Two-way primaries in southeastern Iowa could set up another rematch in one of the nation’s marquee congressional contests this November.
Republican U.S. Rep. Mariannette Miller‑Meeks and Democratic challenger Christina Bohannan are gearing up for what could be their third race against each other since 2022.
The outcome will be pivotal in determining which party controls Congress and whether President Donald Trump has GOP majorities willing to carry out his agenda for the rest of his second term as president. Political analysts consider Iowa’s 1st Congressional District race a toss-up.
Despite each facing party challengers, Both Miller-Meeks and Bohannan have been largely operating in general election mode ahead of the June 2 primary. The two each have stockpiled more than $4 million for one of the nation’s top targeted U.S. House battles.
After being snubbed in her last two election bids, Miller-Meeks secured an endorsement from Republican President Donald Trump.
Meanwhile, the Democratic Congressional Campaign Committee included Bohannan in its highly coveted “Red to Blue” program that funnels resources to the party’s top battleground contenders.
Their primary opponents, Republican David Pautsch and Democrat Travis Terrell, have each cast their party’s frontrunners as establishment figures out of touch with average voters.
Pautsch — a self-proclaimed MAGA candidate — unsuccessfully challenged Miller-Meeks in 2024 for their party’s nomination. Despite relatively low name identification and fundraising, he came within 12 percentage points of denying her a third term.
Bohannan drew primary opponents for the first time this cycle, as some Democrats aired frustrations with her two failed bids to unseat Miller-Meeks. Terrell has fashioned himself as the more progressive alternative.
For Miller-Meeks, Pautsch’s performance will show whether her Trump endorsement succeeded in shoring up her base after some of her previous votes rankled social conservatives and the most Trump-aligned Republicans.
And Bohannan’s margin over Terrell will signal local Democrats’ confidence in her as a messenger on pocketbook issues, at a moment when the party is trying to rebuild voter trust by shifting away from “culture-war” issues.
The 1st District spans 20 counties, including the cities of Davenport, Iowa City, Indianola and Keokuk.
Miller-Meeks touts medical background while critics target her health care votes
Miller‑Meeks, 70, is returning to her roots as she shares her story of enlisting in the U.S. Army at 18 and her career as a nurse and physician.
She says her medical background has shaped her focus in Congress on pharmacy benefit manager changes, rural health funding and efforts to curb patients’ costs by challenging insurance companies.
The Ottumwa Republican leaned into that background in a televised ad she billed as her first general election spot — airing weeks before the primary.
Democrats have turned her medical résumé into a line of attack, highlighting her pharmaceutical industry ties and arguing her positions contribute to rising health care costs.
Still, Miller-Meeks told the Des Moines Register: “I’m confident that everything I have done in the past year and a half, all of the multiple thousands of constituents that I have met with both in Iowa, in the district and in D.C., the work that I have done will speak for itself, and (Pautsch) will once again lose.”
Miller-Meeks dismissed Democratic attacks, saying she is “not at all” concerned they might undermine her message of rooting out waste, fraud and abuse in government spending.
She faces a political balancing act, according to Cook Political Report’s analysis: “The more Miller-Meeks tries to appeal to the GOP base, the more she risks alienating independent voters in this district, which is ancestrally Democratic but has swung to the right over the past decade.”
Miller-Meeks is among the chorus of Republicans touting their sprawling domestic policy package that preserves Trump’s signature tax cuts. But Trump’s global tariffs and the U.S. war with Iran have rattled the economy, complicating the GOP’s message.
The Republican incumbent sidestepped questions about whether Trump’s tariffs have helped or hurt Iowans, saying she believes “tariffs have (been) a negotiating tactic” if used the right way, then pointing to her legislation that seeks to lower farm costs by removing duties on imported phosphate fertilizer from Morocco.
Bohannan promises to lower living costs in third congressional bid
Bohannan is vowing to lower Iowans’ living costs, especially health care — altering her focus after her 2024 message centering on abortion rights failed to propel her to victory.
The 54-year-old University of Iowa law professor from Iowa City is buoyed by her quasi-incumbent status as she looks to oust Miller-Meeks. After Bohannan lost in 2024 by nearly 800 votes, about 0.2 percentage points — even as Trump carried the district by 8 points — she expects the third time to be the charm.
Her campaign is banking on an ambitious field program, Bohannan said, with more campaign stops and canvass trainings to increase doorknockers across the district.
She frames herself as an independent voice for the district willing to buck the party on issues such as immigration, while right-wing attacks seek to paint her as “woke” for her role in UI law school diversity, equity and inclusion efforts.
And she has drawn contrasts with Miller-Meeks on public accessibility, promising regular public town halls. Miller-Meeks declined to hold in-person forums for months before eventually hosting a raucous event in November, where voters shouted over her answers and vented frustrations with Trump’s policies. The Republican has also held several telephone town halls.
Bohannan argues that Miller-Meeks’ voting record shows a disconnect with southeastern Iowans facing affordability woes and pushed back on critics who say she has failed twice to clinch the seat.
“We outperformed here more than any other Democratic congressional candidate running against a Republican incumbent in the entire country” in the 2024 cycle, Bohannan said. “And that happened because I am doing that hard work of coming up with practical solutions to real problems, working to bring people together here. People are tired of the fighting.”
