Iowa’s U.S. House members vote for Trump’s tax bill, Medicaid changes. Here’s what they said

Iowa’s U.S. House members — all Republicans — voted Thursday to pass President Donald Trump’s $4.5 trillion tax breaks and spending cuts bill, sending it to him to sign before the Fourth of July holiday weekend and just a few hours before Trump was set to speak in Des Moines at an event at the Iowa State Fairgrounds.

Democrats unified against the bill as a tax giveaway to the ultra wealthy paid for by slashing social safety net programs that provide health coverage and food assistance to vulnerable Americans. The legislation also rolls back green energy tax credits signed into law by Democratic former President Joe Biden that could derail solar, wind and other renewable projects in Iowa and elsewhere.

Various national polls show muted support for Trump’s sweeping domestic policy bill, including ones from Fox News (38 percent favored vs. 59 percent opposed), KFF (64 percent viewed unfavorably, 35 percent viewed unfavorably) and Pew Research Center (49 percent opposed and 29 percent in favor).

Iowa GOP Congresswoman Ashley Hinson and Iowa’s other members of Congress said the bill will prevent a tax hike on households and grow the economy.

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In a statement, Hinson, of Marion, lauded the bill for providing historic investments in border security and immigration enforcement, and tax relief for working Iowans. That includes no tax on tips, no tax on overtime; an expanded Child Tax Credit of $2,200 per child; and additional relief for seniors. Additionally, the bill makes permanent a provision in the 2017 Tax Cuts and Jobs Act that allows eligible small businesses to deduct up to 20 percent of their qualified business income.

“This transformative legislation enacts tax cuts for working Iowans, permanently secures the border, and strengthens Medicaid for vulnerable populations while rooting out waste, fraud, and abuse,” Hinson said, “… Nearly 80 million Americans voted for this common sense, conservative agenda, and I’m proud to work with President Trump to deliver a stronger, safer and more prosperous America and Iowa.”

Iowa Democratic Party Chair Rita Hart, in a statement, criticized Hinson and the rest of Iowa’s all-Republican congressional delegation for breaking promises made to Iowans to protect Medicaid and rural hospitals and reduce the federal deficit in order to give tax breaks to wealthy donors.

The nonpartisan Congressional Budget Office estimates the proposal will add $3.3 trillion to the nation’s debt over the next decade, and 11.8 million more people will go without health coverage.

Democratic members of the Joint Economic Committee, based on the CBO’s analysis and other research, estimates 113,979 Iowans would lose health insurance coverage.

The Tax Policy Center, which provides nonpartisan analysis of tax and budget policy, projected the bill would result next year in a $150 tax break for the lowest quintile — or one-fifth — of Americans, a $1,750 tax cut for the middle quintile and a $10,950 tax cut for the top quintile. That’s compared with what they would face if the 2017 tax cuts expired.

Potential impacts to rural hospitals give vulnerable Republicans pause

Hinson and House Republicans maintain they are trying to rightsize federal safety net programs for the population they were initially designed to serve — mainly pregnant women, the disabled and children — and root out what they describe as waste, fraud and abuse.

They contend the bill does not cut Medicaid, but rather prevents ineligible people and individuals with unverified or certain legal statuses from getting Medicaid benefits, protecting those who genuinely rely on the program.

“This is a huge win for Iowans and the American People,” Iowa U.S. Rep. Mariannette Miller-Meeks, who represents southeast Iowa, said in brief video posted to X (formerly Twitter).

Miller-Meeks, a Republican from Ottumwa who also resides in Davenport, said in a statement the bill provides a $6,000 tax break for seniors, brings manufacturing jobs back to America, secures the border, and strengthens and preserves Medicaid for those it was intended to serve: children, pregnant women, seniors, veterans, and people with disabilities.

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Additionally, the bill sets up a $50 billion fund to support rural health care providers and enhance care quality. It also introduces work requirements for able-bodied adults under the age of 65, allowing exemptions for certain groups, and prioritizes Medicaid for U.S. citizens and legal residents, eliminating federal support for those without verified legal status.

