Iowa's legislature may never run out of symbolism

 

Iowa House Speaker Pat Grassley
(R-Hartford); from iowa.gov

Legislative session number nine of unified Republican control of Iowa state government ended about the way the first eight did: tax and service cuts, repressing groups they don't like, and full-throated support for whatever President Donald Trump is advocating today. Speaker Pat Grassley posted on Facebook that Iowa voters "send us to Des Moines to be your voice and to do hard things. The session was nothing short of working hard and continuing to do the hard things."

The hard things included some new laws with arguably laudable objectives. Late in the session, Speaker Grassley bragged on resolving conflicts over use of eminent domain to acquire land for a carbon capture pipeline; raising minimum K-12 teacher salaries; and banning student cellphone use in classrooms. Increased funding for community colleges supports a critical service. Requiring cities and counties to allow accessory dwelling units under certain conditions is one approach to providing affordable housing (Strong Towns 2025).

Yet the legislature also spent time on:

• banning drone surveillance of farms
• reducing unemployment insurance tax rates on businesses
• established quotas for Iowa residents in admission to medical and dental residency programs
• expanded work requirements for Medicaid
• removing gender identity from the Iowa Civil Rights Act
• removing perceived traits from the official definition of bullying
• prohibiting diversity, equity and inclusion positions in community colleges and local government
• barring use of Medicaid funds for gender dysphoria procedures and therapies
• lowering the legal age to purchase a handgun from 21 to 18
• barring sex offenders from serving as firefighters
• requiring voters to verify citizenship
• banning ranked choice voting
• banning citizen police review boards
• requiring the University of Iowa to establish a School of Intellectual Freedom

The complete list of legislative enactments is at Murphy 2025 (cited below).

The first two reward Republican constituent groups; the remainder are mostly symbolic efforts to establish in law preferred identities and behaviors. In the absence of real problems being solved, their purpose seems to be to make Republican voters feel better about themselves. That also accounts for U.S. Representatives Ashley Hinson and Marianette Miller-Meeks supporting national Medicaid cuts in the reconciliation bill currently before Congress (Nieland 2025), though a lot of what may seem like undeserved health insurance for the shiftless poor actually supports long-term care for the elderly (Nirappil 2025), many of whom live in Iowa and support Republicans.

Irving Point is an assisted living facility in the Oak Hill Jackson neighborhood
(from burnshousing.com)

I continue to question how these packages of rewards to supporters and punishments for others lays any satisfactory groundwork for Iowa's future. A low-tax, low-service state that's hostile to immigration is laughing in the face of demographic, economic, health care, and climate challenges that every place faces. The Iowa Senate Democrats posted: "Growing our state's economy requires attracting and retaining the best and brightest." Their assumption is that a prosperous future Iowa will differ from current Iowa demographics and culture. That is a principal basis of my using this blog to advocate for diversity.

International immigration in the early 2020s more than compensated for U.S. metropolitan area population losses during the pandemic (Frey 2025).  This is particularly important in cities near Iowa--think Chicago, Milwaukee and St. Louis--that have been prone to domestic out-migration. Frey notes:  "Nationally, recent population projections indicate that with low levels of immigration (the kind observed during the first Trump administration), the nation’s population would start to decline after 2043, and its labor-force-age population will show no gains by 2035." 

I don't doubt that these new laws reflect the priorities of the voters who have been sending Republicans to the executive and legislative branches. A Civiqs survey at the 100-day mark found presidential approval in Iowa at 48 percent, higher than the country as a whole, though lower than deep red states like West Virginia and Wyoming (McGrath 2025). This may create openings for Democrats in 2026, but incumbent Republican legislators and executives, including Governor Kim Reynolds, won their seats by comfortable margins.

Iowa Republicans remain allergic to difference, and keep governing like if the state had any problems they could be solved by returning to 1958. And they keep winning.

