By Zach Grissom and Arya Zandvakili, M.D., Ph.D.
Des Moines Register, March 25, 2025
As budget negotiations heat up, the U.S. Congress has proposed severe cuts to Medicaid nationally and the Iowa Legislature is considering Medicaid work requirements — both of which could place health care out of reach for thousands of Iowans.
Will Iowa’s top elected officials — U.S. Reps. Mariannette Miller-Meeks, Ashley Hinson, Zach Nunn and Randy Feenstra, U.S. Sens. Chuck Grassley and Joni Ernst, and Gov. Kim Reynolds — stand up for their constituents’ health care, or will they push forward policies that strip health care from Iowans? Are tax cuts for the wealthy more important to our legislators than access to health care and keeping rural hospitals open?
Medicaid enrollment in Iowa is between 600,000 to 850,00 in any given month since 2020. In 2022, the federal government covered 72.6% of Iowa’s $6.9 billion Medicaid costs, ensuring access to doctors, prescriptions and hospital care. Work requirements and cuts to Medicaid threaten coverage for thousands of working families and increase financial strain on rural hospitals.
Rural hospitals are the backbone of Iowa’s communities, providing everything from emergency care to maternity services. Cuts to Medicaid would mean less revenue to these hospitals and could push many to the brink — out of Iowa’s 93 hospitals, 31 hospitals have already lost services, 20 are at risk of closure, and five face immediate shutdown. Regardless of whether you use Medicaid, we all depend on the same hospitals. We need our legislators to protect and strengthen rural hospitals, not cut their revenue through decreased Medicaid funding.
On the issue of Medicaid work-requirements, 75% of Iowa’s Medicaid recipients are already working. The majority of those who are not working are in school, providing care to dependents, or are disabled. When Arkansas tried Medicaid work requirements in 2019, 17,000 lost insurance without a significant increase in employment. Experience shows that Medicaid work requirements just create waste and increased paperwork without achieving meaningful goals.
Medicaid work requirements are rooted in the idea that some people are deserving of health care and others are not. We need to stand firm against this idea. Whether you are rich or poor, working or not, we all deserve health care without being saddled with debt. This stance is not only moral. It is also motivated by the fact that our own well-being depends on the well-being of those in our community. When people lose access to primary care and other basic services, they are forced to delay care and become more reliant on emergency room visits; this places stress on the health care system and makes it more difficult to provide care for everyone.
Iowa’s elected officials must put people over politics by protecting Medicaid and the hospitals that keep our communities alive. Contact Grassley and Ernst and your representative and tell them to stand against Medicaid spending cuts. Contact your Iowa senators and representatives to stand against Medicaid work requirements.
Zach Grissom is a first-year medical student, a Navy veteran of nine years, and a founding member of Iowa Students for a National Health Program (iowasnahp@gmail.com).
Dr. Arya Zandvakili is a physician and chair of Iowa Physicians for a National Health Program (iowa@pnhp.org).