Sue Dinsdale is the Executive Director of Iowa Citizen Action Network and the State Lead for Health Care for America NOW.

This Mother’s Day, Senator Joni Ernst and her Republican colleagues are playing a sleight of hand when it comes to supporting families and children. Their rhetoric might sound like a corny greeting card, but their actions tell an ugly truth about their real intentions. Their agenda shifts resources away from the moms and kids who need them to advance a plan that further enriches the wealthy and corporations.

As a mother and a grandmother, it’s really hard to take when Vice President JD Vance wants Americans to have more children, and Ernst gives lip service to the importance of supporting growing families. Especially while virtually every action the GOP has taken since being in the majority makes parenthood harder by raising costs, cutting jobs and taking away health care.

I literally shook my head as I read Alex Isenstadt’s scoop for Axios this week: Vice President JD Vance plans to come to Iowa on April 30 to campaign with U.S. Representative Zach Nunn. Isenstadt wrote that the vice president’s appearances (one with Nunn and another at a Turning Point USA rally in Ames) “will be aimed at helping Republicans in this fall’s elections.”

More likely, a joint event with Vance will hurt Nunn’s chances in one of the country’s top-targeted U.S. House districts.

No one could accuse me of being too optimistic about Democratic prospects in Iowa’s statewide elections. But if there’s one race I’m bullish on, it’s the third Congressional district. National forecasters currently rate this district as a toss-up (Cook Political Report and Sabato’s Crystal Ball) or lean Republican (Inside Elections).

I see this race tilting in favor of the presumptive Democratic nominee, Sarah Trone Garriott. Let’s walk through the reasons.

Adam Zabner represents Iowa House district 90, covering part of Iowa City.

Last May, when Iowa Republicans passed the health and human services budget for the current fiscal year, I asked the bill’s floor manager, State Representative Ann Meyer, a simple question. What would happen when U.S. Representatives Mariannette Miller-Meeks, Randy Feenstra, Zach Nunn, and Ashley Hinson voted to cut federal health care funding?

Iowa Capital Dispatch reported at the time:

Robin Opsahl, Brooklyn Draisey, and Cami Koons collaborated on this article, which was first published by Iowa Capital Dispatch.

Following the second “funnel” deadline of the Iowa legislative session, lawmakers often aim to shift their focus from policy to budgeting. But as lawmakers hit week 10 of the 2026 session, it appears agreements have not been reached on some of the top priorities laid out by Republicans at the beginning of session — primarily, eminent domain and property taxes.

Friday marked the second major deadline of the session, when most bills must be passed by one chamber and approved by a committee in the other chamber to stay eligible for consideration. There are many caveats to this rule — legislation involving spending, taxes or government oversight are not subject to the funnel.

Chamber leadership can also designate bills that have not made it through the committee process required as “unfinished business,” saving the measure from the funnel cutoff – and can also bring back “dead” legislation as leadership-sponsored legislation. Some “dead” bills may be added as amendments to surviving bills in future debate.

Tony Leys is Rural Editor/Correspondent for KFF Health News, where this story was first published.

Leisa and Kent Walker recently received a disturbing notice: The private company managing their son’s Medicaid coverage intends to cut nearly 40 percent of what it spends for caregivers who help him live at home instead of in a nursing home.

Sam Walker, 35, has severe autism and other disabilities. He is deaf and cannot speak. Sometimes when he’s frustrated, he hits himself or others.

Medicaid provides about $8,500 a month for health workers who visit his apartment in the basement of his parents’ home. The staffers help him with everyday tasks, including dressing, bathing, and eating. They also take Walker on outings, such as dining at restaurants, volunteering at Goodwill, and exercising at a recreation center or on park trails. They stick to a strict routine, which soothes him.

His parents say that without the in-home services, their son would need to move to a specialized residential facility in another state. Sending him away would break their hearts and cost taxpayers much more money. They strive to keep him home because they know change makes him anxious.

Jack Hatch is a former state senator and was an author of every health care reform bill in Iowa from 2003 through 2014.

