IA Farmers Union executive director: Cuts are causing crisis in rural healthcare

The enactment of the One Big Beautiful Bill Act in 2025, which cut Medicaid and other federal health programs by $1 trillion over a decade, and the expiration of a federal tax credit at the end of 2025 that had helped people pay for health insurance purchased on Affordable Care Act marketplaces, have left many Iowans unable to afford health insurance or obtain care. Experts say the cuts are being acutely felt in Iowa’s rural communities.

A KFF analysis published in August 2025 predicted that the federal cuts and the expiration of the enhanced premium tax credits would together increase Iowa’s uninsured population by 80,000 people by 2034. As of February, about 21,000 fewer Iowans have ACA insurance plans than did a year before, according to Centers for Medicare and Medicaid Services data.

On July 15, the healthcare advocacy groups Protect our Care and Fairness for Iowa launched their “Sick of It! Fix Health Care Now” campaign with an event in Indianola. Speakers at the event criticized President Donald Trump and Iowa’s all-Republican congressional delegation for their roles in approving the cuts and for allowing the ACA subsidies to expire. 

One of the participants was Matt Russell, executive director of the Iowa Farmers Union, a bipartisan organization of Iowa farmers, ranchers, and other supporters of family farms and ranches. Russell grew up on his parents’ Cass County commodity and livestock farm and now owns a 110-acre family cattle farm with his spouse in Marion County.

On July 17, Russell spoke with the Iowa Independent about the negative impact federal healthcare spending cuts have had on rural communities in the state and his own ability to afford health insurance.

The interview has been edited for clarity and space.

What were things like for farmers such as yourself prior to the passage of the One Big Beautiful Bill when it comes to the economy and access to healthcare?

Last year, we took advantage of the Affordable Care Act. I was in the Biden administration, so I was a federal government worker from fall 2021 through Inauguration Day, so we had access to employer-based healthcare. When we started farming, we were looking at options, and [Matt’s husband] Pat had some preexisting conditions. So employer-based healthcare was really our only option. So over time, when the Affordable Care Act came in, it was a game changer because for families like ours, if we didn’t have access to employer-based healthcare, or we wanted to do something like go full time on the farm, or start our own business, or go to work for a small company or a nonprofit that didn’t have a family policy. Pat’s been full time on the farm since 2006. If we didn’t have that employer coverage, then it was like rolling the dice or hoping nothing happens. 

So the Affordable Care Act changed that, and it was such a game changer. That’s over 10 years ago, and people have forgotten what it was like before the Affordable Care Act. And then in 2021, they passed the enhanced premium tax credits, and that was another game changer because not only did it create policies that worked — no preexisting conditions, no lifetime limitations, those kinds of things, ability to have your kids on the plan — those enhanced premium tax credits created affordability access. So what’s changed now for 2026 is that the cost for people that still have access to the tax credits, like we do, those costs went up dramatically because we changed the tax credits back to the originals and got rid of the enhanced. 

But what’s also really important to understand is that our family is right at that 400% threshold of poverty. So for a family of two, it’s $85,000. So if we make a dollar above 400% of poverty, we lose all of our tax credit. And for us, that is about a $14,000 cost. In ’26, we’re managing our family finances to make darn sure that we don’t make more money. That’s our family situation.

Iowa Farmers Union, we really advocate for farmers and ranchers, rural communities, and on behalf of the whole state. But our constituents are primarily farmers, ranchers, and rural community members. When we should be investing in opportunities for our constituents to be increasing their income, taking risks, innovating, starting small businesses — all the kinds of things that we’d want to see happen — these enhanced premium tax credits going away is an incredible disinvestment.

We’ve created a new fiscal cliff with getting rid of these enhanced premium tax credits, and then in addition to that, we’re seeing the Medicaid cuts. So we did Medicaid expansion, and we did the ACA, and both of those things were incredible investments for rural America, because it’s a lot of older people in rural America, it’s a lot of younger families that want to stay in rural America that don’t have as many job opportunities as if they just went off someplace else to make as much money as they could — they want to stay in their community. Or they have a child with a disability and they want to stay in a rural community. 