Both Miller-Meeks and U.S. Rep. Zach Nunn, of Bondurant, however, signed onto a letter along with 14 other vulnerable House Republicans opposing deeper Medicaid cuts contained in the final version of the bill that target Medicaid provider taxes and state-directed payments to hospitals, nursing facilities and other providers.

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“Throughout the budget process, we have consistently affirmed our commitment to ensuring that reductions in federal spending do not come at the expense of our most vulnerable constituents,” the members wrote.

Miller-Meeks, Nunn and the other lawmakers said the Senate's changes, which the House ultimately agreed to, go "beyond" the "pragmatic and compassionate" Medicaid changes they supported in the House bill.

They said penalties for Medicaid expansion states, including Iowa, and cuts to emergency Medicaid funding “would place additional burdens on hospitals already stretched thin by legal and moral obligations to provide care.”

“Protecting Medicaid is essential for the vulnerable constituents we were elected to represent," the letter states. "Therefore, we cannot support a final bill that threatens access to coverage or jeopardizes the stability of our hospitals and providers."

Democrats criticized the Republicans' letter as “meaningless,” highlighting their initial support for the House bill containing significant Medicaid rollbacks.

Nunn, in a statement, said the bill “fuels growth on Main Street, and puts more money back in the pockets of Iowa families," and ”positions Iowa farmers and producers to lead the charge in delivering affordable, American-made energy.”

The bill raises reference prices for corn and soybeans, expands market access and extends and modifies a biofuels production tax credit.

U.S. Rep. Randy Feenstra, who represents western Iowa, in a statement said the legislation “will dramatically grow our economy, cut deficits, spur U.S. manufacturing, fully fund the border wall, and support American energy independence.”

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CEO: Medicaid changes could force hospitals to make tough decisions

The bill would impose work and reporting requirements on Iowans covered through the Medicaid expansion under the Affordable Care Act, and require states to impose cost-sharing for Medicaid expansion adults with incomes above 100 percent of the federal poverty level, which could lead to decreased enrollment and increased out-of-pocket expenses for some beneficiaries.

Adults would be required to demonstrate they are working, volunteering or participating in a work program for at least 80 hours per month or attending school at least half-time to qualify for coverage under the Affordable Care Act’s Medicaid expansion.

The bill also would increase the frequency of eligibility redeterminations for the Medicaid expansion group; limit state-directed payments to hospitals, nursing facilities and other providers, potentially affecting the financial stability of these institutions; and limit the ability of states like Iowa to raise Medicaid funding through provider taxes.

Iowa hospitals and health care providers have said the Medicaid provisions would lead to significant cuts in federal Medicaid spending and increased financial burdens on states. Such changes would result in reduced access to care for millions of Americans, including those in both the Medicaid expansion and traditional Medicaid populations.

Chris Mitchell, president and CEO of the Iowa Hospital Association, said rural hospitals already operate on thin margins. Cuts to Medicaid will exacerbate their already strained financial situations, forcing hospitals to make tough decisions about reducing services or closing altogether, Mitchell previously told The Gazette.

“Medicaid cuts to Iowa's hospitals affect not only Iowans who rely on Medicaid for their health coverage, but also all Iowans who require hospital care,” he said.

Iowa is already facing significant challenges in its health care sector, including workforce shortages and challenges in recruiting and retaining staff, and financial pressures resulting from low reimbursement rates from Medicare and Medicaid that are not keeping up with rising costs.

Rural Iowa has been losing nursing home facilities, and according to the Center for Healthcare Quality and Payment Reform, 20 rural Iowa hospitals are at risk of closure, with five facing immediate risk of shutting down.

Additionally, a new report from the Urban Institute estimates 26,000 Iowa families would lose at least $25 in monthly benefits from the proposed policy changes.

Among families who would lose at least $25 in monthly Supplemental Nutrition Assistance Program (SNAP) benefits, the Urban Institute estimates 22,000 are families with children and would lose $53 on average per month (or $636 per year).

The Associated Press contributed to this report.

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