Democratic State Auditor Rob Sand and Republican businessman Zach Lahn outlined their priorities for Iowa during a cordial final debate Tuesday night, finding agreement on several major challenges while differing over how to address them.
The 90-minute debate, hosted by The Gazette and KCRG-TV at Prairie High School in Cedar Rapids, came one week before the Nov. 3 election. The candidates are seeking to replace Republican Gov. Kim Reynolds, who is not running for reelection.
Here are five takeaways from their final meeting.
1. Both want more mental health treatment capacity, but disagree on Medicaid privatization
Both candidates acknowledged Iowa needs more psychiatric treatment beds and better access to mental health care.
The discussion turned personal for Sand, who said his own family has struggled to find psychiatric care for someone in need.
"If you're one of the families that struggled to find a bed for people, we're there with you. We've struggled too," Sand said. "It's a real problem in our state, we don't have the availability that we need, and people suffer because of it needlessly."
Sand also recounted returning to his Des Moines home after Thanksgiving last year to discover a man with schizophrenia coming up the stairs from the basement. Sand said his family left the house and called police. He later contacted the man's sister.
"We reached out, and she was just happy to know that he was alive, because she hadn't heard from him for three years," Sand said. "This is a man who was living outdoors, saw a warm place."
Sand said the incident illustrated why inadequate mental healthcare can become a broader public safety concern.
"We've got to do a better job with this for everyone in this state, because it's public safety, not just mental health," he said.
Sand wants to end Medicaid privatization, arguing that delayed payments and denied claims from private insurers have contributed to mental health providers closing their practices.
Lahn said the state should open additional mental health facilities, arguing that some people currently housed in prisons would be better served in treatment settings.
"I believe we do need to open mental health facilities. I do believe that there are people that are in prisons in our state that need to be in mental health facilities," Lahn said.
He said expanding treatment capacity would require prioritizing limited state resources and strengthening economic growth, particularly in rural communities. Lahn favors keeping privately managed Medicaid while strengthening oversight, including requirements for timely provider payments and protections against improper claim denials.
2. Medicaid work requirements drew agreement, with concerns about paperwork
Both candidates said able-bodied Medicaid recipients should work or volunteer to qualify for coverage, but emphasized that administrative requirements should not prevent eligible Iowans from receiving benefits.
The candidates were asked about Medicaid work requirements scheduled to begin in December.
Sand said his administration would follow federal law, but would work to prevent eligible recipients from losing coverage because of complicated reporting requirements.
"I want to make sure that what the government is doing is putting in a work requirement and not a paperwork requirement," Sand said.
He cited cases in other states where people lost coverage despite working because they failed to complete required paperwork.
Lahn supported work or volunteer requirements, saying public benefits should go to people who qualify and that the state should use technology to verify eligibility.
He also said the reporting process should be straightforward for people entitled to coverage.
3. Cancer rates and water quality emerged as shared priorities
Both candidates expressed concern about Iowa's cancer rates and supported expanding voluntary conservation efforts to reduce pollution in waterways.
Sand said nitrate pollution is contributing to the state's cancer problem, while acknowledging other risk factors, including smoking, drinking and physical inactivity.
"There's no doubt that the high nitrate levels in our water are contributing to our high cancer rates," Sand said.
He proposed eliminating waiting lists for farmers seeking conservation assistance and launching a large-scale wetlands restoration effort.
Lahn favored targeted nitrate monitoring and conservation incentives focused on the state's most affected waterways. He opposed imposing additional mandates on farmers, arguing that regulations could worsen financial pressures on agricultural producers.
Sand also emphasized that his water quality proposal relies on voluntary participation.
Both candidates supported funding Iowa's voter-approved Natural Resources and Outdoor Recreation Trust Fund, commonly known as IWILL, which has remained unfunded since voters approved it in 2010.
4. Private and public school funding remain dividing lines
Sand and Lahn agreed that private schools receiving taxpayer funding through Iowa's Education Savings Account program should face stronger financial oversight, but they disagreed over eligibility and admission requirements.
Sand wants to restore income limits on ESAs, arguing the state should not subsidize private school tuition for wealthy families while facing budget pressures. He also said private schools accepting public money should be required to admit all students, including those with disabilities, and follow spending rules similar to public schools.
Lahn defended universal eligibility for the program.
"This is not a welfare program. This is an opportunity fund for Iowa's kids," Lahn said.
He supported independent third-party audits, but opposed requiring all private schools to accept every applicant, saying different schools serve different educational needs.
On public school funding, Lahn said some additional investment is needed, particularly for students requiring intensive behavioral support. He favored targeted funding and greater flexibility for schools to innovate rather than across-the-board increases.
Sand argued the state needs to reconsider its education spending priorities, including the amount directed toward private school scholarships.
5. State spending and tax cuts produced contrasting budget plans
Sand warned that Iowa is spending more than it collects in annual revenue, by more than $1 billion.
He called the situation a "fiscal time bomb," arguing the state cannot continue drawing down reserves indefinitely.
Sand pledged to substantially reduce deficit spending by restoring ESA income limits, changing tax treatment for data centers and regulating and taxing cannabis.
He said those changes could address about half of the annual shortfall.
Lahn defended recent state income tax cuts, arguing Iowans should keep more of their earnings.
He supported examining government spending for efficiencies and defended using accumulated taxpayer relief funds as part of the tax-cut strategy.
Both candidates questioned large tax incentives for data centers, with Lahn calling for those businesses to pay more in property taxes.
The candidates ended the debate by emphasizing their shared interest in keeping young people in Iowa and improving the state's long-term prospects, even as they offered voters different approaches to governing.
Early voting is underway across Iowa, and the election is next Tuesday.
