KFF (health policy organization)

Iowa's rising cancer rate has emerged as a bipartisan issue in the state's competitive 2026 midterm races for Congress and governor. Iowa has the second-highest cancer rate in the country, behind only Kentucky, and is one of just three states where rates are climbing, driven by increases in lung, prostate and breast cancers. Candidates from both parties, including Republican Rep. Zach Nunn and Democratic challenger Sarah Trone Garriott, have made the issue central to their campaigns, with voters increasingly linking it to concerns about nitrate contamination in water from agricultural runoff.

Democrats such as Senate candidate Josh Turek and House candidate Christina Bohannan have tied the issue to opposition against Medicaid cuts under President Trump's tax and spending law, warning of coverage losses for Iowans. Republicans, including Rep. Ashley Hinson, have emphasized expanding cancer screening access and conservation funding. Scientists remain divided on whether nitrate-contaminated water is driving the increase, and a state-commissioned study has yet to reach firm conclusions, but polling shows water quality now ranks among voters' top concerns heading into the election.

Harris County Commissioner Adrian Garcia says local property tax increases stem largely from federal and state policy decisions rather than county spending. He points to Texas's continued refusal to expand Medicaid under the Affordable Care Act, which has forfeited more than $184 billion in federal funds since 2016, according to the Urban Institute, leaving Harris Health, the county's safety-net hospital system, to absorb costs for uninsured patients.

Garcia also cites federal Medicaid cuts under Trump's tax and spending legislation, which the Kaiser Family Foundation estimates will reduce federal Medicaid spending by $911 billion over a decade, potentially adding 10 million uninsured Americans per the Congressional Budget Office. Harris Health reported $179 million in added indigent care costs last year. A new state law exempting billions in business property from taxation, plus unfunded state mandates on elections and courts despite a $24 billion state surplus, further shift costs to homeowners, Garcia argues, even as county leaders work to control spending.

California is assessing whether state funds can cover a gap left after the Trump administration, through the Centers for Medicare & Medicaid Services under Mehmet Oz, moved to restrict federal Medicaid funding for gender-affirming care. Medi-Cal data show youth patients filed about $1 million in claims for hormone therapy and puberty blockers in 2025, plus $6.4 million for related services like counseling and doctor visits. Gender-affirming surgeries for minors remain rare.

The new federal rule, effective October 13, targets puberty blockers, hormone therapy, and surgeries, but leaves mental health services reimbursable and allows states to fund the restricted care themselves. California has set aside a $30 million fund for gender-affirming care and abortion services and a $26 million trans healthcare trust fund, which state health officials expect to cover Medi-Cal needs for three years. Trans youth services represent a tiny fraction of Medi-Cal's roughly $200 billion budget.

Advocates and the state's LGBTQ Legislative Caucus warn of future funding pressure, while Attorney General Rob Bonta's office says it is reviewing the rule but has not announced litigation.