Iowa Highlights

4 Iowa's 2020 Rank
To learn more about state rank, visit our 2020 Scorecard on State Health System Performance.
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Source: Commonwealth Fund 2020

Key Demographics

Iowa US Average
Total Population 3,112,421 322,324,172
Median Household Income $66,662 $67,877
Below 200% of Federal Poverty Level (FPL) 27% 30%
% White Race, Non-Hispanic 85% 60%
% Black Race, Non-Hispanic 3% 12%
% Other Race, Non-Hispanic 5% 9%
% Hispanic Ethnicity 6% 18%

Key Health Policies in Iowa

Iowa has put no rules in place to promote ACA marketplace competition.
Iowa does not have stricter limits than the federal government on the sale of short-term coverage.
Iowa expanded Medicaid through Section 1115 waiver or ballot initiative.

Iowa Performance Data

CSV
Indicator Source 2016 2017 2018 2019
Uninsured adults ages 19–64 American Community Survey, Public Use Microdata Sample (ACS PUMS) 5.8% 6.1% 7% 6.9%
Uninsured children ages 0–18 American Community Survey, Public Use Microdata Sample (ACS PUMS) 2.2% 2.7% 3.1% 2.5%
Hospital admissions for pediatric asthma, per 100,000 children ages 2-17 Healthcare Cost and Utilization Project (HCUP), via AHRQ National Healthcare Quality Report - - - -
Adults age 18 and older who went without care because of cost in past year Behavioral Risk Factor Surveillance System (BRFSS) 8% 8% 8% 9%
Adults age 18 and older with a usual source of care Behavioral Risk Factor Surveillance System (BRFSS) 83% 83% 82% 83%
Adults age 18 and older without a dental visit in past year Behavioral Risk Factor Surveillance System (BRFSS) 29% - 29% -
Adults with age- and gender-appropriate cancer screenings Behavioral Risk Factor Surveillance System (BRFSS) 69% - 70% -
Adults with age-appropriate vaccines Behavioral Risk Factor Surveillance System (BRFSS) 45% 44% 39% 46%
Adults ages 18–64 who report fair or poor health Behavioral Risk Factor Surveillance System (BRFSS) 12% 13% 12% 13%
Adults ages 18 and older who smoke Behavioral Risk Factor Surveillance System (BRFSS) 17% 17% 17% 16%
Adults ages 18–64 who are obese (BMI >= 30) Behavioral Risk Factor Surveillance System (BRFSS) 32% 38% 36% 34%
Mortality amenable to health care, deaths per 100,000 population CDC National Vital Statistics System (NVSS): Restricted Use Mortality Microdata 71.7 73.7 - -
Central line-associated bloodstream infections (CLABSI), Standardized Infection Ratio CDC Healthcare-Associated Infections (HAI) Progress Report 0.635 0.664 0.838 -
Breast cancer deaths per 100,000 female population CDC National Vital Statistics System (NVSS): WONDER 19.2 18 18.3 -
Colorectal cancer deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 13.4 12.9 14.1 -
Suicide deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 14.6 15 15.5 -
Alcohol-related deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 10.9 11.5 10.9 -
Drug poisoning deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 10.6 11.5 9.6 -
Infant mortality, deaths per 1,000 live births CDC National Vital Statistics System (NVSS): WONDER 6 5.3 - -
Hospital admissions among adults ages 18–64 with employer-sponsored insurance for ambulatory care–sensitive conditions, per 1,000 enrollees Truven MarketScan 6.5 6.5 - -
Hospital admissions among Medicare beneficiaries age 65 and older for ambulatory care–sensitive conditions, per 1,000 beneficiaries Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File 36.7 37.7 34.6 -
Potentially avoidable emergency department visits among adults ages 18–64 with employer-sponsored insurance per 1,000 enrollees Truven MarketScan 134.6 116.7 - -
Potentially avoidable emergency department visits among Medicare beneficiaries age 65 and older per 1,000 beneficiaries Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File 182.9 - - -
30-day hospital readmissions among adults ages 18–64 with employer-sponsored insurance, per 1,000 enrollees Truven MarketScan 3.1 3.2 - -
30-day hospital readmissions among Medicare beneficiaries age 65 and older per 1,000 beneficiaries Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File 31 31.2 29.7 -
Individuals under age 65 with high out-of-pocket medical costs relative to their annual household income Current Population Survey Annual Social and Economic Supplement (CPS ASEC) 10% 7.8% 7.7% -
Total Medicare (Parts A & B) reimbursements per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $8,046 $8,327 $8,613 -
Total Medicare reimbursements for inpatient hospital services per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $2,206 $2,258 $2,220 -
Total Medicare reimbursements for ambulatory Evaluation and Management services per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $644 $652 $656 -
Total Medicare reimbursements for inpatient skilled nursing care per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $864 $869 $833 -
Total Medicare reimbursements for home health care services per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $220 $221 $223 -
Home health patients who got better at walking or moving around Outcome and Assessment Information Set (OASIS), via CMS home Health Compare 71% 75% 77% -
Home health patients whose wounds improved or healed after an operation Outcome and Assessment Information Set (OASIS), via CMS home Health Compare 88% 88% 90% -
Home health patients also enrolled in Medicare with a hospital admission Medicare Claims, via CMS Home Health Compare 17% 16% 16% -
Risk-adjusted 30-day mortality among Medicare beneficiaries hospitalized for heart attack, heart failure, pneumonia, or stroke CMS Hospital Compare 15% 14.8% 14.7% -
Hospitalized patients given information about what to do during their recovery at home Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 89% 88% 89% -
Overall patient hospital experience rating (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 74 73 - -
