Iowa has one of the highest cancer rates in the United States. Now the disease is becoming a defining issue in one of the state’s most closely watched congressional races.
When Maria Steele spoke to Republican Congressman Zach Nunn at a public library in Adel, her message was direct.
“I would not be here had it not been for research,”
she said, explaining how advances in understanding radon and cancer had contributed to her survival.
Her testimony came during one of two “Cancer Votes Coffee Chats” organised by the American Cancer Society Cancer Action Network, or ACS CAN. The non-partisan meetings brought patients, survivors and caregivers face to face with the two leading candidates in Iowa’s 3rd Congressional District.
The election on 3 November pits Nunn, the Republican incumbent, against Democratic state senator Sarah Trone Garriott. Both candidates have pledged to support cancer research and improve access to care. But they differ sharply over Medicaid, public insurance and the government’s role in healthcare.
Why Iowa is an outlier on cancer
The Iowa Cancer Registry estimates that 21,700 Iowans will be diagnosed with an invasive cancer in 2026 and that 6,400 will die from the disease.
Iowa has the country’s second-highest rate of new cancer diagnoses and is one of only three states where cancer incidence is rising. Prostate, breast and lung cancers are expected to account for more than 40% of new diagnoses this year. Lung cancer alone is projected to cause nearly a quarter of the state’s cancer deaths.
Researchers say there is no single explanation for Iowa’s elevated rate. Established risk factors include tobacco and alcohol use, radon exposure, ultraviolet radiation, obesity and low participation in some screening programs. Researchers are also examining environmental and occupational exposures, particularly in agricultural communities.
The figures have placed cancer prevention, early detection, research and treatment access near the center of Iowa’s political debate.
The 3rd District includes Des Moines and stretches across much of south-western Iowa, encompassing urban, suburban and rural communities. Nunn was first elected in 2022 and won a second term in 2024 with 51.8% of the vote.
Trone Garriott’s push to widen coverage
For Trone Garriott, the central issue is insurance coverage Speaking to survivors and advocates in Des Moines on 7 July, she said restoring federal Medicaid funding would be among her first priorities if elected. She says medical advances mean little if patients cannot afford diagnosis or treatment. She supports establishing a public health-insurance option that would exist alongside private insurance.
One possibility, she said, would be allowing people to buy into Medicare before they reach the normal eligibility age. She has also called for improved dental and vision coverage.
“Even the folks who do have coverage, it’s too expensive for them to truly take advantage of that coverage,”
she said.
Patients and advocates at the meeting raised concerns about treatment costs, rural clinic closures and the difficulty of participating in clinical trials when patients must travel long distances for appointments. Dr Richard Deming, a cancer physician at MercyOne, said he had seen patients who needed treatment while facing the loss of their insurance. He noted that many Iowans depend on Medicaid, Medicare or plans purchased through the Affordable Care Act marketplace. Trone Garriott has criticised the Medicaid provisions in President Donald Trump’s 2025 tax-and-spending law, known as the One Big Beautiful Bill Act. Nunn voted for the legislation.
The law reduces projected federal Medicaid spending through measures including work-reporting requirements for some adults, more frequent eligibility checks and changes to the way states finance their programmes.
Republicans argue that the measures will preserve Medicaid for people who need it most and reduce inappropriate enrolment. Democrats say they will cause eligible people to lose coverage and place additional financial pressure on hospitals and clinics.
The non-partisan Congressional Budget Office has estimated that the Medicaid provisions will increase the number of Americans without health insurance. Trone Garriott has also promised to oppose reductions in federal cancer-research funding. She said research projects should be protected from being cancelled midway through their work and called for consistent long-term investment.
“We need to make sure that we have consistent investment in research,”
she said.
She has said she would seek to reverse research reductions that she attributes to the Department of Government Efficiency
Nunn’s case for targeted support
Nunn met cancer survivors and caregivers at the Adel Public Library three days later. The two-term congressman pledged to support continued federal investment in cancer research. He said the Republican-led Congress had made important progress on research funding and pointed to patient-navigation services as one way to help people understand insurance rules and locate appropriate coverage.
However, Nunn rejected what he described as a “one-size-fits-all government solution”.
“It also means that we don’t just have a one-size-fits-all government solution,”
he said while discussing the future of public healthcare programmes.
Nunn defended his vote for the 2025 tax-and-spending law, arguing that its Medicaid provisions were intended to preserve the programme for children, older people, single parents and others in need.
He also said he had broken with Republican leaders by supporting an extension of enhanced Affordable Care Act tax credits, which help reduce the premiums paid by people purchasing insurance through the federal marketplace.
Nunn pointed to the Rural Health Transformation Program as evidence of the federal government’s investment in rural care. The program, created by the 2025 law, provides $50 billion to states over five years.
Iowa received approximately $209 million for the programs first year. Its plans include investment in rural medical equipment, telehealth, workforce development, preventive care and a hub-and-spoke model for services including cancer treatment.
The University of Iowa is helping to establish a “Combat Cancer” programs intended to improve early detection, develop rural partnerships and expand access to cancer services.
Nunn said the funding could help communities establish regional healthcare centers and expand preventive services. He argued that future spending should be measured against clear results.
‘We want to see real benchmarks for success,”
he said.
Democrats and some rural-health advocates argue that the five-year transformation fund will not fully compensate providers for the substantially larger reductions in projected Medicaid spending over the coming decade.
Common ground, different prescriptions
Both Nunn and Trone Garriott have signed ACS CAN’s Cancer Promise. By signing, candidates pledge to support cancer research and prevention, improve access to affordable and comprehensive healthcare, and widen the availability of prevention and early-detection services.
ACS CAN says the promise is not an endorsement. The organisation describes Cancer Votes as a non-partisan programme and invites candidates from all political parties to sign. On research, the candidates broadly agree. Both support cancer research, early detection and better access to treatment in rural communities. The disagreement is over how to pay for care and who should provide it.
Trone Garriott favours restoring Medicaid funding and creating a public insurance option while retaining existing private plans. Nunn favours targeted assistance, rural-health investment and a mixed public-private system, while defending the new Medicaid eligibility measures as necessary for the programme’s sustainability. For patients a gap in coverage can come in the middle of treatment.
Clara Cirks, who was diagnosed with stage-four lung cancer that had spread to several parts of her body, told the Adel meeting that she lost Medicaid after being judged to receive too much through disability payments. She bought a marketplace plan but remained uninsured during January while waiting for the coverage to begin. mBoth candidates say they want to prevent such gaps, but propose different solutions.
The candidate fighting to stay on the ballot
Libertarian Marco Battaglia had also sought a place on the November ballot. His campaign has emphasised reducing federal spending, ending the war on drugs and expanding what he calls medical freedom. He did not participate in the two ACS CAN candidate meetings and has not published a similarly detailed cancer-policy platform.
In June, Iowa’s State Objection Panel removed Battaglia from the ballot because he filed under the name Marco Battaglia rather than his legal name, Mark Thomas Andersen. Battaglia has asked a court to overturn that decision. Unless the ruling changes, the names appearing on the ballot will be Nunn and Trone Garriott. Battaglia could still continue as a write-in candidate.
For patients, the debate goes beyond research budgets. It concerns whether rural services remain available, whether screening and clinical trials are accessible and whether someone undergoing m treatment can retain affordable insurance. The two principal candidates agree that Iowa’s cancer burden demands action. Voters will decide which approach they trust.
Written by Evelina Khachaturova