Several growth strategies and long-term plans for the Des Moines market’s influential health systems were disrupted in 2021 following the COVID-19 outbreak. UnityPoint Health and MercyOne, the two dominant systems in the market, received millions in federal aid through the CARES Act to help keep them afloat during the crisis. UnityPoint Health saw its revenues dip significantly, and MercyOne announced it had to furlough workers since the federal money only covered 50 percent of the losses it sustained due to the outbreak. As of fall 2021, Iowa was one the states hardest hit by the virus. In April 2021, UnityPoint president and CEO Kevin Vermeer abruptly stepped down, potentially due to decisions made to furlough workers and because of significantly declining revenues as a result of having to cancel elective surgeries. The Des Moines healthcare market is highly consolidated and has been driven by its two leading health systems, which have dominated the area through their wide networks of care sites, employed or affiliated physicians, and relationships with regional payers. However, the impact of the virus outbreak could alter the market’s healthcare landscape moving forward, as industry experts expect some hospitals will face further financial challenges and possible closures. UnityPoint has more than half of the market’s inpatient discharges, and basically splits the market with rival MercyOne. The latter has seen its influence and ability to compete begin to diminish, as UnityPoint is simply too large, integrated, and well-funded. The Des Moines market continues to struggle to attract and retain providers, and most of the physicians in the market are controlled to some extent by one of the market’s large health systems. Enrollment in the state’s managed Medicaid program, IA Health Link, experienced major upheaval when UnitedHealthcare exited the program and Centene subsidiary Iowa Total Care joined.