When her husband Tom suffered a heart attack in 2022, Mary Stewart remembers that he worried about the cost of the helicopter transportation doctors said he needed.
“‘I’m just telling you, if that helicopter costs $80,000, I’m not getting on it,’” she recalled Tom saying.
“And I’m telling you, you can’t afford to wait,” the doctor replied.
Doctors at Ottumwa Regional Health Center had confirmed Tom was having a heart attack and needed treatment elsewhere. They told the Ottumwa couple he would not survive the time it would take to go by car or ground ambulance, Mary said.
A helicopter flew Tom to Iowa City where he received stents. By the time Mary and their sons arrived by car, Tom was sitting up in bed, joking with a physician. The surgery had been successful.
Mary and Tom have Medicare and additional insurance. But much of the care they need has moved outside their rural town of Ottumwa, forcing them to travel to specialist appointments in cities across Iowa and into Illinois.
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As rural clinics and hospitals close, patients like the Stewarts don’t just worry whether they can afford care. They worry about how far they must go to get it, and whether they can get there in time.
Fewer place to get care
Mary has lived in Ottumwa since 1975. A retired Indian Hills Community College administrator and former Democratic candidate for the Iowa state Senate, she remembers a community that drew patients from across southern Iowa and northern Missouri for medical care.
A combination of factors drove out the providers: Rural clinics were shouldering inadequate reimbursement from insurers, losing money with every patient. Meanwhile, childcare and housing opportunities for new physicians dwindled. With smaller teams of providers came higher rates of burnout. As appointments became harder to get, walk-in clinics inside grocery stores offered another option.
When friends from out of town would ask Mary where she received care, she’d tell them the grocery store.
“It was like, all of a sudden, you were going to buy milk and see the nurse practitioner at the same time,” she said.
Now, she said the clinic she used is gone, along with the grocery store that housed it too.
RELATED: MercyOne to close two South Des Moines clinics, citing expected Medicaid cuts
Then in 2025, Republicans voted in the “One Big Beautiful Bill Act,” which slashed Medicaid even further. It led to more hospitals across the state closing their doors, putting more than 100,000 Iowans at risk of losing care.
MercyOne, a nonprofit healthcare system, announced that its Ottumwa Family and Internal Medicine Clinic would stop seeing patients Feb. 27. Patients were offered information about transferring their records to its Centerville practice, about an hour away, or another primary care provider. MercyOne cited changing demographics and the need to consolidate or relocate services to remain sustainable.
READ MORE: Centerville clinic to close in July amid growing rural healthcare concerns
Earlier this year, gubernatorial candidate Rob Sand said the closure was “the latest blow to healthcare access for Iowans.”
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“For many Iowa towns, especially rural ones, hospitals, and clinics are the lifeblood of their communities,” he said in a statement. “On top of that, the privatization of Medicaid has only made things worse, burdening our healthcare providers with more administrative costs and leading to higher costs for Iowans, and threatening rural hospitals.”
Pella Regional Ottumwa clinic also reduced family practice operations after Jan. 15, citing difficulty recruiting and retaining providers.
Also in January, MercyOne’s parent company, Trinity Health, announced financial adjustments of its own. KIMT3 reported that Trinity Health planned to lay off 40 employees in Ottumwa, along with 34 in Mason City and 67 in Des Moines in March, as it moved certain non-patient-facing functions to a partner.
In the article, Trinity spokesman Todd Mizener said inadequate reimbursement, staffing shortages, rising costs, and government funding policy changes were behind the decisions.
“It is not possible to simply absorb such a significant financial impact without making thoughtful, forward-thinking changes,” Mizener said.
Insurance cannot shorten the drive
The Stewarts never did receive the $80,000 helicopter bill Tom feared. Mary believes insurance covered the transport.
Their coverage has not significantly restricted their choice of doctors, she said, but insurance does not bring those doctors closer to home.
A few months before Tom’s heart attack, Mary suffered a stroke. She was caring for her father in Illinois during the final stages of his cancer.
Mary said she received good care in Illinois. After her father died and she returned to Ottumwa, she tried to establish care locally, but the cardiology office was not accepting new patients, she said.
She continues seeing the cardiologist and neurologist who treated her in Illinois, about a two-and-a-half-hour drive from home. She trusts those physicians and has chosen to stay with them, although she believes she could find care somewhat closer, in Des Moines or Iowa City—even when both options would be more than an hour and a half away from Ottumwa.
Tom’s appointments take them elsewhere: a cardiologist in Iowa City, a rheumatologist in Urbandale, and a pulmonologist in Ankeny. They have also traveled to Mayo Clinic in Minnesota.
“Everything is a long distance for us in terms of anything other than just very basic healthcare needs,” she said.
For now, the couple can afford the trips and their medications, including one prescription that carried a $281 copayment. Mary knows that separates them from others in the community.
“I am fortunate enough to have,” she said. “But I have relatives who cut pills in half to try to stretch them out further, just because they can’t afford to purchase those medications every month. When those are things like blood pressure medications and others, it really has a huge impact on their health. And there’s a point at which it does become a life or death situation.”
Mary still uses Ottumwa Regional when she needs to. During a recent emergency visit, she said she received good care. But living several blocks from the hospital, she regularly hears reminders of the treatment patients must leave town to receive.
“I often refer to healthcare in Ottumwa as the sound of helicopters,” she said.
She hears them during the day and at night. She said she is grateful one was available for Tom.
Although she said she is fortunate, she still worries about how long she and her husband can keep making the trips their care requires.
“We can continue to make that drive,” she said. “But I’m sure that the day will come when we’re not able to.”
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