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.
BIG PICTURE: A TRANSFER OF WEALTH FROM POOR TO RICH
While Republicans have promised all Americans will get a tax cut, two expert reviews confirm the highest earners will benefit the most. Americans near the bottom of the scale will be worse off, because cuts to safety net programs will outweigh any minimal reduction to taxes owed. So the Republican bill will literally take money away from those in need while giving enormous benefits to the wealthy.
Congressional Budget Office
Earlier this week, the CBO reviewed the reconciliation bill that the House Budget Committee approve on May 18. That analysis found tax provisions, such as extending most of Trump’s 2017 tax cuts, plus new language eliminating income taxes on tips and overtime pay, would increase the federal deficit by $3.8 trillion over the coming decade.
Over the same period, the federal government would spend $698 billion less on Medicaid and $267 billion less on the Supplemental Nutrition Assistance Program, more commonly known as SNAP or food stamps. (The final version of the bill unveiled on May 21 will produce deeper Medicaid cuts, by accelerating work requirements and more frequent eligibility checks, which would increase administrative costs and force many eligible people off the program.)
The bill would increase funding for defense, immigration enforcement, and homeland security, while cutting other domestic spending to produce a net reduction in federal spending by $64 billion over the decade.
According to the CBO, total “household resources” would fall for Americans in the lowest 10 percent of earners, mainly from loss of Medicaid and SNAP benefits. In contrast, people in the top 10 percent of income would see their total household resources increase because of the tax savings.
The CBO also estimated that the May 18 version of the reconciliation bill would trigger a process known as “sequestration” through increased budget deficits, potentially leading to nearly $500 billion in Medicare cuts over the coming decade. Republicans in Congress would need to waive certain budget rules to stop Medicare cuts from happening.
Penn Wharton Budget Model
The Penn Wharton Budget Model model looked at the same bill that emerged from the House Budget Committee on May 18, before the final changes from the manager’s amendment. That model estimated the cost of the tax provisions at $4.6 trillion. Taking into account the various spending cuts and other impacts, Penn Wharton sees deficits rising by nearly $3.2 trillion over the coming decade.
Considering the combined impact of tax cuts with reductions in other government programs, especially SNAP and Medicaid, along with subsidies for health insurance through Affordable Care Act exchanges, Penn Wharton sees the average household in the bottom 20 percent of earners about $1,035 worse off under this bill. Households in the next quintile (from 20 percent to 40 percent) would lose an average of $705.
The windfall for the well-off increases the higher you go on the income scale, because wealthy Americans will reap the largest tax breaks and don’t reply on programs like SNAP or Medicaid. According to Penn Wharton, households with incomes at the 80 percent to 90 percent level will see more than $6,050 in gains. For those at the 90 percent to 95 percent level, the average increase is $8,835. Tax savings for those between 95 percent and 99 percent will be around $19,965.
The bill is certainly big and beautiful for the top 1 percent of households, which will be $44,365 better off. And it’s a bonanza for the top 0.1 percent, who will save an average of $389,280.
58,000 IOWANS COULD LOSE SOME OR ALL FOOD BENEFITS
The reconciliation package would cut spending on the main federal food assistance program (SNAP) by more than $290 billion. A centerpiece will be to impose work requirements on adults between the ages of 55 and 64, and on parents with children between the ages of 6 and 17.
Republicans have claimed these policies will promote work and accountability while reducing waste. However, the impact will be severe for needy families. The Center on Budget and Policy Priorities explained in an analysis of the SNAP cuts, “The evidence is clear — these requirements don’t do anything to raise employment rates.[2] But they do result in many people losing food benefits they need, deepening poverty and increasing hardship. Research also shows that many people who lose SNAP are working or should have qualified for an exemption, but the bureaucratic red tape made documenting their employment or proving their exemption too difficult.[3]“
The center posted an interactive map and table showing how many people in each state and Congressional district would be at risk of losing food assistance if the “big, beautiful bill” becomes law.
Around 260,000 Iowans receive some SNAP benefits. The CBPP estimated that statewide, around 29,000 adults would be at risk of losing their food assistance entirely. Around 58,000 Iowans might lose some amount of their SNAP benefits.
All four Iowans in the U.S. House voted for these cuts. Nunn and Feenstra voted for them twice: as members of the House Agriculture Committee and on the House floor. Here’s how the CBPP broke down the number of Iowans at risk in each Congressional district.
If this bill becomes law, we’ll have more precise numbers before the 2026 general election on how many Iowans lost all or part of their SNAP benefits.
The Iowa Hunger Coalition has highlighted other harmful provisions in the reconciliation bill, such as shifting some SNAP costs from the federal government to states. (emphasis in original)
Perhaps the most concerning proposal put forth to achieve this massive budget cut is cost sharing SNAP benefits with states. This would be a drastic restructuring of the program, leaving Iowa to come up with upwards of $27 million dollars annually starting in FY 2028 when the proposal would go into effect.
It would also increase the cost-share for states on administrative costs from 50% to 75%, leaving Iowa on the hook for an additional $15 million starting in FY 2026. This set of policies would place enormous strain on state budgets and force Iowa to make some extremely tough decisions.
The state will spend around $917 million more in the coming fiscal year than it takes in. So it’s unlikely the legislature will be able to find tens of millions more dollars for food assistance in the future.
