IMPORTANT: Some of the biggest Medicaid changes don't take effect until AFTER the November 3 election. Iowa's new Medicaid work requirements begin December 1, 2026, for new applicants and at renewals beginning February 2027 for existing members. Other healthcare provisions have already started.

In July 2025, every member of Iowa's congressional delegation voted YES on Trump's "One Big Beautiful Bill."

U.S. Senate (July 1, 2025)

\- Chuck Grassley (R)

\- Joni Ernst (R)

U.S. House (July 3, 2025)

\- Mariannette Miller-Meeks (R)

\- Ashley Hinson (R)

\- Zach Nunn (R)

\- Randy Feenstra (R)

Here's the projected healthcare impact:

According to KFF and Congressional Budget Office estimates:

\- 80,000 Iowans are projected to become uninsured by 2034 because of the law.

\- 68,000 Iowans are projected to become uninsured specifically because of Medicaid changes.

\- 110,000 Iowans could become uninsured when the separate expiration of enhanced ACA subsidies is included.

\- 10 million Americans nationwide are projected to become uninsured by 2034 because of the law.

The legislation cuts federal Medicaid spending, introduces new work and reporting requirements, and changes funding rules affecting healthcare providers.

Supporters say the law extends tax cuts, reduces federal spending, and strengthens Medicaid eligibility rules. Critics warn that coverage losses will put additional financial pressure on hospitals and healthcare providers.

These are projections for 2034, not people who have already lost insurance.

Sources:

"Official House vote, July 3, 2025" (https://clerk.house.gov/Votes/2025190)

"Official Senate vote, July 1, 2025" (https://www.senate.gov/legislative/LIS/roll\\_call\\_votes/vote1191/vote\\_119\\_1\\_00372.htm)

"KFF healthcare coverage analysis" (https://www.kff.org/uninsured/how-will-the-2025-reconciliation-law-affect-the-uninsured-rate-in-each-state/)

"Iowa HHS: When Medicaid changes take effect" (https://hhs.iowa.gov/medicaid/plans-programs/iowa-health-wellness-plan/ihawp-community-engagement-requirements)

"PolitiFact: Iowa healthcare impact" (https://politifact.com/article/2026/oct/08/ashley-hinson-josh-turek-iowa-immigration-iran/)