Current Affairs Of Pakistan & World: Iowa’s health care election

Iowa’s health care election

Oct 25, 2026

Presented by

With help from Ali Bianco and Irie Sentner

Happy Sunday. This is Eli Okun coming to you with a dispatch from Iowa, where I (narrowly) managed to avoid hitting any deer across hundreds of miles of roads. Drop me a line.

DRIVING THE DAY

Iowa Democratic Congressional candidate Lindsay James outside at the University of Northern Iowa homecoming parade on October 10 in Cedar Falls, Iowa.

State Rep. Lindsay James is in a tight congressional race in northeast Iowa. | Scott Olson/Getty Images

WAVERLY, Iowa — Gas and grocery prices have dominated the midterms, but November is shaping up to be a health care election too.

Few places see the convergence of health care fights as intimately as Iowa, where a cancer crisis, struggling rural hospitals, social safety net cuts and the MAHA movement collide across several of the country’s closest races, your Playbook author reports in a story today.

In Cedar Rapids, seven in 10 people who walk into Eastern Iowa Health Center receive Medicaid. By charter, it can’t turn any of them away for inability to pay. And many patients teeter on economic precarity: The number living on month-to-month leases has more than doubled in three years. So when the bulk of Republicans’ sweeping Medicaid cuts kick in shortly after the midterms, the federally qualified health center will be bracing for impact.

“With the 80-hour work requirements, it’s gonna just be devastating for our patients and for us,” president and CEO Joe Lock told Playbook.

Democrats are eager to exact a political price for Medicaid and SNAP changes in Republicans’ One Big Beautiful Bill Act, along with the expiration of enhanced Affordable Care Act subsidies. And if they flip control of Congress, that momentum could carry right into placing health care at the top of their 2027 agenda.

The Republican megalaw was one of the motivations for Democratic state Rep. Lindsay James to jump into the open House race in Iowa’s 2nd District. At a string of health care- and child care-focused stops last week, the pastor invoked the parable of the Good Samaritan to call for immediate relief from Washington.

Even before most Medicaid cuts take effect, the district has already seen some clinics and hospitals close or trim services, despite a smaller pool of money in the law meant to blunt the impact on rural communities.

James is all in on House Minority Leader Hakeem Jeffries’ priorities to reverse Medicaid changes and restore ACA credits.

Would she play hardball to achieve them, like Democrats tried to do with the 2025 government shutdown? “I am a redhead,” she said with a smile in an interview at NewBo City Market, “and so I’m just wired to stand up and fight for people.”

A message from OpenAI:

Supporting the blind community with ChatGPT.

Brothers Bradford and Bryan Manning lost most of their vision due to a genetic condition, but the disease has never stopped them from moving forward. Now, ChatGPT is helping them navigate life with greater independence while growing their nonprofit that supports the blind community. Whether they’re reading a menu or analyzing fundraising data, ChatGPT turns visual information into answers they can hear and act on. Learn more.

Some GOP moderates supported the ACA subsidies or were uneasy about Medicaid cuts. James’ GOP opponent Joe Mitchell — a Charlie Kirk acolyte who speaks and gestures with a Trumpian inflection — would not likely be among them.

“These people are lying about the quote-unquote Medicaid cuts. They’re not Medicaid cuts. It just says that you have to work,” he told Playbook. “I’m not gonna buy all the rubbish that they’re putting out there about what happened and didn’t happen in the Working Families Tax Cut.” As for Obamacare? It’s the root of the problem, he said: “They complain about health care a lot, for them putting in the exact system we have, which has made things far more unaffordable.”

But Iowa is also ground zero for a new kind of GOP health care messaging — with gubernatorial nominee Zach Lahn leading the way as a MAHA champion. He’s challenged the agriculture industry with detailed proposals to clean up Iowa’s waterways, where he says the fight to lower Iowa’s high rate of new cancer diagnoses begins.

Democratic organizers think their message is breaking through, too. “This cycle, more than any other cycle, people are aware of the way that the Republican-controlled legislature has turned its back on working families,” said Sondra Goldschein, executive director of the Campaign for a Family Friendly Economy, as she stumped with James.

Iowa’s 2nd was seen initially as the most Republican of the state’s three competitive House races, but it has moved to center stage as the national environment got bluer. It’s now such a focal point that President Donald Trump will rally in Dubuque two days before the election.

James has led narrowly in some recent polling, and she could benefit from the coattails of native son Rob Sand, but both parties’ internal surveys show the Midwest getting closer. Republicans publicly project confidence Mitchell can carry the Trump +10 seat, particularly with incumbent Rep. Ashley Hinson’s Senate bid at the top of the ballot.

Democrats privately admit to post-Ann Selzer stress disorder. And there are some indications that polls in Iowa may indeed be struggling to reach Republicans.

But not everybody is convinced Mitchell can hang on. “We give people just the choice of the lesser of two evils too often,” Winneshiek County GOP Chair Thomas Hansen said. “I don’t think he’s a strong candidate.”

