House File 2676 may not be the most harmful of the 80-plus bills the Iowa House approved last week. And language allowing pharmacists to dispense ivermectin without a prescription may not be the most harmful provision of that so-called “Make America Healthy Again” bill.

But the brief Iowa House debate about ivermectin on March 3 illustrated how conspiracy theories—once confined to fringe elements of the conservative movement—now drive the mainstream Republican agenda.

Taking the “healthy” out of MAHA

Governor Kim Reynolds introduced the wide-ranging bill “on health-related matters” that became House File 2676. A few provisions in the original bill could have measurably improved Iowans’ health. For instance, tax increases for tobacco, vaping, and consumable hemp products would reduce cancer-causing behaviors. However, Republicans took the tax hikes out of the bill before advancing it from the Iowa House Health and Human Services Committee.

Republicans left in some provisions that would do no harm, such as banning certain dyes and additives in foods served at schools, and requiring that health care providers and medical school students receive more education on nutrition and metabolic health.

The bill also includes Reynolds’ effort to codify restrictions on foods Iowans can buy with federal food assistance. Republicans maintain those policies will force low-income Iowans to eat healthier food. But hunger advocates dispute that claim, pointing to some confusing and bizarre outcomes from the Reynolds approach. Because the state taxes certain “prepared foods” and exempts foods containing flour from the sales tax, Iowans can now use federal benefits to buy Snickers ice cream bars, Twix candy bars, and cake, but cannot spend those benefits on a fruit cup sold with a spoon, or a salad sold with a dressing packet.

The biggest surprise in the governor’s “MAHA” package was her proposal to make ivermectin available without a prescription. This section of House File 2676 didn’t change a word from Reynolds’ original bill, which states:

1. “A pharmacist or pharmacy may distribute ivermectin for human consumption as an over-the-counter medicine.”
2. “A pharmacist or pharmacy shall not be subject to professional discipline or civil or criminal penalties for the distribution of ivermectin pursuant to this section.”

Why single out one medication, developed to treat worms and parasitic infections?

“Some advocate for expanded use of the drug”

Conspiracy theories have become a defining feature of Republican politics during the Donald Trump era. Trump used conspiracy rhetoric to become the GOP nominee in 2016 and promoted many conspiracy theories after becoming president—most famously, his Big Lie about the “rigged” 2020 election.

During the early weeks of the COVID-19 pandemic, Trump encouraged Americans to use hydroxychloroquine to treat infections, prompting a surge in demand for the drug. By 2021, conservative influencers and some doctors who had touted hydroxychloroquine as a COVID remedy were advocating for off-label use of ivermectin. Despite studies showing hydroxychloroquine and ivermectin were not effective against coronavirus infections, many Americans (especially those skeptical of vaccines) demanded access to the drugs.

I don’t recall Reynolds encouraging Iowans to use ivermectin to treat COVID-19. But over the course of 2021 and 2022, she increasingly pandered to conservatives who rejected vaccinations and other medical advice.

Access to Ivermectin was not a priority for the Iowa legislature in 2023. That year, a non-controversial pharmacy code cleanup bill prompted State Representative Brad Sherman to go on an extended rant about the federal government allegedly intimidating doctors and pharmacists who wanted to make ivermectin available. Only nine other House Republicans (all MAGA conservatives) joined Sherman to vote against the pharmacy bill.

In contrast, Reynolds is leading this year’s charge to expand access to ivermectin. The governor didn’t mention the drug during her Condition of the State speech, but the budget book she submitted to the legislature in January included this short paragraph among other health care proposals:

Human-use ivermectin is approved and effective for certain parasitic infections, head lice, and rosacea, and some advocate for expanded use of the drug to treat a variety of other conditions.

The phrasing gives Reynolds some plausible deniability. After all, she isn’t saying ivermectin cures COVID, cancer, or other medical conditions. She’s just catering to GOP base voters who believe in such fantasies.

The same page of Reynolds’ budget book calls for over-the-counter hormonal contraceptives, a policy she has tried (and failed) to get through the House before. In January, I wondered whether she was dangling over-the-counter ivermectin as a strategy to bring reluctant House Republicans around on birth control. But there was no mention of birth control in the “MAHA” bill she introduced.

“Ivermectin is dangerous, folks”

State Representative Austin Baeth, a medical doctor, led the Democratic opposition to House File 2676 during the March 3 floor debate. The first of his two amendments would have struck the ivermectin provisions from the bill. I pulled this clip from the official legislative video.

Baeth noted that giving pharmacists legal immunity and immunity from licensure discipline for providing a specific medication “hasn’t been done anywhere else in medicine.”

