Pair health insurance with access

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More of Iowa’s kids have health insurance. Now we need a more robust system that allows them to use it.

A report released Thursday by the Robert Wood Johnson Foundation says between 2013 and 2014, about 13,000 more Iowa youngsters received health insurance, mainly through their eligibility for public insurance plans like Hawk-i or Medicaid.

Increased adult access to Medicaid programs came via millions in funding from the Affordable Care Act. Researchers believe that as adults discovered new Medicaid options for themselves, youngsters were also signed up for coverage.

In this report, Iowa claims the fifth lowest uninsured rate for children (3.2 percent) — a significant move in the right direction from it’s earlier placement of 13th in the nation (5 percent).

Many state residents and health care advocates worked tirelessly for the Medicaid expansion being credited. They have reason to crow, but shouldn’t consider their job complete.

Having an insurance card is one thing. Gaining access to quality care is another. If our end goal is to give Iowa’s children the best start possible, both are required.

Long before the Branstad administration reshuffled the Medicaid deck with plans for privatization, access to health care in Iowa’s rural areas was fragile.

Rural hospitals generally have narrow financial margins, and a larger percentage of their patients on public health care plans like Medicaid.

A flu shot, chicken pox vaccine and flu vaccine mist sit on a tray at Cedar Rapids Pediatrics in Cedar Rapids on Monday, October 17, 2011.
A flu shot, chicken pox vaccine and flu vaccine mist sit on a tray at Cedar Rapids Pediatrics in Cedar Rapids on Monday, October 17, 2011. (Cliff Jette/The Gazette)

Medicaid expansion has helped, allowing most rural hospital and doctors to decrease instances of bad debt and redistribute charity care offerings. Even so, financial margins remain slim, typically only sustaining existing services and equipment.

Families who have not previously had health insurance may not know the most cost effective ways to use it. For instance, instead of seeking preventive care or addressing early symptoms with a family physician, those new to public health insurance programs may continue previous patterns — waiting until the illness warrants an emergency room visit.

Many urban areas have health coaches or patient advocates who can help introduce those new to insurance to the ways they can make the most of their plans, but rural areas struggle both with the staffing of such positions and the cost of the hiring.

Nationally, only about 10 percent of licensed physicians choose to practice in rural areas — where a quarter of the nation’s population lives.

Iowans best the national statistics, but still have challenges. The roughly 1.4 million rural residents in Iowa generally have adequate access to basic health care. The state’s network of critical access hospitals and rural health care clinics is one of the largest in the nation.

Access is a greater issue when a rural resident needs specialized tests or care — cardiology, oncology, psychiatry or even dentistry. Across the state there are more than 100 designated health professional shortage areas.

Let’s save the big celebration for when Iowa’s children have both insurance and access.

This column by Lynda Waddington originally published in The Gazette on February 13, 2016. Photo credit: Cliff Jette/The Gazette