Outsider Zach Lahn couldn’t stop Montana Medicaid expansion

Zach Lahn is running for governor of Iowa claiming he is an “outsider.” This assertion has been disputed by his Democratic opponent, for good reason.

But once upon a time, Lahn was a real political outsider, way out in Montana.

Surely the state’s natural beauty was a draw, but Lahn’s mission in Big Sky country was to hunt down Obamacare! Specifically, the law’s invitation for states to expand Medicaid.

In July 2014, Lahn was hired to direct Americans for Prosperity’s Montana operation. The office ramped up from two staffers to 11 and opened field offices in Billings, Bozeman and Missoula.

Americans for Prosperity is a conservative advocacy group founded by Kansas billionaire brothers Charles and David Koch to push for “free-market” policies, lots of tax cuts and slashing government safety net programs rarely needed by billionaire brothers.

In Montana, Medicaid expansion was expected to be a big issue during the 2015 legislative session. Then-Gov. Steve Bullock, a Democrat, wanted expansion passed and some moderate Republicans appeared willing to compromise to help make it happen.

So AFP, with a fat wallet and a national playbook, tried to stop Medicaid expansion before it could recklessly provide healthcare coverage to 45,000 Montanans. Lahn, who grew up near Sioux City, previously worked for a Montana congressman, but AFP was no grassroots, down-home Montana organization.

AFP held town hall meetings across Montana to “educate” people about the evils of making healthcare coverage more widely available. The group also took aim at any Republican lawmakers who did not sign AFP’s pledge to oppose Medicaid expansion.

Forget your constituents. Sign our pledge.

“We have a long-term plan to educate Montanans on economic freedom,” Lahn said, according to the Bozeman Daily Chronicle, in August 2014.

One of the lawmakers AFP targeted was Rep. Frank Gardner, a Republican from Kalispell and former police chief. That was a bad idea.

On Feb. 5, 2015, according to the Flathead Beacon, Lahn brought the AFP road show to Kalispell where 100 people gathered. But many came not to hear AFPs pitch but to loudly defend Gardner. He wasn’t invited by AFP but drove four hours from Helena to defend himself.

Rep. Rob Cook, R-Conrad, told the Beacon, “There is a duplicity in their behavior. On the one hand they want to pretend they are for the betterment of Montana, but on the other hand they are not from Montana and neither is their money.”

The Beacon reported that AFP was partnering with the Foundation for Government Accountability, a Florida think tank plugged into a network of conservative groups funded mostly by rich guys intent on denying healthcare to low-income Americans. Conservative lawmakers were cribbing pre-fabricated anti-expansion ideas from other red states and model legislation.

But the compromising Republicans held their ground and Medicaid expansion passed the Senate and House. Bullock signed it into law. AFP did not like it.

“We are deeply disappointed in the legislature’s decision tonight to expand Medicaid. This decision stands directly against the voices of millions of Montanans who have made it clear that they do not want more Obamacare,” Lahn said in a statement.

But Montana’s population in 2014 was just 1.02 million people. Oops.

“When you’re a DC-based group funded by the billionaire Koch brothers and more concerned with spending unlimited amounts to buy elections than promoting good policies, you don’t care about the facts — or how many people live in Montana,” Bullock said in a statement.

A month after it failed to stop Medicaid expansion, Lahn left Americans for Prosperity Montana. He moved to Kansas, founded a private school in 2018, voted in Kansas elections in 2018, 2020 and in an August 2022 primary, according to the Kansas Reflector. He registered to vote in Iowa in October 2024, just in time to be eligible to run for governor in 2026.

Lahn’s work for AFP in Montana is instructive for Iowa voters.

First, it tells us about his dim view of Medicaid.

Thanks to deep cuts in federal spending on Medicaid — a program funded with federal and state bucks — Iowa stands to lose $9 billion in funding over the next 10 years. That could cost 68,000 Iowans their health coverage. People could die. But, remember, we’re all going to die.

Iowa’s switch to managed care in 2016 has already made life difficult for families that need home care for disabled loved ones and costly treatments they rely on to live.

Medicaid work requirements and more frequent eligibility checks will increase administrative costs for states including Iowa, according to an analysis by the Commonwealth Fund. Like many states, Iowa may have to cut provider reimbursement rates, eliminate benefits and require some recipients to pay fees, aka “cost-sharing.”

Maybe “optional” benefits will be cut, including dental, behavioral health and home-based services to save money. Iowans who can’t maneuver a new bureaucratic maze might just drop out of the program. Ka-ching!

This year, Iowa lawmakers temporarily raised a premium tax paid by HMOs to help cover a $90.6 million Medicaid deficit and a projected $167.6 million shortfall next fiscal year. Republicans are also using $89 million from the general fund to cover the current shortfall while $350 million is transferred into the budget from Iowa’s Taxpayer Relief Fund to cover holes left by fat income tax cuts.

So the next governor is going to face tough decisions on the future of Medicaid. Lahn has already shown us in Montana that he cares very little for people going without health insurance. Painful cuts are likely. Iowans can treat them with the magic of “free-market solutions.”

Rural hospital drowning in budgetary red ink? The free-market solution to that problem is shutting it down.

Speaking of the free market, a 2025 report by the Montana Health Foundation found said expansion creates 5,600 to 8,000 jobs and generates $350 million to $560 million in personal income throughout Montana’s economy annually. It provides health coverage to 13 percent of Montana’s workforce. Not being sick is a real plus for staying employed.

Second, if you’re tired of watching Iowa Republicans embrace legislation cooked up in conservative think tanks and bill mills or imported from other red states, Lahn will be a disappointment. He is well connected to the web of conservative groups attempting to push state-level policy to the right. Hell, he worked in that world.

The Foundation for Government Accountability and its lobbying arm, Opportunity Solutions Project, have lobbied for some really sweet bills in Iowa, loosening child labor laws, slashing holes in the safety net and making it harder to vote absentee. Did someone say duplicity?

Iowa solutions to Iowa problems? That’s so 1998.

So Lahn was an outsider, then became an insider, and now he’s trying to be an outsider again. If he wins, Terrace Hill is going to need a revolving door.

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