Affordable, Accessible Healthcare for All Iowans

The Iowans Over Insiders Agenda: Part Four

Healthcare is personal to me.

My mom Terry is a physician who was diagnosed with multiple sclerosis when I was only a child. She has lived with a chronic illness for most of her adult life. I learned young — too young — that access to quality, affordable healthcare isn’t an abstract policy debate. It is a matter of security and dignity. Nobody should ever have to wonder whether the next prescription, the next specialist, the next hospital stay will be the one that breaks the bank.

My mom Jackie is a union nurse at the VA outpatient clinic in Coralville. She has spent her career on the front lines of our healthcare system, caring for the veterans who served this country. She has seen up close what happens when that system fails the people who need it most. She has watched a system that should serve Iowans get squeezed harder every year by the same corporate special interests that bankroll politicians like Ashley Hinson.

We deserve better.

That’s why in this campaign, I’ve visited with hospital leadership in places like Belmond, Denison, and Red Oak to make sure I understand the issues facing healthcare in Iowa. I’ve seen the promise of hard working Iowans going above and beyond in these places: how Belmond Specialty is stepping up to provide mental health support for their community, how Crawford County Memorial makes sure patients receive care even when insurance fails, and how Montgomery County Memorial is finding ways to expand dental services.

Each of those hospitals are staples of their communities, but see real challenges ahead due to the recently passed federal cuts to healthcare programs that one hospital called “our salvation”.

We need a fighter in Washington D.C. to make sure Iowans get the care they need regardless of their zip code, and I am committed to being that fighter.

No Iowan should go bankrupt because they got sick. No Iowan should drive two hours because the rural clinic in their county closed. No Iowan should ration a life-saving medicine to make it to the next paycheck. And no veteran who served this country should have their VA care privatized out from under them.

That’s the promise I’m running on. And it’s a promise Ashley Hinson has already broken.

The Hinson Healthcare Crisis

Ashley Hinson didn’t just vote the wrong way on healthcare. She bragged about it.

When Congressional Republicans pushed through the largest cut to Medicaid in American history to pay for tax cuts for billionaires. Hinson called it something to be “proud” of. Then she went home and watched the consequences hit her own constituents.

What Hinson’s votes have cost Iowa:

• Roughly 110,000 Iowans are projected to lose their health insurance because of the Medicaid cuts Hinson voted for.

• Up to 117,890 Iowans are seeing their health insurance costs go up.

• Iowa health insurance premiums are projected to rise 97 percent — an average increase of $1,080 a year for working families.

• Two more Iowa clinics have closed — MercyOne clinics in Ottumwa and Des Moines — because of Hinson’s vote to gut Medicaid. That’s on top of the 20 rural Iowa hospitals already at risk before she cast her vote.

• Thirty-four healthcare workers were laid off at MercyOne North Iowa Medical Center in Mason City — in Hinson’s own district — with the hospital system citing her Medicaid vote as a direct cause.

• Iowa is losing obstetric care faster than any other state in the country.

• 37,700 rural Iowans will lose Medicaid coverage over the next 10 years and rural Iowa hospitals will lose $2.7 billion

Then, when Iowans came begging Hinson to at least restore the Affordable Care Act premium tax credits and stop premiums from doubling, she refused.

13,529 fewer Iowans signed up for ACA coverage this year during open enrollment. The cost of insurance for those who kept it doubled.

Ashley Hinson voted for every bit of this. She voted to gut Medicaid so billionaires could get a bigger tax cut. She voted to let premiums double rather than extend the subsidies that were keeping working families covered. And when rural hospitals in her own district started laying people off, she didn’t lift a finger to fix what she had broken.

That isn’t a market outcome. That’s a policy choice. And it’s time to choose differently.

My Plan: Lower Healthcare Costs and Expand Access

The American healthcare system isn’t broken by accident. It is broken because corporate special interests — insurance companies, drug manufacturers, hospital chains, and the middlemen who profit off all of them — spend billions every year to keep it that way. And politicians like Ashley Hinson take their checks and do their bidding.

That ends when I get to the Senate.

Healthcare is a human right, and this healthcare agenda has four pillars, each targeting a specific way the system has been rigged against hardworking Iowans, and offering a concrete plan to fix it.

1. Lower Costs

2. Ensure Access to Care

3. Fight Iowa’s Cancer Crisis

4. Expand Mental Health and Substance Use Disorder Services

Here’s what that looks like in practice.

1. Lower Costs

Americans pay more for healthcare than anyone else in the developed world, and we don’t get better outcomes for it. We get a system that has been engineered by design to extract as much money as possible from Iowa families before it grudgingly delivers care.

