Medicaid can help fix Iowa’s OB/GYN shortage

I’m an OB/GYN in Iowa, and I’m worried — not just for myself, but for the future of maternal care in this state.

Over the past decade, Iowa has quietly become one of the most difficult states in the country to practice obstetrics. Long hours, rising liability costs, and increasing restrictions on reproductive care have all played a role. But there’s one fixable problem that’s pushing OB/GYNs out faster than anything else: the Medicaid reimbursement rate for obstetric care.

Nearly half of all births in Iowa are covered by Medicaid. That means nearly half of Iowa’s pregnant women rely on a state payment system that pays OB/GYNs far less than what it actually costs to deliver safe, high-quality care. Iowa consistently ranks among the lowest in the country for Medicaid reimbursement for prenatal and delivery services. Currently Iowa Medicaid reimburses only $1,364.46 per delivery and the entire pregnancy. This lump sum is what an OB/GYN practice gets paid for all prenatal visits, taking care of the patient in labor, delivering the baby, all doctor visits while in the hospital after delivery, and 6 weeks of postpartum care. This fee has to cover office rent, office staff salaries and benefits, malpractice insurance, medical software licensing, and office supplies before the OB/GYN can pay his or herself.

This is not sustainable.

When OB/GYNs can’t afford to keep their practices open, they leave. We’re seeing it happen across Iowa, particularly in rural communities. And when an OB/GYN leaves, the consequences are immediate: longer travel times for pregnant patients, fewer appointments available, and more emergency deliveries without adequate prenatal care. These conditions put lives at risk.

Lawmakers talk a lot about wanting to support families, strengthen rural health systems, and keep young professionals in Iowa. If that’s true, here’s a concrete action they can take right now: increase Medicaid reimbursement for obstetric care. It's not a political statement. It's a common sense solution to help stabilize a workforce that is essential to the health and future of our state.

This isn’t about making OB/GYNs wealthy — it’s about keeping the lights on and the delivery rooms staffed. It’s about creating conditions where Iowa-trained doctors will choose to stay.

If we value Iowa families, we need to value the people who care for them.

Jennifer Schuchmann, MD, practices in Des Moines.