Iowa Gov. Reynolds’ bill to improve rural health care access, doctor shortage getting lawmakers’ blessing

DES MOINES — A proposal to address doctor shortages in rural pockets of the state, introduced by Gov. Kim Reynolds, was advanced by state lawmakers Tuesday.

Reynolds highlighted the issue during her annual Condition of the State address in January, and last week introduced legislation designed to ensure rural Iowans have access to doctors and health care.

State lawmakers in both chambers of the Iowa Legislature advanced Reynolds’ proposal Tuesday with bipartisan support.

Reynolds’ proposed legislation would:

Once the elements in the legislation would be fully implemented over four years, 460 new physicians would be trained in Iowa, the governor’s office projects.

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Companion bills — House Study Bill 191 and Senate Study Bill 1163 — were approved Tuesday by a three-member subcommittee in the Iowa Senate and by a unanimous vote of the House Health and Human Services Committee.

Reynolds highlighted the House committee’s unanimous approval of her bill Tuesday in a social media post and a statement.

“Access to quality health care is vital for Iowans in every corner of our state,” Reynolds said in the statement. “I want to thank legislators for recognizing the need to increase the number of medical providers that call rural Iowa home by expanding medical residencies for physicians and incentivizing health care providers to practice in Iowa.”

Iowa Rep. Beth Wessel-Kroeschell, a Democrat from Ames, had some questions about the bill but ultimately praised the proposal during Tuesday’s House HHS Committee meeting.

“I think the concept is really good,” Wessel-Kroeschell said. “We are excited about making programs more accessible to students or professionals coming here to the state to try and encourage them to stay in the state.”

During a Senate subcommittee hearing Tuesday, Iowa business, medical and hospital groups praised the proposal for increasing workforce and access to care in Iowa.

Seth Brown, a lobbyist representing the Iowa Medical Society, said the “comprehensive, meaningful set of recommendations” will “move the needle” and “make a meaningful dent” in the physician workforce crisis in state.

Joe Murphy, with the Iowa Business Council, said growing the number of primary care providers in the state “will be a positive force for population growth, economic development and economic expansion.”

Concerns, though, were raised about the potential exclusion of specific professions in the new loan repayment program and the need for transparency and public input in the determining which specialties get priority.

State education director McKenzie Snow said the Iowa Department of Education, in consultation with the Iowa Department of Health and Human Services and various medical associations across the state, would determine eligible health care professions to “ensure responsiveness and timelines to responding to (workforce) pipeline needs across professional endorsements and across regions or communities.”

Doctors will be needed to step into teaching roles

Questions also were raised about the feasibility of establishing 115 new residency slots in teaching hospitals.

Iowa HHS Director Kelly Garcia said the “rate-limiting factor” for new residencies is the availability of teaching doctors.

“And so we need docs to step into that teaching role. The additional payments are really there to support just that,” Gracia told lawmakers.

Once the legislation is approved and a plan submitted to CMS, she said HHS will work with the state’s teaching hospitals on an operational plan.

“We’ve already had significant dialogue with them over the summer into the fall and every moment during the session, and so we feel confident that that operational plan will be easy to put together,” Gracia said. “There will be work ahead … but we’re sitting in a good position to bring those teachers into place and feel confident that we have strong partners for the hospitals to do that work.”

Sen. Sarah Trone Garriott, D-West Des Moines, supported the bill, but highlighted the need for clear processes and public input in determining how and which health care professions are supported, in addition to pushing for higher Medicaid reimbursement rates.

“You can get those folks to do residency in our state, but we also want to ensure that they can get paid no matter where they're working in our state — and that those clinics and hospitals can keep their doors open and keep serving those communities,” Trone Garriott said.

Sen. Mike Klimesh, R-Spillville, who chaired the subcommittee, moved the bill forward with possible amendment.

“I support what we’re trying to do with the bill. … I just want to make sure that as we expand the loan repayment programs and residency spots we’re asking the right questions to ensure that the measure results in what we want to accomplish, which is doctors that want to live in rural Iowa,” Klimesh said. “… I want to make sure that we are filling those slots with folks that want to live in that lifestyle and we’re actually going to end up moving the needle” in closing providers gaps in rural Iowa.

The Senate bill is now eligible for consideration by the full Senate Health and Human Services Committee.

Comments: (515) 355-1300, erin.murphy@thegazette.com

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