She was unconcerned that Terrell’s bid would eat into her margins in the district’s bluest areas like Johnson County, saying that southeastern Iowans “want to bring costs down and to take commonsense actions that will actually bring both parties together to come up with solutions.”
Pautsch makes appeal to MAGA Republicans
Undeterred by Trump endorsing his incumbent opponent, Pautsch, 72, is doubling down on his MAGA bona fides to appeal to the Republican base and more evangelical voters.
The Davenport businessman and founder of the Quad Cities Prayer Breakfast casts Miller-Meeks as “out of step with red-meat Republicans.”
On issues such as immigration enforcement and LGBTQ rights, he stakes more hardline positions.
Discussing federal immigration agents’ fatal shootings of two U.S. citizens in Minneapolis, he said: “You are sad for any loss of life, but both of these people were categorically in the wrong, doing things that were just out of line, and they reaped the consequences for their lawless behavior.”
This cycle, he began campaigning earlier, meeting thousands of voters and focusing on grassroots outreach. With little campaign cash, he believes he will benefit from Democrats’ heavy spending against Miller-Meeks.
“Like I say, my enemy’s enemy is my friend,” Pautsch said.
He downplayed the significance of lacking Trump’s endorsement and chalked up the endorsement to national Republicans’ desperation to keep the House. Pautsch said he has garnered support among voters who find Miller-Meeks “so wobbly and so indecisive” as she tries to straddle both independents and Republicans.
Terrell makes progressive pitch to uplift working-class Iowans
Terrell pledges to be a voice in Washington, D.C., for working-class Iowans, branding himself as an anti-establishment fighter who would expand government social safety net supports, challenge Democratic Party leadership and combat the rise of authoritarianism with Trump at the helm.
Voters, Terrell said, “want to see somebody that says, ‘This is how I’m going to fight for you and these are the policies I’m going to fight for.'”
The 40-year-old University of Iowa Health Care employee from Tiffin has staked positions to Bohannan’s left on issues including health care and the Iran war.
Terrell supported calling for Trump’s impeachment over handling of the Iran war, arguing “we are sending a message to the next wannabe dictator that the president is above the law.” Bohannan, by contrast, said she didn’t “think that’s a productive thing to do” but said she thought Congress should maintain its oversight role over military engagement.
The first-time candidate nabbed endorsements from some of Johnson County’s most progressive local officials but faces an uphill battle beyond the district’s blue bubble. He ended the first quarter of 2026 with only $5,277 in his campaign coffers.
“If a progressive in Iowa wins a primary with not barely a fraction of the percentage of what a person that has the standing of a near incumbent has, then it is going to send shockwaves across the nation,” Terrell said.
Health care at the center of 1st District race
Steep Medicaid cuts in Republicans’ “One Big, Beautiful Bill” have pushed health care to the center of the 1st Congressional District race, with some hospitals already scaling back services.
The law — backed by Miller‑Meeks and the rest of Iowa’s GOP delegation — cuts nearly $1 trillion over a decade. Combined with the lapse of enhanced subsidies, health experts say the moves are straining rural hospitals, driving up care costs and increasing the uninsured population.
Miller-Meeks maintains the subsidies in the Affordable Care Act, known as ObamaCare, are a “bailout” for insurance companies. She was the lead sponsor on House GOP-backed legislation that did not extend the subsidies but sought to lower premiums.
She has defended the Medicaid changes, including work requirements, as preserving benefits for those who need it most and permitting “tremendous exceptions.”
“I don’t think it’s too much to ask a 30-year-old person sitting at home that they shouldn’t go to their neighbor next door and say, ‘Hey, I know you’re 50 years old, but would you mind continuing to work and paying taxes so I can stay at home when I could work and I can have benefits to Medicaid and benefits to food stamp(s),” Miller-Meeks said.
“I’m not going to apologize for that. I think there is a value and dignity to work.”
Pautsch has joined Miller-Meeks in railing against the ACA, with both calling it the “Unaffordable Care Act.” He has pushed a health care agenda aligned with U.S. Health and Human Service Secretary Robert F. Kennedy Jr.’s “Make America Healthy Again” movement, emphasizing lifestyle changes over traditional health care.
“Real good health care begins with preventive health care,” Pautsch said. “… If you start your health care with the doctors, the only tools in their bag of tricks are cut, burn and poison.”
Health care policy has been a dividing line for the Democrats.
Bohannan’s central message is making health care more affordable by reversing the Medicaid cuts and expanding Medicare to allow Americans of any age to opt in and include dental, hearing and vision coverage. She says that would create competition with private insurance and drive down costs.
“I don’t want to force anybody into anything,” Bohannan said. “If people are happy with their private insurance, I think they ought to be able to keep their private insurance.”
Terrell has accused Bohannan of “playing it safe” by stopping short of universal health care, which he supports.
“We basically have so many people that either have to ignore their doctors’ requests or just drive themself into debt and risk losing their home or declaring bankruptcy for trying to save their lives,” Terrell said.
Marissa Payne covers the Iowa Statehouse and politics for the Register. Reach her by email at mjpayne@registermedia.com. Follow her on X at @marissajpayne.
This article originally appeared on Des Moines Register: Iowa’s 1st District primaries offer challenges from the left and right
Reporting by Marissa Payne, Des Moines Register / Des Moines Register
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