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. 

Rather than address the harm that will result from thousands losing their coverage, U.S. Representative Zach Nunn and all of Iowa’s representatives are side-stepping the issues. They tout tax breaks, which amount to pocket change compared with the rising cost of insurance premiums, deductibles and out-of-pocket medical expenses that will hit my neighbors and family hard.  

Let’s be clear: no average income working Iowans are getting new tax breaks under this law. Instead it extends the tax breaks that were already in place while cutting health care, food assistance, and other resources that families need to make ends meet as the cost of everything continues to go up thanks to inflation and tariffs. 

In the last five years, I have intersected with just about every option for health insurance out there.

In 2021, with insurance through the marketplace, I paid $10,000 in medical bills to give birth to our first child with no serious complications. I was insured by Medicaid during my second pregnancy and for the first year after my child’s birth, which covered complications including a preeclampsia scare and urgent care visits during my newborn’s first flu season.

Currently, our kids remain insured under Medicaid through Hawki, Iowa’s version of the Children’s Health Insurance Program. It’s affordable, and when medical issues come up–like our son’s common ear tube surgery–we didn’t have to worry about affording groceries or childcare that month.

Unfortunately, that’s not the case with our adult coverage. Wellmark, our insurance company, sent us a letter that premium prices will increase by 10 percent next year. (Other providers have also raised premiums.) 

Republicans in Congress have refused to extend premium tax credits that help more than 90 percent of Americans who buy health insurance through the Affordable Care Act marketplaces. Iowa’s Senators Chuck Grassley and Joni Ernst voted against a bill that would have extended those tax credits to make coverage more affordable for small businesses like mine.

For nearly a month, the federal government has been shut down. Republicans refuse to include tax credits for affordable coverage after voting in July to cut $1 trillion from Medicaid over the next decade. 

Between the cuts to Medicaid and the enhanced premium tax credits for Affordable Care Act policies, an estimated 106,000 Iowans will lose health care coverage, while thousands more of us will end up paying way more than we can afford. That will affect many small business people like my husband and me, because more than half of people who buy health insurance through the exchanges are self-employed, or work for small businesses with fewer than 25 employees.

This is health care in America right now: complicated, frustrating, expensive, precarious. It feels like our representatives are patting us on the head, claiming the middle class will be saving money during tax season while spreading the idea that many are abusing the system and wasting money. The reality is that Medicaid directly benefits 1 in 5 Iowans—mostly working families, children, seniors, and people with disabilities. Indirectly, Medicaid benefits everyone by reducing the uninsured population.

Small business is the backbone of rural economies. Rather than support affordable health care for us, the Iowans in Congress are giving more breaks to large corporations and Wall Street kingpins who already have every advantage in today’s economy. 

Rather than support Iowa’s struggling families who elected them to fix the economy, these lawmakers are fighting for wealthy people who do not have to weigh the cost of taking their kid with a fever to the doctor against the cost of groceries that month. 

As a small business owner, I’m asking our representatives to listen to us. And we need to pay attention to what our representatives are doing, not just what they’re saying. Small businesses everywhere risk losing staff, stalling growth, and falling behind big competitors if health care costs soar. The public is with us—let’s make sure Congress hears us too.