Iowans lost affordable insurance options after GOP lawmakers blocked ACA subsidy renewal

When Norwalk resident Jill Kordick retired a couple of years ago after a career as a hospital administrator, she was too young to be eligible for Medicare. She went to the Affordable Care Act marketplace and found a subsidized health insurance plan that cost her just $900 a year. 

“I paid $75 a month to be able to have health insurance,” Kordick told the Iowa Independent. “And then Mariannette Miller-Meeks and the rest of the entourage voted not to retain that program, and now I’m paying over $9,600 for the year, so a tenfold increase.”

Kordick and more than 110,000 other qualifying Iowans were able to purchase insurance plans and offset much of the cost with hundreds of dollars a month in tax credits thanks to a temporary program signed into law by President Joe Biden in 2021 and extended in 2022. 

The credits expired at the end of 2025, increasing the average out-of-pocket cost of coverage by an estimated 173% in 2026, according to a September analysis by the nonpartisan Center for American Progress.

In December, Senate Democrats and a number of Republicans voted for a bill that would have extended the enhanced premium tax credits for three years. Iowa Republicans Joni Ernst and Chuck Grassley both voted no, and the proposal fell nine votes short of the 60 needed to overcome a GOP filibuster, 51-48. 

“Biden’s COVID bonuses didn’t succeed at lowering the cost of health care — they just sent more taxpayer dollars into the pockets of insurance companies,” Grassley told the Daily Iowan in December. “Republicans are committed to finding solutions to bring down health care costs for American families, not extending government handouts to insurance companies.”

With the subsidies gone, the number of Iowans purchasing ACA marketplace plans went down by about 10%, from 136,833 in 2025 to 123,304, according to KFF data. 

Many of those who did sign up for 2026 plans have been unable to afford to keep them. The news site NOTUS reported on May 12 that more than 20% of residents of the 30  states that use the marketplace who enrolled or renewed through the HealthCare.gov federal site were subsequently dropped after failing to pay their first month’s premium.

The Centers for Medicare & Medicaid Services did not immediately respond to a request for Iowa-specific data for this story. The nonpartisan Urban Institute estimated in September that, all told, 24,000 Iowans would lose coverage by the end of 2026 without the subsidies. 

In January, after 218 U.S. representatives signed a discharge petition to force a vote in the House against the wishes of the GOP leadership, House Democrats and 17 Republicans passed a bill to restore the subsidies through 2028. That bill has not received a vote in the Senate.

Iowa Republican Reps. Randy Feenstra, Ashley Hinson, and Miller-Meeks all voted against considering the bill and against final passage. 

Republican Rep. Zach Nunn voted against bringing the bill to the floor for a vote, but then voted in favor of final passage. According to an Iowa Capital Dispatch report, he told the Westside Conservative Club in Urbandale in January that he wants to repeal the Affordable Care Act, but did not want to leave Iowans without access to any insurance coverage: “I want the ACA gone as much as any of you, but I’m not going to leave 126,000 Iowans to wait for Congress to get its job done. Because while we can lead on that legislation, if the Senate will not pass it, then it’s effectively doing the worst of both worlds. … When it comes to representing 750,000 Iowans, I’m not gonna leave 100,000 in the lurch while Congress tries to do its job.”

None of the Iowa lawmakers who voted no responded to a request for comment for this story.

Miller-Meeks told the Quad City Times in January that the subsidies “don’t fix the broken system or actually lower costs; they simply hide who pays for them.”

In comments flagged by the research group American Bridge 21st Century, Hinson repeatedly told Iowans in November that the ACA was really the “Unaffordable Care Act” and said she opposed extending the premiums. “The problem here is that what they’re asking for is to just mask the cost of Obamacare, which is the ‘Unaffordable Care Act,’’ she told the Freedom Foundation in Cedar Rapids, according to the local newspaper The Gazette. “It’s driven health care premiums up, and there’s no incentive on the insurance companies to actually lower premium costs.”  

Feenstra told Radio Iowa in December that he preferred to put federal funds into tax-free Health Savings Accounts to help individuals pay for their healthcare. “When you have tax credits and when they go directly to the insurance companies, it dramatically increases premiums,” Feenstra said, without evidence. “We see this time and time again.”

Gerard Anderson, professor of health policy and management and of international health at the Johns Hopkins Bloomberg School of Public Health, said at a November 2025 Q&A that elimination of the subsidies would mean higher premiums for many people: “It would be a step backwards. There’s a concern that many people—typically young, healthy people—will be priced out of their plans and drop out. That creates what, in economics, is called the ‘death spiral,’ where you get more and more older and sicker people into your health insurance plan and prices continue to rise.”

In December, Iowa Farmers Union president Aaron Lehman told Congress that his family was on a subsidized ACA insurance plan that met their needs. “Because we have affordable coverage, I am able to work full-time on the farm where I can concentrate on what’s best for our farm: growing crops, maintaining equipment, exploring the best possible market opportunities, implementing new innovations to make us efficient and to better build our soil health and preserve our resources, and taking smart steps to help our son join the farming operation.” 

With the expiration of the subsidies, Lehman said, the cost for a similar plan for 2026 was more than double what they paid in 2025.

“This affordability issue comes at a time when farmers like me are facing enormous challenges. Trade tensions have led to lower prices for what we grow and sell, at the same time we have higher costs for all the inputs we purchase,” he testified. “Without a doubt, a dramatic increase in 2026 health care premiums for thousands of rural residents will crash individual family budgets and intensify the economic crisis across rural America.”

Kordick said the spike in cost of her health plan caused her to reevaluate her retirement plan: “I’ve worked really hard, so I consider myself blessed, because so many other people have it hundreds and hundreds of times worse. So I’m lucky, but you just change your retirement financial projections a little bit, and I opted into Social Security earlier than what I normally would have.”

“I think there’s a substantial disconnect between our Iowa delegation and their voters, their constituents, because they’re not back here listening,“ she said. “I think that’s not what the job description requires. None of them are being leaders. They’re being followers.”