ALBIA — About 40 people attended Tuesday's town hall with Rob Sand, the Democratic nominee for Iowa governor. One would-be attendee didn't make it.
"We have a very good friend who should be sitting right here and was registered for this town hall," an attendee said. "He's in the Albia hospital right now with stage four lung cancer. Never smoked a day in his life.
"What are you going to do to help solve this problem?"
Sand, serving his second term as state auditor, said Iowa's cancer problem has no single cause. He cited smoking, drinking, inactivity, water quality and radon, the second-leading cause of lung cancer after smoking.
"We have six times the normal amount of radon in the state of Iowa," Sand said. "This is the distinguishing line between me and my opponent (Republican nominee Zach Lahn). I think radon is contributing to our increase in cancer rates. He says that's not it because radon's always been here."
Sand said increasingly airtight homes trap more radon indoors. Gov. Kim Reynolds this year signed a law requiring passive radon mitigation systems in newly built single-family homes and duplexes, a step Sand called good but insufficient.
"Anyone here think they are going to live in new construction before they die?" he said. "That'll be great in 70 years. That's not good enough."
Sand wants home inspectors to disclose Iowa's radon risk and make testing standard during sales of existing homes.
He also called for expanding cost-share programs to help farmers reduce runoff and funding the Natural Resources and Outdoor Recreation Trust Fund. Iowans approved the fund under the 2010 IWILL constitutional amendment, but lawmakers have not raised the state sales tax by the three-eighths of a cent needed to activate it.
"Sixteen years ago, 63% of Iowans said we want to have this trust fund for water quality improvement and outdoor recreation, and now we're 16 years behind because the Legislature won't fund it," Sand said. "Why? Because it's run for insiders and special interest groups, not Iowans."
An Oskaloosa labor and OB-GYN nurse said Mahaska Health's five-bed unit delivered 38 babies in August, with some patients driving two hours or more. She described a patient who was denied care after her water broke because a fetal heartbeat remained. The woman delivered at home and returned to the hospital seriously ill.
"How does the governor and the Legislature work together so that people have access to health care, specifically OB services?" she asked. "If you want to grow the state and the population, people have to have access to have babies safely."
Sand said Iowa's six-week abortion ban is discouraging doctors from practicing in the state. He said hospital lawyers sometimes advise delaying treatment of sick pregnant patients because of legal uncertainty, even when the law's maternal health exception applies.
Lahn has told Iowa PBS he believes life begins at conception and considers the six-week ban a good law. He said he "would likely support" further restrictions depending on the legislation.
Sand also blamed Medicaid privatization for financial strain on hospitals. He said some have taken out seven-figure lines of credit while disputing payments with insurers and pledged to end privatization if elected.
Brenda Case, a retired judicial branch employee and Democratic candidate for Iowa Senate District 13, asked whether Sand would allow privatization of the Iowa Public Employees' Retirement System.
"I'm not going to sign any legislation that would privatize IPERS," Sand said. "If it ain't broke, don't fix it. We have one of the better-funded pension systems in the United States; I think that we should keep doing what we're doing with it."
An electrician representing IBEW Local 13 asked how Sand would keep tradespeople from leaving for higher wages in Illinois. Sand cited Iowa's 48th-place ranking in personal income growth over the past three years and endorsed project labor agreements and stronger enforcement of contractor licensing laws.
Before the town hall, Sand also discussed the state's economic rankings and $1.3 billion annual budget deficit. He criticized federal trade and biofuel policies, saying a dispute with Canada affects about 30% of Iowa's exports and that small refinery exemptions have harmed agriculture.
Sand said data centers should pay full taxes and the costs of upgrading the electrical grid.
"If you're going to build in Iowa, you got to be contributing to Iowan's lives. Period," he said. "We need to have transparency, so we know who is trying to come here. We need to have setback requirements. You got to pay all your taxes. ... If you're going to take so much electricity that the grids need to improve, you should be paying for that."
Sand pushed back on campaign ads calling him a billionaire and suggested they may be confusing him with beverage executive Robert Sands.
"No," he said. "I'm not, and neither are my in-laws."
Sand declined to say whether he would release his tax returns, noting there is no legal requirement. He then criticized Lahn's personal financing of his campaign.
"I think the most ridiculous thing about the whole thing is (Lahn) started his campaign with a two and a half million dollar donation from himself and now he seems to be complaining and suggesting that he's just a regular Joe," Sand said.
Campaign-finance reports show Lahn has loaned his campaign $2.5 million. Since Sand launched his gubernatorial bid in May 2025, his wife and in-laws have contributed approximately $4.52 million to his campaign.
On property taxes, Sand said limited housing supply is driving up home prices and tax bills. He argued that building more housing would ease those pressures but rejected the idea that economic growth alone could close the budget gap.
"The idea that tax cuts will pay for themselves with growth is called trickle-down economics," he said. "We've been hearing about that for literally my entire life, and never has it worked. It's the same idea. They want to give a bunch of tax cuts to people who already have so much money that it's just piling up around them, and they keep promising it's all going to trickle down. I just think that's absurd."