Here’s how we change that.

I will fight to:

• Create a true public option. Every Iowan should have access to a quality, affordable public health insurance plan, whether or not their employer offers coverage. I support allowing every American to buy into Medicare at any age. It’s the quickest path to lowering costs across the entire system, because it forces insurance companies to compete on price instead of squeezing patients. And it’s the foundation for reaching universal coverage in this country.

• Take on Big Pharma. Americans pay more for prescription drugs than anyone else in the world, not because our drugs are better, but because Big Pharma has spent decades buying off Washington. I will fight to:

  • Expand Medicare’s power to negotiate drug prices. The Inflation Reduction Act finally let Medicare negotiate the price of a small number of drugs — and on the first ten alone, the negotiated prices came in 38 to 79 percent below list. That’s the model.

  • Allow Americans to safely import lower-cost prescription drugs from Canada. Big Pharma has spent decades scaring Americans about safety to protect that price gap, but the FDA has had legal authority to certify safe importation since 2003 and Congress has blocked it from being used. I will fight to finally implement safe importation at scale, so Iowa families and Iowa pharmacies can access the same lower prices our neighbors to the north already pay.

  • End the pharmaceutical industry’s stranglehold on what Iowans pay at the pharmacy counter. Big Pharma games the patent system to block generic competition for years after a drug should have gone off-patent. They make small tweaks to existing drugs and call them new inventions to extend their monopolies. All of it is legal. None of it should be. I will fight to close the patent loopholes, ban pay-for-delay deals, and stop the patent abuse that keeps prescription drug prices artificially high in this country and nowhere else.

  • End the taxpayer subsidy for prescription drug commercials. The United States and New Zealand are the only two developed countries that allow direct-to-consumer pharmaceutical advertising. Drug companies get to deduct the cost of those ads as an ordinary business expense — which means American taxpayers are effectively subsidizing the TV commercials that drive up the prices we pay at the pharmacy counter. I support the End Taxpayer Subsidies for Drug Ads Act to close that loophole for good.

• Crack down on Pharmacy Benefit Managers. Pharmacy benefit managers, the corporate middlemen who sit between patients, pharmacies, and drugmakers, are one of the biggest reasons drug prices keep climbing. Three PBMs now control about 80 percent of the U.S. prescription drug market, and they’ve been routinely paying Iowa pharmacies less than the cost of the drug. Iowa has lost more than 200 pharmacies since 2014, with 31 closing in 2024 alone. In a county with one pharmacy, that closure means seniors and farmers drive an extra 30 miles for a prescription. I voted for Iowa’s PBM reform law in 2025, and the federal version of that fight needs to happen too.

• Expand access to affordable children’s health insurance. Currently, state Medicaid and Children’s Health Insurance Program (CHIP) coverage ends when children turn 19. This is despite most private plans allowing children to remain on their parents’ coverage until they turn 26. Eligibility for these programs should work the same way until an individual enrolls in a separate plan by their own choice, or exceeds established income limits.

• Break up the hospital and insurance monopolies driving up Iowa’s healthcare costs. The same corporate consolidation that has hollowed out Iowa’s farm economy and Iowa’s Main Streets has come for Iowa’s healthcare system. A handful of hospital systems and insurance carriers now dominate the market in most of our state. The research is clear: hospital consolidation drives prices up by 20 percent or more without improving care, and insurance consolidation lets carriers squeeze patients and providers on both ends. The federal government has rubber-stamped merger after merger while Iowa families pay the bill. I will push the DOJ and FTC to aggressively review pending healthcare mergers, unwind the ones that should never have been approved, and stop the consolidation that is making American healthcare more expensive every single year.

• End surprise medical billing for good. No Iowan should get hit with a $3,000 bill from an out-of-network anesthesiologist they never chose to see, or a “facility fee” for a five-minute visit at a hospital-owned clinic that used to be a doctor’s office down the street. Congress passed the No Surprises Act in 2020, but hospitals and insurers have spent the last several years gaming it. I will fight to close the loopholes, expand the protections to ground ambulance rides, one of the biggest remaining sources of surprise bills, and ban the hidden facility fees that turn a routine appointment into a four-figure invoice.

• Take on the medical debt crisis. Medical debt is the single leading cause of personal bankruptcy in the United States, and one in three Americans carry it. That isn’t a moral failing on the part of working families. It’s the inevitable result of a system designed to bill people who are too sick to fight back. I will fight to ban medical debt from credit reports, undoing the Trump administration’s rollback of the CFPB rule, cap the interest rates that turn a hospital bill into a decade of compounding debt, and crack down on the aggressive collection practices that nonprofit hospitals use against the very patients they got tax breaks to serve. A medical emergency should not be a financial death sentence.