SEE ALSO: 

"Iowa and the Vision Thing," 24 April 2024

Tom Barton, "Reynolds Secures Most of Her Legislative Agenda," Cedar Rapids Gazette, 18 May 2025, 1A, 10A

Erin Murphy, "Which Bills Passed--Or Didn't--the Legislature?" Cedar Rapids Gazette, 18 May 2025, 9A

Grace Nieland, "Hinson, Miller-Meeks Support Medicaid Limits," Cedar Rapids Gazette, 17 May 2025, 3A

ADDED LATER:

Lydia Denworth, "People in Republican Counties Have Higher Death Rates Than Those in Democratic Counties," Scientific American, 18 July 2022

Iowa's physician shortage

 

Zach Kucharski of the Gazette introduces the panel

Iowa is last in the nation in obstetricians per capita, which is felt most acutely in rural areas where fewer hospitals are offering obstetrics or even pediatric services. Iowa is also third-lowest in the US in retention of physicians. Those are only two data points in an overall shortage of physicians in the Hawkeye State, which was the subject of the latest Gazette Business Breakfast earlier this week. 

Two days later, Iowa earned the infamous distinction of being the first state in the U.S. to shrink its civil rights ordinance by removing gender identity from protection. The action was justified by the legislature's earlier attempts at punishing transgendered people being struck down by the courts as running afoul of this ordinance. Without the pesky civil rights ordinance, our government is free to take whatever potshots at transgendered people that it feels like taking. What an expression of our state's official hostility to difference!

At first glance, these are two different topics. Is it possible, though, that they are connected?

Unity Point Medical District, where your humble blogger gets his doctorin'
(Google Earth screenshot)

At the Gazette event, panelists Dr. Fadi Yacoub (Linn County Medical Society), Dr. Timothy Quinn (Mercy Medical Center), and Dr. Dustin Arnold (Unity Point Health) were interviewed by the Gazette's Zach Kucharski. They referenced two main strategies for improving Iowa's physician retention: improving the doctors' bottom lines, and incentives for Iowa students to do their medical education in Iowa.

Despite Iowa's reputation for low cost of living, Quinn noted physician salaries are not keeping up with increasing levels of medical school debt, and insurance payments relative to cost of living are are comparatively low. Arnold suggested the state should see positive effects of "tort reform," which means the legislature has capped damages for medical malpractice suits. Current legislation (HSB 191) before the Iowa legislature would offer student loan repayment programs for rural doctors, and commission a study of the effects of cutting medical school from four years to three (cf. Murphy and Barton 2025). On the other hand, would-be budget cutters in Washington are looking at Medicaid, which is "essential to medical care in Iowa" (Quinn's phrase) due to the directed payment program.

The legislature is also hoping to improve retention by keeping Iowa residents in the state, creating preferences in medical school admissions. (The University of Iowa, though, is 78 percent Iowan, already near the 80 percent target for schools.) The thought is that people who are close to family and already appreciate the wonders of Iowa will want to stay here. "We don't have pro sports, we don't have concerts, but" Iowa is a state you love, said Yacoub, noting he was "preaching to the choir here." Arnold of Unity Point added Cedar Rapids is a great place to live, "once you're here you want to stay." This may or may not be true, given the state's (not the city's) regressive political culture, but even if we retain 90 percent of Iowa-based doctors the gap between working age doctors and our aging population will continue to increase.

When we take on faith that Iowa is so great you could confuse it with heaven ("Field of Dreams" reference), it precludes serious discussion of our future. When we take on faith that the most important considerations are low taxes, we miss the thousand things that make for quality of life (some of which are paid for with taxes). I'm an urbanist, not a physician, and tend to see things through an urbanist lens. As such I'm probably missing important dimensions of this specific problem. But we want more physicians to move here, so we need to think about how to make it an attractive place, which means attractive for everybody.

Iowa's physician shortage exists in a national context. Quinn noted at the start medical schools nationwide have not kept up with demand, so the whole country must rely on immigration to make up the gap. (Yacoub, who came to the United States in 1989, is one example.) Later he noted the shortage of doctors extends to nurses and support staff as well. 

But it also exists amidst a sociopolitical context in our state that is becoming increasingly hostile to difference. As Richard Florida noted two decades ago, it is openness, not turning inward, that welcomes a variety of people with varieties of talents. Iowa, except for a few larger counties, is shedding population like no one's business. We have managed to combine the worst of northern weather and southern politics: Our policies and public statements are openly hostile to poor people, immigrants, the transgendered, and city dwellers, just for starters. What message does that send to anyone else who might be or feel a little different? 

