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At a January campaign stop, former Vice-President Joe Biden had tough words for Iowa’s Republican governor. “In your state, your governor goes ahead and privatizes Medicaid, which is why hospitals aren’t getting paid on time so they’re shutting down,” Biden said. “They’re shutting down emergency services and they’re at risk.”

Biden was partially right, as the Cedar Rapids Gazette reported at the time. Although a number of the state’s rural hospitals are at risk of closure, they’re all still open for now, which undermines part of Biden’s claim. So do the facts of the rural hospital crisis, which are varied and complex. In Iowa, the privatization of Medicaid is the latest entry in a series of threats that include hospital mergers driven by private equity. But the rest of Biden’s observation is largely correct. Iowa’s governor, Kim Reynolds, did privatize Medicaid, a decision that has benefited certain corporate entities while proving less helpful to medical providers. In January, the Iowa Department of Health Services withheld $44 million in state funds from Iowa Total Care, which provides Medicaid services to low-income people. The company, which recently moved into an office space that includes a food-truck court and heated parking, “had not paid more than 100,000 claims that providers had submitted,” the Des Moines Register reported.