Iowa’s first Congressional district was among the closest U.S. House races in the country in 2024 and is a top target this year. Judging by candidates’ early messages, both sides expect access to health care to be a paramount concern for voters.
In her first television commercial of the cycle, which aired in May and June, Republican incumbent Mariannette Miller-Meeks highlighted her work as a nurse and doctor.
Democratic challenger Christina Bohannan promised to take on insurance companies in her first TV ad, which went up on August 4.
In addition, the Democratic-aligned group 314 Action has announced a large ad buy criticizing Miller-Meeks’ record on pharmaceutical companies and health insurance coverage.
Health care access a hot topic across the district
Health clinic closures or service reductions have made news this year across the first Congressional district, which covers the 20 orange counties on this map.
The losses have been most acute in the area of obstetrics and gynecology. This isn’t a new problem. An analysis in the Health Affairs journal found that 33.3 percent of Iowa hospitals lost obstetric services between 2010 and 2022—the highest percentage measured in any state. Those included several hospitals in the IA-01 counties. No birthing services have been available in Washington County since 2018, in Van Buren County since 2019, or in Henry or Muscatine counties since 2020.
MercyOne Newton Medical Center (Jasper County) ended labor and delivery services in late 2024, citing problems with recruiting and retaining physicians. The nearest options to have a baby in a hospital now are in Des Moines (Polk County), Pella (Marion County), or Grinnell (Poweshiek County).
MercyOne Clinton Medical Center stopped delivering babies in May of this year, saying in a statement that patients would be directed to hospitals in Dubuque, Davenport, or Silvis, Illinois. Reaching any of those by car would take 45 minutes to an hour.
The Southeast Iowa Regional Medical Center in Fort Madison (Lee County) announced in January 2026 that it “will discontinue its inpatient birthing services by the end of the year after its sole obstetrics and gynecology doctor announced his retirement.” Michael McCoy, president and CEO of Great River Health System, told local media at that time, “It’s a service line we had no plans to stop having here, but we are forced to because we can’t recruit a physician or an obstetrician here.”
The cities of Clinton (population just under 24,000) and Muscatine (23,000) are now among the largest in Iowa to have no labor and delivery services in their counties. Marshalltown tops the list for that unfortunate distinction, with no birthing services in a community of about 27,500 residents.
Bohannan and other Democratic candidates, including nominee for governor Rob Sand and Sarah Trone Garriott in the third Congressional district, have frequently blamed Republican policies for Iowa’s maternal health care deserts. Echoing advocates who work in this space, Bohannan has argued that Iowa’s near-total abortion ban is one reason it is so difficult to recruit OB-GYNs to work in places like Fort Madison.
Obstetrics isn’t the only field where Iowans are losing access to care. MercyOne closed its Family and Internal Medicine Clinic in Ottumwa in February. While Wapello County (containing Ottumwa) lies in the third Congressional district, the clinic closure has been all over local news in in central and southeast Iowa. Two of the counties Miller-Meeks represents (Jefferson and Van Buren) are in the Ottumwa-Kirksville television market, and several others receive Des Moines TV stations.
Miller-Meeks highlights role as “Doctor in the House”
For decades, polls have shown that a majority of American voters prefer Democrats to handle health care. Actions of the current Congress have made GOP incumbents particularly vulnerable on that constellation of issues. The so-called “One Big, Beautiful Bill” (which Republicans have rebranded as the “Working Families Tax Cut”) will impose enormous cuts to Medicaid and the Children’s Health Insurance Program.
Along with more House Republicans, Miller-Meeks voted repeatedly against extending subsidies to purchase health insurance through the Affordable Care Act marketplaces. Miller-Meeks defended her votes, saying the subsidies “go straight to profitable insurance companies, are riddled with fraud, don’t actually lower premiums and have ZERO income caps.” House leaders let her sponsor another bill that (they claimed) would lower health care costs in other ways. The alternative bill got through the House but died in the Senate.
Meanwhile, the number of Iowans who purchased ACA health insurance in 2026 dropped by at least 10 percent (around 13,000 people), according to health care policy analyst Charles Gaba. Some estimates suggest that nearly a fifth of Iowans dropped their ACA plans this year. Those who stayed insured through the marketplace saw huge increases in their net premiums and out of pocket expenses.
The attack ads write themselves. Miller-Meeks got ahead of them with her campaign’s first TV ad, which hit the airwaves a few weeks before the June primary election.
