Our View - Plug up holes in Iowa's, nation's health care

Printed in the Iowa City Press-Citizen, Sept. 17, 2009

Our View - Plug up holes in Iowa's, nation's health care

"Why did the IowaCare system have to be set up so it advantages those who live closer to Iowa City? When people in the more remote parts of the state are forced to get health care through IowaCare at the Iowa City hospital, they are going to get a lower quality of care, overall, because of being so far from the hospital. People so far removed from Iowa City also will take greater risks when health care emergencies arise." -- Loren Gaylord Flaugh, Primghar (Feb. 16).

Loren Gaylord Flaugh of Primghar knows firsthand the limitations of the IowaCare program, a state program that offers health care to low-income adults without children.

Back in January, Flaugh had to take his wife Sally to the local hospital in Primghar after she was experiencing some severe flu-like symptoms -- she later discovered she had salmonella poisoning. Unfortunately, because Sally Flaugh receives all her medical care through IowaCare. all of her medical records were in Iowa City -- more than 300 miles away. The local hospital had nothing to compare her current readings with.

The state set up IowaCare in 2005 as a stop gap measure to help catch people like the Flaugh's who are falling through the cracks of the health care system -- as well as to recoup some federal Medicaid dollars Iowa as loosing. It's how the state, with federal approval, offers limited coverage to low-income adults ages 19 through 64, including the previously uninsured and those using the former "state papers" charity program.

The catch is that the program covers treatment only at the University of Iowa Hospitals and Clinics in Iowa City; Broadlawns Medical Center, in Des Moines (for Polk County residents); and the four state mental institutions. It's not surprising, then, that 40 percent of IowaCare patients come from six counties near to UIHC. The hospital has a fleet of 10 vans that picked up 5,480 patients statewide between July 2008 and January 2009.

When the local physician assistant in Primghar strongly advised the Flaughs go to a larger hospital as soon as possible, they knew they could only have their medical expenses covered if they drove across state to the emergency room in Iowa City. Flaugh said that's a six-hour drive when the weather is good, and that January night there was a blizzard.

The couple made it through the wind and snow as far as Webster City until Sally Flaugh's condition deteriorated to the point they pulled into the Hamilton County Hospital. She had to be taken by ambulance the rest of the 175 miles to Iowa City.

Soon after an ordeal in which Sally Flaugh's kidneys almost failed and had to spend days in Iowa City, the Flaughs learned that Iowa Care likely will not pay any of the costs for the ambulance ride from Webster City to Iowa.

Jennifer Vermeer, director of Iowa's Medicaid program, recently told the Associated Press that she knows the current system isn't ideal, but she said that if the state opened up the Iowa Care program to hospitals across Iowa, it would have to cap enrollment and refuse service to eligible people.

"Yes, we would like the program to have better local access," Vermeer said. "When you think of how many people are out there who could enroll if the program was more appealing, suddenly you start to see having waiting lists that are multiple years long is a different kind of problem."

In the short term and at the very least, we hope the university can help people like the Flaughs by setting up an IowaCare clinic on the western side of the state to improve access -- but even that's a very expensive proposition. In the long term, of course, the cracks through which the Flaughs fell can only be fixed by passing national comprehensive health care reform.