The physician shortage is making working conditions for current physicians worse. As scheduling gets tighter, there is less space in a physician's life for continuing education or even lunch. I wonder how else working in Iowa might affect a physician's desire to be here? No one mentioned COVID at all, but I remember patients stacking up at hospital emergency rooms at the same time (early 2021) Governor Kim Reynolds was declaring the pandemic over. Evidence of the negative health effects of data centers (Criddle and Stacey 2025) and corn sweeteners is accumulating, but they are the darlings of our economic plans. Meanwhile, Iowa has the fastest-growing cancer rate in the country. It can't be easy to practice medicine in an environment that consistently chooses corporate bottom lines over public health, and hostility to vulnerable minorities over building prosperous and inclusive communities.

I can't say with any precision whether Iowa's official penchant for nostalgia and resentment is exacerbating our shortage of physicians. Some early-career physicians may prefer the Politics of Yesterday, while others may be indifferent. But overall it is unlikely to lure the talent we need.

SEE ALSO: "Iowa: You're on the Menu," 9 May 2023

Iowa and the vision thing

Brenna Bird, Iowa Attorney General

Iowa's legislative session ended this week, and there's not much to say about its efforts that I didn't say last year. In year eight of unified Republican control of state government, the legislative accomplishments (working off the lists in Opsahl 2024 and Sostaric 2024) again were a mix of punitive actions towards unfavored groups...

• funding cuts to the nine regional Area Education Agencies, though without the wholesale gutting advocated by Governor Kim Reynolds
• cracking down on foreign land ownership
• repealing gender balance requirements for voluntary boards
• tighter label requirements for vegan options to meat and eggs, prohibiting their purchase with SNAP or WIC funds
• criminal penalties and deportation (to where?) for illegal immigrants
• barring diversity-equity-inclusion programs at state universities 
• lowering the income eligibility limit for Medicaid
  

...and favors for the favored.

• qualified immunity for armed school personnel, in hopes of overcoming insurance industry objections to the arming
• less inspection for hotels and motels
  
• lowering the legal standard for religious exemptions from state laws (actually a good bill, but in the current climate likely to be used primarily to discriminate)
• limiting local regulation of stormwater and topsoil
• a social studies curriculum that emphasizes cheerleading and de-emphasizes critical understanding
• proposed constitutional amendments calling for a flat state income tax and requiring supermajorities to increase taxes (translation: tax cuts for the rich, fewer public services for everyone else)
  
• restrictions on local governments' use of traffic cameras (we only disapprove of lawbreaking when we aren't the ones doing it)
  

There was good stuff, too: expanded work-based learning, attention to the new and creepy problem of deepfake nudes, and higher teacher salaries, though where they find the money for the salaries while slashing taxes is anybody's guess. (For the impact of revenue cuts on Iowa City schools, see King 2024.)

But while I'm glad to see the legislature go home, I'd say the poster children for Iowa's medieval attitude towards anyone who can't keep up are in the executive branch. Governor Kim Reynolds declined state participation in a federal summer meals program for poor children in order, she said, to fight childhood obesity. Attorney General Brenna Bird continues suspension of a state program providing Plan B birth control (Rappard 2023), and in some cases abortions, to rape victims. Her office is investigating the program, they say. What are they finding? They won't say. When will their investigation, now well into year two, conclude? They won't say. As with COVID, our government has other things on its mind than helping people in trouble. If it can't be solved with a tax cut or a gun, we got nothing for you.

Expect more stories like this: Algona Public Library faces possible closures

Whatever you think of this blog, I'm a better writer than I am a politician. While I complain, with ever-increasing erudition, Republican legislative majorities grow and executive branch members return with ever-larger electoral margins. So they have definitely found the formula that pleases the people of Iowa.

So, all congratulations to the election winners and their interest group allies. I am left wondering what is the plan for the future of this state? Perhaps our ever-lowering taxes and light regulatory touch on favored businesses will bring the world to our state, but so far they have not done that.

