DES MOINES — Amid a national and statewide shortage of physicians, Iowa Gov. Kim Reynolds proposed rural and maternal healthcare expansions as top priorities for the 2025 legislative session. In her annual Condition of the State address Tuesday night, Reynolds announced partnerships with teaching hospitals to expand medical residencies and research.
Addressing a packed House chamber of Iowa’s politicians and constituents, Reynolds touted the Hawkeye state’s 2024 ranking as fourth in the nation for health care and first in the nation for health care cost by Becker’s Hospital Review. Despite these high rankings, Reynolds said the state still needs more medical professionals and a greater variety of specialists.
Iowa is among the worst states in the nation for physician-to-patient ratio, ranking 44th in the United States for physicians per capita, according to the Iowa Medical Society.
Nationally, a physician shortage is anticipated to grow exponentially. An analysis published by the Association of American Medical Colleges projected the United States will face a physician shortage of up to 86,000 physicians by 2036.
Attempting to obtain more nurses, certified nursing assistants, and licensed practical nurses, Reynolds announced $3 million in grants for employers to train and educate individuals in those areas.
Reynolds said the program will provide more flexibility for employers and help fill in-demand health careers.
To increase Iowa’s number of medical professionals, the governor is looking to a new generation of healthcare workers and making partnerships with the state’s hospitals. Reynolds proposed to consolidate and more than double funding for student loan repayment programs — a jump from $4.2 million to $10 million.
The program is open to anyone who commits to practicing in rural Iowa for five years, even if they have trained outside of the state.
Reynolds announced a plan in partnership with the University of Iowa and Broadlawns Medical Center to create a projected 115 new residency slots each year. Within the span of four years, this would generate 460 new physicians trained in Iowa.
“That is a game-changer for rural communities and our state,” Reynolds said as applause erupted among attendees.
Supported by $150 million in federal funds, the program would be spearheaded by the Iowa Department of Health and Human Services.
“We also know that doctors often decide to practice where they do their residency,” Reynolds said. “We know too that Iowa doesn’t have nearly enough residency slots, preventing many physicians from giving our state a chance.”
Senate Minority Leader Janice Weiner, D-Iowa City, said in a press conference after the address that the increase in medical residencies is one way forward and Senate Democrats would be happy to support expanding loan forgiveness, but there may be more to consider.
“Expanding the number of slots for residents is also going to require expanding, say, UIHC and other staff, I don’t know how you pair the two of those up, but anything that we can proactively do that will bring more medical professionals to this state is a good thing,” Weiner said.
Weiner added that Iowa’s near-total abortion ban deters medical professionals from coming to practice in the state, and emphasized Iowa’s poor ranking for OBGYNs per capita. The Hawkeye state has among the fewest number of OB-GYNs per capita in the nation.
House Minority Leader Rep. Jennifer Konfrst, D-Windsor Heights, said in a press conference after the address that the state’s abortion ban prevents OBGYN residents from learning the full scope of their practice and Reynolds’ proposal will not fix that issue.
“You can extend those loans, but can those professionals actually get the practice that they need in a state with an extreme abortion ban?” Konfrst asked. “That’s a real barrier that was not addressed at all.”
Addressing maternal healthcare deserts
Reynolds outlined a plan to boost support for Iowa’s dwindling maternal health care. A third of the state’s 99 counties are considered maternity care deserts, meaning they have no OB-GYNs or birthing facilities, according to a report from the non-profit March of Dimes.
Reynolds laid out a proposal to invest over $640,000 into unbundled Medicaid maternal rates.
“Today, Iowa reimburses hospitals and physicians at a single, bundled rate, regardless of a pregnancy’s risk level,” Reynolds said. “This rigid approach doesn’t make sense for mothers or doctors, so I’m proposing legislation that would unbundle the rates and increase reimbursement to OBGYNs and primary care physicians for complex cases.”
Reynolds also plans to increase rates for certified nurse midwives and add doula services as a covered Medicaid benefit.
“These professionals also have an important role in supporting our mothers and children,” Reynolds said. “Our rates should reflect that.”
Weiner pointed to Newton Clinic halting labor and delivery care in October, leaving Jasper County — with a population of roughly 32,000 people — without an OB-GYN.
