Iowa's Healthcare Reckoning: Poll Shows Voter Fury Over Rising Costs

DES MOINES, IA – January 12, 2026 – A groundswell of bipartisan frustration over soaring healthcare costs is building across Iowa, with a new statewide poll revealing that a majority of voters feel their expenses are climbing while lawmakers at both the state and federal levels are failing to keep pace. The survey, commissioned by the non-partisan group Iowans for Affordable Healthcare (IAAHC), paints a stark picture of a populace united not by party, but by the shared burden of medical bills and insurance premiums.

The poll, conducted by the independent firm Cygnal in early December 2025, found that 61% of likely Iowa voters say their healthcare costs have increased. This sentiment is fueling a growing crisis of confidence in elected officials. Nearly six in ten Iowans (59%) believe federal lawmakers could be doing more to lower costs, while at the state level, 49% say legislators are not making the right decisions on healthcare prices. This dissatisfaction is already beginning to influence political allegiances ahead of the 2026 elections, according to the poll's findings.

"Iowans are united on one issue: healthcare costs too much," said Phil Jeneary, Executive Director for Iowans for Affordable Healthcare, in a statement accompanying the release. "Voters want lawmakers focused on lowering prices — not policies that make care harder to afford."

A Bipartisan Mandate for Affordability

Perhaps the most striking finding from the poll is the degree to which concern over healthcare affordability transcends traditional political divides. In an era of deep partisan polarization, the data shows that Republicans, Democrats, and Independents are largely in agreement when it comes to the pain of healthcare costs and opposition to policies that would exacerbate it.

One of the most potent examples is the overwhelming opposition to new "facility fees" that can appear on medical bills after a hospital merges with or acquires a local doctor's office or clinic. An astonishing 84% of all voters oppose these fees. This opposition is remarkably consistent across party lines, with 92% of Republicans, 77% of Democrats, and 86% of Independents standing against them. These fees, which hospitals argue are necessary to cover the higher overhead of hospital-based outpatient centers, are often seen by patients as a surprise charge for the same service in the same location.

This cross-party consensus extends to the potential consequences of federal policy changes. The poll sends a dire warning about the impending expiration of enhanced Affordable Care Act (ACA) tax credits, which have helped millions of Americans afford marketplace health insurance plans. A staggering 86% of Iowans enrolled in these plans say they would be forced to delay or skip medical care if these subsidies expire. Crucially, this includes 82% of self-identified Trump voters, demonstrating that the practical benefits of these credits are valued far beyond party affiliation.

The Looming Threat of Expiring Subsidies

The potential expiration of enhanced ACA tax credits at the end of 2025 represents a financial cliff for thousands of Iowa families. These subsidies, originally expanded by the American Rescue Plan and extended by the Inflation Reduction Act, cap the percentage of income a family has to pay for a benchmark marketplace plan. If Congress allows them to expire, premiums will revert to the original, less generous ACA structure in 2026.

According to a December 2025 report from the Iowa Insurance Division, this change will lead to significantly "increased individual contributions towards the costs of their coverage." The impact will be most severe for middle-income individuals and families who currently benefit from the expanded credits. For instance, a 55-year-old Iowa couple with a household income of $84,600 (just over 400% of the Federal Poverty Level) could see their monthly health insurance premium skyrocket. In 2025, their premium is capped at $599. In 2026, without the enhanced credits, they would face the full unsubsidized premium of $1,666 per month.

The poll's finding that 86% of these enrollees would consider forgoing care is a direct reflection of this looming affordability crisis. It suggests a potential public health emergency driven by economic necessity, where Iowans will be forced to choose between their health and their financial stability.

Voters Reject a 'Death by a Thousand Fees'

Beyond the major issue of federal subsidies, the poll highlights deep-seated opposition among Iowans to a range of smaller fees and policies that incrementally drive up costs. There is a clear sentiment that the healthcare system is nickel-and-diming patients, and voters are pushing back.

Specifically, 72% of Iowans oppose allowing pharmacies to add new dispensing fees, such as a proposal in a bill identified as SF 383 that could add an estimated $10 to the cost of each prescription. While pharmacy groups often argue such fees are necessary to cover their operational costs and ensure the viability of local pharmacies, the public's reaction is unequivocally negative. This is further underscored by the finding that a majority of Iowans (58%) would rather have fewer nearby pharmacy options if it meant paying less for their medications, a clear signal that for most, affordability is the top priority.

Similarly, voters registered strong opposition to mandates that would increase health insurance premiums, opposing them by a more than 2-to-1 margin (57% to 24%). This indicates a public weary of any policy, regardless of its stated intent, that results in higher monthly bills. The consistent opposition to these varied cost-increasing measures, from facility fees to prescription charges, suggests a deep-seated voter frustration with the perceived lack of price transparency and control in the healthcare market.

A Political Powder Keg for 2026

The cumulative weight of these concerns is transforming healthcare affordability from a perennial issue into a political powder keg. The poll's indication that "political support for candidates is already shifting" serves as a direct warning to incumbents in Des Moines and Washington, D.C. The data suggests that voters are scrutinizing candidates' records and platforms on healthcare costs with renewed intensity.

The bipartisan nature of the discontent means that no politician is safe. Republican voters are just as angered by facility fees and the potential loss of ACA credits as Democrats. This creates a challenging environment for lawmakers who may have previously relied on partisan talking points. Voters are now demanding concrete solutions that lower their out-of-pocket costs.

As the 2026 election cycle approaches, candidates will likely face intense pressure to move beyond broad statements and offer specific plans to address facility fees, lower prescription drug costs, and protect Iowans from sudden premium hikes. The message from the Cygnal poll is clear: for a growing majority of the Iowa electorate, the candidate who can most convincingly promise and deliver healthcare affordability may be the one who wins their vote.