IOWA CITY - Iowa has been at the forefront of expanding health care coverage, but that effort could be impeded without significant system reform at the national level, Gov. Chet Culver warned today.

At the same time, Culver said he doesn't know what the reform will look like, and one of his top advisers warned the national reform effort might not favor Iowa.

In Iowa City, Culver heard concerns about the lack of health care providers and services, especially in rural Iowa, and the need for mental health services for children.

Despite the gains Iowa has made in expanding coverage of children, primarily through the state HAWK-I insurance program, flat or declining funding has limited the state's ability to meet children's health care needs, Cheryll Jones told Culver. Jones, a former Linn County public health nurse who is now chairwoman of the Iowa Board of Health, said that in addition to too few providers, there is a lack of recognition of the importance of coordination of services and adequate reimbursement.

Medical students at the forum said they worry they can't make enough money in small towns to repay their student loans. Culver said he would look at expanding the state's student loan repayment program.

The concerns come against a backdrop of "truly remarkable" progress in expanding health care services in Iowa, said Dr. Michael Artman, head of the department of pediatrics at University of Iowa Hospitals and Clinics. The Commonwealth Fund, he said, rated Iowa No. 1 in its first national scorecard on children's health.

Earlier, Culver toured Blank Children's Hospital in Des Moines and touted state efforts to bring 42,000 children under the health-insurance umbrella in the past 30 months.

This past session, lawmakers and Culver agreed to spend $5.7 million in the current budget year to provide insurance access to another 12,000 children and to provide dental coverage to 35,000 Iowa kids. However, he said that was only possible in a tough budgeting situation by putting a priority on children's health issues.

Culver said there are mental health issues that pertain to children that need attention during the 2010 legislative session, but he and Sen. Jack Hatch, D-Des Moines, said major reform is needed at the federal level to address accessibility and affordability issues. The governor, however, was noncommittal whether the federal overhaul should include a public option that would compete with private insurance plans.

"That may or may not be a part of the final agreement. The bottom line is we need to have health care reform in America," Culver said.

"There are a lot of different ways that we can reform health care," he said. "I think time will tell in terms of what kinds of agreements and what type of compromises can be made."

They may not favor Iowa, a high-quality, low-cost health care state, said Charlie Krogmeier, Culver's director of the Department of Human Services.

"The concern is that in addressing states that are high-cost, low-quality, some of the good things accomplished in Iowa will get lost," Krogmeier said. "As this thing develops, we could end up with something that moves us back."

Culver said a major focus will be trying to get 27,510 children currently eligible but not covered by state or Medicaid programs enrolled in an insurance plan. He urged parents to go to www.hawk-iowa.org or to call (800) 257-8563.