2026 IMS Legislative Session Recap

The second session of the 91st Iowa General Assembly concluded twelve days past the scheduled end date on Sunday, May 3 after a 35-hour overnight marathon push to finish work on the remaining policy bills.

This session, the Republican Party of Iowa controlled the 100-seat House of Representatives with a 67-33 supermajority, and the 50-seat Senate with a 33-17 majority. Republicans held trifecta control of state government with Republican Gov. Kim Reynolds serving her last session as governor.

During the legislative interim leading up to session, IMS met with members, policymakers, and other stakeholders to identify the top issues and legislative priorities impacting physician practice in Iowa. In September, IMS convened the Committee on Legislation (COL) to draft recommendations for legislative priorities ahead of the upcoming session. In December, the IMS Board of Directors voted to approve the COL’s legislative priority recommendations and encouraged collaboration with key stakeholders on shared priorities.

Session commenced on Jan. 12, 2026 and saw early action to advance physician priorities with HF 2635, a landmark insurance reform bill championed by IMS and the Iowa Hospital Association, passing in record time.

The 2026 Iowa legislative session will be remembered for efforts to close the $90 million Medicaid budget deficit, last minute negotiations to pass property tax reform and medication abortion legislation, as well as the passage of multiple IMS-championed bills to eliminate administrative burdens for physicians.

 

By the Numbers

• 1,791 total bills introduced this session
• 865 subcommittee hearings held before the first funnel (40 per day)
• $90,600,000 the estimated budget deficit in the Medicaid program for 2026
• 141 bills IMS declared on
• 35-hour marathon to finish session
• 112 days to finish session (12 days over the scheduled end date)
• 103 attendees at Physician Day on the Hill

 

Physician Wins

IMS prioritized reducing administrative burdens in practice this legislative session, among other meaningful reforms to reform health care. Some of the top IMS-championed bills to pass this session include:

 

HF 2635 Insurance Reform
IMS partnered with other leading health care organizations to expand requirements for health insurance carriers by ensuring only physician peers may deny or downgrade prior authorization requests, exempting cancer screenings and emergent conditions from prior authorization, prohibiting carriers from penalizing providers for affiliating with out-of-network providers, barring enforcement of unreasonable contract terms with providers and requiring negotiation on contracts with insurers.

 

SF 2184 Physician Licensure Updates
This IMS-led bill reduces paperwork in the licensure process by allowing applicants to use a designee to complete a license application or renewal paperwork, updating licensure renewal to every three years instead of every two years, and setting deadlines for the Board of Medicine.

 

SF 469 Emeritus Physician Licenses
This bill creates a new emeritus license for physicians over 60 years old primarily engaged in supervising and training resident physicians, as recommended by IMS’s Operation I.O.W.A. report. The license reduces the renewal and application fees by half, exempts licensees from CME requirements, and allows holders to maintain their previous scope of practice.

 

HF 2562 Temporary Guardianship of Patients
This bill addresses the placement of adult patients in care facilities when they are unable to consent and have no authorized representative. It allows physicians to act as temporary guardians to petition the court for patient placement and insurance application authority if no representative is available. It provides immunity for those acting in good faith.

 

HF 2564 Minor Consent to Pregnancy Care
This bill clarifies that if a parent, guardian, or legal custodian is not reasonably available, a pregnant minor may legally consent to receive prenatal, intrapartum, and postnatal care from specified health care providers.

 

HF 2782 HHS Budget
The HHS budget and appropriates $1.5 million for grants to create new medical residency programs in rural areas and $400,000 for rural psychiatric residencies specifically. It contained no cuts to physician reimbursement under Medicaid.

 

Successful Defense

In addition to championing many affirmative bills to enhance the practice environment in Iowa, IMS also defended against many proposals that would negatively impact the health of Iowans. The top bills IMS opposed and defeated include:

• HF 2171 K-12 Vaccine Requirements
  Would eliminate school vaccine requirements as a condition of entry.
• SF 2211 / HF 2368 Iowa “Medical Freedom” Act
  Omnibus bill from the anti-vaccine lobby removing longstanding vaccine protections for children during public health emergencies.
• HF 2287 Vaccine Manufacturer Liability
  Prohibited the sale and administration of vaccines in Iowa unless the manufacturer waives legal immunity granted by the federal National Childhood Vaccine Injury Act.
• SF 2154 Gene-Based Vaccine Restrictions
  Established new restrictions on mRNA vaccines in the state.
• HF 2056 Ivermectin/Hydroxychloroquine Mandatory Dispensing
  Required pharmacists to dispense hydroxychloroquine and ivermectin upon request from any patient over 18 years old.
• HF 2332 Feticide
  Criminalized practitioners for providing abortions beginning at conception.
• SF 2155 Misoprostol/Mifepristone/Methotrexate Schedule III
  The bill classified misoprostol, mifepristone, and methotrexate as Schedule III substances and established that individuals involved in the manufacture, distribution, or dispensing of these substances were subject to class C felony charges and fines up to $50,000.
• SF 2455 No Surprises Act Carve Out
  This insurance industry proposal would have required out-of-network physicians to accept the in-network rate or 150% of Medicare, while carving Iowa out of the federal No Surprises Act dispute resolution process.
• SF 319 Cash For Care
  Required all health care providers establish and disclose discounted cash prices for all provided services and publish on an internet website.
• HSB 766 AI Autonomous Medical Providers
  This bill created a Board to regulate and allowed artificial intelligence (AI) fully autonomous service providers (AAASP) to practice medicine in clinical health care settings.
• SF 180 Refusing Medical Services
  Prohibited isolation and quarantine during public health emergencies.