Health care is not a privilege. It is not a reward for good luck, good jobs, or good timing. It is a basic right. And in Iowa, health care, as an issue, has always been understood best when we remember that simple truth. There is another truth: health care is too expensive, in Iowa and across the U.S. 

For decades, our state has shown that when we lead with fairness, openness, and shared responsibility, we can build systems that work. Iowa passed meaningful health care reforms prior to the Affordable Care Act. We created bipartisan commissions to make policy. We listened to consumers, providers and other stakeholders. We debated publicly. And we acted with courage.

That tradition expanded children’s coverage to become the state with the highest percentage per capita for children covered by insurance in the nation as listed by the Kaiser Family Foundation (now known as KFF) in 2013. We led when we modernized health records. We led when we built patient-centered care. We led when we believed that health care reform required public conversation, not private contracts.

Dean Lerner served Iowa as an Assistant Attorney General for sixteen years, Chief Deputy Secretary of State for four years, and about ten years as Deputy Director, then Director of the Department of Inspections & Appeals. He then worked for the CMS Director of the Division of Nursing Homes, and the United States Attorney for the Northern District of Iowa. He is a graduate of Grinnell College and Drake University Law School.

During his interminable State of the Union address, President Donald Trump referred to waste, fraud, and abuse. Of course, such mention was opportunistically political, containing recurrent condemnations of the Somali community, a favorite target of our president’s vile rhetoric. 

While waste, fraud, and abuse is a worthy topic and should be condemned and eliminated, a more introspective approach would have better served our nation.

State Representative Josh Turek is a four-time Paralympian and two-time gold medalist for Team USA, a former professional wheelchair basketball player and a candidate for U.S. Senate. 

As the Olympics come to a close and the Paralympics begin in early March, I’m sure a lot of us are thinking about what it means to cheer for Team USA. 

Representing the United States at four Paralympic games was the highlight of my wheelchair basketball career, and one of the greatest honors of my life. Watching them raise the American flag with USA across my chest, a gold medal around my neck, and the stars and stripes over my shoulders, I was proud to be an American. 

This Olympics, I know many Americans are troubled by the direction of our country.

Robin Opsahl, Brooklyn Draisey, and Cami Koons collaborated on this article, which was first published by Iowa Capital Dispatch. Clark Kauffman and Kathie Obradovich also contributed to this story

Iowa lawmakers took on hundreds of bills in the first six weeks of the 2026 legislative session, though several measures named as top priorities heading into the year, like eminent domain and property taxes, have yet to find consensus.

February 19 was the last day lawmakers met to consider legislation before the first “funnel” deadline of the year. While there are many exceptions, most bills that don’t involve spending, taxes or government oversight must pass through a committee in either the House or Senate in order to stay eligible for consideration.

John and Terri Hale own The Hale Group, an Ankeny-based firm advocating for older Iowans and Iowans with disabilities.

It was disturbing, frustrating and sickening. But it was not surprising. And it’s happened six years in a row. 

Behind closed doors, secretively and quietly, Iowa Senate Republicans once again killed a bill that would improve, and possibly save, the lives of nursing home residents.  

The bill would protect the right of loved ones of nursing home residents to install video cameras in their rooms. The camera would allow families near and far to check in on their moms, dads, grandparents or others to make sure they are well, safe, and receiving good care. 

Chuck Isenhart is an investigative reporter, photographer, and recovering Iowa state legislator offering research, analysis, education, and public affairs advocacy at his Substack newsletter Iowa Public Policy Dude, where this essay first appeared.

In Iowa, Council Bluffs and Dubuque, where I live, have a lot in common.

Council Bluffs is on the Missouri River. Dubuque is on the Mississippi River. Both rivers are prone to flooding. Dubuque’s population is 59,000. Council Bluffs is about 63,000.

Council Bluffs has the Loess Hills. Dubuque has the bluffs of the Driftless. Both are known for their blue-collar industrial heritage with immigrant, working-class populations. Both are crisscrossed by railroads. Both have a strong emphasis on historic preservation and cultural institutions. Our chambers of commerce host first-class legislative receptions.

Abbey Paxton is the owner of Storyhouse Bookpub in Des Moines.

