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University of Iowa News Release


Feb. 10, 2009

Public Policy Center issues evaluation of IowaCare health plan

In its report evaluating the IowaCare health plan for uninsured adults in the state, the University of Iowa Public Policy Center found that the program is providing health care coverage for uninsured Iowans, many of whom have never had health insurance. The program was found to have met the needs of two-thirds of the previously uninsured Iowans with chronic illnesses, while the other third had problems accessing health care services.

IowaCare, a limited benefit, limited provider-network program, provides health care coverage to adults ages 19-64 whose incomes are up to twice the Federal Poverty Level, enrolling almost 30,000 people for at least one month during fiscal year 2007. Recipients must receive care at the University of Iowa Hospitals and Clinics, or the four state mental institutes, or Broadlawns Hospital for residents of Polk County. They pay no premiums or up to $75 in premiums based on income.

This report describes how Iowans use and access IowaCare, and how satisfied they are with this program serving many adults who have never had health insurance.

The Public Policy Center found that IowaCare successfully enrolled a larger than expected number of patients, especially those who have chronic illnesses. It also provided coverage to enrollees had been without any health insurance for more than two years. While IowaCare meets the needs of about two-thirds of enrollees, the other third have some problems accessing services in Iowa City and Des Moines. For example, about one-third of those outside Polk County sought urgent and routine care from a provider outside the IowaCare network because they needed to travel to University of Iowa Hospitals and Clinics for services.

"The chronic health problems of this population increase the need for prescription drugs, a noncovered service that is provided by University of Iowa Hospitals and Clinics and Broadlawns when possible. Dental care, another limited coverage service, was repeatedly said to be needed by enrollees, with oral health problems being the most frequent self-reported chronic health problem," said the authors of the report.
The report is intended to provide information to the Department of Human Services and the Iowa Legislature to make informed decisions about IowaCare, said Pete Damiano, director of the Public Policy Center. "It's up to the policy-makers to determine the amount and the breadth of coverage for this program. By design, it's a limited program that gives people some options for dealing with medical expenses. It is meeting the needs of most but not all enrollees. Policy-makers need to decide what its scope needs to be," he explained.

"IowaCare has become part of the safety net for low-income Iowans who are not eligible for Medicaid and don't have access to other insurance. The usage of this program highlights the needs of single adults and childless couples who are not eligible for Medicaid even if they have no income or resources at all," said Jennifer Vermeer, director of the Iowa Medicaid Enterprise in the Iowa Department of Human Services.

Commissioned by the Iowa Department of Human Services, the report was completed in December 2008 by the Public Policy Center and Iowa Center for Evaluation Research, a part of the National Resource Center for Family Centered Practice in the UI School of Social Work. Three methods were employed for the evaluation. Surveys were used to assess enrollee perceptions, claims data was evaluated to determine outcomes of care, and focus groups and personal interviews were conducted to assess perceptions of hospital providers and administrators.

Specific findings included:

--7,000 people re-enrolled in IowaCare after their first year of coverage.
--25 percent of enrollees had never had health insurance prior to joining IowaCare.
--The most common chronic problems were oral health, orthopedic and high-blood-pressure related issues.
--Over half of those paying a monthly premium worried about their ability to pay.
--62 percent of enrollees had a personal doctor, and for many this person was outside the IowaCare provider network.
--The most common emergency room complaint was chest pain.
--One-third of enrollees needing urgent care went outside the IowaCare network.
--One-third of enrollees had unmet need for routine medical care in the previous six months.
--Of those reporting a need for specialty care, 37 percent indicated having a time they could not see a specialist.
--Over half of the enrollees indicated that their personal doctor always spends enough time with them.
--Health care providers said IowaCare has an easy and quick application process. and administrators understand the IowaCare program and help patients use it.
--More effective marketing of IowaCare Nurse Helpline and Medicaid Hotline is also needed, as only 12 percent of enrollees were aware of the Medicaid Helpline and only 19 percent were aware of the Nurse Hotline.
-Providers at UIHC were concerned because they are not paid for the care provided by physicians, for prescription drugs or durable medical equipment. UIHC is only paid for the hospital care.

The full evaluation report of the IowaCare program is available at
STORY SOURCE: University of Iowa News Services, 300 Plaza Centre One, Suite 371, Iowa City, Iowa 52242-2500

MEDIA CONTACTS: Peter Damiano, UI Public Policy Center, 319-335-6800,; George McCrory, University News Services, 319-384-0012,