• Cap insulin at $35 a month — for everyone. Insulin costs pennies to manufacture. There is no excuse for any Iowan with diabetes to ration a life-saving medication. Democrats already capped insulin at $35 a month for Iowans on Medicare. We need to extend that cap to every American, regardless of how they get their insurance.

• Restore the ACA premium tax credits — permanently. When Congress let the enhanced ACA tax credits expire, Iowa families saw their premiums double overnight. Small business owners told reporters their premiums would “eat up” their entire profits. A breast cancer survivor in Des Moines said her premiums without the credits would exceed her mortgage payment. Ashley Hinson voted to let it happen. I will vote to restore the enhanced premium tax credits permanently — not as a temporary patch, but as a long-term commitment to keeping coverage affordable for the working families who rely on the marketplace.

Insurance companies, drug manufacturers, hospital chains, PBMs, and debt collectors have written the rules of American healthcare. It’s time to write them differently.

2. Ensure Access to Care

Affordable insurance only matters if you can actually use it. In Iowa today, that’s getting harder every year — especially in rural communities where hospitals are closing, OB-GYNs are vanishing, the nearest specialist might be a hundred miles away, and the people who provide care are stretched past the breaking point.

I will fight to:

• Lower the Medicare eligibility age to 55. Medicare works. It’s popular, it’s reliable, and it provides quality coverage for tens of millions of Americans. Lowering the eligibility age to 55 would let more Iowans access affordable coverage during the years when healthcare costs typically rise the fastest, and it would relieve pressure on the entire insurance market.

• Expand Medicare to cover dental, vision, and hearing. It is absurd that Ashley Hinson voted against it. Coverage for healthy teeth, eyes, and ears shouldn’t be optional. Iowa seniors shouldn’t have to choose between a dental procedure and groceries. Medicare should cover dental, vision, and hearing — period.

• Reverse the Medicaid cuts to Iowa’s rural hospitals. The Medicaid cuts Hinson voted for are projected to strip $2.7 billion from rural Iowa hospitals over the next decade and force tens of thousands of Iowans off their coverage. Critical access hospitals in Ottumwa, Oelwein, and Red Oak are now on the brink. Layoffs have already started in Mason City. Clinics in Des Moines have already closed. Iowa cannot afford to lose another rural hospital. I will fight to fully restore the $800 billion in Medicaid funding Hinson voted to cut, and I will work to deliver real, sustained federal investment in the rural hospitals that are the heart of small-town Iowa and establish a federal rural healthcare infrastructure fund that converts abandoned buildings into permanent medical facilities, with long-term lease agreements for rural practitioners and explicit protections against private equity acquisition after title transfers. I’ll push to move rural hospitals away from a volume-based reimbursement model toward upfront, operating-cost-based funding that gives critical access hospitals the stability to keep their doors open year-round. And I’ll fight for a permanent network of mobile health units reaching Iowa’s most underserved counties.

• Defend women’s healthcare and end the maternal mortality crisis. Iowa ranks near the bottom of the country in OB-GYN access, and we are losing obstetric care faster than any other state in America. Women in rural Iowa are being forced to drive hours for basic prenatal appointments. The United States has the worst maternal mortality rate in the developed world, and it is getting worse — with Black women dying in childbirth at three times the rate of white women (six times in Iowa). That is unacceptable, and it’s a direct consequence of decades of disinvestment, the rollback of reproductive rights, and a healthcare system that treats women’s health as an afterthought. I will defend access to the full range of women’s healthcare, including reproductive services, contraception, maternal care, abortion care, and OB-GYN coverage. I will fight to restore the federal protections Iowans deserve, and push for serious federal investment in maternal health, including expanded postpartum Medicaid coverage and the rural OB-GYN workforce Iowa desperately needs.

• Make long-term care safe and affordable for Iowa families. Iowa’s population is aging faster than the national average, and the cost of long-term care is catastrophic for middle-class families. A year in a nursing home in Iowa now costs more than $80,000, and a single bad fall or dementia diagnosis can wipe out a lifetime of savings in a matter of months. I will fight to defend the federal nursing home staffing standards the industry is trying to kill, support the home- and community-based care alternatives that let Iowa seniors age in place with dignity, and crack down on the private equity firms that have been buying up Iowa nursing homes, slashing staffing, and pocketing the difference. Every Iowan who has spent decades contributing to this state deserves to retire with dignity, not to be exploited by a fraudulent operator cutting corners on their care.

