Implementation of the Affordable Care Act and Rural Health Clinic Capacity in Iowa

Objective: To evaluate the capacity of rural health clinics (RHCs) in Iowa as the Affordable Care Act (ACA) is implemented. Methods: We developed and fielded an online survey among the 142 RHCs in Iowa. Results: The survey response rate was 19% and this exceeds the response rate of previously published RHC studies. Responding RHCs report struggling to provide dental care and mental health services, and indicate a high degree of recruiting difficulty for physicians (80%), physician assistants, and nurse practitioners (both 50%), with referrals to specialists being common. Nearly 60% of RHC respondents anticipate an increase in the size of their patient population because of the ACA, with 14.8% expecting a substantial increase. Respondents indicated a lack of preparedness for participating in a value-based health care delivery system. While nearly all RHC respondents (90.4%) report knowing what steps they need to take to respond to the challenges health reform may present, only 19% agree that they have the human, financial, and material resources necessary to respond to those challenges. Conclusion: RHCs have limited capacity to respond to the opportunities and challenges of the ACA, and need additional resources and incentives to thrive in a reformed health care delivery system.