Presidential nominations aren’t the only thing at stake in Iowa. This political season, just as those in years before, Iowa is a battleground for something many feel is more important: the national conversation.

Every four years, issue groups pushing everything from poverty awareness to ending “Don’t Ask, Don’t Tell” plant themselves near the state’s corn and soybean fields with the hope of drawing national attention and steering national conversations to their cause. While the convergence of such groups is nothing new to Iowa residents and has been impacting policy for years, this particular contest has produced a nearly overwhelming crop of such groups, many of them focusing directly or indirectly on health care.

None of the groups with a health care focus thus far has stated an explicit mission for reproductive health. By that same token, none has excluded it. Outside of the traditional organizations with an eye on this segment of health care (i.e., Planned Parenthood, Iowa Family Planning Council, National Organization for Women), those working to push health care as a national priority in Iowa aren’t willing to risk the controversy which so often follows discussions of reproductive health issues.

The importance of these groups, then, isn’t that they are already involved in the fight for reproductive health, but that they are poised to influence the outcome of upcoming battles. Many presidential candidates already have health care plans on the table that will be discussed in-depth in the coming weeks. It is important to note, however, that the candidates did not personally sit down and write out a health care plan. Such documents came from weeks, months and possibly years of planning with the very groups now hard at work in Iowa, driving policy changes that will affect every American.

Iowa for Health Care

The most active and predominant group with a focus on health care is Iowa for Health Care, a project of the Service Employees International Union. In March the group released the results of a poll conducted by Lake Research Partners of likely primary and caucus voters in New Hampshire, Iowa, South Carolina and Nevada. In those states, both Democratic and Republican voters overwhelmingly agreed there was a need for fundamental and not piecemeal reform of the health care system. Ninety percent of Democratic voters and 77 percent of Republican voters agreed that “businesses, government and individuals all have a responsibility to help pay for health care.”

“Iowa’s voters consistently place health care among their top issues,” said Sarah Swisher, director Iowa for Health Care, when the poll was released. “Rising health care costs are continuing to hit Iowans where it hurts.”

As a part of its campaign to keep health care at the forefront of the national conversation, the SEIU launched Walk A Day In My Shoes to encourage presidential hopefuls not only to court voters, but to gain first-hand knowledge of individual circumstances. All of the Democratic candidates have met with individual SEIU members to discuss their plans for America’s future and listen to how those plans could affect individuals working today. None of the Republican contenders have agreed to participate.

Better Health Care Together

One of the broader coalitions pushing for health care reform is Better Health Care Together. The coalition, which calls for reform by 2012, has created some strange bedfellows. Members of the coalition are AT&T, the Center for American Progress, the Committee for Economic Development, Manpower, Kelly Services, Intel, General Mills, Maersk Inc., SEIU, Wal-Mart, Qwest Communications, R.R. Donnelley, the Howard H. Baker, Jr. Center for Public Policy, Communications Workers of America and Embarq Corp.

“The U.S. health care system delivers below international norms at high cost, and consumers and industry suffer the consequences,” said Intel Chairman Craig Barrett while discussing his company’s affiliation with the coalition. “The simple principles and the diverse champions [that are a part of the coalition] will create a framework to develop workable approaches to the problems.”

Divided We Fail

A newcomer on the scene in Iowa this year is Divided We Fail. An arm of the AARP, this organization has a two-pronged focus of health care and long-term financial security. The elephant-donkey hybrid used as the group’s logo is fast becoming a recognized symbol in Iowa for nonpartisan reform.

Since one in five Iowans receives Social Security, and since health care expenditures have grown by nearly 8 percent each year since 1980, the group has found traction with Iowa caucus goers from both parties. Currently, 12 percent of Iowa’s population does not have health care.

Partnership to Fight Chronic Disease

Chronic diseases such as asthma, cancer, diabetes and heart disease as well as the policies that affect long-term care and prevention, are the target of the Partnership to Fight Chronic Disease. The organization is a coalition of many existing agencies, labor groups and businesses such as the Men’s Health Network, Epilepsy Foundation, American Academy of Nursing, Milkin Institute, U.S. Chamber of Commerce, YMCA of the USA and National Association of VA Physicians and Dentists.

The Iowa advisory board includes Iowa for Health Care’s Swisher, former Iowa House Minority Leader Dick Meyers, former Gov. Tom Vilsac, former Gov. Terry Branstad, Community Health Charities President Jim Swanstrom, Greater Des Moines Partnership Chairman Jim Cownie and Des Moines Area Religious Council Executive Director Forrest Harms. As the board membership would suggest, partnering organizations are just as diverse and range from the American Cancer Society of Iowa to local churches.

The organization aims to offer a united voice to promote health and wellness, reduce health disparities, eliminate bureaucracy, enhance health information and increase access to health care, including preventative care.

“Our goal is to restructure and re-frame the debate on health care reform,” Ken Thorpe, executive director of the partnership told American Medical News in June. “Most people are not aware of the key role played by chronic disease in driving up health care costs.”

Thorpe, a health policy adviser to the Clinton administration, says chronic disease accounts for 75 percent of the nation’s health care spending.

On The Fringe

Many other organizations and groups are currently in Iowa pushing agendas that are not associated directly with health care but will nonetheless impact policy if they are successful:

Iowans for Sensible Priorities wants to see the government reduce Pentagon spending and reroute those monies into programs like education, health care and job training. In particular, the group wants $60 billion currently spent on Cold War-era weapons systems to be eliminated in favor of social programs.

Iowans for Tax Relief is interested in how taxes are spent. Although the group primarily targets state issues and spending, its level of activity and presence in the state provides the group opportunity for larger spheres of influence.

ED in ‘08 is a pseudo-newcomer to Iowa, this one targeting education. The program is a revamp of a different push — STAND UP — that was launched in 2006. It is an arm of Strong American Schools, a project of Rockefeller Philanthropy Advisors. The Bill and Melinda Gates Foundation and the Eli and Edythe Broad Foundation have provided funding.

Iowa Global Warming Campaign has been extremely active with the presidential candidates and the general public thus far. This is especially true in the eastern portion of the state. Founding members include the Iowa Environmental Council, Iowa RENEW, the Environmental Law and Policy Center, the League of Conservation Voters, the National Wildlife Federation, the National Audubon Society and the Union of Concerned Scientists.

Iowa Christian Alliance (formerly the Christian Coalition of Iowa) represents Christians and “advocates Christian values” at all levels of government while also training and informing constituents for political action. The group also acts as a watchdog for what it deems “anti-Christian bigotry.”

Working Families Vote 2008 is a project of the American Federation of Labor-Congress of Industrial Organizations. The aim is to inform working men and women on issues that would be of importance in their lives — health care being one of many.

One Iowa focuses on awareness of a wide variety of lesbian, gay, bisexual and transgender issues such as marriage equality, safe schools and military issues.

One Vote ‘08 has targeted several global problems, most of which connect to poverty. Their goals include fighting HIV/AIDS, tuberculosis and malaria; preventing death from poverty; providing primary education for children who have no access; improving impoverish living conditions; and reducing/ending world hunger.