Iowa community pharmacists say Medicaid cuts are hurting business and rural customers

As cuts to Medicaid contained in the budget law President Donald Trump signed into law in July 2025 start to go into effect, many Iowans are losing their health insurance coverage. Community pharmacists say the loss of coverage is already harming rural communities’ health and squeezing their businesses.

Republican Rep. Ashley Hinson, along with the rest of the members of Iowa’s all-GOP congressional delegation, voted to pass the One Big Beautiful Bill Act, which cut $1 trillion from Medicaid and other federal health programs over 10 years to pay for tax cuts that mostly benefited the richest Americans. A May 2025 Hinson press release heralded the law as “a generational investment to secure our borders permanently, provide tax relief for working Americans, and return America to prosperity.” 

Hinson is currently running for Iowa’s open U.S. Senate seat. 

The issues page on her campaign website says: “No matter where you live in Iowa, you should be able to access quality healthcare without driving hours or worrying about the cost. A medical decision shouldn’t be a financial decision. Ashley has worked across the aisle to improve rural healthcare, lower prescription drug costs, and support moms, seniors, veterans, and patients across Iowa who deserve better care.”

Hinson’s Democratic opponent, state Rep. Josh Turek, has proposed a full repeal of the Medicaid cuts. He recently visited Osterhaus Pharmacy in Maquoketa, where he spoke with community pharmacists about the impact of the Hinson-backed law.

Pharmacy manager Kole Gallick told the Iowa Independent in a phone interview after Turek’s visit that about 40% of the patients he serves are Medicaid subscribers. 

Some have lost their coverage entirely, Gallick said: “A story that I shared was a patient that lost insurance coverage, which they found out at a dental appointment. They had to halt their dental treatment plan, and then were also receiving nerve ablations from a pain specialist, and they had to cancel those appointments, as they couldn’t afford them without Medicaid. So coverage drops can happen instantaneously, where patients have little to no communication. And from a pharmacy perspective, trying to help bridge some of those gaps for our patients has been a large chunk of our time over this past year.”

For those who are still covered by insurance, out-of-pocket copays have gone up. “Depending on the medication, it could be anywhere from $1.60 up to $12.65 for a month’s supply of a medication,” Gallick said. “So to some of those patients that are on 10 or 12 medications, that could be up to $120 a month that they’re having to pay, which, based off of their current income status and income level, could become a large barrier for those patients.”

Gallick said he worries that patients unable to afford their prescriptions will be at high risk for serious medical problems. He noted that one local community member had recently stopped taking medication and ended up suffering a stroke. 

“I think it’s very obvious that the patients that we take care of are feeling the pinch of this,” Matt Osterhaus, the former owner of the pharmacy, who still works there part time as a pharmacist, said in a phone interview. “They come to the pharmacy and are ready to have a prescription filled and find out that they don’t have coverage anymore, and it’s news to them. And I think that’s starting, and I think we’ve just scratched the surface, because the biggest cuts are still ahead of us as far as the other qualifications on proving your work status and all that, that I think is just going to make it harder and harder for people. And then there’s less and less support for them to get help getting through the system.”

A spokesperson for the Turek campaign said in an emailed statement: “Ashley Hinson voted to cut health care, increase prices, and further strain Iowa’s already crumbling rural health care just to give tax breaks to billionaires. While Hinson grows her wealth and refuses to make live-saving prescription drugs more affordable, thousands of Iowans are struggling to afford necessary care. Josh Turek is a longtime health care champion, and he will fight like hell to ensure every single Iowan can access and afford the care they need.”

Hinson voted against the Inflation Reduction Act, a 2022 law that capped out-of-pocket prescription drug and insulin costs for millions of Medicare subscribers, and voted against a three-year extension of a tax credit that helped Americans afford to pay their premiums for health insurance plans purchased through the Affordable Care Act marketplace. Between the Medicaid reductions and the tax credit expiration, KFF estimated in August 2025 that 110,000 Iowans would lose insurance coverage by 2034.

The Hinson campaign did not immediately respond to a request for comment for this story.

The increase in uninsured Iowans will also make it harder for independent pharmacies, which already face tough economic realities, to stay in business.

“It can hurt and decrease cash flow for a business like ours, depending on the impact of the population of patients that have been impacted. We could see a significant decrease in prescription reimbursement as we look for patients that are wanting or willing to pay out of pocket,” Gallick said. “That can help cover our overhead costs, but with little profit to put back into the business, just at maintaining the current level we’re at. As we’ve looked across the past decade, we’ve seen numerous pharmacies close, not even just across Iowa, but across the country.”

“We’re losing independent community pharmacies because of the squeeze in the reimbursement on Medicare Part D specifically, but other insurance plans also. And as those margins continue to get scrunched and scrunched, the community pharmacy like ours that’s been in the community since 1965, those are disappearing in towns in Iowa,” said Osterhaus. “You look at what community pharmacies do and the services community pharmacists provide to people in these rural communities, and they’re a critical part of the healthcare system, and we don’t seem to be able to get that across to the people that are making decisions in Washington.”