Randy Nordlund of Albert City lost his job, his insurance, his home and his sight. Now he's struggling with brain cancer. Where can uninsured Iowans in dire need turn?
Randy Nordlund is having a truly lousy year.
Nordlund, 53, of Albert City, lost his job and his health insurance, was diagnosed with brain cancer and has cataracts in both eyes. Homeless and unable to see clearly, he now lives at the Humility of Mary Shelter in Davenport and receives daily treatment from the Genesis Cancer Care Institute.
As health professionals in the Quad-Cities try to help the man from the northwest part of the state, Nordlund has become an example of the cost involved in treating Iowans who do not have traditional health insurance.
He is grateful for the help. The hospital is absorbing a bill of more than $80,000, which is part of the $4.3 million it spends on such patients as Nordlund in a year's time. When all of the charity and uncompensated care was added up for 2007, Genesis wrote off $42.3 million, officials there said, a percentage that has grown dramatically in the past few years.
Nordlund has a high school degree and a year of post-graduate training. He has worked in factories most of his life and is skilled at welding and driving a forklift tractor. Divorced, he is the father of two teenage girls and has an extended family, several of whom live near his father's farm in Albert City.
He moved to Sacramento, Calif., for a job last year, but he began having seizures - eventually found to be caused by the brain cancer - in January. When the seizures became more frequent, he returned home to his father's home and the hospital in Buena Vista County, three-fourths of the way across the state. With no job or health insurance, his best option for coverage is IowaCare.
IowaCare is the state program that provides health benefits to low-income adults not eligible for Medicaid or Medicare. In 2005, it replaced the former "state papers" charity procedure that had been in effect since 1919.
The program essentially covers all eligible Iowans. About 27,000 are enrolled now, and that number is expected to grow. With one exception, treatment is provided at University Hospitals in Iowa City. For Polk County residents only, it is available at Broadlawns Medical Center in Des Moines.
Because Nordlund's address is Albert City, 175 miles northwest of Des Moines, his treatment was ordered to take place at University Hospitals. He was transferred to Davenport for radiation therapy because of some state-of-the-art equipment available at the Genesis Cancer Care Institute.
The appropriation is $63 million for the IowaCare program, which includes a complicated mix of state and federal funds. That amount is expected to grow to $81 million next year as the needs increase.
Stating the case
Legislators are being lobbied by medical organizations, including Genesis, to allow treatment costs to be spread to community hospitals all over the state. That would decrease travel expenses, be more fair and more efficient, advocates say.
It also would be expensive, said Rep. Dave Heaton, R-Mount Pleasant.
Heaton is on the House Health and Human Services Appropriations Committee. He estimated cost at $700 million to cover all Iowans who lack traditional health insurance.
Sen. Frank Wood, D-Eldridge, agrees that a large program expansion would test the state's resources. He is interested in a more limited plan that would allow hospitals such as Genesis to be used in emergency situations.
Shawn Hamerlinck, a Davenport Republican running for election against Wood, said the next Iowa Legislature should fix the inequality he sees.
"The state needs to assist hospitals and individuals who need health care," he said. "IowaCare actually takes away care and puts an undue burden on local hospitals."
Rep. Elesha Gayman, D-Davenport, supports an expansion of IowaCare beyond Polk and Johnson counties, but she wants to keep a close eye on the costs. Some noninsured or underinsured Iowans simply use hospital emergency rooms when they are sick, she said, which increases costs for everyone.
The fact Genesis is not compensated for Nordlund's treatment bothers Ross Paustian, a Republican from Walcott, who is facing Gayman for a statehouse seat.
"It's just not right the way it is," he said, advocating a close look at the budget costs involved.
University of Iowa role
"We are proud of the IowaCare program and of the care the citizens of Iowa receive," said Dr. Dan Fick, a family physician and administrator of the program at University Hospitals.
Physicians, he explained, are not compensated through IowaCare, nor were they when the state papers program was in effect. Fick has no problem with a program expansion beyond the borders of Johnson County as long as university physicians are treated equally with others in the state.
Nordlund arrived in Davenport after undergoing cancer surgery at University Hospitals. Surgeons removed a walnut-sized tumor from his left frontal lobe.
He is receiving radiation treatment at Genesis via its new TomoTherapy equipment, which is among the most advanced forms of care available in the state. He is scheduled to receive 33 treatments and will get follow-up chemotherapy in pill form.
Nordlund will be in Davenport for a month or two and then head back to Iowa City for cataract surgery, he hopes, also to be paid for by the IowaCare program.
When his health is restored, Nordlund intends to pursue certification as a journeyman electrician or explore a new career in human resources. His family went to Iowa City when he had the brain surgery and his relatives keep in touch.
"I'm just trying to stay as positive as I can, as much as possible," Nordlund said as he headed into the cancer institute for treatment.