Advocacy

Key Issues & Priorities

Advocating for Iowa’s Health

Located just blocks from the Iowa State Capitol, IHA and its Advocacy Team represent Iowa hospitals and health systems at the state and federal levels. Our team works year-round to shape public policy, protect hospital and health system interests, and promote legislation that supports high-quality, accessible healthcare for all Iowans.

We build strong relationships with lawmakers, regulatory agencies and community leaders to ensure hospital perspectives are heard and understood. Through strategic lobbying, grassroots mobilization and coalition-building, we help hospitals navigate complex policy landscapes and respond to emerging challenges.

Governor Kim Reynolds with Iowa Hospital Association

Iowa Hospital Association Day on the Hill

Key Issues

Medicaid Managed Care Hospital Directed Payment Program

Iowa’s Medicaid managed care hospital directed payment program provides supplemental funding for non-state-owned hospitals and freestanding behavioral health and rehabilitation hospitals that achieve quality measures aligned to the state’s strategy to improve care quality and access for Medicaid managed care beneficiaries.

Why it's important for Iowa:

More than 700,000 Iowans are enrolled in the state’s Medicaid program
Program goals are aligned with Iowa Department of Health and Human Services’ Medicaid quality strategy
Program funding has significantly improved the financial viability of related services, particularly for rural hospitals

Learn More: Medicaid in Iowa

For more than 30 years, the 340B program has provided funding to help hospitals that serve rural communities and vulnerable populations manage rising prescription drug costs and expand patient services. Despite significant oversight and a proven record of expanding access to vital patient care, the program faces drastic cuts that would reduce the benefits eligible hospitals and patients receive.

Why it's important for Iowa:

340B-eligible hospitals are the safety-net for their communities
The 340B program provides financial assistance for patients who can’t afford their prescriptions
Funding enables providers to stretch limited resources and expand access to care for vulnerable communities
Generates valuable savings for eligible hospitals to reinvest in programs that enhance patient services

Comments letters

IHA Comments on 340B Rebate Model Pilot Program

AHA Resources: 340B Drug Pricing Program Materials

Take Action: Sign the 340B Hospital Commitment to Good Stewardship Principles

Hospitals and their associated outpatient departments treat patients with severe conditions and provide critical services that are not available in other care settings. Hospitals must have emergency stand-by capacity, are open 24/7 to all who seek care regardless of ability to pay and are heavily regulated. These factors add to the overall cost of care. Payment proposals that attempt to treat hospital outpatient departments the same as independent physician clinics ignore the very different level of care hospitals deliver.

Why it’s important for Iowa:

Site-neutral payment cuts would reduce access to critical health care services, especially in rural communities
Medicare beneficiaries in rural communities disproportionately rely on hospital outpatient departments to meet their increased health care needs
On average, Medicare pays only 82 cents for every dollar of hospital care provided to Medicare patients, resulting in many hospitals operating with negative Medicare margins

AHA Fact Sheet: AHA Site-neutral Legislative Proposals

AHA Infographic: Site-neutral Payment Policies Myth vs Fact

Medicare and Medicaid account for approximately 60% of patient revenue for Iowa hospitals, making changes to these government-sponsored programs highly consequential. Under Medicare’s fee-for-service model, hospital payment rates are administratively determined rather than negotiated, often resulting in base payments that fall short of covering the full cost of care.

Medicare payment policies are shaped by federal legislation and regulations issued by the Centers for Medicare and Medicaid Services. IHA advocates for fair and sustainable Medicare reimbursement by engaging with Iowa’s congressional delegation and participating in CMS’ public comment processes. These efforts aim to protect hospital funding and ensure continued access to high-quality care statewide.

Comments letters

The Iowa Hospital Association and our member hospitals and health systems believe that patients and families should be active participants in their health care decisions. Access to clear, accurate, and timely information—including the cost of care—is essential to making informed choices.

As Iowans increasingly take on a greater share of health care costs through high-deductible health plans or limited-benefit coverage options, the demand for price transparency continues to grow. In response, federal initiatives have advanced efforts to make health care pricing more accessible and understandable for consumers.

Iowa hospitals are committed to being part of this solution. By complying with federal transparency regulations, hospitals across the state are working to ensure patients have the information they need—when they need it.

Price Transparency Fact Sheet | American Hospital Association
CMS Resources
Price Transparency Tools
IHA Response to CMS Hospital Price Transparency Accuracy and Completeness RFI | July 2025

Iowa’s hospitals and health systems rely on a dedicated and skilled workforce to deliver high-quality care across rural and urban communities alike. Through strategic advocacy, data-driven insights, and collaborative partnerships, IHA advocates for federal and state policies that invest in the healthcare workforce pipeline, expand access to education and training, and remove barriers to practice. Our goal is to ensure that hospitals and health systems are equipped with the talent and support they need—today and into the future.

24-25 Salary Survey Infographic

2026 Policy Priorities

Advocate for policies and programs that strengthen the financial position of Iowa’s hospitals and enhance Iowans’ access to care.

Retain the Certificate of Need program to protect Iowans’ access to lower cost, high quality care.
Maintain authorization of hospital provider participation funds and secure the state’s submission of an annual preprint to finance Medicaid hospital quality programs and improve access to care for Medicaid managed care beneficiaries.
Support policies to improve access to maternal and behavioral health care.
Oppose site-neutral payment policies and any attempts to curb or eliminate hospital outpatient payments that cover all costs of care aside from professional services fees.
Address delays in post-acute care transitions.
Support proposals that improve access to EMS and non-emergency transportation services.
Oppose pharmaceutical manufacturer practices that restrict 340B drug distribution.
Support repeal of the federal 96-hour rule.
Make permanent Medicare coverage for telehealth and CMS hospital-at-home programs.
Refine the Rural Emergency Hospital model to ensure access and fair payment.
Support proposals to strengthen malpractice claim defenses.

Pursue initiatives to grow, retain, and protect Iowa’s healthcare workforce.

Protect and expand funding for physician, nurse, behavioral health and allied health professional education, training, recruitment, loan repayment, and health careers apprenticeship programs.
Oppose arbitrary staffing mandates for hospitals and nursing homes.
Support reforms to the Conrad 30 J-1 Visa Waiver Program and the EB-3 Visa Program to increase Iowa's physician and nursing workforce.
Support additional state investments to grow Iowa’s physician residency programs.

Be an Advocate

As grassroots advocates, IHA members can represent Iowa’s hospitals while engaging elected officials on high priority policy issues.

Sign up for IHA’s Legislative Advocacy Network