Iowa gubernatorial nominees differ on healthcare policy

A statewide poll conducted in December by Cygnal for the advocacy group Iowans for Affordable Healthcare found 61% of likely Iowa voters say their healthcare costs have gone up. Iowans in November will choose between two gubernatorial candidates with sharply different approaches to health and healthcare policy.

Republican incumbent Gov. Kim Reynolds is not seeking reelection. On June 2, Democratic primary voters selected State Auditor Rob Sand as their nominee, while Republicans nominated investment executive and former GOP political operative Zach Lahn.

In 2024, about 8% of adults aged 18-64 in the state had no health insurance, according to the nonpartisan Commonwealth Fund. A September 2025 analysis by the Center for American Progress predicted that the combination of federal healthcare spending cuts in President Donald Trump’s One Big Beautiful Bill Act in 2025 and the expiration in December of a temporary tax credit that helped millions of Americans afford private health insurance plans will cause 106,000 more Iowans to lose their insurance by 2034.

Here is what the gubernatorial candidates have said about health policy.

Rob Sand

The policy priorities listed on Sand’s campaign website include his healthcare plan, called “The Truer Better Agenda: A Healthier Iowa for All.”

Iowa has one of the highest cancer rates in the country, according to the Iowa Cancer Registry, a concern both campaigns have highlighted.

“Cancer doesn’t care who you vote for, what your politics are, or where you live,” Sand’s plan says. “It’s the top issue on everyone’s mind no matter what part of the state I’m in, and rightfully so. Yet over the last several years, Iowa has become one of only two states in the country with a growing cancer rate – and with the fastest rising cancer growth rate in the nation – while our current elected officials stick their heads in the sand and pretend there is no problem.”

Sand proposes investment in water quality monitoring, radon testing, manure management, digesters to control methane release, a dirty-water notification system, and wetlands conservation, as well as the creation of a Cabinet-level task force to combat Iowa’s cancer crisis.

He proposes to reverse a 2016 executive policy that outsourced the management of Iowa’s Medicaid program to private insurance companies. “This has driven up costs,” Sand told KCCI 8 News in May. “In fact, this Legislature and this governor just raised the costs of health insurance for most Iowans, if you have an HMO program, in order to pay for the profits of the [managed care organizations] that have privatized Medicaid.”

Sand also says he would crack down on pharmacy benefit managers, expand the availability of telehealth services, and protect reproductive healthcare. 

“Communities across Iowa are being left without access to essential care, including labor and delivery units, putting the lives of expecting mothers and their unborn children at risk and forcing health care workers out of our state,” he says in his plan. “As government insiders and my opponents promise further culture wars and restrictions on fundamental freedoms, I would veto any culture war bills that cross my desk that further attacks on providers, make Iowa a less welcoming place to live, and threaten access to surrogacy, contraception, and IVF.”

As state auditor since 2019, Sand presided over audits of state and local health facilities to ensure they were meeting their legal fiduciary obligations. After his 2022 audit of the Iowa Department of Health and Human Services found a risk of duplicate payments and payments to ineligible recipients, a 2026 follow-up found the department had successfully addressed the issues.

On June 10, Sand released a report on findings that pharmacy benefit managers had driven up costs for Iowans and may have illegally charged insurers more for prescription medications than the actual cost at the pharmacy. “This practice is a misuse of tax dollars,” his office said in a press release. “It increases the cost of prescription drugs for consumers, undercuts Iowa Medicaid’s ability to negotiate capitation rates (the fixed amount paid to MCOs), devalues pharmacy networks, and reduces the quality of care for beneficiaries.” 

In 2021, Sand encouraged Iowans to get vaccinated, citing the cost of COVID-19 hospitalizations. “Please don’t add to others’ expenses: get the vaccine,” he urged, according to the Iowa Capital Dispatch. “Most importantly, it saves lives, but it also saves money.”