So why is that language in the bill? “Well, because ivermectin is dangerous, folks,” Baeth said. “I mean, it might be OK for horses. It might be OK if you’re in Africa and you have a roundworm. Those are the FDA-approved reasons for it. But the reasons why people currently take ivermectin are due to internet lore.”

After randomized controlled trials demonstrated the drug “doesn’t work” for COVID, some people started claiming ivermectin could cure cancer, Baeth said. He denounced the “misinformation” in public comments on the bill, claiming ivermectin is “perfectly safe.”

We saw emails saying, “Oh, it’s safer than Tylenol.” It is not. It causes seizures, causes comas, causes liver failure, causes Steven Johnson Syndrome. I encourage you to Google that if you haven’t seen it before, you will see people with their skin peeling off of their body. Perhaps that is why there is a clause in this bill that gives immunity to pharmacists who are handing this out now like candy, because people want to experiment on themselves from something they read on the internet.

“This is just a scare tactic”

Republican State Representative Austin Harris, who was floor managing the MAHA bill, urged colleagues to oppose Baeth’s amendment. He noted that the bill “does not require pharmacists” to dispense ivermectin. It merely allows them to do so.

(Earlier this year, GOP State Representatives John Wills, Charley Thomson, and Mark Thompson introduced a bill to require Iowa’s state medical director to issue a standing order authorizing the dispensing of hydroxychloroquine and ivermectin. The same proposal would have required pharmacists to dispense those medications to patients who are at least 18 years old. At a subcommittee meeting in January, Baeth denounced that bill as “mandated medical malpractice.” Republicans did not advance it from committee before the legislature’s “funnel” deadline in February.)

During the March 3 debate, Harris noted that Tennessee, Arkansas, Louisiana, Texas, and Idaho have enacted similar laws. “A total population of 49 million people have access to over-the-counter ivermectin and in that time there have been zero reports of overdoses from this. This is just a scare tactic,” he said.

Tennessee was the first in 2022, and the other four states passed their bills only last year. The Texas law went into effect in December.

In his closing comments on his amendment, Baeth said, “During the height of the COVID pandemic I saw people who overdosed on ivermectin. You ask any ER doctor, they have seen people in their ERs after taking ivermectin. This is not a scare tactic.”

Overdose isn’t the only danger. Ivermectin can interact with other medications, and can have “serious neurological side-effects” even when taken appropriately to treat a parasitic infection.

The House rejected the amendment by 60 votes to 35. All 29 Democrats who were in the chamber that day voted to take the ivermectin language out of the bill, joined by Republican State Representatives Chad Ingels, Tom Jeneary, Brian Lohse, Gary Mohr, Matt Rinker, and Hans Wilz.

Think about that: only six House Republicans—none of them medical professionals—voted against allowing Iowans to obtain a potentially dangerous drug without a prescription.

Sixty Republican lawmakers voted to keep this language in the bill, including three medical professionals: State Representatives Brett Barker (a pharmacist), Steven Bradley (a dentist), and Ann Meyer (a registered nurse). Fear of the MAGA base must run deep.

Speaking to reporters on March 5, Baeth compared ivermectin to the “bloodletting and leeches of yesterday.”

What’s next

Baeth’s amendment was important, because it forced House Republicans to vote up or down on this part of House File 2676. Otherwise legislators could claim they didn’t support broad public access to ivermectin, but thought the good parts of the bill outweighed the bad.

Indeed, Rinker was the only Republican to vote with Democrats against the bill on final passage.

The measure is now pending in the Iowa Senate, but it’s far from clear it will pass in its current form.

The Senate didn’t advance the governor’s bill. Instead, Senate Health and Human Services Committee chair Kara Warme introduced her own “health-related matters” bill, which got through committee and is eligible for floor debate. That legislation (Senate File 2367) incorporated the governor’s proposals on nutrition education, certificates of need for health care facilities, federal food assistance, and food dyes in schools, but left the ivermectin language on the cutting room floor.

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P.S.—During the floor debate on the MAHA bill, House Republicans added several provisions related to K-12 schools. One had broad bipartisan support, to limit screen time at school to an hour per day for students in grades K-5. Other Republican amendments would increase physical activity requirements for elementary school children, would require high school students to be involved in at least one cocurricular or extracurricular activity, and would require Iowa to seek a waiver from federal school nutrition requirements.

Baeth’s other amendment to the MAHA bill would have allocated $10 million to help schools bring nitrate levels in drinking water below 3 milligrams per liter. The speaker declared it not germane, and Republicans unanimously rejected Baeth’s motion to suspend the rules to allow the amendment to be considered. Baeth told reporters on March 5 that Democrats wanted to highlight public concern about water quality and didn’t think providing “safe, healthy drinking water to our kids” was too much to ask.

Democratic State Representative Ken Croken’s amendment seeking to require radon testing in Iowa schools was likewise declared not germane.