatory burden, requiring them to use a system that includes nine different codes for turkey injuries. His office pointed us to the new codes, which will be required for Medicare claims by October 2014. Indeed, if your Thanksgiving tradition takes a tragic turn that year, your doctor will be able to describe it in seven-digit detail. (We hope it’s just W61.42XA and not W61.43XS.)" Claim: "Ted Poe Says new Medicare billing guidelines ""have nine codes for (injuries by) turkeys."

Poe said doctors face a new regulatory burden, requiring them to use a system that includes nine different codes for turkey injuries. His office pointed us to the new codes, which will be required for Medicare claims by October 2014. Indeed, if your Thanksgiving tradition takes a tragic turn that year, your doctor will be able to describe it in seven-digit detail. (We hope it’s just W61.42XA and not W61.43XS.)