Thousands of Linn County residents would be impacted by proposed changes to Medicaid, food assistance programs

CEDAR RAPIDS — Reductions in spending and tightened eligibility requirements on social safety net programs like Medicaid and food assistance being considered by Republicans in Congress will significantly reduce access to health care and food assistance, impacting thousand of low-income individuals and families across Linn County.

That assessment and warning came from a panel representing nonprofits and community-based organizations that provide health care, mental health support and food assistance across Eastern Iowa.

“It will have a dramatic and direct impact on our ability to provide patient care,” Joe Lock, President and CEO of Eastern Iowa Health Center, said Tuesday during a roundtable discussion at the downtown Cedar Rapids Public Library moderated by Linn County Supervisor Sami Scheetz, a Democrat.

Other panelists included representatives from HACAP, Linn County Public Health and UnityPoint Health — AbbeHealth Services.

President Donald Trump’s budget reconciliation and tax bill’s cuts to Medicaid and the Affordable Care Act (ACA) marketplaces are projected to increase the number of uninsured Americans by millions, according to the nonpartisan Congressional Budget Office. Additionally, the bill proposes substantial cuts to the Supplemental Nutrition Assistance Program (SNAP), potentially leading to increased food insecurity and hunger.

The House-passed bill, which is likely to be amended in the Senate, makes significant changes to Medicaid and SNAP eligibility, primarily by imposing stricter work requirements and reducing benefits to offset trillions in tax cuts that disproportionately benefit the most wealthy.

The CBO said the tax provisions would increase the federal deficit by $2.8 trillion over the next decade, while the changes to Medicaid, food stamps and other services would lead to $1 trillion in reduced spending. The lowest income households in the U.S. would see their resources drop, while the highest ones would see a boost, it said.

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What the bill does

The bill would require adults age 19-64 to demonstrate they are working, volunteering, going to school or participating in a work program for at least 80 hours per month to qualify for Medicaid under the Affordable Care Act expansion.

States would need to verify their eligibility every six months, as opposed to once a year.

The bill includes certain exemptions for those who are medically frail, pregnant, unemployed, caring for dependent children, homeless and those with disabilities.

The bill also reduces the federal matching rate for states that provide financial assistance or "comprehensive health benefits" to immigrants. Only a limited subset of lawfully present immigrants would remain eligible for assistance.

It also would expand SNAP work requirements for able-bodied adults without dependents; freeze the cost of the Thrifty Food Plan outside of inflation adjustments and limit future benefit increases; restrict eligibility for certain immigrants; increase the share of SNAP administrative costs that states must pay; and shifts some SNAP benefit costs to states.

Congressional Republicans — including Iowa’s U.S. House members — have said the bill delivers on Trump's domestic agenda, including securing the border, increasing domestic energy production and preventing tax increases that would occur if the 2017 tax cuts expire. It also includes provisions exempting federal taxes on tips and overtime pay, and increased tax relief for seniors.

Iowa U.S. Sen. Joni Ernst and U.S. Reps. Ashley Hinson and Mariannette Miller-Meeks, all Republicans, have said the Medicaid and SNAP changes and work requirements are necessary to eliminate "waste, fraud and abuse" and improve the programs’ effectiveness, weeding out individuals who could work taking advantage of the system and protect the program for those who truly depend on it.

Impact on food access in Linn County

Aaron Becht, community food systems manager at HACAP Food Reservoir, said the bill would force states to make difficult choices about which programs to cut or how to raise additional revenue to offset the loss of federal funding.

Such changes would significantly impact Iowa’s budget, and likely lead to dramatic cuts in assistance at a time when food insecurity across the state is on the rise and food banks are seeing record demand, Brecht said.

He said different versions of the bill could cost Iowa anywhere from $40 million to $13 million — amounting to a potential loss of 10 million meals for SNAP recipients in Iowa.

“That is a lot of food that we would need to come up with,” Becht said. “… It would be more impossible decisions for the SNAP beneficiary if they had less benefits — Do I pay for groceries? Do I pay for health care? Do I pay for transportation? That’s the impact that we’re fearing right now.”

The federally funded program provides money to more than 40 million people in eligible low-income households — mostly older adults, people with disabilities and families with children — to help buy groceries. About one in 12, or more than 259,000, Iowans were enrolled in SNAP at the end of last year. Of those, 64 percent of SNAP participants are families with children, 35 percent are families with members who are older adults or are disabled, and 50 percent are in working families.

