title: Implementation of the Affordable Care Act and rural health clinic capacity in Iowa.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Iowa, Iowa City, IA, USA brad-wright@uiowa.edu.
authors.forename: Brad
authors.initials: B
authors.lastname: Wright
authors.affiliation: University of Iowa, Iowa City, IA, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Damiano
authors.affiliation: University of Iowa, Iowa City, IA, USA.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Bentler
mesh_terms: D000554:Ambulatory Care Facilities; D003695:Delivery of Health Care; D003729:Dental Care; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D019538:Health Care Surveys; D006282:Health Personnel; D006295:Health Resources; D006301:Health Services Needs and Demand; D006801:Humans; D007484:Iowa; D008605:Mental Health Services; D009722:Nurse Practitioners; D058991:Patient Protection and Affordable Care Act; D010560:Personnel Selection; D010823:Physician Assistants; D010820:Physicians; D012017:Referral and Consultation; D012423:Rural Health; D019035:Rural Health Services; D014481:United States; D000078329:Workforce
keywords: Affordable Care Act; Iowa; rural health clinics; safety net capacity