Patients' experience communicating with nursing staff (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 80 79 - -
Patients' experience communicating with doctors (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 80 81 - -
Responsiveness of hospital staff when called by patients (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 65 65 - -
Patients' experience communicating with hospital staff about medicines they received (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 63 63 - -
Patients felt prepared to manage their care after a hospital stay (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 53 53 - -
Patients discussed discharge plans with hospital staff and received written instructions (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 89 89 - -
Hospitals with overall patient experience ratings higher than the national average Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 68% 66% - -
Adult diabetic patients ages 18–64 with employer-sponsored insurance with at least one hemoglobin A1c test during the year Truven MarketScan 90.9% 93.5% - -
Adult diabetic patients ages 18–64 with employer-sponsored insurance with at least one LDL-C test during the year Truven MarketScan 82% 82.5% - -
Adult patients ages 18–64 with employer-sponsored insurance and a diagnosis of bacterial pneumonia who received an appropriate empiric antibiotic Truven MarketScan 80.2% 75.2% - -
Adult patients ages 18–64 with employer-sponsored insurance and a diagnosis of major depression who were prescribed an antidepressant medication, and who had pharmacy claims of at least 5 months’ worth of the medication Truven MarketScan 61.5% 60.5% - -
Adult patients ages 18–50 with employer-sponsored insurance who had a new primary diagnosis of low back pain with an Imaging study (plain X-ray, MRI, or CT scan) within 28 days of the diagnosis Truven MarketScan 76.1% 75.7% - -
Total employer-sponsored insurance reimbursements per enrollee, ages 18–64 Truven MarketScan $3,851 $4,569 - -
Total employer-sponsored insurance reimbursements for inpatient hospital services per enrollee, ages 18–64 Truven MarketScan $966 $1,119 - -
Total employer-sponsored insurance reimbursements for physician office services per enrollee, ages 18–64 Truven MarketScan $499 $508 - -
Short-stay nursing home residents with a 30-day readmission to the hospital Residential History File 16% - - -
Long-stay nursing home residents with a hospital admission Residential History File 14% - - -
Medicare beneficiaries who received at least one drug that should be avoided in the elderly Medicare Part D Claims 6.7% - - -
Total premium cost for employer-sponsored health insurance plans Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $13,946 $14,539 $15,570 $15,592
Total premium cost for employer-sponsored health insurance plans as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 20.6% 20.8% 20.8% 22%
Employee contribution to total premium cost for employer-sponsored health insurance plans Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $3,658 $3,587 $4,326 $4,288
Employee contribution to total premium cost for employer-sponsored health insurance plans as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 5.4% 5.1% 5.8% 6.1%
Employee deductible for employer-sponsored health insurance plans Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $2,652 $3,059 $3,306 $3,578
Employee deductible for employer-sponsored health insurance plans as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 3.9% 4.4% 4.4% 5.1%
Employee total potential out-of-pocket medical costs (premium contribution + deductible) Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $6,310 $6,646 $7,632 $7,865
Employee total potential out-of-pocket medical costs (premium contribution + deductible) as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 9.3% 9.5% 10.2% 11.1%
Children ages 19–35 months who received all recommended doses of seven key vaccines National Immunization Survey (NIS) 73% 73% 74% -
Children ages 10–17 who are overweight or obese (BMI >= 85th percentile) National Survey of Children’s Health (NSCH) 30% 33% 36% -
Children ages 0–17 with all components of a medical home National Survey of Children’s Health (NSCH) 58% 55% 59% -
Children with age-appropriate medical and dental preventive care visits in the past year National Survey of Children’s Health (NSCH) - - 67% -
Children ages 3–17 who received treatment or counseling from a mental health professional when needed during the past 12 months National Survey of Children’s Health (NSCH) 93% 91% 87% -
Adults age 18 and older with any mental illness reporting unmet need National Survey on Drug Use and Health (NSDUH), via State of Mental Health in America 19% 18% - -
Adults age and older with any mental illness who did not receive treatment National Survey on Drug Use and Health (NSDUH), via State of Mental Health in America 46% 47% - -
Long-stay nursing home residents with an antipsychotic medication Minimum Dataset (MDS), via CMS Nursing Home Compare 15% 15% - -
High-risk nursing home residents with pressure sores Minimum Dataset (MDS), via CMS Nursing Home Compare 4% 4.2% - -
State-based public health spending per resident Trust for America’s Health (TFAH) $71 $41 - -
Primary care spending as share of total health care spending among adults ages 18–64 with employer-sponsored insurance Truven MarketScan 8.29% - - -
Primary care spending per enroleee among adults ages 18–64 with employer-sponsored insurance Truven MarketScan $500 - - -
Primary care spending as share of total health care spending among Medicare beneficiaries age 65 and older CMS Limited Data Set (LDS) 6.25% - - -
Primary care spending per Medicare beneficiary, age 65 and older CMS Limited Data Set (LDS) $679 - - -

