Kim Reynolds touts Iowa's rising 'national profile' as she defends contentious legislation

As she signed a bill into law Wednesday that would allow physician assistants to practice without a supervising doctor, Gov. Kim Reynolds defended controversial legislation passed this session, arguing an influx of residents shows Iowa is on the right path.

"Our national profile is rising," Reynolds said at Washington County Hospital Wednesday afternoon after signing House File 424. "We're reducing taxes and regulations. We're building out our health care system. We've been recognized as a Top 10 state to live by U.S. News and World Report.

"Top 10. Iowa. So I am excited about what is happening and I'm excited about our future.”

The Republican-dominated Legislature gave Reynolds a host of victories this session, passing much of her agenda, including controversial bills such as a ban on gender-affirming care for children, taxpayer-paid savings accounts for private schooling and a ban on books describing or visually depicting a sex act in the state's schools.

During the signing of House File 424, Reynolds called the bill a way to remove the legal tie between physician assistants and physicians, part of her administration's larger efforts to boost the state’s strained health care workforce.

She also signed another bill in Bettendorf Wednesday afternoon establishing an apprenticeship division within Iowa Workforce Development.

She said she had no concern that recent Republican legislative victories would make some see Iowa as a less friendly state.

She said U.S. Census Bureau data shows that Iowa has seen more people come to the state, while nearby Illinois and Minnesota — which both have Democratic governors — have seen people leave. She said Iowa saw 7,000 people move into the state, while Minnesota lost 17,000 people and Illinois 280,000.

"I believe that's low. You're going to continue to see those numbers grow, so I'm really excited," Reynolds told reporters.

The figures correlate to Census Bureau data for July 2021 to July 2022. The bureau notes that Iowa saw a growth in net migration because of international migration, but it lost residents domestically.

What's in the new physician assistant law?

The new law, House File 424, which passed the Iowa Legislature earlier this month, removes the state mandate that physician assistants maintain a legal relationship with a physician to practice in the state. It also stipulates physician assistants are legally responsible for the care they provide.

This move aligns regulations for these providers with nurse practitioners, who have a similar scope of practice but fewer hours of training and aren't required to be supervised by a physician.

It's estimated 1,300 physician assistants are practicing in Iowa.

With this move, Iowa joins five states that have removed the legally mandated relationship between physician assistants and doctors, according to the American Academy of Physician Associates.

Health systems could still choose to require its physician assistants to be overseen by doctors. Republican lawmakers said during the session that the bill would be a boon for rural health care.

“Iowa communities are facing a serious health care provider shortage, and House File 424 will ensure that the health care system has the necessary choice and flexibility to meet the needs of Iowans," Sen. Dawn Driscoll, R-Iowa, the bill's floor manager, said April 20 during Senate debate.

Physician assistants say mandate had hindered job prospects

Some medical groups pushed back against the legislation during the session, raising concerns that loosening oversight could lead to poorer health care for patients. Lawmakers compromised by adding supervision requirements for a physician assistant with less than two years of experience who plans to open an independent practice.

About 60% of graduates from Iowa's five physician assistant programs leave the state after graduation, according to the Iowa Physician Assistant Society, which lobbied for the bill.

The new law comes after Reynolds previously signed a law limiting the amount of money Iowans can receive for pain and suffering in medical malpractice lawsuits.

“Tort reform was huge," she said to reporters Wednesday. "That was driving physicians and health care professionals out of the state as well. We were an outlier, so that will help us retain and attract.”

The Medical Liability Monitor, a specialty publication that focuses on medical malpractice insurance rates, lists Iowa as the fifth-lowest state in the country for medical malpractice insurance rates across all medical specialties.

Bill creates new state apprenticeship designation

Reynolds also signed Senate File 318 into law Wednesday afternoon. The law creates the Iowa Office of Apprenticeship, a new division within Iowa Workforce Development that will regulate apprenticeship programs.

The law also requires licensing agencies to grant an occupational license to anyone who successfully completes an apprenticeship and passes necessary examinations.

Sen. Adrian Dickey, R-Packwood, said the bill will provide new opportunities to young people who want to learn a trade. Apprentices must be at least 16, under the law.

“Many students and adults have no interest in attending college altogether — and there is nothing wrong with that,” Dickey said. “Many Iowans are simply interested in just working. They want to gain valuable on-the-job training in a practical field that they find interesting.”

Democrats opposed the bill’s passage, arguing it would allow the Office of Apprenticeship to approve apprenticeship programs that do not meet federal standards.

“The approval of apprenticeship programs that do not meet (Department of Labor) requirements risks empowering second-rate training programs that water down quality and safety,” Sen. Todd Taylor, D-Cedar Rapids, said in a statement.

Lawmakers passed another bill, Senate File 542, that allows teenagers to work longer hours and take jobs that were previously banned, if the job is part of a work-based learning or apprenticeship program. Reynolds has not yet signed that bill into law.

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm.

Katie Akin is a politics reporter for the Register. Reach her at kakin@registermedia.com. Follow her on Twitter at @katie_akin.

This article originally appeared on Des Moines Register: Oversight of physician assistants in Iowa loosened under new law