SPECIAL ASSIGNMENT: Is IowaCare effective? - KWWL - Eastern Iowa Breaking News, Weather, Closings

SPECIAL ASSIGNMENT: Is IowaCare effective?

Posted:
WATERLOO (KWWL) -

The IowaCare program has seen many changes since it began in 2005, mainly due to the overwhelming response from Iowans who have no where else to turn for coverage. Some say, the state-run health insurance program is a lifesaver. Others believe it's a system flawed from the start.

IowaCare was designed to meet the needs of those who don't have access to private insurance, and don't qualify for Medicaid or Medicare. More than 72,000 Iowans have signed up since its inception. That includes 3,360 in Black Hawk County, 1,681 in Dubuque, 5,281 in Linn, 20,192 in Polk County. IowaCare has good intentions, but between limited funding, high demand, and a lack of participating clinics in rural areas, questions remain of the feasibility of the program.

A few years ago, Patricia Coughlin found herself in a place she never imagined she'd be. She'd retired early from a job with a major Cedar Valley employer, without realizing she was putting her health at risk.

"I continued with my COBRA insurance, but that only lasted 18 months ran out and I couldn't get insurance," she said.

That's when Coughlin learned about IowaCare. Like many Iowans, she'd never heard of the state-run plan.

"I was very grateful that it existed," Coughlin said.

Initially, when state lawmakers approved IowaCare, they only expected to serve about 14,000 adults at two state-run facilities including University of Iowa Hospitals and Clinics. But the demand was much greater than expected.

In 2009, IowaCare grew to 32,000 members, requiring lawmakers to re-think how the program worked.

"We did start running into problems with people not being able to get help, if you're way in western Iowa, it's hard to get to Iowa City or Des Moines. So we're expanding it now where we're slowly getting into other sites across the state," said Sen. Bob Dvorsky, a Democrat from Coralville.

People's Clinic in Waterloo was one of eleven Federally Qualified Health clinics to sign on as a "Medical Home" in 2010. The clinic was immediately flooded with new patients.

"We went from 1,300 patients to now more than double that," said Executive Director of People's Clinic Jennifer Lightbody.

"It took us about three months to get through all the calls to catch up. So yeah, it was pretty overwhelming," said Linett Kane, Director of Medical Services at People's Clinic.

In January, the "Medical Home" program was reformatted, aiming to alleviate some of the pressure on clinics like People's. But Krisha Clopton, the director of a free clinic in Waterloo, says it's not enough. She recalls one time in particular when the system failed to serve a very ill patient.

"Her medical home was in Iowa City. And that was 145 miles away from her home. On the night she was ill, she had called them to see where she could receive services nearer to her home. They suggested she come see us at IHOPE," Clopton explained.

Unfortunately it was an evening when IHOPE provides chiropractic care, not medical care. So Clopton referred her to People's Clinic.

"What I learned was, because People's Clinic wasn't her established medical home, they wouldn't see her. So as a result, the patient ended up going to the emergency room," Clopton said.

Kane said, distance from a medical home and access to specialty care are some of the many cracks in IowaCare's foundation.

"I think we have hurdles to overcome. And every hurdle involves money," Kane said.

Medicaid funds cover part of a patient's care. But the bulk of the funding comes from the provider.

"I believe for Fiscal Year 2011 we were probably subsidizing somewhere north of $40 million," said Stacey Cyphert, Assistant Vice President for Health Policy UIHC.

$40 million sounds like a lot, but it could cost even more. Currently, 51,801 adults are enrolled in IowaCare. But the Kaiser Family Foundation estimates 345,000 more do not have any insurance.

"That's roughly the population of Cedar Falls, Waterloo, Cedar Rapids, and Iowa City combined," Clopton noted.

When the Affordable Care Act does go into full effect in 2014, states will have to figure out how to serve everyone.

"I really see the IowaCare program as it stands now as a step. It's a step toward ensuring access to health care for all regardless of what your insurance status is," Lightbody said.

It is unclear what will happen to IowaCare when, or if, the national law is implemented.

"It's a complicated issue, you answer some questions and it opens up other questions," said Dvorsky.

"I don't think there is a magic answer. I think we will be discussing this for years to come. But every time we will improve the way we are doing it," explained Jean Robillard, Vice President for Medical Affairs at UIHC.

Clearly the program has its flaws. But in Iowa City, Robillard and Cyphert said it is working, and patients are receiving the care they need.

"Having a program like this has enabled a lot of people to have better services than they would have had it not existed," Cyphert added.

That leads us back to Coughlin. Because of IowaCare, she has regular check-ups with her doctor at People's Clinic. Her blood pressure is down, and she's adding years to her life in retirement.

"I think it's a great program. And I don't know what I would have done without it," she said.

You can learn more about the IowaCare program, including information about receiving coverage, by clicking here.

Powered by Frankly