“The governor can try and paint a rosy picture about maternal health care, but it is really not rosy,” Weiner said. “I mean ask all of the rural Iowans who no longer have labor and delivery services, ask the people of Newton whose labor and delivery unit closed.”
A 2022 Iowa Department of Public Health report found at least 41 Iowa hospitals have closed their labor and delivery services since 2000. In 2020, only 46 of Iowa’s 99 counties had at least one hospital providing obstetric services — plummeting from 77 counties in years prior.
Weiner said the legislature needs to put forth policies that will actively encourage doctors to be in Iowa and practice in rural areas.
House Majority Leader Pat Grassley, R- New Hartford, said in a press conference after the address that Reynolds’ proposals for maternal health care are forward-thinking. He anticipates House Republicans will be interested in engaging to expand obstetric services in rural Iowa this legislative session.
Cancer research collaboration with UI
Reynolds got personal with the hundreds of Iowans packed in the House Chamber Tuesday night. She spoke of her husband, Kevin’s recent battle with cancer, and said an adverse health diagnosis can change everything in the blink of an eye.
“This is a path my family has walked,” Reynolds said. “More than a year after Kevin received a lung cancer diagnosis, I’m happy to share that the cancer remains in remission and he continues to do well.”
The chamber rose to its feet and clapped in celebration of Kevin’s recovery.
Reynolds also addressed Senate Majority Leader Jack Whitver’s fight with cancer as he serves his state, and said colleagues, friends, and constituents alike are inspired by Whitver’s quiet fortitude as he undergoes the grueling pressure of treatment.
“Every case of cancer is a tragedy,” Reynolds said. “And I’m concerned by the data showing that these tragedies disproportionately affect Iowans.”
Iowa has the second-highest cancer incidence rate in the United States, and the state’s cancer rate is rising faster than any other state in the country, according to a report by the UI’s College of Public Health.
The U.S. Surgeon General issued an advisory on the link between alcohol and cancer risk on Jan. 3. The advisory highlighted alcohol use as a leading preventable cause of cancer in the U.S. The evidence put forward in the advisory demonstrates a causal relationship between alcohol use and increased risk for at least seven different types of cancer — breast, colorectum, esophagus, liver, mouth, throat, and voice box. The more alcohol consumed, the greater the risk of cancer, the advisory warned.
The UI’s report found Iowa has the fourth-highest incidence of alcohol-related cancers and has the highest rate in the Midwest. Iowa was also ranked fourth in the nation for adult binge drinking, which is defined as consuming five or more drinks for men or four or more drinks for women in a single occasion.
“There’s a lot we still don’t know, and multiple factors are likely at play,” Reynolds said. “We shouldn’t jump to conclusions, but we need to get to the bottom of this.”
Reynolds announced a partnership between Iowa Health and Human Services and the UI to establish a team of epidemiologists to research the behavioral, genetic, and environmental factors that play a role in binge drinking. She asked the state legislature to appropriate $1 million for the team to begin its work.
“Iowans don’t need more speculation — they need answers,” Reynolds said.
Grassley said he supports the partnership with the university, but the legislators need to learn more about how the partnership would work and how the money would be allocated.
“We have a world class hospital in the University of Iowa, and if we can find ways to partnership with the issue, like she laid out there, I think that’s something that the legislature should definitely consider,” Grassley said.
Medicaid review and medical facility approval process.
Reynolds proposed a Medicaid rate model review and structural changes to streamline the approval process for condition-of-need requests.
Reynolds announced her plan to eliminate the Health Facilities Council and shift the reviewing process of the condition of need requests to the Iowa Department of House and Human Services, or HHS, and a new health care economist. The new economist will also help develop the report on the state of Iowa’s healthcare economy and the condition of need process.
Iowa’s HHS will seek federal approval to provide more flexibility for Medicaid rates. Reynolds wants to incentivize creative regional partnerships to better support Iowa’s healthcare providers and improve services.
Reynolds also aims to build a “superhighway of data sharing” among all of Iowa’s hospitals and health providers. Her proposed bill provides Iowa’s HHS with the authority to competitively procure and manage the network and replace the board with an advisory committee.
“The well-being of working families and rural communities also depends on access to high-quality health care,” Reynolds said. “And while we have real challenges, Iowa is working from a position of relative strength.”