On a related note, Governor Kim Reynolds announced on May 22 that the U.S. Department of Agriculture had approved the state of Iowa’s request for a waiver to restrict eligible food purchases with SNAP benefits. Starting on January 1, 2026, Iowans will not be able to use SNAP to buy any taxable food items, including pop, most kinds of candy, and most granola or fruit bars.
TENS OF THOUSANDS OF IOWANS COULD LOSE MEDICAID
The reconciliation bill would cut Medicaid funding by at least $700 billion over the next decade—perhaps more, due to last-minute changes that phase in some burdensome requirements more quickly.
About 600,000 Iowa adults and children currently receive health insurance through Medicaid. That includes some 183,000 Iowans who are part of the Medicaid expansion (Iowa Health and Wellness Plan). Here’s the Medicaid expansion enrollment, broken down by Congressional district:
- 46,800 in IA-01
- 42,700 in IA-02
- 49,700 in IA-03
- 43,400 in IA-04
An estimated 50 percent of Iowa’s enrolled adults already work full-time, and another 27 percent work part-time. But they might still lose coverage if they fail to submit all of the paperwork demonstrating their employment, or cannot re-prove their eligibility every six months. The CBPP notes that increased reporting requirements “frequently end up pushing eligible people off Medicaid because they don’t receive or submit the necessary paperwork, or because the state fails to process the paperwork.”
The CBPP estimates that the proposed work requirements would result in 9.7 million to 14.4 million Americans losing Medicaid coverage nationwide, including 56,000 to 117,000 Iowans. In each Congressional district, between 14,000 and 30,000 Iowans could lose Medicaid coverage.
The CBPP also warned, “The legislation would also raise costs for Medicaid expansion enrollees and will lead many of them to defer needed care. The bill requires states to charge working people with incomes just above the poverty line — $16,000 year for an individual — new cost-sharing charges when they go to the doctor.”
Such policies won’t just harm people on Medicaid. The American Hospital Association sounded the alarm in a May 22 statement:
The sheer magnitude of the level of reductions to the Medicaid program alone will impact all patients, not just Medicaid beneficiaries, in every community across the nation. Hospitals — especially in rural and underserved areas — will be forced to make difficult decisions about whether they will have to reduce services, reduce staff and potentially consider closing their doors. Other impacts could include longer waiting times to receive care, more crowded emergency departments, and hospitals not being able to invest in technology and innovations for clinical care.
Why more crowded emergency departments? When people can’t afford to get routine medical care, they may wait until their health deteriorates to see a doctor. Reducing the number of uninsured people was one of the leading arguments for passing the Affordable Care Act in 2010.
Speaking of which, the “big, beautiful bill” would do a lot to undermine that landmark health care reform law, which the GOP trifecta failed to repeal and replace during Trump’s first term.
HEALTH INSURANCE COSTS THROUGH THE ACA EXCHANGE WOULD SKYROCKET
The Centers for Medicare & Medicaid Services announced in January that 136,833 Iowans had purchased health insurance for 2025 through the Affordable Care Act marketplaces.
Many of them won’t be able to afford those policies next year.
In 2021 and 2022, Congressional Democrats and President Joe Biden “dramatically expanded and enhanced” premium subsidies for health insurance purchased through ACA marketplaces. Those subsidies are set to expire at the end of 2025, and the Republican-controlled Congress is not seeking to extend them.
Without the enhanced subsidies, an estimated 22 million Americans, “including 3 million small business owners and self-employed workers, will see their health coverage costs skyrocket,” according to the CBPP analysis. The CBO anticipates that ACA plans will become unaffordable for about 4.2 million people across the country, who will drop their health insurance coverage.
How many Iowans might become uninsured for this reason is unclear. In December, Charles Gaba estimated that nearly 100,000 Iowans were enrolled in subsidized ACA plans, and calculated how much premiums might rise for four different types of households.
The reconciliation bill compounds the problem: not only are enhanced premium subsides going away, the government would end a practice known as “silver loading.” If you want to wonk out, you can read explainers by Charles Gaba at ACA Signups or Christen Linke Young at the Brookings Institute. Linke Young summarized some possible outcomes:
The premium increases spurred by ending silver loading would have a range of consequences. As premiums increase, some people, mostly healthier enrollees, will drop their health insurance coverage. According to estimates, several hundred thousand people or more could lose coverage as a result of the end of silver loading, reducing their financial security and access to care and likely also increasing uncompensated care burdens for providers. Enrollees who are sicker are more likely to accept the higher premiums and stay enrolled, raising costs for insurers. […]
The same article pointed out that this policy adds uncertainty for insurers when the ACA “market is already facing very large premium increases and enrollment reductions. […] This type of uncertainty may make insurers more reluctant to serve this market, leading them to exit, at least until the dust settles.”
One thing is certain: Miller-Meeks, Hinson, Nunn, and Feenstra just voted to raise health insurance costs for tens of thousands of their constituents who buy coverage through the ACA marketplace. Many of them will be uninsured by this time next year; Drew Altman of KFF reported on May 20, “many Marketplaces believe they are facing a one-third drop in enrollment (about 8 million of the 24 million currently covered, if extrapolated nationally), once all these changes would be in place.”
I will update this post as needed as more details are known about the reconciliation bill’s impact on Iowans.