DES MOINES, Iowa – Since Iowa expanded its Medicaid program in 2013, more low-income rural residents are covered by health insurance.

A new report from Georgetown University shows that coverage gaps in states where Medicaid was expanded are much smaller than in states that did not expand.

Anne Discher, executive director of the Child and Family Policy Center with the Iowa Department of Human Services, says only 15 percent of Iowa's low-income rural residents were uninsured in 2016.

That's compared with a nationwide high of 47 percent in neighboring South Dakota, which chose not to expand.

"I think that Iowa's decision to expand Medicaid to low-income adults has really paid off and it's paid off across the state, really, including folks who live in small towns and rural areas in every part of the state," Discher states.

In 2016, Iowa moved its Medicaid program away from federal and state management and hired private companies to run Medicaid programs and administer benefits paid for by the state.

Medicaid serves 685,000 low-income or disabled Iowans.

Study co-author Joan Alker, executive director of the Georgetown University Center for Children and Families, says the uninsured rate for low-income adults has dropped much faster in states that expanded Medicaid.

She notes that unlike some states where the gap between metro-area uninsured residents and rural residents is significant, Iowa is nearly equal.

"And rural areas are struggling for a lot of reasons,” she states. “They already have a higher poverty rate. Oftentimes they have higher unemployment rates. And so being uninsured is just adding another woe to these struggling communities."

Discher says Iowa is a healthier state because more residents have insurance.

"Health insurance is the key that opens the door to the health care system,” she points out. “Without insurance, you just can't get the kind of regular care that you need to be healthy, to be a productive parent and worker."

Parents make up about half of rural low-income uninsured adults, many of whom are relied on by children as parents, child care providers, teachers or other caregivers.


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While many Americans have resumed normal lives after the past two years, the COVID pandemic has not gone away, especially if you have a pre-existing condition or are pregnant.

The nonprofit and nonpartisan Foundation for a Healthy Kentucky is reminding mothers-to-be in the Bluegrass State that being vaccinated against COVID-19 is one of many ways to better ensure a safe and healthy pregnancy.

Vice president for communications Ashley Brauer said all available data shows vaccination is safe for pregnant women and their children, and the goal of the campaign is to give mothers the facts they need to make an informed decision.

"The Foundation for a Healthy Kentucky and the Kentucky Association of Health Plans have partnered on this educational campaign with a goal to really increase knowledge," said Brauer, "and really encourage pregnant women to have a conversation with their doctors so that they can learn more and decide what's right for them."

Brauer says science-based information, including a series of video testimonials from medical professionals and mothers who were vaccinated while pregnant, are available online at Healthy-KY.org.

The Centers for Disease Control and Prevention says COVID-19 vaccination is recommended for people who are pregnant, breastfeeding, trying to get pregnant now - or might become pregnant in the future.

In a testimonial video, vaccinated mother Chelsea Lexington said she chose to be part of the campaign to encourage expectant mothers to make the same decision she did.

"Getting pregnant during a pandemic is one thing I will never forget," said Lexington. "My decision to get the COVID-19 vaccine was about the safety and protection of my child. My advice to you would be to go and talk to your doctor to see if the shot is the right thing for you."

Katherine Kington North - director of external affairs for the Kentucky Association of Health Plans - said while the decision is ultimately up to each mother-to-be, the benefits of vaccination are clear.

"It is so important because only 31% of pregnant women in the U.S. are vaccinated for COVID," said Kington North. "And unvaccinated pregnant women are 40% more likely to develop serious complications from COVID. So empowering pregnant women to have a deeper conversation about the vaccine."

When given to a pregnant woman, the COVID-19 vaccine works in the muscle where the vaccine is injected, and does not cross to the baby directly. But antibodies are received through the placenta or through breast milk after birth, providing some protection to the baby against the novel coronavirus during the first six months of life.

South Dakota is among the states hardest hit by the lack of baby formula in stores. There is debate about the underlying factors, but one health expert said there are steps new parents can take in the meantime.

Supply-chain disruptions and a recent product recall have been connected to the empty store shelves parents have encountered.

Dr. Esther Chung, a pediatrician at the University of Washington, said panic buys are also at play, and stores are having a hard time keeping up with demand. She cautioned some people might try to stretch the formula they have by diluting it, and strongly advised against it.

"We would say that's not safe," Chung stated. "Particularly for young infants, because it wouldn't give them the proper nutrition, and it could cause health problems."

Chung pointed out a possible solution is to look for alternative brands sold under a store's name, with ingredients often similar to name brands. According to Datasembly, South Dakota had an out-of-stock rate of more than 50% in late April.

Other experts suggest calling your pediatrician for recommendations on available products. Industry officials noted smaller stores and pharmacies might have more consistent supplies. And Chung added for older infants, parents can get a little creative with puréed food.

"The other thing that people have tried is taking puréed foods that they've made at home and put them in little ice-cube trays" Chung suggested. "That way, they can freeze these little mini-meals and pull them out for later use."

She stressed it is still important for parents to follow pediatric guidelines in not introducing solid food to babies until they're four to six months old. She also discouraged trying to buy formula products through eBay or similar resale platforms, citing safety concerns.

Nurses from across Wisconsin converged on the state Capitol building Thursday, as part of a rally demanding fairer wages and safer staffing ratios as the pandemic continues.

A report from the Wisconsin Hospital Association (WHA) indicates medical facilities across the state are struggling to fill vacant health care positions, as the strain from the COVID-19 pandemic has driven nurses out of the health care industry.

Carolyn Miller, a registered nurse from Eau Claire, said at a news conference in the Capitol Rotunda on Thursday, the issues plaguing the health care system affect workers at every level.

"Radiology techs, lab technicians, CNAs, unit clerks, EMTs and paramedics," Miller outlined. "All jobs and livelihoods have been slashed in the name of for-profit health care and without regard to patient outcome."

Thursday's event was part of a national series of protests organized under the banner of the National Nurses March, which culminated with a separate march on Congress in the nation's capital. Among other demands, participating nurses are pushing hospitals to ensure fair pay, increased safety standards for health care workers and better caregiver-to-patient ratios.

According to the WHA report, Wisconsin's population is steadily aging, and the health care demand the aging population creates will persist for at least the next two decades.

Adina Sharafinski, a registered nurse who specializes in hospice and end-of-life care, said she has had to endure grueling work conditions at prior jobs to ensure her patients were cared for.

"All of us have one thing in common: you guys are all going to come and see me someday," Sharafinski noted. "There is no avoiding it. And every single one of you deserves to die in peace, in dignity and in comfort."

The report said in 2015, Wisconsin had no counties with more than 40% of the population over age 60. By 2040, about one-fifth of Wisconsin's 72 counties will cross the threshold.

Miller added the pandemic exposed long-standing issues within the American health care system, and contended it needs to be reformed to ensure nurses and other front line medical workers have safer and fairer working standards.

"We lack so much infrastructure, and we aren't heard," Miller observed. "It is time for us to be respected, and it is time for administrators to sit down, stop talking and let us have what we need to do our jobs."

According to the state's Department of Health Services, nearly 90% of hospital beds are currently in use, and COVID-19 hospitalizations are charting upward for the first time since the Omicron surge peaked mid-January.