Cuts to Medicaid will worsen Iowa’s cancer crisis, advocates warn

Gary Streit grew up on a state-designated Century Farm that his great-grandparents homesteaded in northwest Iowa, between Ashton and Sibley. His brother still owns part of that farm, which earned the designation by being owned by a single family for over 100 years. 

Streit went to college at Iowa State University, and he later went to law school at the University of Iowa. He’s been a lawyer in Cedar Rapids since 1975. 

“Iowa born and raised, that’s for sure,” said Streit, who just turned 76. 

He has been a volunteer with the American Cancer Society since 1977. In the time since, his sister had breast cancer roughly 30 years ago. His wife had thyroid cancer nearly 20 years ago. His nephew had testicular cancer. And about 10 years ago, Streit was diagnosed with prostate cancer. 

All of them received successful treatment, he said, thanks in large part to early detection. But during an interview with the Iowa Independent, Streit also remembered mentors in his law career and friends who died of cancer. 

Iowa has the second-highest rate of new cancers in the country. PBS reported June 16 that it’s one of only three states where rates are rising. A 2026 report by the Iowa Cancer Registry says that an estimated 21,700 Iowans will see new cancer diagnoses this year, and 6,400 Iowans will die from cancer this year. Both of those numbers are up from 2025. 

What can Iowa do to change course? 

“You can do one-on-one advocacy ‘til you drop, but when you can change systems across the state, you’re going to impact far more people far more effectively,” Streit said. 

Medicaid cuts at the federal and state level

One of the most significant factors in estimating whether someone survives cancer or not is whether they have health insurance, Jackie Cale, the Iowa government relations director for the American Cancer Society Cancer Action Network, told the Iowa Independent in a phone interview.

In Iowa, about 603,000 people are enrolled in Medicaid, according to numbers shared last year by KFF, a health policy nonprofit. About 2 in 5 of those people are children, and slightly more than 2 in 5 are people who live in a rural area. 

The budget law that President Donald Trump signed last year included $1 trillion in cuts to Medicaid spending over 10 years. The cuts in spending for Iowa over a decade are about $9 billion, according to KFF, and its August 2025 report estimates that 68,000 Iowans will be uninsured in 2034 due to Medicaid changes such as new work and reporting requirements. 

The Iowa Independent recently reported that three hospitals in the state are at risk of closing or reducing services as a result of Medicaid cuts. 

Last June, Cale blasted a Medicaid work reporting requirement law signed by Republican Gov. Kim Reynolds, saying in a statement, “This cut to Medicaid expansion will plunge our state deeper into this cancer crisis.” 

The law requires that those ages 19 to 64 who are enrolled in Iowa’s expanded Medicaid program, known as the Iowa Health and Wellness Plan, report 80 hours of work per month. The Legislative Services Agency found that 32,000 people could lose health insurance because of the reporting requirements. 

“If you are an able-bodied adult who can work, you should work,” Reynolds said in a statement on the bill signing, according to the Iowa Capital Dispatch. “We need to return Medicaid back to its intended purpose—to provide coverage to the people who truly need it.”

Cale said work reporting requirements don’t boost employment rates; rather, they add red tape that causes people who can’t keep up with it to lose coverage. 

“This law will do grave harm to the health and well-being of our state,” Cale said in the statement. “Iowa Medicaid serves as a lifeline for many workers, veterans and our rural hospitals.”

Cale told the Iowa Independent she would like to see more exemptions in these reporting requirement laws for cancer patients and survivors because there is a lot of potential for them to accidentally lose coverage. 

She also said she was worried about another law Reynolds signed that removed retroactive health coverage under Medicaid for most adults. Now, only pregnant women, children and nursing home residents may get up to two months of retroactive coverage of expenses incurred before the month they submit a medical assistance program application.

Streit said barriers to enrolling in or maintaining eligibility for Medicaid can be overwhelming for cancer patients who are just trying to keep their heads above water. He thought back to his own time in treatment. 

“I thought: You’re one lucky fellow. You’ve got a great job. You’ve got a great support system. You’ve got health insurance. You’ve got every conceivable tool to take care of your cancer,” he said. “What if you were unemployed and on Medicaid and you couldn’t drive or something? How would your treatment have come out differently on the other side?” 

Streit went to a recent fundraising walk at a spot called Mount Trashmore, a former landfill turned into a hiking area. He said he walked almost 20 miles. At the event, he was joined by one of his friends and their 5-year-old son. 

“That kid was so fun and so full of energy,” Streit said. “And I thought, I hope to heck that what we’re raising money for will keep him from ever having to deal with this, either for himself or his parents.”