In 2021, I opened an independent bookstore in downtown Des Moines. My husband, also a small business owner, and I have had two children since moving back to Iowa in 2020, and we work full time running our businesses. 

Like many other small business owners and self-employed Iowans, our family resides in the gap between barely affordable, mediocre, private individual health insurance and Medicaid—a gap that will only widen after the most painful provisions of the Republican budget reconciliation bill (the so-called “One Big Beautiful Bill Act”) are fully implemented.

Every Iowa member of Congress voted in favor of the bill, which makes historic cuts to Medicaid while providing big tax breaks for the wealthy and new tax loopholes for big corporations like health insurance and prescription drug companies. 

Tara Guion is a mother of three from Iowa and an advocate for families affected by Medicaid policy, sharing her story to highlight the real impact of proposed cuts on Iowa children and families. 

As I stood in line at the Iowa State Fair, waiting to meet Senator Joni Ernst, I couldn’t help but think about my child, Luca, and the struggles we’ve faced as a family. My experience is a testament to the importance of Medicaid, a lifeline for many families like mine.

As a pregnant mother of two (soon to be three) boys, I’ve had my fair share of challenges, but it’s the memory of Luca’s four-and-a-half-month stay in the NICU that drives my advocacy. Born at just 25 weeks in March 2021, Luca’s prematurity and subsequent medical complications led to $1.7 million in medical costs, a burden that would have been insurmountable without Medicaid.

The care he has received, including occupational and physical therapy, as well as nutritional services, was crucial to his development. Today, at four and a half, he’s a thriving child, defying the odds, and he started school this fall. 

Sue Dinsdale is the Executive Director of Iowa Citizen Action Network and the State Lead for Health Care for America NOW.

Politicians in Washington, D.C. are getting ready to shut down the federal government once again, despite single-party Republican control of the House, Senate, and the presidency. 

This time, disagreements in Congress over health care costs and access are preventing an agreement that would keep critical services going without interruption. 

Earlier this year, Republicans in Congress passed and President Donald Trump signed a massive budget reconciliation bill, the so-called “One Big Beautiful Bill Act,” which extended trillions of dollars in tax breaks that would otherwise have expired this year. The lion’s share of those tax breaks will go to wealthy households making over $400,000 a year and to large corporations through extra loopholes that were reinstated in the law. 

Adam Zabner represents Iowa House district 90, covering part of Iowa City.

In April 2024, Bleeding Heartland published an op-ed I wrote detailing my fight with Governor Kim Reynolds’ administration to secure voting rights for Iowans on Medicaid. The fight centered around a federal law, the National Voter Registration Act, which requires states to offer voter registration to people registering for public assistance programs.

As I wrote, at the time, “Iowa’s Medicaid application form is 27 pages long. Many other states include a voter registration form in the packet. In Iowa, at the bottom of page 16, the packet contains one sentence and a link to the voter registration form. The link is printed out. An Iowan would have to type the 46-character link into their browser and access a printer to print it out. This is unlikely to register voters and states with similar policies have been found to be out of compliance with the NVRA.” The result was that far fewer people were registering to vote through Medicaid applications in Iowa, compared to almost any other state.

Rose Mary Pratt is a native of Des Moines and has been involved in Polk County and Iowa Democratic Party politics for fifty plus years. She is a former secondary education teacher in Minnesota, Council Bluffs, and the Des Moines area. She worked on the administrative staff of Governor Tom Vilsack and as a Legislative Secretary in the Iowa House of Representatives. She has volunteered and worked in many campaigns and remains committed to mentoring young people who want to be in politics and run for public office. She and her husband reside in Des Moines, and she is a proud mother and grandmother. 

As a long-time Democratic party activist, I’ve met many candidates running for office over the years and have worked in campaigns and been involved at a grassroots level in Iowa elections. I have given my time and money, and tried to encourage and mentor those who are committed and know why they want to run for public office. I have been fortunate to work with and for people who believe they can make a difference. I love the idea that when I see good people run, and win or lose, I am still glad to have had the chance to be a part of their campaign. 

