Medicaid cuts reduce medical care access for Iowans

In the summer of 2025, the Republican-led Congress and President Donald Trump enacted the “One Big Beautiful Bill Act,” a massive budget package that cut federal health programs by about $1 trillion over a decade and used those funds to help pay for a permanent tax cut for the wealthiest Americans. Iowans say the law’s cuts to Medicaid are already imperiling access to healthcare, even for those with private insurance coverage.

Iowa’s all-Republican congressional delegation — Sens. Joni Ernst and Chuck Grassley and Reps. Randy Feenstra, Ashley Hinson, Mariannette Miller-Meeks, and Zach Nunn — voted for the legislation, which cut Medicaid spending by about $917 billion over the 10 years and imposed new requirements that beneficiaries of the program prove their eligibility every six months. 

According to an August 2025 analysis by KFF, about 68,000 of the 603,000 Iowa residents enrolled in Medicaid are likely to lose their coverage by 2034. 

Cuts trickling down

People who rely on Medicaid say they are scared.

Jonna Higgins-Freese of Iowa City is the mother of two children with disabilities. “Both of them were on Medicaid for a time. Now one of them is on Medicaid,” she told the Iowa Independent in an interview. “Medicaid covers anything our private health insurance won’t cover. It provides respite. It provides voc[ational] rehab. It pays for some of the services that children with disabilities get when they’re in public schools, and it pays for housing in group homes, if folks need that. So it’s really critical for families who have a loved one with disabilities that Medicaid is available. It makes life possible for the person who has a disability, and it makes life possible for their families as well.”

Higgins-Freese, who is active in lobbying Congress on healthcare issues, said even before the added bureaucratic requirements, navigating the process of proving eligibility was difficult, taking hours each month to document and redocument her children’s situations. Now, with the new requirements, she worries that eligible people could lose coverage. 

“I’m highly educated, I’m white, I’m relatively wealthy, I’m married, and I have a great support system, and I work in a job where I have some flexibility and time off that I can take to use as I need it. I think so often about a mom who works in a meat-packing plant, a mom who does shift work at the gas station, parents who don’t have the kinds of resources that I have. It’s darn near impossible for me to get my kiddo the support that he needs through Medicaid,” Higgins-Freese said. “I don’t even understand how someone who is facing any kind of language or educational or work constraint barriers can keep their benefits even now the way it is, before this gets even harder.” 

University of Iowa junior Grace Nelson was diagnosed with spinal muscular atrophy at the age of 18 months and has relied on the Medicaid program since that time for medical care and personal caregiving. 

“It covers about 75% of my personal caregiving hours as of right now,” said Nelson, who serves as the disability constituency senator in the university’s Undergraduate Student Government. “Slowly, it has been on the decline. It’s been getting harder and harder to make sure that my waiver, my exception, gets reapproved each year. That’s already a hurdle in and of itself, just with documentation, having to reprove my disability every single year to ensure that I am approved for the number of caregiving hours I need. I’m always approved for less than what I actually need and then have to fill in the gap somewhere. But with the recent Medicaid changes, it’s looking like the hours that I am approved for, for my personal caregiving, is going to be decreasing even further.”

Erin Vercande of Decorah is a registered nurse with four kids. Her oldest child, who has cerebral palsy and epilepsy, is nearly 15 and has relied on Medicaid since he was 18 months old. Vercande worries that the cuts will affect families like hers: “I mean the numbers, the trillion-dollar deficit with Medicaid and the ACA: That’s got to come from somewhere, and I know that our budget in this state, it’s going to start trickling down.”

Medicaid’s respite program has allowed Vercande and her husband to care for their disabled son at home rather than in a more expensive institution, but is already seeing cuts: “There are statistics that it does work. I mean, you can look up the life expectancy of kids with Down syndrome, and it’s significantly higher. If Medicaid cuts trickle down to families, caregivers, and respite workers, that’s where we’re headed, is back to institutionalization.” 

Healthcare services go away for everyone

Prior to passage of the One Big Beautiful Bill Act, rural hospitals across the United States, including 20 in Iowa, were at risk of closing, according to the nonpartisan Center for Healthcare Quality and Payment Reform. 

