Rob Sand’s Medicaid contradictions will cost Iowa’s hospitals

The national media and D.C. Democrats are not the only ones spreading falsehoods about Medicaid changes in the One Big Beautiful Bill (OBBB). Based on State Auditor Rob Sand’s comments and social media posts, he doesn’t appear to have even a basic understanding of fundamental principles of the Iowa Medicaid program.

On July 15, Sand tweeted the following meant to push frightening talking points that the OBBB will be a disaster to rural hospitals:

“Every member of Iowa’s federal delegation voted for a bill that will hurt Iowa’s rural hospitals and kick people off their insurance. We need leadership willing to put what’s right for Iowans ahead of party bosses.”

And literally the next day, on July 16, Sand tweeted that he is going to repeal Medicaid managed care in Iowa:

“Decisions at the federal and state levels have made it difficult for rural Iowans to access health care. The privatization of Medicaid in Iowa chief among them. Medicaid in Iowa was privatized via an executive order, and if elected, I will be reversing that order.”

What Sand fails to understand is that hospital state directed payments — the very thing that Rob Sand is saying was cut in the OBBB — can only exist in states, like Iowa, with Medicaid managed care (what Sand calls privatized Medicaid). The federal regulations governing hospital state directed payments ONLY show up in the managed care federal regulation chapter — 42 C.F.R. 438. If Iowa were to repeal Medicaid managed care, as Sand repeatedly says he will do if elected governor, Iowa’s hospitals will lose more than $1 billion annually.

Yet another interesting aspect of Democrats’ falsehoods about Medicaid in the OBBB is that every single Democrat in the Iowa House and Senate voted AGAINST codifying Iowa’s hospital directed payment program into Iowa law, jeopardizing the very thing they publicly bash in the OBBB.

Additionally, Sand’s claim that OBBB will “kick people off their insurance” doesn’t tell you the full story. OBBB contained many common sense provisions to ensure accurate eligibility of individuals on Medicaid:

OBBB also contains work requirements for adults on Medicaid expansion by simply requiring 20 hours in a week of work, volunteering, education or work programs for able-bodied adults to receive free health insurance. Iowans support work requirements to reduce the dependence of low-income Iowans on public assistance and to help them move up the economic ladder.

Democrats and Sand would call this kicking people off their insurance. Republicans call those common sense program integrity efforts to focus taxpayer resources on those truly in need, like disabled individuals.

Rep. Ann Meyer of Fort Dodge represents House District 8. As a registered nurse, her main focus in the legislature is Health and Human Services appropriations and policy.

  Buy Photo