At the Hancock County Fair in Britt on Saturday, Republican candidate for governor Zach Lahn was asked about Medicaid. He gave a clear answer.

"I don't think the government would do a good job of delivering healthcare for the people of Iowa. I think that the private sector can do a great job delivering this, but the government has to hold them accountable."

He called Iowa's privatized system "bipartisan", noting that 42 states use managed care organizations, and promised to continue Governor Kim Reynolds' approach.

Here's the thing about "the government has to hold them accountable." Iowa's government already tried. It ran the numbers. And the numbers are devastating.

891%

In October 2021, the Iowa Auditor of State released a report on what privatization actually did to Iowans on Medicaid.

Iowa moved its Medicaid members in April 2016 from a state-run system to a managed care system run by private companies for a fee. To measure the effect, auditors analyzed six years of "State Fair Hearings" — the appeals process where an independent judge decides whether a denial of care was legal. Three years before privatization, three years after.

The finding: the share of cases where a judge overturned a denial — ruling it illegal and reinstating the care — increased 891%.

The report didn't hedge about what that means:

"Seeing a denial overturned is always a bad result, because it means a legally incorrect decision was made, which also negatively impacted the health care a member received. Unfortunately, denial overturnings increased by 891%, showing privatization has substantially increased the number of illegal denials of care in Iowa."

Its conclusion was one sentence: "Privatized Medicaid in Iowa is substantially less likely to follow the laws and regulations regarding providing care to members."

Even using the privatized-Medicaid figures the companies themselves supplied in response, the increase was 588%.

The audit also found the companies were breaking their contracts. Iowa Total Care violated numerous provisions of its state contract; Amerigroup violated one. In one case auditors described, a managed care company repeatedly claimed it couldn't comply with the requirement to keep providing home- and community-based services until a member was transitioned to a new provider — so Iowans went without things like bathing and wound care, while the company kept collecting its payment.

That is what "the private sector can do a great job delivering this" looks like in practice in Iowa.

The promise Lahn made, and what it's worth

Lahn did add a pledge on Saturday: "I will not allow any of these companies to use AI in denying coverage from people."

Take him at his word for a second, and then notice what the audit says. The illegal denials in Iowa happened without AI. They happened because a company paid a flat fee has a financial reason to say no, and because nobody stopped it. Banning one tool doesn't touch the incentive.

And Lahn's promise is to keep the system that produced those denials and manage it better. Governor Reynolds' administration was supposed to be managing it better too. Iowans on Medicaid have been living with the results.

He's also defending an ad built out of chopped-up news clips

Lahn is running against state Auditor Rob Sand — the office that produced that Medicaid report.

The Lahn campaign has been running an ad attacking Sand over a misallocation of court debt payments caused by a coding error in Iowa's judicial payment systems. The ad uses edited clips from KCCI broadcasts in which anchors say the "auditor's office took no action."

At a Fort Dodge town hall on Monday, Sand said the ad was so far off that the station itself intervened:

"The only thing that he ran for six weeks after the general election was an attack on me and my record that was so fundamentally dishonest that the TV station, when they saw their anchor's words being taken out of context, actually made a news story about the television ad to tell people how dishonest it was."

He's describing something that happened. When the same "took no action" clips were used in an earlier ad this spring, KCCI published a fact-check stating the ad omitted "some context included in KCCI's original reporting" — including that one of the reporter's statements was describing Republicans' argument, not the station's own finding.

That's the whole trick, and it's an old one: when a journalist reports what one party is claiming, you can cut away the attribution and make the journalist appear to be stating it as established fact. KCCI said publicly that its reporting had been used that way.

Lahn's answer on Saturday was that the ad is fine:

"They're not false. He is not doing his job."

The station that made the footage says its words were used without their context. Lahn's position is that he gets to decide what its anchors meant.

For the record, Sand's office has said it was in contact with the state judicial branch and the Department of Transportation multiple times after being notified of the issue in 2022, that it conducted internal and independent investigations, and that the office did not have staff equipped to investigate computer errors.

You can think Sand should have done more. Reasonable people do. But "I disagree with how he handled it" and "here's a news anchor saying he took no action, with the part where he's quoting Republicans cut out" are two different things — and only one of them is an argument.

Two answers on the same day

Put Saturday together.

Asked about healthcare, Lahn defended a system the state's own auditor found was illegally denying Iowans care at nearly ten times the previous rate.

Asked about an ad that a television station publicly said stripped the context out of its own reporting, he said it wasn't false.

Both answers have the same shape: the documented record says one thing, and Zach Lahn says the record doesn't apply to him.

Iowans on Medicaid — the kids, the seniors, the people with disabilities waiting on a wound-care visit — don't get to argue with the record. They just live in it.

We deserve better.

Source

Kadin Luhmann, Lahn advocates for privatized Medicaid, defends attack ad against Sand, Iowa Capital Dispatch, August 1, 2026. Photo by Kadin Luhmann for Iowa Capital Dispatch.