Capitol Notebook: Bill aimed at helping rural health care headed to Iowa Gov. Reynolds’ desk

DES MOINES — A proposal designed to address physician shortages in Iowa — particularly in rural areas — that was proposed by Gov. Kim Reynolds is on its way to her desk for her signature.

Lawmakers in the Iowa Senate approved her proposal Tuesday to increase funding and consolidate state programs designed to entice physicians to practice in Iowa. The bill previously passed the House, so now it goes to Reynolds to become law.

The bill, House File 972, passed the Senate by a 41-4 vote. It moved through the House on a 95-1 vote in March.

Reynolds’ proposed legislation would consolidate state loan repayment programs and more than double the investment to $10 million, and direct the Iowa Department of Health and Human Services to partner with University of Iowa Health Care and Broadlawns Medical Center in Des Moines to secure $150 million in federal money to train a projected 115 new medical residents at 14 hospitals across the state.

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.

Iowa ranks 44th in the nation for patient-to-physician ratio per 100,000 population. The nation also is experiencing a significant physician shortage estimated at 64,000 doctors.

Iowa has the fewest OB/GYNs per capita of any state, according to the American College of Obstetricians and Gynecologists, and is one of five states with the highest losses of access to obstetric care over the past 13 years.

“What we’re looking at here is a transition from our traditional, siloed programs” to more of a “flexible program that’s going to allow both (Iowa) HHS and DOE (Department of Education) to adjust in real time to the needs that are presented to us,” Sen. Mike Klimesh, R-Spillville, said during debate, “to fulfill those positions in rural Iowa, to ensure that we are getting doctors, nurses, potentially physical therapists — anybody else that we see a need for in those areas, and be flexible enough in this approach to ensure we’re able to fill that.”

Senate Republicans OK Medicaid work requirements

Republican lawmakers continue to advance legislation that would require able-bodied Iowans aged 19-64 enrolled in Iowa's Medicaid expansion program for low-income adults to work at least 80 hours a month to maintain coverage.

The bill includes exceptions for certain groups, including those determined disabled by the Social Security Administration, the caregiver of a dependent child under 6, those undergoing a high-risk pregnancy or in treatment for a substance abuse disorder, and those deemed medically frail or medically exempt under the Medicaid program.

It also contains a provision that would end the Iowa Health and Wellness Plan — the state's Medicaid expansion program — entirely if work requirements are ever approved by the federal government and later revoked. Iowa Health and Human Services would be directed to discontinue the expanded Medicaid program if federal law or regulations are changed to exclude work requirements — contingent on the federal government having previously approved Iowa’s implementation of the eligibility restrictions.

Senate Republicans passed Senate File 615 Tuesday on a party-line, 33-13 vote with Democrats opposed, after amending the bill to strike a provision inserted by House lawmakers that recommends studying a program for disabled workers.

“There will be ongoing conversations along those lines this summer, voluntary basis,” said Sen. Mike Klimesh, R-Spillville, the bill’s floor manager.

The bill now heads back to the House for approval there before going to Gov. Kim Reynolds.

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Reynolds already has directed the Iowa Department of Health and Humans Services to request a waiver from the federal government to implement similar requirements. The department recently has held public hearings on the proposal.

The waiver request sets a higher work requirement. It would require Iowans enrolled in the Iowa Health and Wellness Plan to work at least 100 hours per month or to be enrolled in an educational or job skills program to qualify for health care.

Democrats criticized the measure, saying past evidence in other states shows work requirements impose administrative barriers and red tape that lead to coverage losses among both people who are working as well as people who have caretaking responsibilities, disabilities or illnesses that keep them from working.

Moreover, research shows that work requirements do not increase employment, they argue.

While supporters have said work requirements will help reduce the costs of Medicaid, Sen. Sarah Trone Garriott, a Democrat from West Des Moines, said other states that have implemented similar work requirements have not seen significant savings.

Senate Democratic leader Janice Weiner, of Iowa City, also said the Legislature is moving forward “without having any firm idea what the fiscal impact will be.” The nonpartisan Legislative Services Agency’s analysis of the bill’s potential financial impact on the state is incomplete because, the state agency said, Iowa Health and Human Services has not responded to its multiple requests for information.

Klimesh said the department has estimated its waiver request would generate a cumulative savings of $50 million for the state over a five-year period.

Klimesh also pointed to movement by the U.S. Congressional Committee on Energy and Commerce to make federal changes to Medicaid that includes requirements for able-bodied people between ages 19 to 65 to work, attend educational programs or participate in community service for at least 80 hours a month to stay eligible for coverage.

“Essentially, if you look at the blueprints the federal government is utilizing, it almost lines up specifically with what the state’s requirements are,” Klimesh said.

Senate confirms Byrnes to utilities commission

Former state Rep. Josh Byrnes was confirmed to a new term on the Iowa Utilities Commission on a 45-1 vote Tuesday in the Iowa Senate.

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The three-member commission, whose members are appointed by the governor, has been criticized by state lawmakers upset that the state regulators granted a permit to Summit Carbon Solutions for a carbon dioxide capture pipeline in Iowa.

The lone vote against Byrnes’ confirmation came from Sen. Doug Campbell, R-Mason City. Byrnes, a Republican, represented Worth, Mitchell and Howard counties and part of Winneshiek County in the Iowa House and was first appointed to the utilities panel in late 2020.

The Senate also voted to confirm Victoria Sharp to the Iowa Board of Medicine, 43-3; and David Weetman to the Iowa Board of Pharmacy, 46-0.

Gazette-Lee Des Moines Bureau