Medicaid attacks are latest attempt to target the ACA

It’s déjà vu all over again. Those who tried and failed to repeal the Affordable Care Act in 2017 are now rushing again to undo it. If they get away with it, Iowans will suffer.

No one on Medicaid is safe from the billions of dollars in cuts proposed by congressional Republicans. But these lawmakers seem most focused on taking coverage away from low-income adults who gained access to Medicaid under the ACA — a remarkable success that cut Iowa's uninsured rate in half.

Around 13% of Iowa adults were uninsured before the ACA; today it’s about 6%. A big reason was the expansion. Not only did the expansion get more people insured, but it did so inexpensively for states, with the federal government picking up 90% of the costs.

Known in our state as the Iowa Health and Wellness Plan — the Medicaid expansion is now the big target of federal lawmakers who are willing to sacrifice the health insurance of millions nationally, just to cut taxes for the wealthy.

Let’s not forget who we’re talking about. People covered by Medicaid have very low incomes — often making less than $30,000 a year — can’t afford to pay out of pocket for doctor’s visits and don’t have access to insurance through a job. They are folks caring for their children, grandchildren or aging parents; they work in nursing homes, or serve us in restaurants. More than one-third of childcare workers in Iowa are covered by Medicaid.

In short, cutting Medicaid hits the heartbeat of our communities.

This emphasis to kill the Medicaid expansion and block insurance for over 180,000 Iowans is exactly the wrong direction for Iowa. With 6% of our population still uninsured, we should focus on getting those folks insured — not ripping insurance away from those who have it.

Iowa is projected to see among the highest losses of insurance in the states if the Medicaid expansion were scrapped — a 93% increase in uninsurance, according to the Urban Institute.

One mechanism that congressional leaders are eyeing to cut Medicaid is to shift costs to the states. The Governor and Republicans in the Iowa Legislature have already shown they are willing to take away Medicaid from Iowans who can't meet harsh work reporting requirements or jump other administrative hurdles. There is little reason to expect they would continue to support Medicaid expansion if the federal government required them to pick up more of the costs.

The fact is, nearly 63% of nonelderly Iowans on Medicaid in 2023 had at least one full-time worker in the family — and about 17% more had someone working part time. Never mind that keeping people away from health care makes it tougher for them to work.

An economy in flux, with tremendous uncertainty driven by tariffs, is no time to cut back on access to health care. Rather, state lawmakers and the congressional delegation should work in concert to improve it, and to get coverage for that final 6% of our population.

Mike Owen is deputy director of Common Good Iowa. Contact: mowen@commongoodiowa.org.