Former Iowa Speaker of the House Linda Upmeyer recently touted on these pages the positive trajectory of rural healthcare in our state under Republican leadership.
But here’s the rub.
The former speaker’s observations seem consistent with how today’s elected Republicans view the world as they prefer it to be rather than how it really is.
I worked in rural healthcare for four decades, primarily in Iowa, to include over 20 years as a hospital president. That entailed collaborating daily with physicians and a wide range of hospital professionals to offer health services to our community.
While Ms. Upmeyer downplayed the role of the federal government in healthcare policy, that support is essential to ensure the fiscal integrity of Iowa rural hospitals. About 60% of rural Iowa hospital revenue comes from the federal government to provide services to Medicare and Medicaid patients.
So it matters when the Republican’s Big Beautiful Bill (BBB) begins a process to strip Medicaid coverage from an estimated 70,000 Iowans following the 2026 midterm election. The bill also failed to extend Affordable Care Act premium credits that could result in a loss of coverage for about another 8,000 Iowans. That represents a tragic loss of routine health access for Iowa families and less funding to support Iowa health providers.
I credit the Iowa Department of Health and Human Services for recently supporting a directed payment program that leverages increased federal Medicaid dollars for Iowa hospitals. However, the BBB will incrementally reduce some of those new dollars over the next several years. Iowa’s Republican congressional delegation cast their votes against your community hospital by supporting that bill.
Ms. Upmeyer noted that the BBB is making a $50 billion investment in rural hospitals across the country. Sounds great, but it’s misleading. Those dollars are estimated to replace only about a third of the provider funding that will be lost through the aforementioned Medicaid enrollment cuts. That adds up to a significant net financial loss for Iowa rural hospitals.
The Medicaid work requirement that Ms. Upmeyer mentioned, advanced by Republicans in the Iowa legislature, falsely feeds the perception the program is awash with undeserving beneficiaries. Similar programs in Arkansas and Georgia are floundering, as added bureaucratic steps result in otherwise eligible — and employed — citizens losing coverage.
I join Ms. Upmeyer to applaud the state for increasing medical school slots for Iowa residents and revising their training to include rural rotations. While logic suggests these future physicians may then choose to remain in Iowa to practice for decades, there are no guarantees. It’s not that simple.
Physicians, like all people, seek bright futures for their families. Yet, Iowa is no longer the state I grew up in.
Today it suffers from polluted waterways, chronic underinvestment in its public schools, eroding farm markets and the limiting of healthcare service options for women. In addition, state fiscal challenges loom as government overspending is being papered over through the use of rainy-day funds.
As Ms. Upmeyer highlighted, the quality of Iowa hospitals is outstanding. I was honored to work for a hospital that has been recognized by the Chartis Center for Rural Health as a Top 100 Rural and Community Hospital in the nation for 10 consecutive years.
Hospital excellence is achieved, I learned, through the talents, commitment and perseverance of the people who selflessly serve their patients each day. Some of the laundry list of programs that Ms. Upmeyer shared offer help in their work, but the overarching initiatives —like the BBB — actually make the lift heavier on the whole.
What Iowa care and service providers really need to sustain excellence is reasonable reimbursement from the federal government. Also, no more Medicaid enrollment shell games by the state’s governing majority.
The BBB made clear that your Republican congressional representatives are not fighting for your community hospital. Nor are many of your Republican state elected officials demanding that they do.
Given that hospitals are major employers and an economic driver in rural counties, you’d really think that they would.
Bill Bumgarner is a retired hospital executive from Spencer who worked for over 40 years in rural healthcare, primarily in Iowa.
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