Iowa is often viewed as a farming state, even though it has long since diversified into a variety of industries, including manufacturing, which currently trumps agriculture. In fact, Iowa was ranked as the tenth best state in the nation on CNBC’s list of “Top States for Business in 2015” thanks to high scores for economy, cost of doing business, and quality of life, among other categories.
This state, located in a section of the Midwest known as America’s heartland (thanks to manufacturing and agricultural interests), derived its name from the Native American tribe that inhabited the region prior to colonization, the Ioway tribe. It is the only state whose east and west borders are rivers; the Mississippi and the Missouri, respectively.
With rivers, lakes, and rolling hills covered with tall prairie grasses interspersed with dense forested lands, there’s a lot to love about this pastoral state. On the other hand, the climate is dominated by extreme temperatures and humidity in both summer and winter seasons, and that’s not even mentioning the thunderstorms.
Still, the people are nice, the economy is good, and living in Iowa is affordable. In addition, Iowa is ahead of the pack when it comes to providing residents with access to affordable health care options. If you’re already living in Iowa or you’re interested in moving to this great state, here are a few things you should know about the state’s healthcare provisions.
There are a couple of different systems in place to rank states (and the District of Columbia) in terms of the health-related performance indicators. The first is the Scorecard on State Health System Performance and the second is America’s Health Rankings.
There is some overlap in criteria between the two, but they also differ in some of the factors they consider for ranking purposes. In both the state has fared relatively well, consistently ranking higher than at least half of the other states in the nation.
As of 2014, Iowa held the number 10 position on the Scorecard on State Health System Performance, setting it ahead of most of the nation for factors such as healthcare for children and seniors. However, in America’s Health Ranking Iowa fell from 18th to 24th in 2014, a drop that is most likely attributable to a pertussis outbreak, as well as increased levels of binge drinking (this despite high immunization rates and limited deaths related to drug use).
The long and short of these reports is that Iowa remains ahead of the majority of states when it comes to providing healthcare for residents, and the state is likely to rebound in the next round of rankings.
Implementation of Obamacare
Initially, Iowa politicians were fairly evenly split over the enactment of the Patient Protection and Affordable Care Act (ACA), more commonly known as Obamacare. One senator voted for and one against, and three of five representatives voted for it.
Governor Terry Branstad (R) voiced opposition to the law and even went so far as to join Florida in a lawsuit challenging Obamacare. The governor further stated that the ACA had not provided enough information for the state to move forward with creating a state-run exchange.
Iowa therefore did not take advantage of full federal funding provided for the purpose and ended up with a state-partnership marketplace (as opposed to fully federally-managed or fully state-managed options). The state did, however, gain federal approval for two waivers concerning Medicaid expansion, allowing for Medicaid coverage to fund private health insurance plans for specific, qualified residents (those with incomes between 100% and 138% of the federal poverty level).
Initially, enrollment rates for Obamacare in the state of Iowa were tepid, with only a small percentage of eligible uninsured residents signing up for coverage. In fact, the rate of uninsured residents actually rose from 2013 to 2014 (although it was less than 1% increase).
By the middle of 2015 the rate of uninsured residents had dropped significantly, though, from 13.4% in 2014 to just 5% the following year. Compared to the national average of 11.7%, this is great news for Iowa residents.
The state of Iowa co-manages the state health insurance exchange with the federal government. Until recently, however, Iowa residents didn’t have a lot of options for coverage through the marketplace.
In 2014, there were only two providers offering plans through the state exchange: Coventry and CoOpportunity Health, the latter of which stopped selling plans at the end of 2014 (bringing the total number of failed co-ops in Iowa to nine). At this point, several new providers have been added, including Avera Health Plans, Gunderson Health Plan, Medica, United Healthcare of the Midlands, and Wellmark Blue Cross and Blue Shield.
Prior to the enactment of Obamacare, Iowa had established the Health Insurance Plan of Iowa (HIPIOWA) to provide alternative insurance options for individuals unable to secure policies due to pre-existing health conditions. There are still a small number of residents who continue to purchase their health insurance policies through HIPIOWA.
Many have already cancelled such plans, likely due to finding better options through the state insurance exchange. The state is working to transition the rest to comparable health insurance policies through the ACA insurance marketplace.
Thanks to waivers granted to the state of Iowa, certain low-income residents living below the poverty level are allowed to enroll in the Iowa Health and Wellness plan, a source of private insurance coverage that is largely paid for by Medicaid funding. In some cases, participants pay low premiums, but many pay nothing at all.
Over 17% of Iowa residents are enrolled in Medicare, which is greater than the national average of 16%. Of that number 85% are qualified due to their age, while 15% qualify for benefits based on disability. Only 14% of Iowa’s Medicare recipients are enrolled in Medicare Advantage plans that offer enhanced coverage, but 47% use Medicare Part D for prescription drug coverage as of 2014.
All in all, the state of Iowa seems to be ahead of other states when it comes to providing health insurance coverage and options for residents, despite split opinions when the ACA was enacted. The state especially excels in offering coverage for children, seniors, and other underserved groups, which was the main goal of healthcare reform under the Obama administration.