Iowa Race Questions Logic of Significance of Health Policy Debate

Joe Molloy, health policy, Congressional gridlock


According to the Democrats, their success across the country in the midterm elections has largely been due to the party running on healthcare. Indeed, surveys such as the one conducted by Health Research Incorporated indicated that health was the number one concern for voters during the midterms. In the three states where Medicaid expansion was on the ballot, voters were in favor of it. We’ve been wondering about that, so we took a look at how Iowa voted.

It’s one thing for voters to support healthcare on its own. It’s another for an issue to outweigh all others. Did healthcare really beat every other concern a voter thinks about when picking a candidate during the midterms?

Congressional and Statewide Races

Democrats took 3 of the Iowa’s 4 seats, unseating 2 Republican incumbents. They had a sizeable majority of the votes cast, so things looked good for the Democrats. If the theory holds up, the focus the Democrats kept on healthcare throughout the race would pay off. And it would seem it worked, right?

There’s a big problem here. If Democrats had made gains in Iowa because of healthcare issues, we should expect them to have a pretty resounding victory in the gubernatorial race and in the statehouse.

In the past two years, Iowa’s Republican governor made substantial changes to the state’s Medicaid program, resulting in its privatization. This was done with the expectation that the privatized program would lead to savings of up to $140 million.

However, this has caused a lot of discord, with one insurer pulling out of the program with no notice just months in—and there are payment issues with others. Furthermore, healthcare providers have claimed that these issues have been passed down the chain, to the tune of hundreds of thousands of dollars in payments owed.

The Democrats were vocal about the Republicans’ woes concerning Medicaid during the campaign. With an electorate supposedly fired up about healthcare and sending Democrats to Congress as a result, the governor’s race would be an easy win.

Trouble is, they didn’t win it. Republican Kim Reynolds kept her seat in a 3-point win. In fact, in the over 150 races for state office, only 8 incumbents were defeated—2 Democrats, 6 Republicans. Whatever role healthcare might have played in Iowa, it indeed wasn’t pivotal to the state elections.

The numbers are even more interesting. Compare the total votes cast for Congressional candidates to those cast for Reynolds. The governor beats out her party’s national candidates by 10%. Her Democratic challenger, Fred Hubbell, loses 5% compared to his colleagues.

So what else could explain the loss of two congressional seats? Well, there is one primary reason. Farmers in the losing districts are very unhappy with the president’s trade tariffs that are part of the trade war between the U.S. and China. Meaning, the Republicans’ loss is a manifestation of the opposition to the national policies, but not local ones.

Therefore, while it’s interesting to see a potential shift in how the country is viewing and voting on healthcare, other local dynamics come into play. Elections are complicated because people are complicated, and there’s almost always more to a win or loss than what mainstream stories express. People care about their healthcare, but suggesting it’s an issue they hold above all others is a big deal, and we’re not there yet.

Joe Molloy works with Toothpic, a dental app that allows you to get a dental report directly to your phone by simply taking a few photos of your mouth. His interests in healthcare and politics mean that Joe followed the impacts of the midterm elections closely.

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