Sand has spoken out against cuts to Medicaid in the One Big Beautiful Bill Act signed into law by Trump last year and the impact the law will have on rural healthcare access. “That’s been brutal, and it’s going to be brutal in Iowa,” he said in a November podcast interview. “We’re estimating a little over 100,000 Iowans that will lose health insurance. That increases everybody’s costs, because at the end of the day, what that means is they’re not getting access to regular care that helps prevent big health problems.” 

Zach Lahn

Lahn highlights an endorsement from MAHA Action, a tax-exempt political organization aligned with Secretary of Health and Human Services Robert F. Kennedy Jr., on his campaign website.

His website says his priorities for confronting the cancer crisis are incentives to farmers to address agricultural runoff and water contamination, independent safety testing of products, research at the University of Iowa to solve the crisis, and “antitrust suits against monopolistic agricultural input companies to help our farmers.”.

“Iowans deserve things they can count on: a government that prioritizes people, low taxes, clean water, healthy kids, safe communities, and excellent schools,” his policy section says.

The Lahn campaign did not respond to a request for comment for this story.

Lahn’s gubernatorial campaign on May 26 shared a clip of a 2009 Rush Limbaugh radio segment in which Limbaughhe praised Lahn for a question he had asked then-President Barack Obama. The campaign ad was posted to YouTube with the title “Zach Lahn Confronts Obama 2009.” 

At a Colorado town hall, Lahn, who was then a student at the University of Colorado Boulder, asked Obama a question about including a public option in the Affordable Care Act.

“How in the world can a private corporation providing insurance compete with a entity that does not have to worry about making a profit?” he asked Obama. A clip of the exchange went viral in conservative circles at the time. 

The campaign video did not show Obama’s response, in which he said, “I think there are ways that we can address those competitive issues. And you’re absolutely right, if they’re not entirely addressed, then that raises a set of legitimate problems.”

Lahn went to work in 2014 as state director of the Montana chapter of Americans for Prosperity, a right-wing political committee founded by petrochemical billionaire Charles Koch and his late brother David. There, he oversaw an unsuccessful campaign to stop Montana from opting in to the ACA’s optional Medicaid expansion program, which enabled 75,000 Montana adults to enroll and obtain health insurance. 

An Americans for Prosperity-Montana flyer from that campaign, reported the Montana Standard in 2015, said: “THE FIGHT AGAINST OBAMACARE IN MONTANA IS NOW. Through more reckless federal spending, big government legislators on both sides of the aisle are working on several bills that will push Obama’s Medicaid expansion in Montana.” 

In an April 2015 op-ed on the conservative site Townhall, Lahn wrote: “As more and more Americans come to personally understand Obamacare’s many deficiencies, they’re rightfully outraged that state lawmakers would work to exacerbate its consequences even further. But instead of heeding that warning, a handful of Governors and lawmakers have gone to greater lengths than ever before to make sure Medicaid is expanded under Obamacare in their states.” 

Lahn urged “real free-market solutions that create good-paying jobs; policies that give the most vulnerable the ability to lift themselves up and live out their own version of the American dream” instead of “just more of the ObamaCare mess.”

Iowa expanded Medicaid in 2014 through the Iowa Health and Wellness Program; as of February, about 180,000 Iowans received health insurance through the expansion.

According to research by American Bridge 21st Century, Lahn opposes reproductive rights, calls himself “pro-life at conception” and supports a ban on abortion from that moment. 

Lahn also opposes allowing individuals to obtain medication abortion by mail.

According to Radio Iowa, during a January debate hosted by Moms for Liberty, which has been designated a far-right antigovernment group by the Southern Poverty Law Center, Lahn endorsed a ban on mRNA vaccines, including those used to protect against COVID-19.

 “mRNA vaccines are an experimental, rushed failure, ineffective against transmission, linked directly to harms like myocarditis, and propped up by Pharma capture,” Lahn falsely claimed in a December post on X. 

In February, he posted that mRNA vaccines should be banned “for livestock and other animals as well.”

Researchers say that mRNA technology can be used to help treat cancer. In April, researchers at Washington University School of Medicine in St. Louis published findings that mRNA vaccines triggered anti-tumor immune responses in mice.