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.

In fact, according to the Congressional Budget Office, about 7.6 million Americans and tens of thousands of Iowans—who are playing by the rules—would lose health care coverage going forward under the Republican plan that passed the House on May 22. Children, the elderly, the disabled, and working citizens would all be among those affected. 

Given my long experience with hospital finance and reimbursement, I know well that the planned cuts would negatively impact all members of our communities, not simply those directly insured through Medicaid. That’s because the cuts would also reduce critical revenue paid to local hospitals. Those revenues support a wide range of services, new technology, physician recruitment, and other needed investments that serve everyone.

You see, a wide range of routine services many hospitals provide do not draw sufficient revenue to cover expenses, due to low payment rates from government and private insurance companies. That includes services such as inpatient care, intensive care, mental health services, emergency care and more. Hospitals internally subsidize such services by making moderate margins through just a few outpatient service lines.

But the funding is critical. Maintaining sufficient revenues from Medicaid as well as Medicare and private insurance companies all serve to sustain a local hospital seeking to meet community need. The funding also helps support good jobs. Health care represents one of the largest employers in most rural counties in Iowa.

Some in the GOP tout Medicaid cuts by falsely claiming that program participants are lazy or otherwise unworthy of government support. Despite what Republicans would like voters to believe, most Medicaid recipients are responsible citizens, just trying to meet fundamental health care needs for themselves and their loved ones.

In a recent article published by KFF, the authors refuted such Republican misrepresentations by presenting an accurate breakout of adult Americans receiving Medicaid benefits. Some 64 percent have full-time or part-time jobs. Another 12 percent can’t work due to family caregiving responsibilities. Some 10 percent suffer from illness or disability, 7 percent attend school, and 8 percent are retired, unable to find work, or not working for another reason. 

Nationally and in Iowa, Republican politics increasingly involves punching down on people with no power to fight for themselves rather than seeking ways to lift up the lives of all Americans. Taking that analogy a step further, Iowans who support Medicaid cuts are punching themselves in the face. Lost Medicaid revenue only hurts your local hospital and reduces the range of services available in your community.

Republicans are trying to reduce spending on Medicaid to help pay for tax cuts that disproportionately benefit the most affluent Americans. That’s clearly a misplaced priority. It’s my hope that most Americans and Iowans can see through that ruse and hold a measure of compassion for their friends and neighbors who rely on Medicaid to access health services with dignity. Who among us would feel at ease bringing our sick child to an emergency room with no means to pay?

Beyond basic decency, it’s foolish to take our local hospitals, physician clinics, and other important health care services for granted. Your federal Republican elected officials—and your state representatives who curry favor with Donald Trump—don’t want you to understand the full implications of their cynical Medicaid scheme.

That’s why they lie to you. And they know they are lying to you. Straight up.

This fight is not over. The harsh Republican budget bill now moves on to the U.S. Senate. If senators alter the reconciliation bill, the House would need to pass the new version, or the Senate and House would negotiate a compromise that both chambers would need to pass again.  

Let Iowa’s Congressional delegation hear from you. Start with Senators Chuck Grassley and Joni Ernst as the Senate takes up the House bill in the coming weeks. Remind them that they work for you, and you vote.