 

Other Headlines from Session

HHS Director Nomination Blocked

The Iowa Senate failed to confirm Gov. Kim Reynolds’ appointment of Larry Johnson as director of the Iowa Department of Health and Human Services. The Senate rejected the nomination with a 28-16 vote, falling short of the required two-thirds majority. Democratic senators raised concerns regarding a lack of transparency, communication breakdowns, and concerns within Iowa’s foster care system.

 

Medicaid Budget Deficit Funded by New HMO Tax

HF 2739 HMO Tax

To fill an estimated $90.6 million Medicaid budget deficit, the legislature passed legislation to establish a new 3.5% health care-related tax on Health Maintenance Organizations (HMOs) in Iowa. The bill uses funds from the new tax to appropriate $89 million to HHS for medical assistance under the Medicaid program to cover the totality of the 2026 Medicaid budget deficit.

 

Vape Tax Created to Fund Pediatric Cancer Research

SF 2480 Vape Tax for Pediatric Cancer

This bill broadens the scope of Iowa’s tobacco laws by including “nicotine analogs” in the definitions of alternative nicotine and vapor products to include vapes subject to a new excise tax. As a result, $3 million in new tax revenue is appropriated annually for pediatric cancer research and related activities at the University of Iowa Stead Family Children's Hospital.

 

Wide-Ranging “MAHA” Bill Passes

HF 2676 Governor’s MAHA Bill

This bill institutes wide-ranging reforms in Iowa's health, nutrition, and educational laws. It requires physicians and physician assistants in certain specialties to complete one hour of continuing education on nutrition and metabolic health every four years and requires Iowa medical schools to include 40 hours of integrated nutrition coursework for graduation. The bill also permits Ivermectin to be dispensed over-the-counter by pharmacists without liability. Other components of the bill relate to school meals, physical activity requirements, and screen time.

 

Agriculture Budget Appropriates Funds for Water Quality

HF 2771 Agriculture Appropriations

The final Agriculture Appropriations budget invests significant funds in water quality improvement for Iowa, appropriating $8 million to the Water Quality Financial Assistance Fund and establishing a new Rural Iowa Infrastructure Bank Program Fund with $10 million dedicated to low-interest loans for water and wastewater projects, particularly targeting communities with populations of 11,000 or less. The bill also increases the maximum allowable grant for water quality projects from $500,000 to $1 million, expanding opportunities for larger-scale improvements. These initiatives aim to enhance water infrastructure and quality across both rural and urban areas of the state.

 

Other Notable Bills – Where Did They Land?

HF 2254 UIHC Noncompete Clause Prohibition PASSED, SIGNED INTO LAW

This bill prevents UIHC from including noncompete clauses in contracts with physicians, ARNPs, RNs, LPNs, pharmacists, PAs.

 

HF 2563 Medication Abortion Restrictions PASSED, SIGNED INTO LAW

This bill requires all abortion-inducing drugs to be dispensed in a health care setting directly to the patient and adds informed consent requirements. The bill ultimately passed after IMS secured substantial amendments addressing all previously-shared concerns. Namely, IMS negotiated amendments to remove $50,000 strict liability private cause of action provisions, mandated clinical statements relating to medication abortion reversal using progesterone, and all cumbersome reporting requirements.

 

SF 2480 Vape Tax for Pediatric Cancer PASSED, SIGNED INTO LAW

This bill broadens the scope of Iowa’s tobacco laws to include “nicotine analogs” in the definitions of alternative nicotine and vapor products to include vapes subject to a new excise tax. As a result, $3 million in new tax revenue is appropriated annually for pediatric cancer research and related activities at the University of Iowa Stead Family Children's Hospital.

 

HF 2694 Limitations on Governor’s Authority PASSED, SIGNED INTO LAW

This bill created new prohibitions and limitations on the governor's powers during disaster emergencies, specifically barring any regulation of places of worship and prevents the governor from mandating vaccinations during a disaster emergency. An amendment to prohibit isolation and quarantine for any person not yet infected with a disease during a public health emergency was not accepted.