Transcript:
Miller-Meeks, speaking to camera: For 40 years I have had one job: it’s health care. I enlisted in the Army, became a nurse, and then a doctor.
In my practice, I took care of patients from all walks of life. Now, I fight for Iowans in Congress.
Voice-over: Mariannette Miller-Meeks—she’s the doctor in the House.
Miller-Meeks: I fight against big insurance companies that are ripping us off. They made prices too high.
I’m Mariannette Miller-Meeks. I approved this message, because nobody should go broke just because they get sick.
Miller-Meeks is also pushing positive health-care-related messages in digital ads, radio ads, and emails funded through her Congressional office budget. Since the June primary, her office has sent out emails about “Policies to Make America Healthy Again,” her work to secure “historic funding for breast cancer research,” a bipartisan bill she introduced “to build a nationwide, federally coordinated effort to eliminate the hepatitis C virus,” and an $825,000 earmark she secured to help reopen a hospital in Keokuk (a city that’s been without a hospital since 2022).
In addition, Miller-Meeks has often touted her support for $50 billion in federal funding to support rural health care, passed as part of the 2025 budget reconciliation measure. Iowa is receiving $209 million from the Rural Health Transformation Program this year and is expected to receive a total of $1 billion over five years, which will support a range of worthy projects. That’s small fraction of the Medicaid funding the state is on track to lose because of the 2025 bill. Tens of thousands of Iowans are expected to lose Medicaid coverage.
Since last year, Miller-Meeks has consistently defended her vote for Medicaid cuts as a way to target waste, fraud, and abuse, despite evidence that the cuts will affect many eligible recipients. She has used similar talking points about Affordable Care Act policies. In one recent taxpayer-funded email, Miller-Meeks claimed the ACA marketplace was flawed: “weak safeguards allowed fraudulent and unauthorized enrollments to slip through the system.”
Bohannan putting health care front and center
Since Bohannan launched her third Congressional campaign in June 2025, she has put health care issues at the center. In an interview with me last year, before the budget reconciliation bill was finalized, she slammed the proposed Medicaid cuts. Bohannan said the MercyOne hospital in Newton was “seriously at risk of shutting down,” after losing its birthing center a few years ago.
Promising to repeal the Medicaid cuts if elected to Congress became a regular part of Bohannan’s speeches. From a public appearance in July 2025, around the 60th anniversary of Medicaid becoming law:
“The thing is, these Medicaid cuts don’t just affect the people on Medicaid,” Bohannan told reporters Wednesday during a news conference. “They affect access and affordability of health care for everyone. Health care costs will go up for all of us as a result of these cuts, because the medical costs of uninsured people are going to be passed along to the insured, and all of us will find it harder to access the treatments that we need as local hospitals shut their doors, cut staff or reduce services.
“ … I have traveled every corner of southeast Iowa, and I have seen firsthand that our smaller Iowa hospitals have been struggling already for years,” she continued. “These Medicaid cuts could be this final straw that forces them to close or to reduce staff and beds or to cut vital services.”
Bohannan spoke at length about this issue during an in-depth conversation about the rural economy in January. At that event in Marion County, she said access to health care was critical for the broader community, not only for those currently uninsured. She came out for letting Americans buy into Medicare at any age—a new stance for her, which wasn’t part of her platform when she ran against Miller-Meeks in 2022 and 2024.
The Democrat argued that a Medicare buy-in would prevent Americans from being beholden to any employer. That would be good for self-employed people, farmers, and others now buying insurance through the Affordable Care Act. “This would dramatically bring down health care costs for everybody,” she said, because uninsured people often end up needing more expensive care.
This summer, Bohannan toured rural hospitals in five counties across the district, discussing access problems with health care professionals at each facility.
At public events and in interviews, Bohannan often recalls her family’s health care struggles when she was a child. When she was in high school, her father developed emphysema. “He hit his coverage limit on his insurance, and then they canceled his health insurance […] So at that point we kind of lost everything trying to pay for his prescriptions and, you know, all that kind of stuff.”
She refers to that experience in the television commercial that went on the air August 4. Here’s that spot, connecting the candidate’s biography with public policy.
Bohannan narrates the ad. Transcript:
Growing up in a mobile home in a town of 700, my dad worked construction, drove me around in his truck, proud to show what he built. Then he got sick and they cancelled his insurance. I waited tables to help out, but it wasn’t enough.
Washington has forgotten the hardworking people who built this country. I’m Christina Bohannan, and I approve this message, because I’ll fight for Iowa families, not insurance companies. I’ll never forget that I work for you.
