OPINION:
As a physician, a 24-year Army veteran, and a former director of the Iowa Department of Public Health, I have spent my life caring for patients. In Congress, my mission is just as clear: lower health care costs and expand access to high-quality care for every American.
Health care reform does not have to mean bigger government. In fact, Washington’s habit of layering on mandates, micromanagement and bureaucracy has too often driven costs higher, not lower. A conservative approach starts with a simple principle: empower patients, increase transparency, strengthen competition, and hold middlemen accountable.
Costs remain the top concern I hear from families across Iowa. Premiums, deductibles and out-of-pocket expenses strain household budgets. Small businesses struggle to provide coverage to employees. Seniors on fixed incomes are forced to choose between prescriptions and groceries. We can, and must, do better.
That is why I have continued to lead on the Lower Health Care Premiums for All Americans Act, legislation focused on tackling one of the biggest drivers of rising costs: the lack of competition and transparency in our system. When insurers, hospital systems, or other entities consolidate and operate without meaningful market pressure, patients pay the price. My bill strengthens oversight, promotes competition, and helps ensure that savings are passed along to consumers, not absorbed by bureaucracy.
Another area demanding urgent reform is prescription drug pricing.
Across Iowa, I have met with independent pharmacists who are fighting to survive under a system increasingly dominated by Pharmacy Benefit Managers, or PBMs. These middlemen were originally intended to help negotiate lower drug prices. Instead, in many cases, they have become opaque gatekeepers who determine which medications are covered, how much pharmacies are reimbursed, and how much patients pay at the counter.
I have worked with Jane and John Nicholson, owners of Mahaska Drug, a Main Street Pharmacy in Oskaloosa for years now, and they have shared firsthand how PBM practices threaten the viability of community pharmacies. John and Jane are not faceless bureaucrats. They are trusted local health care providers who know their patients by name. When PBMs reimburse pharmacies below cost or steer patients toward preferred networks, it is Main Street that suffers, and patients ultimately lose access and choice.
That is why I was proud to support and help advance the most consequential PBM reforms in years. These reforms increase transparency, curb abusive practices and begin restoring fairness to a system that too often works against patients and independent pharmacies alike. Conservative reform does not mean abandoning oversight. It means ensuring markets function honestly and competitively.
Lowering health care costs also requires addressing chronic disease, expanding preventative care, and embracing innovation. Early detection technologies, value-based payment models and telehealth expansion all offer pathways to improve outcomes while reducing long-term costs. A healthier population is not only a moral imperative, but also an economic one.
We must also ensure that federal health programs are sustainable and focused on those they were designed to serve. That means rooting out fraud, waste, and abuse, strengthening program integrity, and resisting policies that expand bureaucracy without improving care.
There is no single silver bullet in health care. But there is a clear path forward: transparency over secrecy, competition over consolidation, innovation over stagnation and patients over special interests.
Conservatives believe in empowering individuals, not systems. We believe families, doctors and patients, not Washington bureaucrats, should drive health care decisions. And we believe that real reform means delivering measurable relief to the people who pay the bills.
As we look ahead to 2026, my focus remains where it has always been: lowering costs, protecting patient choice, strengthening local providers and ensuring that every American can access quality care without financial ruin.
Health care is personal. It is about peace of mind. It is about dignity. And it is about keeping our promises to the people we serve.
That is the standard I will continue to fight for in Congress.
• Rep. Mariannette Miller-Meeks, M.D., has represented Iowa since 2021. A retired Army officer and ophthalmologist, she is a member of the House Committee on Energy and Commerce, where she sits on the subcommittees on Health, Energy and Environment. She’s also a member of the House Committee on Veterans’ Affairs, where she serves as chairwoman of the Subcommittee on Health.
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