Iowa is part of a slow-growing region, the Upper Midwest. Our 2023 population estimate was 3,207,004, up 0.52 percent from the 2020 Census, about half the rate of the country as a whole, and up 5.27 percent from 2010 compared to 8.48 nationally. While for most of the 21st century Iowa's population growth has been concentrated in a few urban counties, the 2020-23 county-level data have a mixed message: Polk (Des Moines) and Johnson (University of Iowa) are found among the fastest growing counties, but Story (Iowa State University) added only 33 people, and Linn (Cedar Rapids) is down 0.5 percent. Overall, 31 counties increased in population, with 68 decreasing, though some changes were of trivial magnitude: Cass County lost four people, while Allamakee County gained ten. 

The biggest gains and losses since the 2020 Census:

COUNTY	2023 POP	2020-23 CHG	COUNTY	2023 POP	2020-23 CHG
Dallas	111,092	+11.39%	Henry	19,547	-4.56%
Warren	55,205	+5.36%	Adams	3,544	-4.40%
Lyon	12,324	+3.25%	Osceola	5,978	-3.44%
Johnson	157,528	+3.05%	Crawford	16,013	-3.06%
Polk	505,255	+2.61%	Monona	8.493	-2.97%
Madison	16,971	+2.57%	Lee	32,565	-2.96%
Dickinson	18,056	+1.99%	Chickasaw	11,658	-2.94%
Lucas	8,747	+1.32%	Louisa	10,513	-2.93%
Bremer	25,307	+1.27%	Kossuth	14,396	-2.90%
Jones	20,900	+1.24%	Hardin	16,463	-2.46%

(Calculations by author from U.S. Census Bureau data.)

Despite the mix of stories in the data, five of the ten fastest growing counties are near Des Moines, with two in the northwest corner Iowa Great Lakes area; the others are Johnson, Jones (near Cedar Rapids), and Bremer (near Waterloo and Cedar Falls). None of the ten fastest shrinking counties contain large cities, though Lee County--which briefly had major league baseball in 1871, and peaked in population in 1960--is home to Ft. Madison and Keokuk. Population losses are found all over the state, with clusters in the west central and southeast sections. Osceola, Chickasaw, and Louisa are actually located adjacent to fast-growing counties.

Nationally, large metro areas took some hits during the pandemic, but they have recovered their growth trajectory (see Frey 2024). Pete Saunders (2024) argues this was just a matter of time, as cities increasingly have the economic and social infrastructure that appeals to today's global movers and shakers.... But, in a nation with falling birth rates, and an increasing reliance on international immigration to fuel economic as well as population growth, what does this mean for smaller metros and even smaller non-metro places?

So what's the strategy here, Iowa, if there is one? The legislature will be back in 2025, with plans to resume consideration of bills limiting the legal liability of pesticide manufacturers, make early voting more difficult, ban local police review boards, and deny legal recognition of sex changes (Sostaric 2024).

So far Iowa has managed to reap both the economic benefits of growth in smaller metros like Cedar Rapids, Des Moines, and Iowa City, and the political benefits of bashing them. Tactics may get us from election to election, but with inequality increasing, brains draining, and everything else aging. how do we get to 2049, much less 2074? Do we have anything approaching a vision for our future?

SEE ALSO

"The Age-Race Gap in Iowa," 7 August 2023

"Iowa: You're on the Menu," 9 May 2023

"Is Iowa Becoming Even More Republican?" 3 December 2022

The age/race gap in Iowa

 

Iowa politicians sell nostalgia and homogeneity to their large white majority
(campaign ad screen capture... see video at foxnews.com)
(you could spend a semester unpacking this ad)

The times they are a-changin'--BOB DYLAN

America is getting older, but there's more to it than that, according to William H. Frey, senior fellow at the Brookings Institution (Frey 2023). The oldest Americans are predominantly white, while the younger generations are far more racially diverse. According to data from the 2020 U.S. Census, whites are a minority among those under age 18, and less than 55 percent of those aged 18-44 (see Frey's Table D).

Americans 65-plus were 27.5 percentage points whiter in 2020 than those under 18. This age/race gap increased from 22.7 points in the 2000 census. Frey argues this has amplified generational cultural divides, as seen in responses to the Supreme Court decision on affirmative action and state policies limiting diversity in public school curricula. (See also Frey 2018.) 