Bohannan won’t be the only one tying the incumbent to unpopular corporations in the health care arena.
Outside group plans ad campaign about health care
314 Action, a hybrid PAC/superPAC that helps elect Democratic candidates with a background in science, announced this week that it plans “a $750,000 accountability campaign” targeting Miller-Meeks. Television, digital advertising, and direct mail will tie the Republican to rising health care costs. The campaign is scheduled to run from August 11 to August 24.
Shaughnessy Naughton, president of 314 Action, said in a news release, “As a doctor in Congress, Rep. Mariannette Miller-Meeks should be standing up for Iowans on healthcare, but instead she’s sided with insurance companies and Donald Trump. […] This accountability campaign is about making sure Iowans know who is driving up costs while paying for bombs instead of healthcare.”
A script provided to Bleeding Heartland indicates the ad will make this case against the incumbent.
Follow the money. Insurance companies gave Mariannette Miller-Meeks thousands. Premiums for families and farmers doubled.
An insulin maker cut her a check. She voted against capping costs.
Big Pharma supported her campaign. Miller-Meeks put rural hospitals at risk to fund corporate tax breaks.
And after Miller-Meeks stripped healthcare from 110,000 Iowans, she admitted: “Pharmaceutical companies are one that’s gonna benefit.”
Let’s make sure we do. Tell Miller-Meeks. Take care of Iowa. Not Big Pharma.
I wasn’t familiar with that quote. It comes from a September 2025 interview Miller-Meeks gave to the conservative outlet Real America’s Voice. She was explaining the pro-business tax provisions of that “One Big, Beautiful Bill,” such as capital expensing, bonus depreciation, and 100 percent expensing for research and development. She said those provisions would promote manufacturing in the U.S., and help “any kind of company, and pharmaceutical companies are one that’s gonna benefit.”
314 Action has endorsed Bohannan (who worked as an engineer early in her career) before, donating $10,000 to her campaign in 2022 and $15,000 in 2024, according to the OpenSecrets database. This year’s investment will be on a much larger scale, reflecting the importance of IA-01 for Democratic aspirations to regain control of the U.S. House.
Political landscape
Miller-Meeks won the closest U.S. House race in the country in 2020 and won a third term in 2024 by 799 votes, a margin of less than 0.2 percent. She was the worst-performing House Republican in the country, relative to how Trump did in her district. Conversely, Bohannan outperformed Kamala Harris by more than any other Democratic challenger two years ago.
Election forecasters including the Cook Political Report, Sabato’s Crystal Ball, and Inside Elections rate this race a “toss-up.”
Donald Trump carried the IA-01 counties by a margin of about 8.5 percent in 2024, but more recent polling suggests he is underwater in this part of Iowa.
Miller-Meeks and Bohannan were the only candidates here for the last two elections, but independent Michael Bridgford has also qualified for this November’s ballot. He’s running as a centrist and hopes to drive Congress away from the extremes of both parties. He has cited former Senator Joe Manchin of West Virginia as a political figure he admires. Manchin’s Independent Leadership Council is supporting his candidacy.
The nonprofit Independent Center Voice (which doesn’t expressly endorse candidates) is spotlighting the IA-01 race, because it’s a competitive district where independents make up a large share of the electorate.
The latest official figures indicate that as of August 3, the IA-01 counties contained 169,748 registered Democrats, 185,655 Republicans, 196,808 no-party voters, and 4,504 voters with some other affiliation (mostly Libertarians). However, turnout rates in Iowa’s midterm elections are typically far lower for independents than for Democrats or Republicans.
Last month, Bridgford’s campaign reported raising about $189,000, with the candidate chipping in nearly two-thirds of that total. That’s a major investment and more money than we’ve seen any other independent or third-party candidate spend on an Iowa Congressional race. That said, Bridgford won’t be able to match spending by the other candidates. As of June 30, Bohannan’s campaign reported about $5.4 million cash on hand, and Miller-Meeks had about $4.7 million. Outside groups backing the major parties will likely spend tens of millions on this race.
A poll conducted by the Bullfinch Group in mid-July, commissioned by the Independent Center and the Independent Leadership Council, found a small lead for the Democrat and a surprisingly high level of support for Bridgford. The 705 “likely voters” surveyed went 40 percent for Bohannan, 35 percent for Miller-Meeks, and 11 percent for Bridgford. Some 2 percent said they would back “another candidate,” and 11 percent were unsure.