Looming health care policies will hurt Iowans

The lingering shutdown of the federal government is not just political theater. It is driven by a standoff over health care that threatens working Iowans with dramatic increases in health care costs, diminished access to care, or the loss of coverage altogether.

These risks stem from provisions of the “One Big Beautiful Bill Act” passed this summer, which included deep cuts to the federal share of Medicaid benefits and an end to tax credits that put “marketplace” coverage under the Affordable Care Act (ACA) within reach of working Iowa families. These disastrous policies are expected to throw over 113,000 Iowans into the ranks of the uninsured, nearly triple average premiums for ACA coverage, and threaten to close struggling rural hospitals.

The first blow will be the expiration of the ACA tax credits. These credits, established under the American Rescue Plan in 2021 and extended by the Inflation Reduction Act, lowered the cost of ACA premiums for working and middle-class Iowans, and led to a dramatic increase in ACA enrollments. When those credits expire at the end of this year, premium costs will skyrocket: the average ACA premium in Iowa is projected to increase form $352/month to $962/month.

Those who rely on the ACA in Iowa (over a quarter of whom are small business owners or self-employed) will first experience this sticker shock in early November, when enrollment opens for 2026 plans. They will either empty their pocketbooks or forego coverage. By one estimate, nearly 10,000 Iowans currently covered under the ACA will join the ranks of the uninsured next year.

Medicaid cuts will hit more slowly, but with devastating results. Changes to Medicaid include new work requirements, new restrictions on provider taxes and provider payments, and new barriers to program enrollment or renewal. For Iowa, where over 700,000, or almost one in five citizens, rely on Medicaid, almost 70,000 would lose Medicaid coverage — most of those due to the burden of navigating the new work requirements. Over the next decade, the state would lose over $ 9 billion in federal spending, over a third of which would come from losses in rural areas.

This coming cascade of misery is unnecessary, unwarranted, and unfair. Republicans have sought to undermine the ACA at every turn — despite its effectiveness, and its popularity with voters. The ACA and Medicaid cuts are animated not by any demonstrable flaws in these programs, but by the need to pay for the extension of Trump’s 2017 tax cuts. Indeed the net impact of the full package — the ACA and Medicaid changes and the tax cuts — will erode the incomes of those making less than $30,000/year, and pad incomes of those earning more than $200,000 annually.

At a time when Iowa’s working families are struggling to sustain health coverage, and to weather rising costs for other basic needs,

We need to reopen our government. And, more importantly, we need to do so on terms that will sustain policies that benefit the common good.

Colin Gordon is professor of history at the University of Iowa, and the author of “Dead on Arrival: The Politics of Health Care in Twentieth Century America.”