Rebecca Schweitzer on Iowa's Healthcare Crisis

Rebecca Schweitzer is a Des Moines, Iowa writer covering politics, healthcare, public accountability, and civic life. In response to ongoing discussions around Iowa's healthcare system, this piece offers perspective on how these issues impact communities across Iowa, including Des Moines and Polk County.

Iowa's Healthcare Crisis Is Already Here

Iowa leads the nation in closing maternity wards. Rural hospitals are shutting down or reducing services across the state. A quarter of Iowa farmers rely on the Affordable Care Act for health insurance. When enhanced premium credits expired at the end of 2025, families faced immediate cost increases of thousands of dollars per year. Earlier this year, Iowa's legislature passed two healthcare bills in a single week that made access to care harder, not easier, for everyday Iowans. I wrote about what those bills mean for Iowa families — you can read that piece here.

Earlier this year, Iowa's legislature passed two healthcare bills in a single week that made access to care harder, not easier, for everyday Iowans.

This is not a future problem. It is happening right now in communities across the state.

What Is Happening Now

Iowa ranks 45th in the nation for patient to physician ratio. That means Iowa families are already waiting longer, traveling further, and paying more to access basic medical care than families in almost every other state in the country.

Maternity wards are closing in rural communities at a rate that should alarm every Iowan regardless of political affiliation. When a maternity ward closes in a rural community, women face longer drives in labor, higher risk pregnancies, and in some cases no local option at all. Iowa is supposed to be a place where families can put down roots and build a life. That is hard to do when you cannot safely have a baby in your own community.

The Medicaid shortfall the state is currently managing did not appear out of nowhere. It is the direct consequence of years of tax cuts that reduced state revenue and left the legislature with less money to fund programs that Iowa's most vulnerable residents depend on. The solution Republicans chose was a temporary tax increase on health insurance providers that insurance companies have said could raise premiums for Iowa families by hundreds of dollars per year.

Iowa farmers are being squeezed from every direction. Input costs are up. Commodity prices are down. Farm income is projected to drop 24 percent in 2026. And now healthcare costs are rising at exactly the wrong time. When that coverage becomes unaffordable the ripple effects go far beyond the individual family. They go through the entire rural community that depends on that farm family staying financially viable.

What Iowa Deserves

Iowa deserves a healthcare system that works for everyone, not just people who live near a major metro area or who can afford rising premiums without feeling it.

That means fully funded rural hospitals and maternity wards. I wrote about Iowa's maternity ward crisis and what it means for Polk County women — you can read that here. It means protecting and expanding access to the Affordable Care Act rather than allowing it to erode. It means a Medicaid program that is funded adequately rather than patched together with temporary tax increases that get passed along to families. It means elected officials who show up for their constituents when those constituents reach out about healthcare costs.

In recent years, the state has run annual surpluses of roughly $2 billion. The question is not whether Iowa can afford to invest in healthcare access for its residents. The question is whether Iowa's leaders have the will to prioritize it.

Why This Matters for Iowa's Future

Strong communities are built on access to healthcare, education, and economic opportunity. When any of those three erodes the others follow. Iowa is watching all three erode simultaneously right now and the communities feeling it first and hardest are rural communities that have fewer resources to absorb the impact.

Iowa's 2026 governor's race is a direct referendum on these priorities. Iowans who care about healthcare access, rural hospital funding, and Medicaid stability should be paying close attention to what every candidate is saying and what their records actually show.

Rebecca Schweitzer is a Des Moines, Iowa writer covering politics, healthcare, and public accountability. Read more at iowaraisedrebeccaschweitzerunfiltered.com. Follow along on Medium and on X .