I have had the honor of working for Governor Tom Vilsack and alongside Democratic and Republican lawmakers at the state capitol. I feel my activism should continue and I have to stay involved and work to find and support candidates whose qualities and abilities to lead are evident.  However, more significantly is the candidate’s desire to be of public service and in the public arena at this time of polarization and disillusionment with government.

I believe the country’s future depends on electing strong and visionary candidates who give us hope. I am endorsing Jennifer Konfrst for Iowa’s third Congressional district. I am confident she is the best candidate to represent our district and can win.

Kay Pence is vice president of the Iowa Alliance for Retired Americans.

I’m a retired union representative for the Communications Workers of America living in rural Eldridge with my husband of 50 years. As a union rep I bargained contracts, and health care was always the biggest issue, especially before the Affordable Care Act became law in 2010.

I’m currently the executive vice president for the Iowa Alliance for Retired Americans, which has 4.4 million members nationwide. I’m extremely concerned about how Donald Trump’s so-called “Big Beautiful Bill” (the budget reconciliation package) will force people off their insurance and cause problems for providers. I’m especially concerned about insurance rates for everyone who thinks these cuts to Medicare, Medicaid, and the Affordable Care Act premium subsidies won’t impact them, since their coverage comes through their employer or private insurance plan.

Dean Lerner served Iowa as an Assistant Attorney General for sixteen years, Chief Deputy Secretary of State for four years, and about ten years as Deputy Director, then Director of the Department of Inspections & Appeals. He then worked for the CMS Director of the Division of Nursing Homes, and the United States Attorney for the Northern District of Iowa. He is a graduate of Grinnell College and Drake University Law School.

The unimaginable has now become commonplace:

Stripping health care from 56,000 Iowans.

Taking food assistance and safety nets away from Iowa’s children, seniors, and veterans.

Adding $3.3 trillion to the national deficit. And on and on….

Jack Hatch is a former state senator who chaired the Iowa Senate Health and Human Services Committee and was the 2014 Democratic nominee for governor.

I was one of the legislative authors of expanding health care through the expansion of Medicaid in 2013. At least two members of Iowa’s current U.S. House delegation should know that the expansion was designed to help children and adults who previously did not qualify for Medicaid. Randy Feenstra, who now represents Iowa’s fourth Congressional district, was a state senator at the time. Mariannette Miller-Meeks, who represents the first Congressional district, was then the director of the Iowa Department of Public Health.

Iowa became the only state with a Republican governor that enacted Medicaid expansion in 2013. The Iowa Health and Wellness Plan would eventually extend health insurance coverage to nearly 200,000 residents of our state.

Al Charlson is a North Central Iowa farm kid, lifelong Iowan, and retired bank trust officer.

I had to send Senator Chuck Grassley a quick email to thank him for starting my day with a chuckle. In the latest edition of his email newsletter “The Scoop,” he commended the U.S. Supreme Court’s ruling that federal district courts do not have the authority to issue universal injunctions blocking the Administration’s Executive Order. Grassley declared the decision “a victory for checks and balances.”

Checks and balances? Since Grassley and his Senate Republican colleagues voluntarily abdicated their Constitutional authority, responsibilities, and prerogatives, we no longer have a functioning constitutional representative democracy. We essentially have a king.

Of course, the biggest show in Washington, D.C. has been the around-the-clock push to pass a budget reconciliation bill. Republicans want to get the One Big, Beautiful Bill (also known as a Big Ugly Mess) to President Donald Trump’s desk for a reality TV style triumphant bill signing on the Fourth of July. The days-long Senate debate ended on July 1 with a dramatic tie-breaking vote by Vice President J.D. Vance. Grassley and Iowa’s junior Senator Joni Ernst voted for the bill, along with all but three of their GOP colleagues.

Congressional Republican leadership have characterized the bill as Trump’s domestic policy agenda. That’s misleading at best. At its core, this legislation is the Senate Republican leadership’s tax cut agenda with enough of Trump’s ideas and MAGA bumper stickers attached to keep his support base on board.

