Sand Vows Executive Order to Undo Medicaid Privatization
Democratic gubernatorial candidate Rob Sand pledged this week to use an executive order to reverse Iowa's Medicaid privatization, a move that would bypass the state legislature and upend a decade of managed care. Sand also used a Centerville town hall to criticize Republican nominee Zach Lahn's public schedule and call for stricter oversight of private schools receiving taxpayer funds.
How would Sand reverse Iowa's Medicaid privatization?
Speaking to a crowd of more than 50 people at Lucile's restaurant in Centerville on Monday, Sand blamed Iowa's shift to managed care for a massive increase in denied medical claims. He argued that because the privatization was originally done by executive order a decade ago, he could undo it the same way without needing legislative approval.
As governor, I will reverse the privatization of Medicaid in the state. It has been a disaster.
Sand cited an audit from his own office, claiming that illegal denials of care rose at least 500% after the state handed Medicaid over to private managed-care companies. He said providers now have to hire staff just to fight those denials, which drives up costs for everyone.
What is the state of rural health care in Iowa?
The town hall focused heavily on rural health care struggles. Brett Mohler, an Albia Democrat running for the Iowa House, asked Sand how he would keep clinics open and retain medical staff. Mohler noted that River Hills Community Health Center will close its Centerville clinic on July 31, worsening access in a county that already faces shortages.
The nurses and providers who staff these clinics are stretched past the limit, working double- and triple-booked schedules. Many of them pay nearly $1,000 a month for their own family's health insurance. We're losing the clinics and the people who keep them running at the same time.
Sand tied these local struggles to federal Medicaid cuts and the state's managed-care system, arguing that a decade of single-party control in Des Moines has hurt everyday Iowans.
It's time to rotate the crops in Des Moines, it's plain and simple.
How does Sand view private school funding and school choice?
Education remains a sharp dividing line in the governor's race. Lahn has stated that the governor should be the state's leading champion for public schools, while also arguing that competition from private schools makes everyone better.
Sand, who has two children in public schools, dismissed Lahn's ability to advocate for public education.
I'm the only candidate with kids in Iowa public schools. I don't know how you can be the chief advocate if your kids aren't there. I think that's an issue.
Sand also took aim at the state's private-school funding program, criticizing the lack of financial scrutiny compared to public districts. He argued that taxpayers deserve transparency when their money is involved.
Every public school in Iowa gets audited every year. Here, we're not even allowed to audit a private school that gets your money.
He pushed for more accountability, suggesting that even supporters of school choice should recognize the program needs better oversight.
You can be a person who thinks, 'I like the idea of school choice' and yet also concludes, 'the program as it was written is a mess, and it needs oversight and it needs rules.' I'm not asking for things that I think are unreasonable, I'm asking for things that even with a Republican legislature ... that we could agree upon.
What is Sand's plan for agriculture and water quality?
Local farmer McKinley Lain asked Sand about supporting small and midsize farms following federal cuts to local food programs. Sand expressed support for expanding these programs, which allow producers to sell directly to nearby schools, hospitals, and jails.
There's a large, local source for consistent food demand that you know is going to be there. If you can support people locally, not only are you getting fresher and typically healthier foods ... you are keeping that money circulating within the state of Iowa as opposed to giving it all to Sodexo.
Sand connected this to his water-quality plan, which includes the largest wetlands restoration in state history and an expansion of a program that converts marginal cropland to grazing.
My kids drink Iowa water. My kids play in Iowa waters. We need to have cleaner water. I would love for us to expand the working lands program that [the Iowa Department of Agriculture and Land Stewardship] runs right now.
He emphasized the environmental benefits of wetlands, stating,
Because if we do that, there is nothing that filters water better than the system God made to do it.
Where is Zach Lahn on the campaign trail?
Sand repeatedly drew a contrast with Lahn, who has not held a public event since winning the Republican nomination on June 2. Sand said his campaign has challenged Lahn to hold 100 public town halls and agree to four debates in October, but no agreement has been reached. Sand defines a public town hall as an event announced two weeks in advance, open to everyone, with no screened questions.
I do 100 public town halls every year. I'm going to keep doing them. They stay on the calendar; they're already announced. What he does will be up to him and Iowans can decide the degree to which they want someone who's open and accessible.
The debate locations remain a sticking point. Sand said the proposed debates were set in cities where television stations are based. Lahn pushed back, arguing that city debates ignore rural Iowa. Sand countered that Lahn ignored the challenge to hold town halls in rural areas.
During the Republican primary, Lahn had a different stance. In an April 28 post on X, he challenged then-rival Randy Feenstra to four debates and wrote,
Iowans deserve to hear from the candidates.
Lahn has also faced questions about his ties to Kansas. The Des Moines Register reported in May that Lahn flew to Wichita 37 times since October 1 in a plane he owns, and he maintains a home there. Lahn stated the home and flights allow him to see his children from a blended family and that he is