Don't privatize prison health care in Iowa

The State of Iowa is quietly moving toward a decision that would harm hundreds of dedicated public servants, endanger the well-being of incarcerated people, and create long-term risks for taxpayers. The Department of Corrections has issued a Request for Proposal (RFP) to privatize medical and mental health care across all nine state prisons — outsourcing the work of more than 200 state-employed nurses, physicians, mental health professionals, and other medical staff.

If this plan moves forward, those employees will lose their status as state workers. Many will lose their IPERS pensions. Some may lose their jobs entirely. And the people in their care — more than 8,500 incarcerated Iowans — may lose the only continuity in healthcare they've had.

Let's be clear: this is not just a modernization effort. The RFP includes a badly needed upgrade to the state's outdated electronic health record (EHR) system — something nearly everyone agrees is necessary. But it doesn't stop there. Instead of improving the system while strengthening the workforce already in place, the state is proposing to hand over the entire operation to a private company — changing both the technology and the staff at once, on an unreasonably short timeline. Anyone who's been through a major EHR rollout knows how challenging it is even under ideal conditions. Doing it while longtime employees are preparing to walk out the door is a recipe for failure.

Even more troubling: two former Iowa DOC health administrators — including the immediate past head of the prison healthcare system — now hold executive roles at a for-profit company likely to bid on the contract. That company, VitalCore Health Strategies, has built its business on taking over state-run systems like Iowa's. While no wrongdoing has been proven, the overlap raises legitimate questions about whether this process is truly fair — or already decided. Meanwhile, the Governor recently signed legislation expanding parental leave for state employees — a move publicly celebrated as a win for working families. Yet this RFP threatens to strip more than 200 public workers of their pensions, benefits, and jobs. How can we celebrate protecting state employees on one hand while quietly cutting them loose on the other?

And for what? States that have privatized prison healthcare have repeatedly faced lawsuits, rising costs, and dangerous lapses in care. Iowa would be no exception. Privatization doesn't eliminate the state's responsibility — it just adds layers of profit and risk. The constitutional obligation to provide adequate medical care to people in state custody remains with the state, no matter who signs the paychecks. So does the liability when things go wrong. And beyond the legal duty, this is a moral one: caring for those in our custody — many of whom are sick, poor, or forgotten — is one of the clearest tests of whether we live up to our values. As Iowans, that responsibility is ours. There are places where private partnerships make sense — but when it comes to core functions of government and care for the least among us, decisions should be grounded in responsibility, not driven by profit.

And if cost savings are part of the justification, this approach may backfire. Most private vendors bring their own proprietary EHR systems, which makes switching providers later costly and disruptive — something many states have had to do after contracts failed to deliver. If Iowa truly wants flexibility and control, it should invest in a modern, vendor-neutral EHR that integrates with the University of Iowa, which already provides specialty care. That’s a smarter and more sustainable path.

We should be modernizing our systems and investing in the workforce we already have — not handing off our duty to a private company. Incarcerated Iowans deserve consistent, accountable, high-quality care. The professionals who've devoted their careers to this work deserve respect, not removal. And the public deserves a process guided by transparency, not behind-the-scenes connections.

There's still time to change course. Iowa doesn't need to privatize its prison healthcare system to fix what's broken. It needs to lead with values — and remember that some responsibilities should never be for sale.

Thomas Hansen lives in Burlington.