Ed Tibbetts, a longtime reporter and editor in the Quad-Cities, is the publisher of the Along the Mississippi newsletter, where this article first appeared. Find more of his work at edtibbetts.substack.com.

In February, House Speaker Mike Johnson of Louisiana justified the looming cuts to Medicaid by complaining the program wasn’t designed to cover a bunch of “29-year-old males sitting on their couches playing video games.”

Give Johnson credit: that is a powerful image.

Nobody wants their tax dollars going to pay for government health insurance for some dude who just hangs around his parents’ basement gaming while the rest of us have to haul ourselves out of bed each morning to go to work. Which is why Republicans have been focusing so much on the Medicaid work requirements in Donald Trump’s big, ugly tax bill.

They won’t admit the money they save by taking health insurance away from millions of poor Americans will go to finance tax cuts for some of the wealthiest families in the country. So, they falsely claim these cuts will protect the most vulnerable, who also are covered by Medicaid.

Chuck Isenhart is an investigative reporter, photographer and recovering Iowa state legislator offering research, analysis, education and public affairs advocacy at his Substack newsletter Iowa Public Policy Geek, where a version of this essay first appeared.

Iowa has a new director of the Office for State-Federal Relations. But it’s not clear whether anyone is looking out for Iowa as the federal government slashes programs.

Madeline Willis, a former staffer for U.S. Senators Chuck Grassley and Joni Ernst and U.S. Representative Zach Nunn (IA-03), posted on LinkedIn that she accepted “a position with Governor Kim Reynolds as her DC-based Director of State and Federal Relations” in April. Only a few weeks earlier, the Iowa Senate had confirmed Eric Baker as director of that office, an “independent agency” position he had held for the past two years.

I put “independent” in quotes because, although Iowa Code says the Office for State-Federal Relations is a nonpartisan program “accessible to all three branches of state government,” Baker led that office from Des Moines while also serving as Governor Kim Reynolds’ director of strategic operations.

Sue Dinsdale is the Executive Director of Iowa Citizen Action Network and the State Lead for Health Care for America NOW.

Apparently, the new official response to Iowa families worried about losing their health care is: “Well, we all are going to die.”

That’s what Senator Joni Ernst told Iowans when asked at a recent town hall meeting about the devastating cuts to Medicaid being proposed in Congress. And while she’s technically correct—we are all going to die—it’s hard to imagine a more callous, out-of-touch response to the very real fear that families like mine carry every day.

Iowa’s 2026 U.S. Senate race had its first viral moment on May 30, when an unscripted comment from Senator Joni Ernst generated massive coverage across Iowa and national news outlets.

The words Ernst blurted out in frustration at that town hall meeting may or may not have staying power in the next Senate campaign.

But we’ll definitely keep hearing what the senator said before and after making that gaffe. Republicans around the country, including Iowa’s U.S. House members, have used the same false claims in defense of the budget reconciliation bill now pending in the Senate.

Those statements were among more than a dozen messages about Medicaid and the federal food assistance program known as SNAP that Republicans tested this spring in telephone polls. I was a respondent for one of the surveys in early May and have transcribed the questionnaire at the end of this post.

I don’t know which GOP-aligned entity paid for the robo-poll I received, but it’s clear the memo on how to spin deep Medicaid and SNAP cuts has gone out to all Republicans in Congress.

Bill Bumgarner is a retired former health care executive from northwest Iowa who worked
in hospital management for 41 years, mostly in the state of Iowa.

Prior to retiring at the end of 2023, I worked in hospital leadership for 41 years. For the last 24 years of that time, I served as president at two hospitals in rural Iowa.

I’ll be quick to my point and blunt. When President Donald Trump or any Republican member of the U.S. House or Senate tells you that their Medicaid budget plans are strictly focused on cutting waste, fraud and abuse, they’re lying.

All four Iowans in the U.S. House voted on May 22 to pass a federal budget reconciliation package combining massive tax cuts with deep spending cuts on health care and food assistance.