• Make disability care part of traditional Medicaid coverage. Iowa is the birthplace of the “Medicaid Waiver” system that allows states to include additional necessary services for individuals with specific diagnoses. Whether that’s home health, supported community living, adult day care, or expanded mental health support - these waiver programs help ensure that individuals with disabilities can receive the services they need. The problem is that Iowa has a waitlist of 13,406 individuals - and can be years out - despite these Iowans needing services today. We need to revisit what’s covered under traditional Medicaid so that Iowans have access to the care they need to thrive in their communities. Rules regarding employed people with disability should be updated to ensure employment doesn’t risk jeopardizing these critical healthcare services.

• Solve Iowa’s healthcare workforce shortage. Iowa’s rural counties have lost nearly 10 percent of their primary care physicians, and the wait to see a specialist in many parts of our state is now measured in months. We are not going to fix Iowa’s healthcare access problem without fixing the people problem behind it. I will fight to expand federal loan forgiveness for doctors, nurses, and behavioral health providers who commit to serving rural and underserved communities; expand the number of Medicare-funded residency slots so we can train more physicians and keep more of them in Iowa; and invest in the nursing schools, community colleges, and apprenticeship programs that are training the next generation of Iowa healthcare workers.

• Protect and expand telehealth. In a state as rural as ours, telehealth isn’t a luxury — it’s a lifeline. A farmer in Pocahontas County shouldn’t have to take half a day off to drive to Des Moines for a 15-minute appointment. I will fight to make permanent the telehealth expansions that proved their value during COVID, and to expand reimbursement for rural providers so telehealth is a real option, not a half-measure.

• Hold privatized Medicaid systems accountable. In Iowa, the privatization of our Medicaid program has led to an almost 1000% increase in denials of care prescribed by medical professionals, and has failed to demonstrate meaningful cost savings while insurance companies profit millions every year from tax-payer funding. The federal government should provide resources to help states transition to direct fee-for-service models that provide better access to healthcare, and provide higher scrutiny to Managed Care Organization (MCO) models that profit from denying needed care.

• Keep Artificial Intelligence out of insurance denials. Simply put: we cannot allow health insurance companies to delegate decisions over whether an Iowan is denied medically prescribed healthcare to artificial intelligence platforms. If insurance companies are going to deny care, it should be done by a licensed professional trained to evaluate the facts and record, not by a calculated coded machine. The stakes are too high. We should end the Medicare pilot program that seeks to integrate AI into Medicare claims. Insurance companies should also not be allowed to use AI to reduce provider reimbursements (down-coding) without human review.

• Defend the VA from privatization and stand with the veterans who served. My mom Jackie has spent her career as a union nurse at the VA in Coralville, caring for the veterans who served this country. The VA is not perfect, but the people who work there are some of the most dedicated healthcare professionals in America, and the care veterans get there is in many cases better than what the private sector provides. There is a coordinated effort underway in Washington to privatize the VA — to siphon veterans into the private healthcare system, hand the contracts to corporate middlemen, and gut the VA workforce in the process. I will fight to stop it. I will defend VA staffing, expand mental healthcare and suicide prevention services for veterans, address the toxic exposure crises that have harmed Iowa veterans for decades, and make sure that no veteran in this state has to fight their own government to get the care they earned through their service.

3. Fight Iowa’s Cancer Crisis

Iowa has the second-highest cancer rate in the country. We are one of the only states in America where the rate is still climbing. This is a public health emergency, and our state’s political leaders have been treating it like background noise. That has to change.

In Marshalltown, I heard from a woman going through cancer treatment, who has to go to six different providers to get the comprehensive care she needs. We need to do better on both cancer prevention and care for Iowans..

I will fight to:

• Invest in cancer research, detection, and prevention. Iowa families deserve a federal partner in fighting this crisis. I will push for major federal investment in cancer research, with a focus on the cancers hitting Iowans hardest. I will fight to expand early detection and screening programs, especially in rural communities where access to mammograms, colonoscopies, and other preventive care is limited or nonexistent.

• Address the environmental drivers. We cannot have a serious conversation about Iowa’s cancer rate without talking about what’s in our water and what’s on our land. Agricultural runoff, nitrate contamination, and water quality issues are affecting what Iowans drink, what we eat, and ultimately what is making us sick. I will support tougher federal standards, real funding for water quality research and remediation, and a federal commitment to identifying and addressing the environmental contributors to Iowa’s cancer crisis.