Iowa Policy Data

CSV
Policy Source Action Taken Notes Info
Medicaid expansion status The Commonwealth Fund 2 Expanded Medicaid with 1115 waiver -
Medicaid work requirement status The Commonwealth Fund 0 No work requirement status -
Affordable Care Act health insurance marketplace type Center on Health Insurance Reforms, Georgetown University Health Policy Institute 2 Federally facilitated marketplace; state conducting plan management (13 states) The federal government (HHS) is legally responsible for all marketplace functions, but defers to the state to conduct health plan management. Individuals must use HealthCare.gov to enroll in coverage.
State requirements for individuals to maintain adequate health coverage (individual mandates) J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 Does not require individuals to maintain adequate health coverage -
State subsidies for individual market coverage J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States."The Commonwealth Fund 0 Provides no premium or cost-sharing subsidies -
State regulation of short-term limited duration coverage J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 Does not limit the sale of short-term coverage more strictly than the federal government Does not limit the sale of short-term coverage more strictly than the federal government
State decisions to extend the annual open enrollment period for ACA marketplace coverage J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 Did not extend 2018–2021 open enrollment Did not extend the open enrollment period for 2022 coverage; Did not extend the open enrollment period for 2018, 2019, or 2020 coverage. Did not extend the open enrollment period for 2021, but in response to the COVID-19 pandemic, the federal government reopened HealthCare.gov for 2021 coverage from Feb. 15, 2021 through Aug. 15, 2021.**
Rules to a promote competitive marketplace J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 No rules to promote marketplace competition Has not established a rule to promote a competitive ACA marketplace.
State decisions regarding whether to allow non-compliant transitional policies in the individual market J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 1 Permits non-compliant transitional policies Permits insurers to sell non-compliant transitional policies in the individual market
State decisions to exempt other coverage products from federal and state consumer protections J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 1 Exempts other coverage from insurance rules Exempts other coverage products from federal and state rules for individual market insurance; Health plans sold by the Iowa Farm Bureau are not considered insurance under state law and are exempt from federal and state protections otherwise applicable to the individual insurance market.
Status of state Affordable Care Act (1332) innovation waivers J. Giovannelli and K. Lucia, "States See Opportunities for Flexibility in the ACA’s Innovation Waiver Program." The Commonwealth Fund 4 Waiver withdrawn from federal consideration/no longer under active federal review (7 states) Waiver application and supplemental materials submitted to the federal government in August September, and October, 2017 and determined complete during preliminary federal review. Application was withdrawn by the state on October 23, 2017, prior to a decision on whether to approve the requested waiver. Application sought to 1) allow individual market insurers to offer only a single, standard plan at the silver tier level; 2) eliminate the ACA's premium tax credits and cost-sharing reductions and provide a new premium credit mechanism adjusted for age and income and a cost-sharing credit based on income; 3) add a continuous coverage requirement for special enrollment periods; 4) secure federal funding to support a state-based reinsurance program. Iowa has not enacted legislation that specifically authorizes the development or submission of a waiver.
State-operated individual market reinsurance programs supported by federal funding from an ACA innovation waiver J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 Does not operate a waiver-funded reinsurance program Does not operate a reinsurance program. Has not applied for a future waiver.