Acardinal rule as elected officials is not to break things — as in, if it isn’t broken, don’t “fix” it — not unlike the medical profession’s Hippocratic oath: first, do no harm.

Our state faces multiple self-inflicted healthcare crises that result from ignoring that rule.

• We have the second highest cancer rate in the nation and are one of just two states with a rising rate of new cancers.

• We have the lowest ratio of OB-GYNs in the country, paired with one of the steepest declines in access to maternal healthcare.

• We have high rates of mental illness, with deficient access to mental health care.

• We have an aging population, and serious problems with nursing homes and other options for care.

• And then there are all the unknowns coming from Washington with respect to Medicaid and Medicare.

Decisions, whether made in Des Moines or in Washington — both controlled by Republican trifectas — are actively making caring for Iowans more difficult.

Take our state’s cancer crisis — we all know a friend or family member impacted by cancer. A rational person would conclude that Iowa needs increased funding for research and treatment, and an influx of medical professionals to tackle the problem. Instead, the federal government slashed National Institute of Health (NIH) grant funding to our universities (including ongoing patient trials), and the governor asked the legislature to allocate just $1 million for new cancer research, a relative drop in the bucket.

Meanwhile, some of our state legislative colleagues have been so focused on attacking higher education that it is increasingly difficult to attract and retain the medical professionals and researchers we so desperately need. We only need to look across the Missouri River to neighboring Nebraska for a different model. They have purposefully built a robust, well-funded, and well-staffed research and development program. We can, too.

Iowa struggles to provide adequate access to maternal healthcare, especially in our rural areas (fully one-third of our counties are considered maternity care deserts). After abandoning the federal Medicaid family planning network in favor of an anemic state-run program, the legislature passed one of the country’s strictest abortion bans. Now, even more hospitals are closing labor and delivery units, in part because legislative policy has created an environment where medical professionals must walk a legal and medical tightrope while trying to make split-second, complex decisions. We must again become a welcoming state for medical professionals.

We’ve lost out on a dozen CDC grants aimed at providing funding for state and local health departments because Republican officials fell in line, rather than challenging President Trump’s draconian cuts in court. States that did, won their legal challenges and kept their grants. We work for Iowans – we should have, too. We still can.

Carefully researched legislation aimed at addressing Iowa’s nursing home issues can’t even get subcommittee hearings because they were introduced by a Democrat. Good ideas aren’t red or blue – they’re Iowan. Let’s pass them.

On top of it all, every member of our Republican federal delegation signed onto a disastrous budget bill that has our rural hospitals, which already run on thin margins, worried that upcoming cuts to Medicaid may force them to shutter. And when a hospital closes, it doesn’t just close for Medicaid patients, it closes for everyone, with enormous economic knock on impacts for that community as well. That’s bad policy – let’s reverse it.

Improving healthcare access, affordability, and quality for ALL Iowans, regardless of zip code, starts by examining what actually works, not “fixing” things that aren’t broken. The next step is showing a spine and working for Iowa solutions. Real leadership means getting it done. We’re ready.

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Janice Weiner is a member of the Iowa Senate

and represents the 45th District.