The key for Republicans will be rallying Trump’s base to turn out, so Mitchell has hitched his wagon closely to the president. There was no clearer distillation than his rally in the state last week, when Mitchell invented a Nobel makeup prize for Trump: a gold-framed “Man of the Century Award.”

Does he think Trump is the greatest man of the 21st century?

“I do,” Mitchell told Playbook the next morning. “He was deserving of it, and he obviously enjoyed it.” Read the full story here

A message from OpenAI:

SUNDAY BEST …

— Trump on the Iran war, on Fox News’ “Sunday Morning Futures”: “Do I make a deal with them, or do I finish them off? That’s the only question … We now control the Hormuz strait. They get nothing. We get everything.”

— Speaker Mike Johnson on Trump’s approach to Russia, on “Fox News Sunday”: “I talked to Marco Rubio, secretary of State, at length over the weekend. I talked with the president as well on Saturday. We were together. And there’s a lot of nuance to this. … They’re going to have trilateral negotiations. They’re right on the verge of that. There’s a lot of moving parts to this. The administration is doing everything possible to bring an end to that conflict. … Vladimir Putin cannot be trusted, and we have to treat him as such.”

— Sen. Adam Schiff (D-Calif.) on the Justice Department’s lawsuit over the Alaska Senate race, on NBC’s “Meet the Press”: “Bill Barr crossed a lot of ethical lines. But there was one he refused to cross which was trying to overturn a legitimate election. This time with [AG Todd] Blanche, they’re all in on this disgraceful campaign.”

8 THINGS FOR YOUR RADAR

1. DEMOCRACY WATCH: Mary Peltola and the DSCC have filed a motion in court to try to stop the Justice Department’s extraordinary Trump-ordered strike to block a loss by Sen. Dan Sullivan. The DOJ’s moves — both in Alaska and in threatening California over its voter rolls — have brought Blanche and his department to a precarious moment that will test whether law enforcement is “effectively mobilized as a guarantor of [Trump’s] political power,” NYT’s Glenn Thrush and colleagues report.

Adding to the chaos: At least 18 early voting sites in rural Alaska haven’t opened yet, warned Democrats who raised the question of whether they were intentionally blocked or just struggling with logistical difficulties, per the Anchorage Daily News’ Iris Samuels. And California election officials were baffled over how to proceed after DOJ demanded that they keep separate ballots from tens of thousands of voters who the administration alleges might be non-citizens, AP’s Safiyah Riddle reports.

2. SUNDAY READ: “Trump’s DOJ told a judge how to rule. Then it pulled her from court,” by WaPo’s John Woodrow Cox: Karen Donoso Stevens’ “allegations, which she’s sharing publicly for the first time because of her deep concern for the court’s integrity, were corroborated by her extensive contemporaneous notes as well as colleagues, family and private attorneys interviewed by The Washington Post. They contradict Trump officials’ insistence to the public and to The Post that — as required by law — immigration judges serve under the administration as independent arbiters of justice.”

3. WAR REPORT: Tensions in the Iran war are escalating again as both sides prepare for possibly imminent attacks by the other, balancing on the knife’s edge of U.S. and Israeli elections, NYT’s David Sanger and colleagues report: “This is how countries can escalate into full-scale war, several diplomats and outside experts noted.” Any attack could unleash quick and spiraling retaliation. Nonetheless, an Iranian official said they’re still open to negotiations, per the AP.

Thom Tillis warns Republicans ahead of the midterms

In the latest episode of On the Road, Jonathan Martin sits down with retiring Sen. Thom Tillis in Charlotte to discuss why he expects Republican losses in November, his relationship with Trump and what he believes the party needs to do differently moving forward.

Watch now.

4. ON THE TRAIL: Trump hit the campaign trail in Georgia, where he unveiled both carrot and stick: The president announced a huge new Audi plant, a $4.2 billion project, in the state, per The Atlanta Journal-Constitution. But he also threatened to withhold federal resources if Democrats win next month. Meanwhile, Barack Obama stumped for Democrats in Ohio and Michigan, tearing into Trump (“He’s got the White House looking like Saddam Hussein opened a Cheesecake Factory”) and Vivek Ramaswamy (“no low he will not sink to”).

Michigan Democrats believe Obama could be a difference maker in the state’s razor-thin Senate race, POLITICO’s Lisa Kashinsky writes in.

“Him coming here certainly makes a difference,” Abdul El-Sayed told a throng of reporters after the rally in Detroit last night. “He’s a great closer because … he reminds us of what it was like to have a president who actually cared about the American public.”

The former president is clearly still popular within the party — at least if adoring interruptions and unauthorized T-shirts are any indication. His face was plastered across crewnecks from classic Warhol-style prints to at least two variations of “Obama ’28: Since the rules don’t exist anymore.”

Some El-Sayed supporters told Lisa they believe Obama can help shore up the Democratic nominee with still-skeptical Black voters. Obama pointedly downplayed El-Sayed’s past splits with him — “We are not going to agree on every detail of every issue” — and he dismissed Republicans’ racial and faith-based attacks against El-Sayed by saying “that stuff didn’t work on me … it’s not going to work on Abdul.”

