Rob Sand pledges to reverse Iowa Medicaid privatization

CENTERVILLE — When Brett Mohler's son was airlifted to a Des Moines children's hospital two years ago and diagnosed with Type 1 diabetes, the worth of rural health care came to the forefront of his mind.

So when Rob Sand opened the floor at a Centerville town hall Monday, Mohler — an Albia Democrat running for the Iowa House — stood to ask the Democratic candidate for governor how he would keep clinics open and their workers from leaving. River Hills Community Health Center will close its Centerville clinic July 31, he said, in a county where access was already a challenge.

He also noted that beyond clinic closures, rural health care is struggling with staffing shortages in the state.

"The nurses and providers who staff these clinics are stretched past the limit, working double- and triple-booked schedules," Mohler said. "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 the strain to federal Medicaid cuts and to Iowa's decision a decade ago to privatize its Medicaid program through managed-care companies. The privatization was done by executive order, he said, and he could undo it the same way, without the Legislature.

"As governor, I will reverse the privatization of Medicaid in the state," Sand said. "It has been a disaster."

An audit by his office found that illegal denials of care rose at least 500% after privatization, Sand said. He said providers now employ staff whose only job is to challenge those denials, driving up costs for everyone. Iowa has had 10 years of single-party control, a theme he returned to throughout the morning, and he said the state needs a change.

"It's time to rotate the crops in Des Moines, it's plain and simple," he said.

The stop drew more than 50 people to Lucile's, a restaurant inside the historic Continental Hotel, and was part of the 100-town-hall tour Sand holds each year. He opened by asking the Republicans in the room to raise their hands, then the independents — a couple went up for each — before leading the room in the first verse of "America the Beautiful."

"We don't want to make Iowa bluer or redder," Sand said. "We want to make it truer and better."

Education drew a sharper contrast with Republican nominee Zach Lahn, who has said the governor should be the state's leading champion for public schools.

"The governor of Iowa must be the number one advocate for public school kids in the state," Lahn has said, adding that competition from private schools "makes everybody better."

Sand, who has two children in public schools, said Lahn could not claim that role.

"I'm the only candidate with kids in Iowa public schools," Sand said. "I don't know how you can be the chief advocate if your kids aren't there. I think that's an issue."

He also faulted the state's private-school funding program for escaping the scrutiny applied to public districts.

"Every public school in Iowa gets audited every year," Sand said. "Here, we're not even allowed to audit a private school that gets your money."

Sand also specified the different rules private schools have with taxpayer money that differ from public schools and called for more transparency and accountability in the program.

"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,'" Sand said. "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."

McKinley Lain, who raises produce and pork in the county, asked what Sand would do to support small and midsize farms after federal cuts to local and regional food programs. Sand said he supports expanding those programs, which let producers sell to nearby schools, hospitals and jails.

"There's a large, local source for consistent food demand that you know is going to be there," Sand said. "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."

He tied the issue to his water-quality plan, which calls for 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," Sand said. "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." Sand was referring to the department's pilot program that takes land less suitable for row crops and converts it into grazing land.

Sand also said he wanted to expand wetlands in the state.

"I would like us to have the single biggest wetlands restoration we've ever seen," Sand said. "Because if we do that, there is nothing that filters water better than the system God made to do it."

Contrast with Republican nominee Zach Lahn

Lahn has not held a public event since winning the nomination June 2. Asked before the town hall about the contrast, Sand said it was "a better question for him."

"I do 100 public town halls every year. I'm going to keep doing them," Sand said. "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."

Sand said his campaign has challenged Lahn to hold 100 public town halls of his own and to meet for four debates in October, but said Monday that the two sides have not reached an agreement. He defined a public town hall as one held with two weeks' notice, open to anyone who wants to attend, with questions that are not screened in advance.

The debates were proposed in cities because that is where television stations are based, Sand said. Lahn pushed back, arguing that city debates would ignore rural Iowa.

"That completely leaves out the fact that we said you should do 100 public town halls," Sand said.

Lahn took a different position during the Republican primary. In an April 28 post on the social platform X, he challenged then-rival Randy Feenstra to "four debates, one in each congressional district" and said that if the debates were not confirmed within a week, he would "head to Rob Sand's office and challenge him to debate instead."

"Iowans deserve to hear from the candidates," Lahn wrote.

Lahn, who lists Belle Plaine as his home, has faced questions about his ties to Kansas. The Des Moines Register reported in May that Lahn had flown to Wichita, Kansas, 37 times since Oct. 1 in a plane he owns and that he maintains a home there.

Lahn told the newspaper the home and flights allow him to see children from a blended family and that he is "in Iowa the majority of the time." He co-founded a private school, Wonder, in Wichita, the Kansas Reflector reported, and Iowa Democrats have labeled him a "Kansas carpetbagger."

On Monday, Sand told the assembled crowd that Iowa's problems will not be solved "with a part-time Iowan as governor."

Sand's tour continued Monday with town halls in Corydon and Chariton, in Wayne and Lucas counties. His campaign is scheduled to return to southeast Iowa in August, with events set for Bloomfield and Fairfield on Aug. 10, as well as Ottumwa, Sigourney and Oskaloosa on Aug. 11.

Lahn's website lists three events scheduled: a meet and greet in Tama County on July 3, and Fourth of July parades in West Des Moines and Clear Lake on July 3 and 4, respectively.

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