Health Care Shakes Up The Iowa Election

WAVERLY, Iowa — Gas and grocery prices have dominated the midterms, but November is shaping up to be a health care election too.

Few places see the convergence of health care fights as intimately as Iowa, where a cancer crisis, struggling rural hospitals, social safety net cuts and the MAHA movement collide across several of the country’s closest races.

In Cedar Rapids, seven in 10 people who walk into Eastern Iowa Health Center receive Medicaid. By charter, it can’t turn any of them away for inability to pay. And many patients teeter on economic precarity: The number living on month-to-month leases has more than doubled in three years. So when the bulk of Republicans’ sweeping Medicaid cuts kick in shortly after the midterms, the federally qualified health center will be bracing for impact.

“With the 80-hour work requirements, it’s gonna just be devastating for our patients and for us,” president and CEO Joe Lock told POLITICO.

Democrats are eager to exact a political price for Medicaid and SNAP changes in Republicans’ One Big Beautiful Bill Act, along with the expiration of enhanced Affordable Care Act subsidies. And if they flip control of Congress, that momentum could carry right into placing health care at the top of their 2027 agenda.

The Republican megalaw was one of the motivations for Democratic state Rep. Lindsay James to jump into the open House race in Iowa’s 2nd District. At a string of health care- and child care-focused stops last week, the pastor invoked the parable of the Good Samaritan to call for immediate relief from Washington.

Even before most Medicaid cuts take effect, the district has already seen some clinics and hospitals close or trim services, despite a smaller pool of money in the law meant to blunt the impact on rural communities.

“Some of the most consequential votes in our country are gonna be taken on health care in the next two to four years,” James said at a roundtable in Hiawatha’s library.

James is all in on House Minority Leader Hakeem Jeffries’ priorities to reverse Medicaid changes and restore ACA credits.

Would she play hardball to achieve them, like Democrats tried to do with the 2025 government shutdown? “I am a redhead,” she said with a smile in an interview at NewBo City Market, “and so I’m just wired to stand up and fight for people.”

Some GOP moderates supported the ACA subsidies or were uneasy about Medicaid cuts. James’ GOP opponent Joe Mitchell — a Charlie Kirk acolyte who speaks and gestures with a Trumpian inflection — would not likely be among them.

“These people are lying about the quote-unquote Medicaid cuts. They’re not Medicaid cuts. It just says that you have to work,” he told POLITICO. “I’m not gonna buy all the rubbish that they’re putting out there about what happened and didn’t happen in the Working Families Tax Cut.” As for Obamacare? It’s the root of the problem, he said: “They complain about health care a lot, for them putting in the exact system we have, which has made things far more unaffordable.”

But Iowa is also ground zero for a new kind of GOP health care messaging — with gubernatorial nominee Zach Lahn leading the way as a MAHA champion. He’s challenged the agriculture industry with detailed proposals to clean up Iowa’s waterways, where he says the fight to lower Iowa’s high rate of new cancer diagnoses begins. (The WSJ editorial board is less convinced, though they reserved their opprobrium on the topic last week for Democratic Senate nominee and state Rep. Josh Turek.)

Lahn told POLITICO his primary victory is “evidence” MAHA can be a novel way forward for Republicans. A couple hundred people in the conservative vacation town of Clear Lake noshed on popcorn and root beer floats as Lahn and Mitchell warned that this election is an existential fight for American culture — and Lahn won applause for saying pulling the Covid-19 vaccine off the market is a pro-life issue. “That combined with the economic populism that I’m talking about,” he added. Mitchell, too, has skewered some sacred Big Pharma and Big Agriculture cows.

But Democratic organizers think their message is breaking through. “This cycle, more than any other cycle, people are aware of the way that the Republican-controlled legislature has turned its back on working families and know more about those cuts than they ever have before,” said Sondra Goldschein, executive director of the Campaign for a Family Friendly Economy, as she stumped with James at a Dubuque brewery.

Some local Medicaid recipients are watching the impending changes with concern. Drew Carfrae, a 27-year-old college graduate who uses a wheelchair and needs 24/7 care for his rare arthrogryposis condition, already saw his benefits reduced in early 2025, he said at his home in Waverly. His mom, Jessica, had to quit her job to care for him thereafter. “We’re both afraid of what else could happen once it fully kicks in,” she said.

In the House race, there’s little love lost between James and Mitchell, the two former statehouse colleagues. Neither has made many overt efforts to tack toward the center. Mitchell calls James a far-left Portland native, with a heavy dose of transgender messaging. She accuses him of self-enrichment and says “he is deeply unserious about the realities and the needs of hard-working families.”

Iowa’s 2nd was seen initially as the most Republican of the state’s three competitive House races, but it has moved to center stage as the national environment got bluer. It’s now such a focal point that President Donald Trump will rally in Dubuque two days before the election. The district sprawls from Democratic urban hubs like Cedar Rapids and Waterloo, to the rural Driftless Area, to the literal Field of Dreams (for any candidate in need of inspiration) or the plane-crash site of The Day the Music Died (for any candidate in need of humbling).

James has led narrowly in some recent polling, and she could benefit from the coattails of native son Rob Sand, but both parties’ internal surveys show the Midwest getting closer. Republicans publicly project confidence Mitchell can carry the Trump +10 seat, particularly with incumbent Rep. Ashley Hinson’s Senate bid at the top of the ballot. Democrats privately admit to post-Ann Selzer stress disorder, worrying that polls may be overstating their position again. And there are some indications that polls in Iowa may indeed be struggling to reach Republicans.

Mitchell, who’d be the first Gen Z Republican in Congress, has leaned into anti-corruption messaging in ways a little atypical for his party, vowing to eschew corporate PAC money and calling for a constitutional amendment to undo Citizens United. A real estate developer, he leads his affordability pitch with tax cuts — and says his business hasn’t felt any hit from tariffs.

But not everybody is convinced Mitchell can hang on. “We give people just the choice of the lesser of two evils too often,” Winneshiek County GOP Chair Thomas Hansen said. “I don’t think he’s a strong candidate.”

Former Rep. Abby Finkenauer, the last federal Democrat to win in northeast Iowa, said she thinks James is the right fit to flip Dubuque County and make inroads along the Mississippi River. “Things like health care are the reason it’s going to come down to the wire here — and why I think Lindsay truly has the edge,” she said.

The key for Republicans will be rallying Trump’s base to turn out, so Mitchell has hitched his wagon closely to the president. There was no clearer distillation than his rally in the state last week, when Mitchell invented a Nobel makeup prize for Trump: a gold-framed “Man of the Century Award.”

Does he think Trump is the greatest man of the 21st century?

“I do,” Mitchell said the next morning. “He was deserving of it, and he obviously enjoyed it.”