In addition to taking away Medicaid coverage for tens of thousands of Iowans, the legislation also reduced reimbursement rates for hospitals. The Iowa Hospital Association estimated hospitals in the state will lose about $4 billion in funding over 10 years. “So, ultimately, hospitals would have difficult decisions to make,” the association’s president and CEO Chris Mitchell told the Gazette of Cedar Rapids in June 2025. “There’s not a lot of levers for them to pull with these kind of cuts. They either reduce labor (or) reduce services, and when those services go away, they don’t just go away for the Medicaid population.”

The law already has spurred some Iowa providers to close clinics or scale back services offered. MercyOne, a nonprofit chain of healthcare facilities, announced several closures in April, saying in its announcement: “Health care providers nationwide are facing significant challenges, including the steady decline in government reimbursement, pushback from commercial payers and increasing inflation. These pressures combined with the expected Medicaid cuts require us to make difficult but necessary changes to continue delivering high-quality care to our communities long term.”

In February, MercyOne closed its Ottumwa medical clinic. Dr. Peter Reiter, a retired internist, worked for MercyOne in Ottumwa for 18 years. 

“Our clinic was closed with five healthcare practitioners and 47 employees, along with a several-million-dollar-a-year revenue line to the community,” Reiter told the Iowa Independent. “So that’s a big hit, and it’s a particularly bad hit for healthcare access in a town of 25,000, service area of about 35,000 people, left only two full-time physicians in the community practicing general medicine that were not affiliated with MercyOne. That’s a bad thing.”

A Jefferson County Health Center clinic opened in Ottumwa in April.

Reiter predicted more closures, which will require residents to travel long distances to obtain medical care. That influx of patients could put a strain on medical providers in larger communities. “I think it’ll increase wait times. It’ll reduce available numbers of appointments,” he said. “I don’t know that that’s happened yet, although this is kind of a slow-moving wave.”

Abi Calvert, a licensed independent social worker in Sioux City, recently worked at a local clinic helping individuals with mental health challenges. At least half of the patients relied on Medicaid to cover medical expenses. “My patients were older and/or disabled, living on a fixed income, and if they lose their Medicaid next year, they won’t be able — they’re just going to stop going to the doctor, and they’re going to end up in hospitals as their primary care, and that’s going to back up hospitals even more and stress them, especially when they’re already at risk of closing or have closed,” Calvert said. 

Sioux City resident Sheri Porter is CEO and founder of Simple Life, Inc., a nonprofit organization that provides training in daily living skills for individuals with mental illness that prevents them from working or staying home alone. Cuts to the Medicaid reimbursement rates have already affected the organization, Porter told the Iowa Independent: “I’ve already had to dismiss three employees. I’m going to start to do some of the hands-on work, as well as a couple of my other staff. We’re shuffling duties right now.”

In response to a request for comment for this story, a spokesperson for Sen. Chuck Grassley spokesperson pointed to an op-ed published under the senator’s name on May 7 in the Gazette with the title “Republicans’ Rural Health Transformation Fund Is Improving Access to Care in Iowa.” Grassley applauded Iowa Gov. Kim Reynolds’ work in obtaining money from the fund, included in the budget law, or what he called “Republicans’ Working Families Tax Cuts Act, which President Trump signed on July 4 last year.” The fund is meant to provide $50 billion over five years in federal funding to states for rural healthcare access.

That amount, however, is just a fraction of the total healthcare spending that has been cut and will go to different programs. “None of this funding can be used to replace the cuts that were put into effect,” the Iowa Hospital Association’s Chris Mitchell said in October, according to the Gazette. 

No other members of the delegation responded to requests for comment. 

On May 8, the Washington Post reported that Rep. Ashley Hinson is running campaign ads saying the law “delivered more than $209 million for rural healthcare in Iowa.” The Post noted that KFF estimates Medicaid cuts will mean $3.84 billion less for rural Iowa over 10 years.

“This is going to have a negative impact on everyone, regardless of if you think that you’re a Medicaid recipient or not,” Nelson said of the cuts. “I know it will have a huge impact on my life and impact on everybody around me.”

“I should not have to beg for healthcare that I deserve and my neighbors deserve,” Calvert said.