So there’s a lot of things there, where all of those strategies to invest in healthcare that we’re unwinding, that’s where Iowa Farmers Union, we’re paying really close attention. Because we’re hearing from our members that this is just a real challenge. 

Did your family’s premiums go up, even staying under the cliff?

Oh yeah. It’s a combination of reduced tax credits and increased premiums, but last year, in ’25, our total outlay for an HMO — we were paying just over $6,000 in 2025 [for the year]. 

In 2026 we adjusted, we went down a little bit, we chose a product that was a little bit less than last year’s, and our premiums are going to be over $9,000. So it’s like a $2,300-$2,400 increase in out-of-pocket, and that’s a combination of increased percentage on the premium, although we went to a different plan that was a little bit less than if we just stayed in the plan as we were.

If you were to lose access to the premium credit at all, roughly, what sort of hit would that be?

Then our total premium, if we had no tax credits, is over $23,000. So let’s just say we go over the $85,000 and we make $90,000, then our health insurance premium for an HMO with deductibles, not super-high deductibles, but still out-of-pocket costs for both of us over $4,000 plus the co-insurance and all that. If we made $90,000, $23,000. It’s over [a quarter] of our adjusted gross income.

So if you earned $10,000 more in income, you would be paying more than $10,000 more on premiums.

If we earned $10,000 more in income, it would be a $4,000 loss. This is the irrationality of members of Congress who said, We’re not going to extend these tax credits because we’re not going to be paying these insurance companies, whatever the kind of rationale they publicly talked about. What they did is they chose, by not extending the enhanced premium tax credits, they chose to unleash on working-class Americans, including farmers — we went backwards. We were moving in the direction of more rational public policy. Still a long ways to go, Affordable Care Act is not perfect, but we were moving in the right direction, and we just went backwards, so that we were creating an economically irrational situation for millions of Americans. And farmers are right in the middle of it because — KFF, their analysis last fall was that about 27% of American farmers, ranchers, and agricultural managers would fall into needing a healthcare plan that’s not provided by an employer.

Are you hearing from members that farmers across Iowa are losing the ability to afford their plans?

Yes, we’re hearing some of that. There’s a lot of studies coming out now. We’re seeing the implications of it. So we’re seeing a downturn in the farm economy in general and some real challenges in the rural economy in Iowa, and now the Medicaid and Affordable Care Act changes are compounding that as well, as well as inflation on energy, inflation on inputs, so all the different ways that we’ve used government to invest in farmers and rural communities and our food system and the SNAP program …. We’re tearing it all down. 

As this is happening, we’re also seeing in Iowa and elsewhere that the Medicaid cuts are leading to closures of hospitals, clinics, other providers in rural areas. 

The ability of communities, community leaders, small businesses, farmers, when we partner — their willingness to take risks and make investments in their communities, their farms, their businesses — with investments from government, whether it’s county, state, federal — when you put those two things together, then we unleash the power of rural America to do amazing things, in food, in energy, in conservation, environmental investments, in big projects. And we have a history of this. And when you disrupt that by pulling back those government investments, the taxpayer investments, you unleash a spiral that shows up on Main Street, it shows up in your school system, and it shows up in your local health delivery. That’s what you’re seeing. 

You’re seeing what were challenging times for rural community health centers, pharmacies, hospitals, clinics — now you’re seeing that, in a lot of places, those are no longer challenging times; they’re just done. So they’re either dramatically changing how they’re doing service, so it’s no longer a hospital, it’s, like, an emergency room with 20 beds. No longer delivering babies. We’ve got it in Ottumwa, Iowa. We’ve got it in Mason City, and I think now I’ve heard Newton. These are not tiny rural communities. But they’re all seeing health services shrink, close. These big networks are just saying, We’re no longer providing, we’re closing our clinic, or in Newton, we’re no longer delivering babies.

So, again, it’s spiraling. When you invest, you get growth, you get innovation, you get risk-taking, and when you divest, you undermine that, and then you get decline, you get shrinking, you get closure, you get consolidation of schools. And healthcare is kind of the tip of the spear in many ways.