Sue Dinsdale is the executive director of the Iowa Citizen Action Network, a grassroots public interest organization committed to creating social change in Iowa and across the nation. She is also the state lead for Health Care for America NOW.
Republicans in Congress have passed a federal budget resolution that instructs Congressional committees to slash trillions in services for everyday people in order to finance the extension of tax breaks that mainly benefit the wealthiest households. Some of the Trump tax cuts enacted in late 2017 expire this year. The top priority for Republicans in Congress is to extend those tax breaks, so the wealthiest 1 percent of households can continue to save on average $60,280 in 2026 alone.
But tax breaks for the wealthy cost the rest of us. When wealthy people and corporations don’t pay their fair share of taxes, revenue is drained out of the budget which means lawmakers will have to cut services.
In this case, Medicaid is on the chopping block. That health insurance program serves more than 80 million people, about one in five Americans. The House-passed proposal includes $880 million in cuts for health care that could very well take coverage from the 678,107 enrolled in Iowa Medicaid.
All four Republicans who represent Iowa in the U.S. House—Mariannette Miller-Meeks (IA-01), Ashley Hinson (IA-02), Zach Nunn (IA-03), and Randy Feenstra (IA-04)—voted for the budget blueprint, despite the devastating impact it could create locally. Medicaid cuts on that scale would take health care away from thousands of people, shifting massive costs to the state budget, and cutting jobs and revenue for hospitals, clinics and treatment centers. Although Republicans insist that there won’t be any cuts to constituents, anyone who can do math can see through those excuses.
As the federal government’s accountants have already pointed out, there’s no way to get to $880 billion in reduced health care spending without slashing Medicaid. The Energy and Commerce Committee (on which Miller-Meeks serves) will decide what specific cuts to propose, but since Medicaid accounts for 93 percent of the funding under the committee’s jurisdiction, Medicaid will absolutely be affected.
That means those who get our health care coverage from Medicaid have cause to worry. Whether it’s seniors in nursing homes or receiving in-home care, kids, people with disabilities, veterans, or low-wage workers, taking health care away from people who need it can only lead to shifting costs that affects all of us.
For instance, Medicaid is the leading payer of behavioral health services including substance use disorders, which have plagued our state over the last decade. Addiction to opioids and other drugs have driven crime rates, destroyed families and even lowered U.S. life expectancy by nearly a year.
After spiking during the COVID-19 pandemic, substance use deaths are finally starting to fall, but cutting Medicaid could reverse that progress. Moreover, substance use disorder isn’t going anywhere–more treatment options, not fewer, will be needed over the next decade to address addiction, reduce crime, and prevent loss of life.
The same applies to people over 65, most of whom will need Medicaid at some point if they live into advanced age. Medicaid is the leading payer of long-term care for seniors, the fastest growing segment of the American population. The number of people over 65 is expected to double by 2030, and people in this age group are living longer than ever, which means they require support as they age and their health needs increase.
Given that reality, it makes little sense to cut Medicaid as the demand for services is projected to increase. Already, seniors and people with disabilities, the two groups that most often need long-term care, make up a fifth of the Medicaid population. But they account for about half the spending in the program. Claims that Congress could cut hundreds of billions without affecting this program are pure fantasy.
In fact, lawmakers should be increasing investment in Medicaid so that states and families can meet the growing needs of seniors and disabled people who depend on these services.
While Iowa’s members of Congress claim that concerns about waste and abuse are behind the efforts to slash Medicaid, the truth is it is far more wasteful to pile trillions more in tax breaks to the wealthy than to invest in health care for seniors, working families, and kids. It’s clear that waste isn’t the issue here, but rather upside down priorities.
After all, if Congress can afford to give trillions in tax breaks to the wealthiest 1 percent of households, they can afford to provide Medicaid coverage to Americans who have no other source of health care.
Editor’s note: This fact sheet shows information about Medicaid in Iowa, as of August 2024.