Health care is on the minds of Iowans; polls have shown it is the number-one domestic issue in both the state and the nation.  Health care is also on the minds of Iowa legislators and the governor, and the atmosphere at the Statehouse is charged with talk of statewide reforms.

For all of Iowa’s hospitals, including RHSHC, this is an exciting time that presents real opportunity for the state to reaffirm itself as a health care leader.

Iowa’s health care system is already one of the best in the United States. With a focus on primary care and ensuring all Iowans have a “medical home” from which their care can be coordinated, Iowa’s hospitals and physicians provide real value – that is, high-quality care at a fair price.

Others have recognized this. In a recent study, the Commonwealth Fund ranked Iowa’s health care system second in the nation, primarily because of the value Iowa hospitals and physicians offer. The study found that if the rest of the nation adopted Iowa’s sensible, value-laden approach to providing health care, the U.S. would save billions of dollars each year.

Iowa is also a well-insured state.  People with insurance receive care more regularly then those who are uninsured, helping them establish and strengthen their “medical home.”

These two facts – a high-quality health care system and a well-insured population – put Iowa in a position of strength as it examines possible changes in health care.  Many other states, struggling with massive numbers of uninsured and poorly functioning health care systems, are not as fortunate.

With that in mind, the Iowa Hospital Association and RHSHC have put forth the following recommendations aimed at reforming and strengthening health care in Iowa:

Invest directly in Medicaid:  This includes maximizing beneficiary eligibility and provider payments.  A fully funded Medicaid program must address the massive losses – more than $147 million each year – that Iowa’s hospitals are forced to absorb.  While this is not an inexpensive proposition, Medicaid investments are matched nearly 2-to-1 by the federal government, making this a more cost-effective strategy than creating new programs financed solely by state dollars.

Enroll all eligible children in HAWK-I and Medicaid. Additional outreach efforts for these programs could raise the number of insured children in Iowa to virtually 100 percent.

Expand family insurance coverage to include young adults to age 25.  This not only affects young adults who have insurance options but who choose not to accept coverage, but positively impacts Iowa’s Medicaid program as well. Approximately 40 percent of all Iowa births are now Medicaid-eligible.  Expanding family coverage would keep many of those mothers off the state’s Medicaid rolls.

Apply mandates for insurance coverage only toward those who have the means to pay. Instead of a costly and administratively burdensome new system trying to achieve universal coverage, any individual mandates to buy health insurance should be directed only toward those Iowans with sufficient incomes to pay. Building upon Medicaid, expanding family insurance coverage, and aiming any insurance mandates only upon those who can afford it would address Iowa’s uninsured population from three meaningful angles, while allowing the state to better manage its budget.

Develop a Medicaid payment system that rewards value. The experience of other states demonstrates that a punitive pay-for-performance system does not work, especially in a state like Iowa where most providers are already at the high end of quality rankings.  But recognizing value through payment incentives can a have system-wide impact on a collaborative health care system such as the one we enjoy in our state.

Support provider-led pilot projects that demonstrate savings.  Providers already are developing chronic disease management programs and other cost-saving initiatives.  However, most insurers, including Medicaid, do not reimburse for such services.  The state should create financial incentives for providers who demonstrate health care savings to recoup a portion of those savings.

Support a statewide emergency mental health treatment alternative.  Development of a system that can help divert acute mental health patients from the hospital emergency room is critical for Iowa, where a shortage of psychiatrists is hampering the ability to provide hospital inpatient behavioral health services. 

Create a more standardized county mental health service delivery system.  Iowa’s behavioral health care providers currently have to contend with 99 different sets of benefits and payment structures from 99 different counties. Iowa should establish a core set of behavioral health services that all counties must adhere to in order to provide equity across the state.

IHA has shared these recommendations with Iowa legislators.  Working with their community hospitals, our leaders at the Capitol now have the opportunity to make high-quality health care accessible to even more Iowans. Health care in Iowa is already among the best. Together, we can do even better.