Letter to the Editor

Medicaid expansion is right for Iowa

Monday, April 22, 2013
Bill Bumgarner

Like hospital administrators across Iowa, I have the privilege of serving an organization whose mission is to promote good health. Our focus each day is to meet the health care needs of our community - to diagnose, to heal, to comfort and to promote wellness.

At Spencer Hospital, our commitment to serve as a healing presence to the most vulnerable among us means the debate over whether Iowa should expand the Medicaid health insurance program comes down to a fundamental concept ... we believe caring for the least fortunate among us is simply the right thing to do.

We appreciate the complexity of the Medicaid program for both the federal government and our state legislators. We also understand the challenge of forecasting the financial impact of a "yes" or a "no" decision.

However, as an organization that takes its healing mission very seriously, we believe that expanding access to health care to an additional population of very low-income Iowans fits squarely within our mission to serve all who need medical care. We also believe our hospital's mission reflects the priorities and values of the communities Spencer Hospital serves.

Governor Terry Branstad's proposed Healthy Iowa Plan - while well intended - is not practical and reflects a misunderstanding of health care access challenges in rural Iowa. Most notably, Iowans who are part of this newly covered population may not be able to use local hospitals and physicians. It would also be more costly to the State of Iowa by not maximizing the availability of federal government dollars over the next five years. Our first objective should be to provide increased access to care before considering the more complex health improvement initiatives proposed by the governor.

Governors in the majority of the states - both Republican and Democrat -- have opted to support Medicaid expansion. In deciding that his state should move forward with Medicaid expansion, Ohio Republican Gov. John Kasich said he was guided by his personal ethics. "I can't look at the disabled, I can't look at the poor, I can't look at the mentally ill, I can't look at the addicted and think we ought to ignore them," he said. Similarly, Gov. Rick Scott of Florida, also a Republican, said, "America's greatness is largely because of how we value the weakest among us ... I cannot, in good conscience, deny Floridians the needed access to health care."

A decision against extending Medicaid coverage to more Iowans also could have a financial impact on health care providers. Spencer Hospital and other Iowa health care providers already serve those who would benefit from Medicaid expansion when they become so sick they need care in our emergency departments - and we absorb those costs as unreimbursed charity care. This too reflects the hospital's mission, but the rate of growth for charity care is unsustainable and undermines our ability to support the overall demand not only for hospital services, but for other community-benefiting programs that, frankly, only our organization can provide.

More importantly, the emergency department is no replacement for a personal physician. Expanding Medicaid will improve access to primary care providers and begin the process of driving down costs by offering care earlier after a health condition arises rather than delaying treatment until it becomes more serious -- and more expensive - to treat.

Spencer Hospital has supported the governor's goal of making Iowa the healthiest state in the nation. We take an active role in improving the wellness of the people and communities we serve. The hospital works continuously with its medical staff to improve the quality of care for every patient while also creating efficiencies that ensure every health care dollar is wisely spent.

Providing high value health care is part of our mission that also reflects the expectations of the community. Accomplishing this goal - ensuring quality while also lowering health care costs through improved care management - will also support economic growth, a top priority for both our state and city.

However, refusing to expand Medicaid and keeping thousands of poor Iowans uninsured undermines the physical health of our people and the economic vitality of our hospitals and our state.

If Iowa legislators decide against Medicaid expansion and support the alternative Healthy Iowa Plan, we will be left with the worst of both worlds: providing more uncompensated care for Iowans still not eligible for Medicaid while receiving less money from the federal government to cover these costs.

And we will have let down thousands of struggling Iowans who are counting on our compassion.

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