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In Marshalltown, we understand how important it is to have quality health care close to home.
When someone has a heart attack, suffers a serious injury or receives a cancer diagnosis, the distance between a patient and the care they need matters. So does having enough doctors, nurses and other health care professionals to serve our community.
As a former Marshalltown police chief, I spent my career thinking about public safety. I believe access to health care is part of that conversation. A strong community needs police officers and firefighters, but it also needs a hospital, emergency care, mental health services and doctors who can treat people without requiring them to drive an hour or more.
That is why I am concerned about the direction of health care in Iowa.
For nearly a decade, Republicans have controlled both chambers of the Iowa Legislature as well as the governor’s office. That is more than enough time for voters to look at the results.
Iowa entered this year facing a Medicaid shortfall estimated at approximately $91 million for the current fiscal year and $168 million next year. The state’s response included temporarily increasing the tax on HMO insurance premiums from 0.925 percent to 3.5 percent. During debate over the legislation, Wellmark warned that the cost could amount to roughly $500 for a family of four covered by its affected HMO plan. Gov. Kim Reynolds argued that insurers don’t have to pass that cost along to their customers.
Meanwhile, rural hospitals were already operating under serious financial pressure before Congress made major changes to Medicaid in the One Big Beautiful Bill Act.
Congress also created a $50 billion Rural Health Transformation Program, and Iowa received $209 million for its first year. Some of that money is already being put to good use here in Marshalltown, including funding to recruit cardiology and oncology providers.
I welcome that investment. But temporary funding doesn’t answer the larger question.
What is Iowa’s long-term plan for keeping health care accessible and affordable in communities like ours?
Iowa’s Medicaid system has been under private management for a decade. Now the program faces another substantial budget shortfall. Health insurance costs continue to burden families. Rural hospitals face financial pressure. And new federal Medicaid changes create another layer of uncertainty.
At some point, leadership means taking responsibility for the system you have been running.
Republicans have controlled Iowa state government long enough that simply pointing toward Washington is not an adequate answer. State leaders should explain what they intend to do to protect rural hospitals, maintain access to care and keep health care affordable for Iowa families. And at a certain point, Iowa House Republicans have to stop blaming other people and start taking steps to solve the massive problems they created.
That doesn’t mean every single problem in health care was created at the Iowa Statehouse. It wasn’t. Health care costs are a national problem, federal policy has contributed to these negative effects, and hospitals themselves face complicated financial challenges.
But state government matters too.
Iowans deserve leaders willing to acknowledge what isn’t working, listen to patients and health care providers, and change course when necessary.
Most importantly, we need a long-term rural health strategy rather than moving from one budget problem to the next.
Because when a rural community loses a medical service, the consequences spread far beyond the hospital. Families travel farther for care. Employers have a harder time recruiting workers. Older residents have fewer options. And emergency responders have fewer places to take people when minutes matter.
Rural hospitals don’t just provide health care. They are part of the infrastructure that keeps communities alive.
After nearly a decade of one-party control at the Statehouse, I think Iowans are entitled to ask a straightforward question:
What is the plan?
Mike Tupper is a former Marshalltown police chief and the Democratic candidate for Iowa House District 52.