Guest columnist

Thomas Hansen is a Burlington-based software engineer, husband, and father whose friends and family care for patients in Iowa’s Department of Corrections.

The state of Iowa is quietly moving toward a decision that would harm hundreds of dedicated public servants, endanger thousands of incarcerated Iowans, and cost the taxpayer dearly. The Department of Corrections has issued a Request for Proposal (RFP) seeking bids from private companies to take over health care services across all nine state prisons — eliminating roughly 300 state positions currently held by nurses, doctors, and mental health professionals.

If this happens, these dedicated professionals will lose their IPERS pensions and other benefits like public service student loan forgiveness. These are people who have chosen to serve in one of the most challenging health care environments. Some may lose their jobs entirely; others will be forced to reapply under worse terms. The incarcerated individuals in their care — more than 8,500 humans — will lose the only continuity in health care many of them have ever had.

Meanwhile, the governor celebrates expanding parental leave for state employees while her administration quietly prepares to lay off hundreds of them. A cruel irony.

Let’s be clear: This is not just a modernization effort. The RFP includes a needed upgrade to the state’s outdated electronic health records system—something everyone agrees is necessary. But bundling this with full-scale privatization is a recipe for disaster. Private vendors bring proprietary systems that create expensive lock-in. And anyone who’s been through a major electronic health records rollout knows how challenging it is even under ideal conditions. Doing one while experienced staff prepare to walk out all but guarantees failure — these very people and their institutional knowledge are essential to making a system transition work!

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Even more concerning, however, is who’s positioned to profit. Two former Iowa prison-health administrators now occupy executive suites at VitalCore Health Strategies — one of the likely bidders. And the state’s RFP even appears to lift language from contracts in states where VitalCore is expanding. No wrongdoing has been alleged in Iowa. But in Tennessee, a company has accused the state in a lawsuit of rigging bids for providing prison health care. Iowa must do better.

The evidence of privatization outcomes from other states is shocking. After Florida privatized its prison health care, costs ballooned by 36% over four years while the annual inmate death rate skyrocketed by over 1,000%, according to Prison Legal News. In Arizona, it led to what courts called “grossly inadequate” care, costing the state over $23 million in legal fees and fines. These are the predictable outcomes of replacing duty with profit-seeking.

Here’s the problem: Markets don’t function without consumer choice, and privatization doesn’t eliminate the state’s responsibility — it just adds a layer of corporate management while leaving taxpayers to shoulder the risk. The constitutional obligation to provide adequate medical care remains with Iowa. As does the liability when things go wrong. But beyond the legal duty, this is a moral one: Caring for those in our custody — many of whom are sick, poor, or forgotten — is one of the clearest tests of whether we live up to our values. As Iowans, that responsibility is ours.

When it comes to core government functions and caring for the least among us, decisions must be grounded in responsibility, not driven by profit.

Most importantly, there is a better way. States like Texas and New Jersey have proven that partnerships with public universities deliver results. University of Iowa Hospitals already provides specialist services at no cost to the Department of Corrections. An even stronger partnership with the university would improve care, create a stable workforce, and unlock federal savings unavailable to for-profit companies. We should modernize our systems and invest in the Iowans we already have — not hand off our duty to the lowest bidder.

Incarcerated Iowans deserve consistent, adequate care. The professionals who’ve devoted their careers to this difficult work deserve respect, not removal. And taxpayers deserve smarter policy and a government guided by transparency, not a process clouded by conflicts of interest.

There’s still time to change course. Contact your state representatives. Iowa doesn’t need to privatize prison health care. We need to lead with our values — and remember that some responsibilities should never be for sale.

Thomas Hansen is a Burlington-based software engineer, husband, and father whose friends and family care for patients in Iowa’s Department of Corrections.