El-Sayed in turn positioned Obama as a direct counterweight to Trump ahead of the Republican’s rally with GOP nominee Mike Rogers in Port Huron today (Rogers’ campaign confirmed yesterday that he planned to attend). El-Sayed is counterprogramming that with a rally of his own headlined by Sen. Bernie Sanders (I-Vt.) in Grand Rapids.

5. ON THE WORLD STAGE: Today’s Brazilian election is a huge test for one of the century’s most successful left-wing politicians, President Luiz Inácio Lula da Silva. And regardless of what happens, center-left governments around the world are watching for signs of whether and how they can hold difficult coalitions together, Eva Hartog reports in POLITICO Magazine. But the Trump administration has actively tried to tilt the election toward Flavio Bolsonaro, Reuters’ Gabriel Stargardter reports: State Department officials Darren Beattie and Ricardo Pita explicitly told diplomats not to interact with potential conservative rivals to Bolsonaro, said it was U.S. policy to support the Bolsonaros and advocated for sanctions on Brazilian liberals.

6. WAKING UP IN VEGAS: Nevada AG Aaron Ford wants to point a way forward for Democrats with working-class, Hispanic and labor voters by unseating Gov. Joe Lombardo, POLITICO’s Liz Crampton reports from Henderson. But he faces a significant financial disadvantage in the race, and many rank-and-file union members have abandoned Democrats.

7. FOR YOUR RADAR: “The Trump administration moves to treat millions of mentally ill veterans with psychedelics,” by POLITICO’s Amanda Friedman: “[VA official Andrew] Gradison told a conference for psychedelics enthusiasts this month that he is eager to ramp up the VA’s capacity to give the drugs to as many as 2.1 million veterans with mental illnesses like post-traumatic stress disorder or depression. … Veterans, frustrated with high suicide rates among their fellow ex-service members, are lobbying aggressively to see Trump follow through.”

8. SURVEY SAYS: “Poll: Data center backlash builds as midterms near,” by POLITICO’s Timothy Cama and Katherine Long: “Half of Americans now oppose data centers being built within three miles of their home, according to new results from The POLITICO Poll, conducted by PF Global. That’s the highest opposition since POLITICO began tracking Americans’ views of the sprawling technology hubs.”

A message from OpenAI:

TALK OF THE TOWN

IN MEMORIAM — “Noah Adams, Longtime Host of ‘All Things Considered,’ Has Died at 84,” by NYT’s Trip Gabriel: “Mr. Adams was a postman’s son from Kentucky who never finished college … But he never lost his respect for rural and working-class Americans, and he delighted in leaving Washington, where NPR is based, to travel around the country interviewing miners, farmers, single mothers and factory workers.”

MEDIA MOVE — Bill Owens will be executive producer of Newpress, a new Emerson Collective-backed startup “that publishes video journalism from independent creators,” NYT’s Ben Mullin scooped. He previously was executive producer of “60 Minutes,” which he departed after accusing the new CBS head honchos of editorial interference.

HAPPY BIRTHDAY: James Carville … CBS’ Jan Crawford … Geoff Burr … Protect Democracy’s Eric Conrad … Nate Hodson … Chuck Baker of the American Short Line and Regional Railroad Association … Phil McNamara … Penta Group’s Bryan DeAngelis … Gordon Johndroe … The Bulwark’s Bill Kuchman … Emily Prosser … POLITICO’s Simon Levien and Kylie Williams … Trey Hodgkins … Brigid Ueland of Sen. Pete Ricketts’ (R-Neb.) office … Cameron Kilberg … Bobbie Kilberg … Ross van Dongen of Accelerator for America … Samantha Tausendschoen … Daniel Chung of Rep. Mike Bost’s (R-Ill.) office … Victoria Nuland … The Herald Group’s Haley Gross … Kendall Heath … U.S. Chamber of Commerce’s Nicole Rose … Patrick Butler … Summit Campaign Strategies’ Charles Chamberlain … Chuck Conconi

Did someone forward this email to you? Sign up here.

Send Playbookers tips to playbook@politico.com or text us on Signal here. Playbook couldn’t happen without our editors Giuseppe Macri, Garrett Ross and Kyler Alvord.

A message from OpenAI:

ChatGPT is changing everyday life for visually impaired brothers.

Bradford and Bryan Manning founded Two Blind Brothers to support the blind community and create more opportunities for people like them. Both have Stargardt disease, a rare genetic condition that has caused them to lose much of their central vision.

Today, they use ChatGPT to move their mission forward. It helps them analyze fundraising data and build a website for Thrive Blind, their initiative connecting young blind people with training and career opportunities. It’s also part of everyday life: they can point their camera at a menu and hear answers to their questions in real time.

“Folks that have been left out are now going to have this tool that allows them to compete in areas where they were never able to compete before,” Bradford explains.

For the brothers, ChatGPT is a tool for pursuing their ambitions and helping others pursue theirs. Explore their story.