IAAHC’s Phil Jeneary Calls for Facility Fee Restrictions in Des Moines Register Story About Mission Cancer Billing

The September 15, 2026 article in the Des Moines Register by Lee Rood is below.

Iowa bill limiting hospital charges coming after Mission Cancer columns

Health care advocates are asking Iowa legislators to consider a ban on facility fees at outpatient clinics owned by hospitals and increased billing transparency in response columns from the Register's Reader Watchdog highlighting big price hikes for patients. The spike in costs follows the sale of Mission Cancer + Blood, a leading oncology care provider based in Des Moines, to University of Iowa Health Care. The operator of the state's largest hospital, UIHC, has added hospital facility fees to bills for services provided by the clinical network, dramatically increasing expenses for patients and their insurance providers.

Phil Jeneary, executive director of Iowans for the nonprofit Iowans for Affordable Healthcare, said his group is drafting a bill for the next legislative session that would require hospitals to notify patients when they are charged the added fees. Jeneary said he also is talking to legislators about a ban on fees for outpatient and telehealth visits.

The organization is asking patients who have experienced higher prices from hospital facility fees to contact iaahc.com/contactus so its representatives can share their stories with state lawmakers.

"I think they are intrigued by this idea," Jeneary said of legislators he's talked to so far from both parties. "There’s a lot more conversation happening now than, maybe, 12 months ago. A lot of the legislators have read the stories and have seen what’s going on. ... I think there will be a lot of support behind this."

UIHC communications officials said the organization supports the idea of more transparency.

"UI Health Care supports that every hospital should notify patients when they are charged hospital facility fees. To support patients, we have additional information on our website https://uihc.org/patient-financial-resources. This includes financial patient services for those with difficulty to pay," the communication officials said in a statement.

Hospitals rely on facility fees as a revenue stream, Mitchell said. And one reason hospital officials are buying up outpatient clinics like Mission Cancer + Blood across the country is to make the revenue needed to provide the high-quality care the public expects.

The American Hospital Association has strongly opposed state and federal efforts to ban or restrict facility fees. Proposed federal measures, the organization said, would cut anywhere from $3 billion to $180 billion from hospitals over 10 years.

Hospitals, it has said, treat patients who are sicker and have more chronic conditions than those in other settings. They also disproportionately care for the uninsured and individuals enrolled in Medicaid, and the "financial losses associated with caring for these patients must be covered by other sources of revenue," the AHA has said.

Restrictions on fees becoming more common

Facility fees are extra charges added by hospital-owned clinics or health systems for routine visits, telehealth appointments or outpatient procedures, separate from physicians' professional fees.

Nine states prohibit providers from charging hospital facility fees for care settings such as off-campus locations far from a main hospital, according to research from Georgetown University's Center on Health Insurance Reforms. More than 20 states have taken action to curb the fees in some way, and members of Congress from both parties have introduced legislation to limit hospitals’ ability to charge them to Medicare for outpatient treatment.

The added fees can tack hundreds, even thousands, of dollars onto patient bills for non-hospital care. One 2025 study, using modeling issued by Brown University's Center for Advancing Health Policy and United States of Care, found prohibiting hospitals from charging facility fees for most regular doctor appointments would have a very modest impact on hospital profits. In the three states studied, Indiana, Massachusetts and North Carolina, it would amount to 1%.

Mission Cancer + Blood patients have been angry and frustrated over the past year by the substantially higher bills they've gotten since UIHC took over Mission Cancer + Blood's billing last summer. Some said they changed providers; others said their insurers refused to pay the higher bills and moved them to less-expensive infusion centers for their medication.

Debbie Lemke, a 67-year-old leukemia patient who lives in Johnston, said Medicare's cost for her treatments at Mission since the sale has increased around $10,600.

Once a month, she said, she drives to a Mission clinic on E Court Avenue in Des Moines for treatment, including an immunoglobulin G drip to build up her body's immunity. After billing switched to UIHC last summer, she said, the cost of each visit, billed to the taxpayer-funded federal health insurance program, shot up to $18,000 from around $7,400.

"That's just crazy," she said.

Lemke said she works in health care and understands the need for hospitals to cover their costs. But she said she and others at the Mission clinic "are not anywhere near a hospital." That revenue is flowing to UIHC and she said she doesn't think it's fair.

"And I'm a Hawkeye fan!" she said.

Health care affordability a top concern

Gov. Kim Reynolds and some members of the Iowa Board of Regents, which oversees the state's public universities including the University of Iowa, were surprised to learn from a July Watchdog column about the increase in the cost for care at a time when Iowa has the second-highest cancer rate in the country.

Subsequent Watchdog reports highlighted new research showing health care costs have increased for patients, insurers and employers as giant hospital networks have bought up independent clinics.

When UIHC bought Mission Cancer for $280 million, university officials touted that bringing the 45-year-old cancer practice with 20 clinics around Iowa into its fold would help provide better cancer care, particularly in rural Iowa.

But more people are struggling with rising premiums and out-of-pocket health care costs, and that's become a major issue in state and federal political races.

On average, workers contribute $6,850 annually toward the cost of family coverage, according to KFF Health News. The average deductible among covered workers in a plan with a general annual deductible was $1,886 for single coverage.

A Washington Post analysis, released in July, shows health-care premiums are expected to increase significantly again this year.

In an annual economic well-being survey conducted by the Federal Reserve Board, 26% of adults said they skipped medical expenses in 2025 because of the cost. Almost 40% of Americans cannot afford an unexpected $400 medical expense without selling assets or borrowing money.

Jeneary said he has been in contact with the gubernatorial campaigns of Republican Zach Lahn and Democratic State Auditor Rob Sand and that they have been monitoring what's happened with Mission Cancer bills.

"Both said they’ve read the stories," he said. "I think this is becoming a pretty big issue."

Headquartered in Des Moines, Wellmark Blue Cross Blue Shield said in a statement it also believes health care costs should be based on the care received, not who owns the facility.

The insurance giant said it supports policies that ensure the same price for the same service, whether it's in a hospital-owned clinic or an independent physician's office. "This helps make healthcare costs fair, predictable and easier for Iowans to understand, so they know what to expect and can manage costs with confidence," the statement said.

On the federal level, U.S. Sen. Joni Ernst's office did not respond to an email seeking comment on federal legislation. But the communications team for her fellow Iowa Republican, U.S. Sen. Chuck Grassley, said he hears from Iowans about the high cost of health care and prescription drugs as he tours Iowa's 99 counties each year.

Grassley has fought for greater transparency in health care costs, including in the federal 340B drug discount program Watchdog columns have covered.

He's also cosponsored the Patients Deserve Price Tags Act to make costs more transparent by requiring providers to publish the costs of services. That legislation advanced out of the Senate Health, Education, Labor and Pensions Committee in July.

"I’m always working to find meaningful solutions that will make healthcare more accessible and more affordable for Iowans," Grassley said in a statement.