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Reynolds pitches wide-ranging health care bill
Focuses on rural health care and supports for new parents
DES MOINES — Gov. Kim Reynolds has proposed a sprawling bill dedicated to health care that includes a focus on strengthening rural health care and providing care to expecting and new parents.
Among the nearly dozen divisions of the proposed House Study Bill 91 are provisions creating an OB-GYN fellowship program, allowing pharmacists to dispense birth control without a prescription, putting funding toward rural health care systems and apprenticeships and giving paid parental leave to state employees.
Reynolds, a Republican, announced the contours of the plan in her Jan. 10 Condition of the State address, saying it would bolster Iowa’s health care system.
“To support our families, we need a strong health care system in every part of the state,” Reynolds said in her speech. “While our health care system is in the top 10 nationally, we still face challenges, especially in rural Iowa.”
Republican House Speaker Pat Grassley of New Hartford said House Republicans have interest in providing maternal care and other aspects of the bill, but he hasn’t determined the party’s support on every provision in the proposal.
“There is some interest to make sure we provide support when it comes to maternal health and other things,” Grassley told reporters Thursday. “I have not had the time to sit down and meet with my members.”
Democrats, too, said late last week they had not had time to look over the specifics of Reynolds’ bill.
“If there’s a health care bill that’s going through the Legislature, it’s important that everyone knows that Democrats had absolutely nothing to do with writing it or any part of the process,” said House Minority Leader Jennifer Konfrst of Windsor Heights. “And so we don’t know what’s in the bill because we weren’t asked to participate. I imagine there are some things in that bill we would do differently, so we’re going to pay close attention to that.”
Primary care OB fellowship
The bill would create a fellowship program for family medicine obstetricians to work for a year at a teaching hospital and then work at least five years in a rural or underserved area of the state.
The state would pay the fellows’ salaries, and the bill calls for funding four fellowships in the first year.
“There’s a real shortage of OB-GYNs in rural Iowa, you can definitely see that,” said Dane Schumann, a lobbyist for the American College of Obstetricians and Gynecologists, which is registered in support of the bill. “This is one good step towards helping reverse that trend and providing more care to more Iowans in areas that don’t have it.”
The lack of OB-GYNs means that rural Iowans have to travel sometimes up to hundreds of miles to get prenatal care, Schumann said. With a five-year requirement that doctors remain in the state, Schumann said the hope is that fellows will settle in the state.
“If a physician decides to set down roots in a rural area and start to practice for a beginning period of time in their career, then they will start to practice there longer … and they develop a bond and a relationship with the people out there that they’re providing care for,” he said.
The bill would expand Reynolds’ “more options for maternal support” program passed last year to include initiatives that support men involved in a pregnancy.
Referred to as the MOMS program, it provides funding and resources designed to encourage childbirth and discourage abortion. The funding provided by the law Republicans passed last year goes to facilities that promote “healthy pregnancies and childbirth instead of abortion.”
These facilities have been criticized by abortion rights advocates as misleading and not fully licensed medical facilities. According to the American College of Obstetrics and Gynecologists, they often “use false and misleading information, emotional manipulation, and delays to divert pregnant people from accessing comprehensive and timely care.”
Reynolds has asked the state Supreme Court to reinstate a 2018 law that would have banned abortion when cardiac activity is detected in a fetus, usually around the sixth week of pregnancy.
Democrats opposed the MOMS bill last year, in part because the money went to crisis pregnancy centers.
This year’s bill would bump up funding for the MOMS program to $2 million.
Adding fatherhood initiatives to the program, the state Health and Human Services Department would provide grants that help fathers find employment, manage child support, transition after incarceration and enhance parenting skills.
“Studies show that without a father present, a child is more likely to have behavioral issues, live in poverty, and die in infancy,” Reynolds said during her speech. “With him, those indicators and others are reversed. Mothers are more likely to receive prenatal care, have a healthy birth and experience less stress as a parent.”
One program that could receive state funding under the change is the YMCA of Greater Des Moines’ fatherhood program. The program helps absent fathers reconnect with their children and become a healthy presence in their lives, YMCA of Greater Des Moines Chief Executive Officer Leisha DeSmet said in a statement.
“We know that when fathers play an active role in their children’s lives, everyone benefits — family economics improve, kids do better in school, mothers feel supported, and fathers are motivated to be positive role models for their children,” she said.
Prescription-free birth control
Reynolds is taking another swing at a proposal she introduced in 2019: allowing pharmacists to dispense birth control without a prescription. The provision would allow Iowans over 18 to skip a doctor visit to be given birth control pills, vaginal rings or contraceptive patches.
Pharmacists would administer a screening to a patient who requests birth control, and patients would need to follow up with a physician within 27 months of being provided the birth control method.
The bill passed the Senate in 2019 but did not advance. Grassley said he didn’t know if the proposal would have support of House Republicans this year.
“In the past we’ve had mixed reviews within the caucus, but with that many new members, we really have not had that conversation to be able to gauge what the entire opinion would be from all the members,” he said.
Senate President Amy Sinclair, a Republican from Allerton, said on “Iowa Press” on Iowa PBS that she’s supportive of the idea.
“It has been a priority of some of my colleagues in the Senate and I think it will continue to be,” she said. “It's all part of that overarching view of women's health care that we've really been trying to focus on.”
Rural emergency hospitals, medical malpractice
Reynolds’ bill also includes two provisions already making their way through the Legislature under separate bills: creating a license system for rural emergency hospitals and capping non-economic damages from medical malpractice lawsuits at $1 million.
Grassley said the House is likely to continue moving those provisions under separate bills and choose which provisions from Reynolds’ bill they want to move forward.
Reynolds made capping non-economic damages a priority at the beginning of the session as well. She said during her Condition of the State address that high lawsuit verdicts are driving medical school graduates away from Iowa.
Opponents argue the proposal puts an arbitrary limit on legal awards when someone suffers long-term disabilities or quality-of-life damage from a medical procedure.
“In cases where things go catastrophically wrong, there has to be the ability of a jury of our peers to determine what the appropriate consequences of that decision are,” Iowa Senate Democratic leader Zach Wahls of Coralville said Thursday.
Other initiatives included in Reynolds’ bill are:
- Providing paid parental leave for state employees
- Requiring review and approval for group accident or health insurance policies
- $1 million in grants for regional health centers
- Providing subsidies for adoption expenses
- Lowering property taxes for commercial child care centers
- Providing flexibility for foster care students who receive an All Iowa Opportunity scholarship.