Members of Iowa’s congressional delegation double down on Medicaid cuts in federal budget

A week after U.S. House Republicans passed President Donald Trump's budget priorities, members of Iowa's congressional delegation are doubling down on their support for it, including reductions to Medicaid spending.

Dubbed the "One Big Beautiful Bill Act," the legislation, which passed the House 215-214, includes a $625 billion reduction in spending on Medicaid, a joint federal and state program that helps cover medical costs for some people with limited income.

These changes include placing work requirements on Medicaid benefit recipients, meaning able-bodied adults aged 19-64 without dependents would need to work, volunteer or go to school for 80 hours a month in order to maintain benefits.

The current bill is expected to decrease Medicaid enrollment by 10.3 million, according to estimates from the non-partisan Congressional Budget Office. That number includes 58,084 Medicaid recipients in Iowa, according to the CBO.

All four of Iowa's Republican U.S. representatives voted for the bill.

Republican U.S. Rep. Ashley Hinson, of Marion, was met by boos, jeers and heckling during a pair of town halls Wednesday in Northeast Iowa over her support of the bill.

Constituents at the town halls shared concerns about access to Medicaid and other health care insurance, funding cuts to university research, and Hinson's support of President Donald Trump's policies.

Hinson decried what she called "fear-mongering" about the House-passed reconciliation bill.

Speaking to reporters Thursday, Hinson highlighted the importance of using town halls to correct misinformation and discuss the administration's agenda with constituents.

"I had a question from a woman who is on Medicaid, for example, and was concerned that her benefits could be going away," Hinson said. "She heard, you know, some misinformation about that. … This bill exempts those who are medically frail and disabled. And so if you are legitimately getting these Medicaid benefits, you have nothing to worry about. If you're a 29-year-old man choosing not to work, sitting on the couch in your mom's basement, then you're going to have to have a conversation about getting a job if you want to continue to take a government benefit."

Revenue, spending

White House officials say the sprawling tax bill is a once-in-a-generation opportunity to cut spending, fuel growth and "level the fiscal footing of the American economy."

Stephen Miller, White House deputy chief of staff, posted to X arguing the CBO's calculations rely on an "accounting gimmick."

"Income tax rates from the 2017 tax cut are set to expire in September. They were always planned to be permanent," Miller wrote. "CBO says maintaining *current* rates adds to the deficit, but by definition leaving these income tax rates unchanged cannot add one penny to the deficit. The bill's spending cuts REDUCE the deficit against the current law baseline, which is the only correct baseline to use."

Peter Navarro, White House senior counselor for Trade and Manufacturing, argued in an op-ed published by The Hill, that CBO and other forecasts fail to account for the bill's contributions to economic growth and debt reduction, and claims that tariffs could generate substantial revenue.

"Remember here a key goal of Trump's fair-trade policies is to shift the U.S. tax base from one primarily reliant on income taxes to one that, with the vision of the new External Revenue Service, is also supported by tariff revenues," Navarro wrote. "Consider, then, the impacts on the CBO's projected revenue shortfall of just the modest 10% global baseline tariff Trump recently put into effect."

Such a tariff, depending on consumer response and enforcement, "should generate between $2.3 trillion and $3.3 trillion in additional revenue over the ten-year forecast period," according to Navarro.

Economists widely dispute Navarro's figures, considering them vastly inflated, as the tariff tax base is smaller than the income tax base, tariffs can reduce demand and thereby reduce tax revenue and retaliatory tariffs would hurt exports and overall tax revenue.

Miller-Meeks on vote

Republican U.S. Rep. Mariannette Miller-Meeks defended her vote for the "big beautiful bill" during a media availability with fellow Republican congressman Jim Jordan, of Ohio.

Jordan was in town for a fundraiser for Miller-Meeks' campaign Thursday morning at the Rhythm City Casino in Davenport.

"We voted to preserve and strengthen Medicaid. Had we not done that, the trajectory of Medicaid spending is unsustainable," Miller-Meeks said. "What we have done are very common-sense reforms to the expansion population, having community engagement requirements for able-bodied adults."

Miller-Meeks said Democrats are exaggerating coverage losses.

"If someone is not doing community engagement, if they're at home, receiving Medicaid, or receiving SNAP, and they are not either for 80 hours a month at work, looking for a job, in an educational program or volunteering, and they are a person without disabilities without raising dependent children, they aren't mentally ill, they aren't on a substance abuse program, they're not raising a dependent adult – if they're not doing some community engagement, they may lose coverage, but that's their choice to lose coverage."

Democrats respond

But Democrats are stressing that the reduction in Medicaid spending is predicted to block access to health care for many Iowans.

Democratic State Rep. Megan Srinivas, of Des Moines, who is a physician, said the cuts will hit nursing homes in the state, adding that 50% of patients in nursing homes have Medicaid as their primary payer.

Issues facing facilities including bed availability, inspections and staffing shortages will only be exacerbated under the bill, Srinivas said.

"Medicaid in our state is not just integral for health care, but because of the reaches into maternal health, nursing homes, mental health, children's health," she told reporters Thursday during an Iowa Democratic Party press call. "With these Medicaid cuts, we're endangering that ability for them to get the health care they need and the health care they deserve."

The cuts could also impair access to labor and delivery care when Iowa is seeing an increase in maternal health care deserts, she said.

Fifty-seven percent of Iowa counties don't have an obstetric facility and over the past 20 years, 40 birthing facilities have closed across the state, according to the American Medical Association.

The cuts to Medicaid could also limit health care accessibility for Iowans in rural areas of the state, said Democratic Crawford County Supervisor David Muhlbauer, a farmer and board member of the Manning Regional Healthcare Center.

Muhlbauer said the health care center is having tough conversations and Medicaid cuts could put them in a "dire financial situation" while they are already facing challenges dealing with managed care organizations.

"It really puts us in limbo, because we can't really make a plan going forward strategically of what services best fit our community and our needs, because we don't know what funding is going to be there," Muhlbauer told reporters Thursday. "Medicaid funding cuts could really decimate our rural hospitals and the abilities that we provide for services."