The early morning vote on the “One Big Beautiful Act” (adopting President Donald Trump’s preferred phrase) followed an all-night debate. House leaders rushed the vote before the nonpartisan Congressional Budget Office (CBO) could analyze a manager’s amendment released on the evening of May 21, which made many substantive changes to tax provisions and deepened the planned Medicaid cuts.

House members approved the measure by 215 votes to 214, with two Republicans joining all Democrats to vote no, and one Republican voting “present.” The one-vote margin means U.S. Representatives Mariannette Miller-Meeks (IA-01), Ashley Hinson (IA-02), Zach Nunn (IA-03), and Randy Feenstra (IA-04) each can claim to have cast the deciding vote to cut taxes. They did it without waiting for a nonpartisan analysis of the costs and impacts for their constituents.

This vote will likely become a central theme for Democratic candidates in Iowa’s 2026 Congressional campaigns—and the governor’s race, if Feenstra becomes the GOP nominee. Within hours, Congressional challengers Travis Terrell (IA-01), Sarah Trone Garriott (IA-03), and Jennifer Konfrst (IA-03) blasted the vote in social media posts and fundraising emails. A video of Miller-Meeks running away from Social Security Works executive director Alex Lawson as he presses her about Medicaid cuts has gone viral on several social media platforms and will surely be seen in television commercials.

Tens of thousands of Iowans will lose their health insurance, food assistance, or both if the “big, beautiful bill” becomes law. Meanwhile, the package would raise the debt ceiling by $4 trillion and add at least $2.3 trillion to the deficit (or perhaps $3.2 trillion) over the next ten years.

Robin Opsahl covers the state legislature and politics for Iowa Capital Dispatch, where this article first appeared. Brooklyn Draisey, Cami Koons, and Clark Kauffman contributed to this report.

Republicans’ supermajorities in both chambers of the Iowa Legislature allowed them to push several high-profile bills to the governor throughout the legislative session – but many of the thousands of bills discussed this session failed to advance.

Lawmakers adjourned for the 2025 legislative session early on May 15 after a night of debate and closed-door caucus meetings and nearly two weeks after the session was scheduled to end. Republicans were able to reach agreements on May 14 to pass several of the policy bills that had failed to advance earlier in the session, including Governor Kim Reynolds’ bills providing paid parental leave for state employees and reducing the state’s unemployment insurance taxes on employers.

Earlier in the year, the Republican-controlled chambers moved quickly to pass a bill removing gender identity from the Iowa Civil Rights Act. Other measures passed through with less coordination—legislation on eminent domain use in carbon sequestration pipelines only made it to a vote on May 12, following a concerted effort by twelve GOP senators who said they would not support any budget bills until the pipeline bill was brought to the floor.

President Donald Trump’s first 100 days back in the White House have brought the U.S. an economy weakened by tariffs, a depreciating dollar, and the worst stock market performance during a new presidency since 1974. Trump now has historically low approval ratings, even on his handling of the economy—which had long been his strongest public opinion metric. Economists and market analysts increasingly see a recession likely to come this year, and consumer confidence just dropped to its lowest level since the early days of the COVID-19 pandemic.

But to hear U.S. Representative Ashley Hinson tell the story, the country has experienced “100 days of WINNING under President Trump!” The Republican from Iowa’s second Congressional district told reporters on May 2 that the president is “ushering in the new era, the golden age for our economy.”

Whether she’s speaking to a national television audience, her social media followers, the press, or a hostile town hall crowd, Hinson is working hard to demonstrate her loyalty to Trump.

Her tight embrace of a polarizing president could hurt her with swing voters in 2026 but may be essential for her 2028 ambitions.

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.

U.S. Senator Bernie Sanders’ campaign has a staffer on the ground again in Iowa. No, the senator from Vermont isn’t getting a head start on the 2028 caucuses.

In an April 3 telephone interview, Evan Burger described his focus and early work as Iowa organizer for Friends of Bernie Sanders.

Robin Opsahl covers the state legislature and politics for Iowa Capital Dispatch, where this article first appeared. Brooklyn Draisley, Cami Koons, and Kathie Obradovich contributed to this article.