• Take on the agricultural chemical companies poisoning Iowa. Iowa uses more pesticides per acre than almost any state in the country, and the scientific evidence linking certain agricultural chemicals to cancer, Parkinson’s disease, and developmental harm in children has grown substantially over the past decade. I will fight to strengthen EPA review of the most dangerous pesticides, including paraquat, which is banned in more than 60 countries and linked to Parkinson’s disease, close the loopholes that let chemical companies keep products on the market for decades after safer alternatives exist, and invest in independent research on agricultural chemical exposure that isn’t funded by the companies selling the chemicals. And I will fight any effort by Bayer-Monsanto and the chemical industry to strip Iowans of their right to sue when these products cause harm. The companies making billions off these chemicals can afford to make them safer.

• Pass the Protecting Patient Access to Cancer and Complex Therapies Act. The Inflation Reduction Act’s drug price negotiation provisions — which I support — contain a structural flaw: they lower drug costs by cutting the add-on payment to physicians who administer those drugs, not by requiring manufacturers to rebate the savings. That means independent oncology practices — the ones closest to Iowa patients — absorb the financial hit. Avalere Health analysis projects oncologists could see a nearly 50 percent reduction in the payments that fund infusion, pharmacy staff, and care coordination. H.R. 4299 fixes this by requiring drug manufacturers to provide rebates directly to Medicare, so we get the savings without dismantling the delivery system. This is a bipartisan fix, and I will push to get it done.

• Fix the Stark Law loophole that forces Iowa cancer patients into more expensive care settings. Current federal law restricts physicians from dispensing specialty medications directly from their practices — a holdover rule designed to prevent self-referral that has had the unintended effect of forcing patients into hospital outpatient settings that cost 53 percent more for the same cancer treatment. Hospital outpatient chemotherapy is more expensive for Medicare and for patients out of pocket. The Seniors’ Access to Critical Medications Act, bipartisan legislation that has already cleared committee, would fix this through 2030. I will fight to pass it and to make the fix permanent.

• Stop the private equity consolidation of Iowa’s oncology practices. When independent practices close, private equity steps in — not to deliver better care, but to extract margin. The consolidation of cancer care into corporate-owned networks and hospital systems drives prices up, limits patient choice, and puts profit ahead of treatment decisions. I will fight to give the DOJ and FTC the tools and the mandate to stop it.

Iowans shouldn’t have to choose between farming and clean water. We can do both, but it requires a senator who will actually fight for it.

4. Expand Mental Health and Substance Use Disorder Services

In rural Iowa, the wait for a mental health appointment can stretch for months. For a family in crisis, that might as well be forever. We have a mental health workforce shortage, an opioid crisis that has hit small-town Iowa especially hard, and an insurance system that still treats mental health like a second-class concern.

I will fight to:

• Make real investments in mental healthcare. I will fight for serious federal investment in mental health services — including expanding the mental health workforce in rural Iowa, increasing funding for community mental health centers, and supporting school-based mental health programs so Iowa kids can get help before a crisis becomes a tragedy.

• Enforce true mental health parity. Insurance companies have been gaming mental health parity laws for decades — covering physical health one way and mental health another. That ends now. I will support tough enforcement of mental health parity requirements so insurers cannot deny, delay, or limit mental healthcare on a different standard than they apply to physical health.

• Expand substance use disorder treatment. The opioid crisis and alcohol addiction continue to hit rural communities hard. I will fight to expand access to substance use disorder treatment, recovery services, and medication-assisted treatment with a particular focus on the small-town Iowa communities that have been hit hardest and have the fewest resources to fight back.

The Bottom Line

Ashley Hinson made her choice. She voted for the largest Medicaid cut in American history. She voted to let ACA premiums double. She watched rural hospitals in her own district lay off workers and close their doors, and she did nothing. She works for the corporate special interests that bankroll her campaign. She doesn’t work for you.

Iowa families are paying more for prescriptions, more for premiums, more for hospital bills, more for nursing home care, not because the market randomly decided to raise prices, but because the politicians writing the rules in Washington have been bought and paid for. That’s the connection between corruption and costs. And in healthcare, more than anywhere else, Iowans are the ones paying the price.

My Promise to Iowa

I grew up in a family that has lived with a chronic illness, with a union nurse on the front lines of our healthcare system, and with a healthy fear of what an unexpected medical bill can do to a working family. I am raising my own family in Iowa now, and I think about my mom Terry and my mom Jackie every time I talk about this fight.

I refuse corporate PAC money. I will not take a check from the insurance companies, the drug manufacturers, the hospital chains, or the corporate middlemen whose business model depends on overcharging Iowa families. Iowans need a Senator who will work to lower the cost of healthcare, save our rural hospitals, defend the VA, take on Big Pharma and the insurance companies, and put Iowans first — every single time.

This is what Iowans Over Insiders means.

On my honor, I will be that senator.