William H. Frey (from brookings.edu)

The same age/race pattern appears in each state and metropolitan area: the older the group, the more white, and the younger the group, the more nonwhite. States differ in how strong that effect is, but it's present everywhere (see maps 1a and 1b in Frey 2023). 

Compared to the states that surround us, Iowa is somewhat older and whiter, and has a smaller age/race gap than of our neighbors except Missouri. We're pretty similar to most of them on the metrics used in Frey's article, with the exception of Illinois, which is more diverse among all age groups, and has had a steep decline in the proportion of under-18s of any race.

The largest gap is in Arizona, where the oldest group is 77.9 percent white and the youngest is 37.2 percent white, a gap of 40.7 percentage points; that may account for that state's notoriously riven racial politics over the years featuring the likes of Evan Mecham, Jan Brewer, and Sheriff Joe Arapaio. Nevada, New Mexico, Delaware, Rhode Island, Florida, and Oklahoma are the next six. The age/race gap may account for the scorched-earth toxicity of, say, Florida governor Ron DeSantis; but it's noteworthy that not all states with a large age/race gap experience the same political expressions.

Older white Arizonans have had to get used to diversity
(Source: cronkitenews.asu.edu)

The age/race gap is smallest among states that remain predominantly white. These states also tend to have small and declining populations, because with a few exceptions (Idaho, North Dakota, Utah) the white birth rate is low everywhere. Seven of the ten smallest gaps--West Virginia (#1), Vermont, Maine, New Hampshire, Kentucky, Wyoming and Montana--are in states who are also among the ten whitest states in America. On the other hand, the District of Columbia (#2) and Hawaii (#5) are so diverse even their oldest age groups are not that white. 

Iowa is the sixth whitest state according to the 2020 Census, with 82.7 percent of Iowans identifying as white (mixed-race not included). Iowa's age/race gap is 21.1 points, 35th highest (a.k.a. 16th lowest). Iowa is 15th in percentage for both over 65 and under 18. That's an explanation, but only a partial one, for why we Iowans have been far more receptive to the white nationalist politics championed by Donald Trump than are Maine, New Hampshire, and Vermont. Perhaps, like North and South Dakota (and Wyoming?), our age/race gap may be small by national standards, but it's gotten large enough to alarm the traditional establishment.

Iowa's approach to public education--which old-timers will tell you was once a source of state pride--is not unique but is an outlier even for states with aging, predominantly white populations. As the current school year approaches, the state is shifting substantial funds to private education through vouchers, as well as sending ominous but vague directives to remove books deemed offensive from classrooms and libraries. This is after the state's per-pupil education funding change from 2016 to 2021 trailed all neighboring states except Nebraska, not to mention all five states that have whiter populations.

At the county level, the four Iowa counties that favored Deirdre De Jear in the 2022 gubernatorial election tend to be younger and more racially diverse than the state as a whole, particularly Johnson (home to the University of Iowa) and Polk (home to the state capital). These are the counties Governor Kim Reynolds excluded from "the real Iowa," and while her statement was hateful, on some level she was also correct. Johnson, Polk, and a very few other counties are neither as white nor as old as the whole state.

(Note that I wasn't able to replicate Frey's data at the county level with 2020 census data, so I used data from the 2021 American Community Survey. To keep the age categories consistent with the original presentation, I split those aged 35-44 in half. Even American Community Survey data were not available for all counties.)

The larger age/race gaps in Johnson and Polk are also more typical of the country as a whole than the State of Iowa. Another relatively diverse Iowa county had an even higher age/race gap: Woodbury (Sioux City), 80% white, had 34.6 points (93.1-58.5), which is getting towards Arizona-level difference. Black Hawk (Waterloo), 82.9% white, had 23.9 points (90.5-66.6). 

Demography is certainly not political destiny--not every nonwhite person is down with The Squad, cares deeply about immigration policy, or even guaranteed to vote Democratic. But it does point to changes in the way of doing things (see Arizona and Georgia in recent years) and the difficulty of maintaining a sense of common life in the face of that change. 

Whether to change is not a choice. It happens everywhere, even in Iowa, though certainly not as much or as fast as in the United States as a whole. Every community does have a choice whether and how to accommodate that change. That choice is not between white prosperity and inclusive prosperity--it's between successfully managing diversification and irrelevance. Not only our souls, but our future is at stake.