As the Iowa legislature advanced past the second major deadline of the 2025 session, conversations on pipelines, Medicaid work requirements and new higher education requirements are continuing through surviving bills—though agreements have not necessarily been reached between the two Republican-controlled chambers.

The session’s second “funnel” deadline is another checkpoint for lawmakers during the legislative session, culling the bills that remain eligible for consideration as the Legislature nears the end of session. During the first funnel, bills were required to gain approval by a committee in one chamber to survive. In the second funnel, bills must have passed in floor debate in one chamber and gained committee approval in the other chamber to remain eligible.

There are several exceptions to this deadline, such as bills involving taxes, spending and government oversight components, and they include the property tax legislation proposed by Iowa lawmakers. Legislative leaders can also sponsor a bill and bring it forward without abiding by the deadline.

In addition, the language of a bills considered “dead” because of the funnel can still be added, at any point, as an amendment to a surviving bill.

There are also several bills that remain eligible for consideration by being placed on the “unfinished business” calendar, allowing them to remain up for consideration during the remainder of the session.

Peggy Huppert retired in 2023 following a 43-year career with Iowa nonprofit organizations, including the American Cancer Society and NAMI (National Alliance for Mental Illness) Iowa. She is also a long-time progressive political activist.

It does not surprise me, but disappoints me greatly, that the Iowa legislature is poised to adopt a policy requiring “able bodied” Medicaid recipients to work at least 80 hours a month in order to stay enrolled.

This is nothing new. Some Republicans tried to implement this in Iowa during Donald Trump’s first administration. As the head of NAMI Iowa, I successfully helped fight this legislation for four years before a reprieve during the Biden administration. Now, with an even larger majority in both the Iowa House and Senate, encouragement from our governor, and a green light from the new Trump administration, there is nothing holding the Republican majority back.

As a mental health advocate and family member of loved ones with serious mental illness, I would like to see the phrase “able bodied” (just like “It’s all in your head”) permanently retired from our lexicon.

Rod Sullivan is a Johnson County supervisor. 

I searched the word “Medicaid” in my archive. I was shocked to find how much I have written on the topic—tens of thousands of words over the years. 

Why have I written so much about Medicaid? For one, you write what you know. I used to work in the Iowa Medicaid program. Even though that was several years ago, I know Medicaid quite well. That is why the Republican scheme to cut the program upsets me so much.

Charles Gaba is a health care policy wonk, advocate, and blogger who mixes data analysis with snark at ACASignups.net, where this article first appeared. You can follow him on Threads, Bluesky, Mastodon, Spoutible, or X/Twitter.

Over the past couple of months I’ve compiled a master spreadsheet breaking out enrollment in Affordable Care Act plans (Qualified Health Plans and Basic Health Plans), Medicaid/Children’s Health Insurance Program coverage (both traditional and via ACA expansion) and Medicare (both Fee-for-Services and Advantage) at the Congressional district levels.

With the pending dire threat to several of these programs (primarily Medicaid and the ACA) from the federal budget proposal House Republicans approved in late February, I’m going a step further and am generating pie charts which visualize just how much of every Congressional district’s total population is at risk of losing health care coverage.

All four Republicans who represent Iowa in the U.S. House voted for the budget blueprint.

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. Brian Keyser is a health policy research associate at Center for American Progress, an independent, nonpartisan policy institute that is dedicated to improving the lives of all Americans through bold, progressive ideas, strong leadership, and concerted action.

Last year, 60-year-old Iowan Susan McKinney started a new job working from home for a travel agency. Susan suffers from diabetes, arthritis, and atrial fibrillation (AFib), and her insurance coverage hadn’t kicked in before her health deteriorated to the point where she couldn’t walk up or down her apartment steps. She couldn’t get to a doctor—which she had no way to pay for anyway—so her conditions went untreated. In November, her concerned siblings moved her back to her hometown of Cedar Rapids, where the local free clinic told her that she qualified for Medicaid. Susan’s sister says, “Medicaid saved her life.”

Medicaid provides comprehensive medical coverage and long-term care for approximately 21 percent of Iowans like Susan. In 2023, the federal government covered around 72 percent of Iowa’s $7 billion in Medicaid spending.

