Больницы штата Айова увеличили расходы на социальные программы на 33% в 2025 году

When you think of the services a hospital provides, you might assume they’re all paid by insurance. But that’s not always true — hospitals voluntarily offer resources like community health screenings, free or reduced care and transportation assistance that insurance doesn’t cover. These extra services are called community benefits, and Iowa hospitals are increasingly paying more for them. Hospitals in the state spent $1.4 billion on community benefits in 2025, 33% more than in 2022, according to data from the Iowa Hospital Association. That spending is increasing in rural and urban hospitals. Mercy Medical Center and UnityPoint Health — St. Luke’s in Linn County spent 31% and 41% more, respectively, on community benefits in 2025 than in 2019. Pella Regional Health Center in Marion County saw an even greater increase of 48% in the same time period. That upward trend is likely to continue even as strains on the healthcare industry like Medicaid cuts and the rising cost of care wear on. But while their pockets are limited, Linn County’s hospitals say they’re committed to providing community benefits to the degree they’re able. Meeting community needs Community benefits are a broad category, and hospitals define and prioritize them in different ways. President of the Iowa Hospital Association Chris Mitchell described them generally as expenses insurance doesn’t adequately reimburse or doesn’t reimburse at all but that hospitals offer anyway. Under the Emergency Medical Treatment and Labor Act, hospitals are required to treat anyone with an emergency medical need, regardless of their ability to pay. Beyond that, hospitals aren’t legally required to provide community benefits, but Mitchell said hospitals recognize that offering community benefits is seen as part of their role. “I think there’s been a growing expectation that hospitals — I think traditionally nonprofit hospitals, but now all hospitals — provide some level of charity care,” Mitchell said. “Communities expect hospitals to be there when they’re needed.” A new report from the Iowa Hospital Association shows Iowa hospitals served more than 2.6 million people and provided $742 million in “communi… In Linn County, those community needs are determined in part by the Community Health Improvement Plan, a three-year roadmap of health priorities and goals for the county produced by Linn County Public Health in partnership with local hospitals and other partner organizations. Improving healthcare access, including increasing insurance coverage for so-called underserved populations was one of the three key needs identified in the 2025-2027 Community Health Improvement Plan. Mercy has primarily focused on access to care when deciding how to structure its community benefits, said Melissa Dean, director of mission outreach and community benefit at Mercy Medical Center. “We were founded by the Sisters of Mercy because there was a need to care for the poor at the time, and so we’re continuing to live that legacy,” Dean said. Some of Mercy’s community benefits include paying staff to work at the Community Health Free Clinic, as well as offering lab testing and radiology for patients there and at His Hands Free Clinic when needed. The hospital partners with some providers to offer cancer screenings for homeless patients. If someone seeks care at Mercy and doesn’t have sufficient insurance — or any insurance at all — the hospital has nine employees who can identify ways they can get better coverage, Dean said. “One of the things that we’ve really done over the last couple years is try to help people get access to insurance because we know they’re going to have better health outcomes if they have access to insurance, whether they come here or they go anywhere.” Charity care Roughly half of St. Luke’s community benefits in 2025 were for subsidized care, said Lori Weih, director of community engagement at UnityPoint Health-St. Luke’s. Subsidized care is for care that hospitals provide at a loss, even after accounting for charity care and Medicaid gaps. The hospital spent $21 million on services including mental health services, chronic disease management and cancer care in 2025, Weih said. Weih said St. Luke’s budgeted for subsidized care based on the gaps it saw between insurance reimbursements and the cost of care for certain services. “As an example, we have one of the largest adolescent and adult inpatient behavioral health units that doesn’t necessarily reimburse at what it takes to provide those services,” Weih said. “(We can) make that whole in order to deliver the care that our community needs.” Weih highlighted St. Luke’s community benefit spending on career exploration experiences for local high school and college students to bring future professionals into the healthcare workforce. Hospitals also may offer a type of financial assistance called “charity care” in which they provide services at a reduced or waived cost for patients who meet certain requirements. Like community benefits overall, the amounts Iowa hospitals are spending on financial assistance is increasing. Mercy and St. Luke’s spent 28% and 13% more, respectively, on charity care in 2025 than in 2019. Pella Regional Health Center’s charity care costs increased the most — 35% in the same time period. Dean said she believed the rise in charity care Mercy was paying for is coming from increased need. Although the percentage of uninsured people in the state is fairly low, at 5.7% it’s the highest it’s been since 2014 and is trending upward, according to data from KFF. Hospitals are staring down the barrel of significant Medicaid cuts as the cost of providing care continues rising. The One Big Beautiful Bill is predicted to cut $911 billion in federal Medicaid spending over the next decade. The legislation placed limits on state-directed payments. Medicaid reimbursements to providers don’t always match the cost of providing the service, so state-directed payments account for low reimbursement rates by allowing states to decide how Medicaid managed care organizations pay providers, usually to address specific state health priorities. The One Big Beautiful Bill capped state-directed payment rates. Further, in states where these rates are higher than Medicaid reimbursement rates, state-directed payment rates will decrease by 10 percentage points annually starting in 2028 until they match Medicaid reimbursement rates. Weih said state-directed payments “significantly” helped end un-reimbursed Medicaid payments from St. Luke’s patients. But with upcoming cuts, the gap between Medicaid rates and the cost of care may return. “The headwinds ahead are concerning,” Weih said. “We need to continue to be diligent on what reimbursement we have available to us, kind of work within those means.” These cuts will affect urban and rural hospitals alike, Mitchell said. The impacts of cuts will be less about which hospitals are affected the most and more about the impact each type of hospital has on the overall healthcare ecosystem. “When rural hospitals are struggling, then that adds pressure to the other hospitals, which is also very problematic,” Mitchell said. “I would characterize it as more compounding than one is better or worse than the other.” There’s no one factor driving the increased demand for financial assistance, Mitchell said. In addition to inflation, rising costs of healthcare and growing rates of people without insurance, hospitals also are changing their strategies on what to spend based on emerging information about community priorities or best practices for different conditions. That’s not to say hospitals are giving up. The amount hospitals are able to spend on community care might change, but both Dean and Weih said their hospitals will continue to provide community benefits regardless. “Historically there’s been lots of challenges that the healthcare community has faced, and each and every time hospitals have met the moment, and that will continue,” Mitchell said. “Helping and healing people and communities is in hospital DNA.”