 

SF 2417 AI Chatbots PASSED, SIGNED INTO LAW

This bill regulates conversational AI services accessible to the public in Iowa. It specifically targets the protection of minors using these services by mandating clear AI disclosures, prohibiting manipulative engagement tactics, and restricting inappropriate or misleading content. Operators must implement privacy management tools for minors and their guardians, adopt protocols for self-harm and suicide-related interactions, and are forbidden from presenting AI as a licensed mental health provider.

 

SF 304 Minor Treatment Consent PASSED, SIGNED INTO LAW

This bill from last session removes minor patients’ authority to independently consent to the provision of vaccinations for sexually transmitted diseases or infections. While minors retain the right to consent to diagnosis or treatment of STIs, they must now obtain consent from a parent, guardian, or other authorized adult to receive vaccinations for these conditions.

 

HF 2543 Subacute Care Facilities PASSED, SIGNED INTO LAW

A subacute mental health care facility is a short-term mental health service provider offering a level of care more intensive than outpatient therapy, but less than acute hospitalization, with the aim of stabilizing individuals and transitioning them back to less restrictive environments. This bill requires facilities to develop an initial treatment plan with residents within 24 hours of admission and establishes timelines for insurance preauthorization determinations for subacute mental health services. It also establishes an electronic system to track psychiatric bed availability for children.

 

SF 2190 Physician Assistant to Physician Associate PASSED, SIGNED INTO LAW

This bill changes all references to "physician assistant" in Iowa law, rules, and related documents to "physician associate". The new and old terms, along with "P.A.", are considered synonymous, with no change to scope of practice, rights, or responsibilities.

 

HF 2297 Radon Mitigation PASSED, AWAITING SIGNATURE

The bill requires all new single-family and two-family residential construction in Iowa to include a passive radon mitigation system as specified in appendix AF of the 2021 International Residential Code.

 

HF 571 Medical Conscience Protections PASSED, AWAITING SIGNATURE

This bill creates broad protections for health care practitioners and institutions, that refuse to participate in certain health care services due to ethical, moral, or religious beliefs. It prohibits discrimination, civil, criminal, or administrative liability for such refusals, and provides explicit whistleblower and free speech protections. It also clarifies that such protections do not relieve entities from providing emergency services and do not exempt anyone from federal health privacy laws. The Senate amended the bill to remove health insurance payors and require practitioners to notify employers of any conscience objections.

 

HSB 766 AI Autonomous Service Providers DID NOT ADVANCE

This bill creates a new legal and regulatory framework for licensing, oversight, and reimbursement of artificial intelligence augmented and autonomous service providers (AAASP) in clinical health care settings. It establishes the Board of Autonomous Medical Practice to regulate AAASPs, sets out multiple license classes and autonomy modifiers, and defines the scope of practice for clinical AI services. The bill includes requirements for patient disclosures, professional duties, safety and performance benchmarks, and annual reporting. It creates special rules for provisional licenses, outlines insurance and Medicaid reimbursement processes, and preserves patient protections, liability standards, and data continuity. The bill also prohibits unlicensed practice and establishes penalties for violations.

 

HF 2758 Standing Appropriation for Pediatric Cancer DID NOT ADVANCE

This bill creates a separate standing appropriation from the state general fund to the state board of regents, starting July 1, 2026, for pediatric cancer research at the University of Iowa hospitals and clinics. The funding amount is set at $1 per state resident, based on the latest U.S. Census Bureau estimate, with an annual cap of $3 million. Funds are restricted to direct pediatric cancer research, including laboratory and clinical trials, and may not be used for administrative or overhead costs. The board of regents is required to submit an annual report detailing the use of funds to the governor and legislature.

 

HF 978 Medical Psilocybin DID NOT ADVANCE

This bill creates a medical psilocybin program in Iowa. The bill legalizes the recommendation, possession, use, dispensing, delivery, transport, and administration of psilocybin when conducted in compliance with new regulations. It establishes licensing for production facilities and testing labs, sets requirements for medical and therapy providers, implements inventory control and electronic verification systems, and outlines detailed compliance, reporting, and enforcement mechanisms. The bill permitted PAs, ARNPs, APRNs, psychologists, and social workers to administer psilocybin without direct physician supervision.

 

SF 2184 / HF 2133 Kratom DID NOT ADVANCE

This bill adds kratom and its synthetic equivalents to the list of Schedule I controlled substances in Iowa.

 

Looking Ahead

Looking ahead, IMS will continue working with physicians, policymakers, and health care partners to prepare for the 2027 legislative session, which convenes in January. As Iowans head to the polls in November to elect state leaders, IMS will remain focused on educating candidates and elected officials about the issues that matter most to physicians and their patients. Building on the momentum of this year's legislative successes, IMS will continue advocating for policies that strengthen Iowa's physician workforce, reduce unnecessary administrative burdens, address reimbursement challenges, and improve access to high-quality care across the state.