But on February 25, all four members of Iowa’s House delegation voted in lock step with the Republican majority to advance a budget that would necessitate slashing federal contributions to state Medicaid programs to fund tax cuts for the wealthy. If implemented, this legislation could mean a loss of more than $8 billion for Iowa’s economy over the next decade.

The Center for American Progress estimated how the $880 billion in proposed Medicaid cuts nationwide would cost each Congressional district in federal funding. Here are the Iowa numbers:

Ed Tibbetts, a longtime reporter and editor in the Quad-Cities, is the publisher of the Along the Mississippi newsletter, where this article first appeared. Find more of his work at edtibbetts.substack.com.

Republicans at the Iowa capitol like to think they’re good at managing money.

They cut taxes. They’ve got a big surplus. They’re so proud of themselves, they want to teach the locals how to do it.

In her Condition of the State address in January, Governor Kim Reynolds said it was time to impose discipline on local governments, “because to pass meaningful property tax reform, we also need to be lean at the local level.”

But is the state really that much better at spending discipline than the locals?

Turns out, not so much.

Tony Leys is Rural Editor/Correspondent for KFF Health News, where this story was first published.

Collection agents for the state of Iowa have sent letters seeking millions of dollars from the estates of at least two people with disabilities who died after spending most of their lives in a state institution.

The amounts represent what Medicaid spent covering the residents’ care when they lived at the Glenwood Resource Center, a state-run facility that closed last summer.

The bills are extraordinary examples of a practice called Medicaid estate recovery. Federal law requires states to try to collect money after some types of Medicaid recipients die. The point is to encourage people to use their own resources before relying on the public program. But some states, including Iowa, are particularly aggressive about the collections, national reports show.

Iowa Attorney General Brenna Bird enjoyed suing the Biden administration. She filed or joined more than a dozen multi-state lawsuits against the federal government during her first year in office alone. At least a dozen more lawsuits followed in 2024.

Bird has often welcomed media coverage of her legal battles against Biden administration policies. Her office issued many press releases to announce new litigation or joint letters challenging the federal government.

But Bird’s office kept quiet about one case, which Iowa and sixteen other Republican-controlled states filed in the Northern District of Texas last September. Texas v. Becerra could prove catastrophic for Americans with disabilities. Not only are the plaintiffs seeking to vacate a federal rule prohibiting discrimination against disabled people in health care settings, they are also asking the court to declare a 1973 law known as Section 504 unconstitutional and unenforceable.

After reporters began asking questions about that lawsuit last week, Bird and her staff lied repeatedly about the scope of the case and the plaintiffs’ goals.

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

With the Iowa legislative session beginning January 13, it is time for a rundown of important maternal health policies that should become priorities for state lawmakers in 2025.

Since I am focusing on access to midwifery care, it is worth noting that in October 2024 the World Health Organization issued a new position paper on “Transitioning to Midwifery Models of Care.” That paper offers an international definition by describing the guiding principles of midwifery models of care and reviewing the advantages of adopting them. 

According to the World Health Organization’s position paper, 

Henry Jay Karp is the Rabbi Emeritus of Temple Emanuel in Davenport, Iowa, which he served from 1985 to 2017. He is the co-founder and co-convener of One Human Family QCA, a social justice organization. This essay first appeared on his Substack column.

Shortly after the recent election, Democratic State Representative Ken Croken, one of the members of the Quad Cities delegation to the Iowa legislature, hosted a meeting at a local library. The theme was, “Where Do We Go From Here?”

The room was packed. It was booked for an hour, but for the first half hour those in attendance were obsessed with the question of “Where did the Democrats go so wrong?” Every speaker had his or her view on why Democratic candidates failed so miserably, both nationally and in Iowa.

It was interesting, to a point. It allowed people to grieve and vent their anger, but it wasn’t very useful and it definitely was off topic. Finally, I raised my hand in frustration and said, “We’re talking about the wrong thing! It will be two years before we can effect change through the voting booth! But it will only be two months before January 20 and day one of the Trump presidency! Right now we have bigger fish to fry and not a lot of time to get cooking!”