“If those people see less benefits, that means that they will go to your local food pantry or the charitable food system to try to get more food,” Becht said. “And that is already a system that is … redlining right now.”

Impact of Medicaid cuts on Eastern Iowa Health Center

Eastern Iowa Health Center is on track to see 71,000 patient visit this year. The center provides family medicine along with pediatric, women’s, dental and behavioral health care to socioeconomically disadvantaged individuals and families.

About seven out of 10 of the roughly 17,000 patients the health center serves use Medicaid for insurance, Lock said. The bill, he estimated, would result in a $1.5 million to $3 million loss in funding.

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The center plans to expand services, adding a pharmacy, urgent care and vision, care which would be significantly affected by the cuts, Lock said.

“Our profit margins don’t allow for that kind of deficit” as a nonprofit provider, he said.

Lock, too, warned cuts could significantly impact hospitals by increasing uncompensated care costs, potentially leading to service reductions and even hospital closures, especially in rural areas.

He said federally qualified health centers like his and others across Iowa serve as an off-ramp for emergency room visits, providing quality care at a fraction of the cost of emergency room visits, preventing hospitals from being overwhelmed by patients seeking care for non-emergency conditions.

In 2024, one out of 10 Iowans utilized a federally qualified health center for their care, which is more than 325,000 unduplicated patients.

“I think it’s fair to say that rural critical access hospitals are going to suffer the most and most immediately,” Lock said. “… That effect will be immediate and consequential.”

Public health consequences of Medicaid cuts

Cindy Fiester, chronic disease services coordinator and a registered nurse at Linn County Public Health, said the legislation would reverse strides the state has made through Medicaid expansion to expand access to health care for underserved populations.

“Undoing support for Medicaid is going to undermine our best efforts at … helping people get health insurance, understand how to use it and help them keep it,” Fiester said.

Most Medicaid adults in Iowa are working already, without a “work requirement.” About 8 percent of Medicaid adults reported that they are retired, unable to find work, or were not working for another reason.

Research done in other states that have implemented Medicaid work requirements shows work requirements impose administrative barriers and red tape that lead to coverage losses among both people who are working as well as people who have caretaking responsibilities, disabilities or illnesses that keep them from paid work.

Studies also show the requirements increase the number of people who are uninsured and are unlikely to significantly increase employment.

Fiester said the requirements and increased eligibility checks would pose an “undue burden” on Medicaid recipients, and likely lead to disruptions in care that would make it harder for Iowans to manage chronic conditions.

“So there's well visits, age-appropriate cancer screenings, diagnostic testing, treatment, things of that nature, and those can all be disrupted with more frequent verification or proof of work,” Fiester said.

Impact on mental health services

Theresa Graham-Mineart, director of outpatient clinic services at Abbe Center for Community Mental Health, said they serve about 11,000 people annually and rely heavily on Medicaid.

She said about 52 percent of patients who come to the center use Medicaid as their primary insurance. About 67 percent of crisis services patients, and 99 percent of specialty services for patients with severe, persistent mental health issues use Medicaid.

Graham-Mineart expressed concerns about the impact on caregivers, individuals with disabilities and those with mental health challenges.

“Able-bodied adults are a lot harder to determine than you think, especially if the difficulty is mental health-related,” she said, adding the Social Security determination process for disability can take up to four years.

Graham-Mineart said the changes could jeopardize the center’s ability to provide early intervention and comprehensive mental health care.

Having individuals with mental health issues recertify every six months to maintain coverage also poses larger barriers due to difficulties with concentration and organization, she said.

“Those are common symptoms across many mental health conditions. So getting the mail, opening the mail, taking care of it,” Graham-Mineart said. “Anybody here get any mailers from their insurance company? Does that make a lot of sense on the first reading. It does not. It's hard to understand. And that's not just for people with mental health problems. That's for anybody. So it isn't just about not having the insurance. It's also how hard is it to get the insurance so that it's in place so people can get their needs met?

“There's a lot of good research that shows if a person cannot get in for care within (a certain) time frame, they will just skip it,” she said. “And skipping it means a lot of different things for behavioral health. Skipping it can mean I'm going to just dig my heels in and try and get through. Skipping it can also mean suicide and overdoses. And so we really need to pay attention to access and hoops to jump through to get access.”

Comments: (319) 398-8499; tom.barton@thegazette.com