Access to quality health care in Iowa is critical

I’ve been practicing medicine for 25 years. In my time as a physician, I’ve administered care in the rural farmlands of Iowa as well as the bustling neighborhoods of urban America. The landscapes may differ, but the fear in a patient’s eyes when they can’t afford needed care is always the same.

For 30 years, the 340B Program has been a quiet force for good in places like these. It has kept clinics open, medications affordable, and hope alive.

If we let this program erode, the consequences will be measured in lives, not just dollars.

Health care deserts and medication rationing

In small towns, patients may delay cancer screenings because the nearest specialist is two hours away. When rural hospitals close (and over 140 have in the past decade), 340B is often the only thing keeping others afloat. These facilities don’t just provide care, they’re the heart of their communities. Lose them, and people will drive past shuttered clinics on their way to distant emergency rooms, praying they make it in time.

But cities aren’t immune to health disparity issues. In urban clinics, physicians treat working parents who are rationing doses of insulin to pay rent. One in four Americans now skips prescriptions due to cost. If 340B discounts disappear, so does a clinic’s ability to offer sliding-scale care — turning manageable conditions into crises.

Prevention isn’t enough

I teach my patients how to eat well and stay active. And although some are able to manage their cholesterol and blood sugar without medications, many people need prescriptions for optimal control. Regular medical care isn’t optional! It allows people to live long enough to enjoy those healthy choices.

340B means:

● A farmer gets his blood pressure meds before a stroke hits.

● A single mom picks up free prenatal vitamins at her community health center.

● A grandmother doesn’t have to ration her insulin due to her fixed income.

These aren’t handouts. They’re the foundation of thriving communities.

Pills vs groceries?

The reality for many is a choice between a prescription and groceries. Your child’s teacher is splitting arthritis pills to stretch them for an extra month. Your neighbor is choosing between refilling their glaucoma drops or eating dinner this week. And as drug prices continue to soar, it will become life for more and more Americans.

340B clinics mean:

● A $400 inhaler can be purchased at $40.

● A lifesaving HIV regimen costs nothing for a person experiencing homelessness.

● A child gets antibiotics before an ear infection becomes an ER visit.

Without these discounts, medical debt — already the leading cause of bankruptcy — will swallow more families whole.

What we stand to lose

The 340B program isn’t politics. It’s the diabetic teenager in Des Moines, the abuelita with high blood pressure in Los Angeles, and the veteran being treated for PTSD in rural Kansas who all share the same right: to see a doctor without going broke.

I’ve witnessed what happens when health care stays within reach. Patients live. Families stay intact. Communities grow stronger. That’s not just policy — it’s the oath I took as a physician.

To anyone who thinks 340B isn’t necessary, I urge you to sit in my exam room. Hear the stories, and then tell me who should lose their care so drug companies can add another zero to their profits.

Because in Iowa, health care shouldn’t be a privilege.

Suzanne Bartlett Hackenmiller is an OB-GYN, integrative medicine, and lifestyle medicine physician, author, wife, and mother.