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.

Continuing and expanding Trump’s 2017 tax cuts has long been the apparent highest priority of Senate Republican leadership. On January 31, 2024 (before Trump was officially 2024 Republican nominee), Semafor reporter Joseph Zeballos-Roig asked Grassley whether the Senate should approve an extended child tax credit, which had passed the House by an overwhelming bipartisan majority. Grassley replied, “I think passing a tax bill that makes the president look good mailing out checks before the election means he could be reelected and then we won’t extend the 2017 tax cuts.”

Senate leaders have joined Grassley to defend the 2017 tax cuts in the current “debate.” Senator Ron Johnson of Wisconsin, a key architect of the 2017 reconciliation bill, at least recognized the threat of exploding national debt—which is why he pushed for deeper Medicaid cuts.

Former Senate Majority Leader Mitch McConnell, who considers the 2017 tax cuts one his greatest achievements but is no longer a Trump fan, recently assured GOP colleagues, “I know a lot of us are hearing from people back home about Medicaid. But they’ll get over it.” (His remark behind closed doors echoed Ernst’s infamous town hall comment: “Well, we all are going to die.”)

No member of our immediate family depends on Medicaid, so I have no direct experience with the program. But we all need to pay attention because it’s extremely important to so many of our neighbors and our communities. According to the Congressional Budget Office, the House version of the budget reconciliation bill would have cut federal Medicaid spending by $793 billion over 10 years. The latest estimates indicate the Senate version will cut Medicaid by nearly $1 trillion. One-tenth of that amount or $100 billion equals over 16 percent of federal Medicaid spending in fiscal year 2023—a huge cut.

According to a January 2025 “Medicaid Overview” by Eric Richardson of Iowa’s nonpartisan Legislative Services Agency,

As of December 2024, there were 417,485 individuals enrolled in
the Medicaid program in Iowa. This included:

• 240,427 children
• 67,181 adults
• 34,264 elderly
• 75,613 disabled

Medicaid covers more than 13 percent of Iowa’s population, including nearly 40 percent of children, nearly 40 percent of births in the state, and around 50 percent of nursing home residents.

Medicaid funding and reimbursement rates are critical to Iowa’s entire health care system. According to a 2024 fact sheet from the American Hospital Association, Medicare and Medicaid patients accounted for 75 percent or more of inpatient days for 69 percent of Iowa hospitals in 2022. (The national average was 43 percent of hospitals where Medicare and Medicaid patients accounted for 75 percent or more of inpatient days.)

At 11 percent of Iowa hospitals, Medicare and Medicaid covered 90 percent or more of inpatient days (compared to a national average of 5 percent of hospitals).

Medicaid alone accounts for 16 percent of Iowa hospitals’ annual revenues. Medicare and Medicaid non-negotiable reimbursement rates do not cover the full cost of providing care. The Medicare Payment Advisory Commission found that hospitals experienced a record average loss of 12.7 percent on Medicare services in 2022, and Medicaid reimbursement rates are generally lower.

These financial pressures are felt most acutely in rural Iowa communities, which generally have higher proportions of both elderly and lower-income residents. Actually, our nation’s entire very complicated, interconnected system of funding healthcare is teetering. It’s one of our top long-term national challenges—one our elected leaders need to seriously focus on.

As devastating as the proposed Medicaid cuts would be, the increase to our national debt poses a greater threat to our country’s financial strength and stability. The bipartisan Committee for a Responsible Federal Budget projects more than $4 trillion in added debt over the next 10 years based on the more costly Senate version of the reconciliation bill. It would be incredibly irresponsible to dump this much more debt on our children and grandchildren.

Of course, as much as Republican leadership would want to cast this debate as a choice between maintaining support of Medicaid versus controlling our national debt level, the obvious logical alternative is a moderate, rational package of tax cuts. There is some responsible tax policy in this bill. Larger standard deductions make sense; they both simplify return preparation for many taxpayers and reduce the potential audit burden for the Internal Revenue Service.

To be honest, my wife and I, who are retired on a comfortable income, would benefit from passage of the “One Big, Beautiful Bill.” The analyses I’ve seen indicate a potential net benefit in the range of 1 to 2 percent of income for people in our income range. (Over the past four years our federal income tax obligation has averaged 5.2 percent of our actual cash income.) But any benefit we might derive pales in significance when compared to the potential for harm to our grandchildren, our community, and so many of our neighbors.

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Top photo of Senators Joni Ernst and Chuck Grassley was first published on Ernst’s official Facebook page on March 13, 2024.