Sand: Expand eligibility for rural health care loan forgiveness

NEWTON — Medical reimbursement rates and keeping physicians in Iowa were among the topics Democratic gubernatorial candidate Rob Sand dug into with rural Iowa health care leaders during a campaign event Wednesday.

After the roughly one-hour discussion with eight stakeholders, Sand told reporters that one action item he’d like to see taken is expanding eligibility for the state’s existing rural health care loan forgiveness program.

Sand, the state auditor since 2019, is one of two Democrats seeking the party’s nomination in Iowa’s 2026 race for governor; the other is West Des Moines political consultant Julie Stauch.

Four Republicans are seeking their party’s nomination after incumbent Republican Gov. Kim Reynolds announced earlier this year that she will not seek re-election in 2026.

The Rural Iowa Primary Care Loan Repayment Program offers student loan repayment funds for up to five years to physicians who pledge to practice certain kinds of medicine in Iowa but outside the state’s largest metro areas for at least five years. The program provides up to $40,000 annually for up to 20 individuals each year.

Eligible physicians must be enrolled in medical school at the University of Iowa or Des Moines University and must pledge to practice in those rural Iowa areas for five years in family medicine, pediatrics, psychiatry, internal medicine, obstetrics and gynecology, or general surgery.

The state dedicated $2.6 million to the program in the 2025 budget year. For the 2026 budget year, four more, similar loan repayment programs — totaling $1.7 million in state investment — were created.

Sand said Wednesday that he would like to see more individuals eligible for the rural health care loan repayment program, including by allowing doctors to apply at any time. He highlighted one of the roundtable speakers whose wife moved to Iowa and unexpectedly decided to stay here.

“Think about the experience of someone who comes to medical school in Iowa, would be happy to stay here, but realizes, ‘Well, I don’t qualify for loan forgiveness because I didn’t know I was going to love Iowa when I moved here,’” Sand said. “This is just a foolish choice on our part. We want doctors here. We should be saying, ‘Hey, if you’re taking a job in Iowa, in rural areas as a doctor, then we’re going to do loan forgiveness. We don’t care if you thought to sign up at the beginning of medical school to do that.’”

Sand added, “I've always said let’s get people into Iowa, because they’ll fall for it, they’ll love it the same way I do.”

Medicaid reimbursement rates

Sand and the participants also discussed frustration with Medicaid reimbursement rates. When Sand said his campaign’s survey of medical providers in Iowa found they have staff positions created just to argue with Medicaid about payments, virtually all of the roundtable participants nodded knowingly.

“With the way that Medicaid is moving in the state of Iowa, doctors don’t get paid, hospitals don’t get paid. And so you’re having to sue Medicaid to get the money,” Dr. Bill Vandivier, a retired doctor who serves as chief physician executive and president of Mercy Clinics in Des Moines, said during the discussion.

Sand alleged that managed care organizations — or MCOs — that operate Iowa’s Medicaid system are financially driven and intentionally charge rates that push providers to the brink of taking legal action to recoup payments.

“I’m a believer in incentivizing care and in behavioral care. Managed care can be publicly run, and I think that’s an important distinction to make,” Sand told reporters after the event. “But what we’ve been doing now for 10 years is we’ve had these companies in here that are looking to make a profit out of it, and that's costing Iowans.”

The four Republican candidates for governor are U.S. Rep. Randy Feenstra, of Hull; state legislator Eddie Andrews, of Johnston; former state agency director Adam Steen, of Runnells; and former state legislator Brad Sherman, of Williamsburg.

Iowa’s primary election is June 2, 2026, and the general election is Nov. 3, 2026.

Comments: (515) 355-1300, erin.murphy@thegazette.com

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