# Medicaid



Seven bad policies Iowa Republicans slipped into budget bills

Second in a series on under-covered stories from the Iowa legislature’s 2023 session.

During the seven years of the Iowa GOP trifecta, the majority party has often enacted significant public policy through eleventh-hour appropriations bills. Just before adjourning in 2019, Republicans amended spending bills to change the judicial selection process, restrict medical care for transgender Iowans on Medicaid, and block Planned Parenthood from receiving sex education grants.

A lengthy amendment to a budget bill approved in the closing hours of the 2020 session made it harder for Iowans to vote by mail and sought to restrict some companies from bidding on electric transmission lines projects.

The Iowa Supreme Court sent the legislature a message in March, blocking the 2020 provision on transmission lines, on the grounds that it was likely passed through unconstitutional “logrolling.”

Republican legislators weren’t pleased with the ruling known as LS Power, but seem to have adapted to it. This year’s “standings” appropriations bill was relatively short and focused on spending and code corrections—a far cry from the usual “Christmas tree” featuring unrelated policy items from lawmakers’ wish lists.

Nevertheless, many surprises lurked in other bills that allocated spending for fiscal year 2024, which begins on July 1.

This post focuses on seven provisions that appeared in budget bill amendments published shortly before Iowa House or Senate debate. Most of this policy language never appeared in a stand-alone bill, allowing Republicans to avoid the scrutiny that comes with subcommittee and committee discussions. Democratic legislators had little time to review the proposed budgets before votes on final passage, which mostly fell along party lines.

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Six ways the GOP budget shortchanged Iowans with disabilities

The biggest stories of the Iowa legislature’s 2023 session are well known. Before adjourning for the year on May 4, historically large Republican majorities in the Iowa House and Senate gave Governor Kim Reynolds almost everything on her wish list. They reshaped K-12 public schools; passed several bills targeting LGBTQ Iowans; enacted new hurdles for Iowans on public assistance; cut property taxes; reorganized state government to increase the power of the governor and “her” attorney general; and undermined the state auditor’s ability to conduct independent audits.

Many other newsworthy stories received little attention during what will be remembered as one of the Iowa legislature’s most influential sessions. This post is the first in a series highlighting lesser-known bills or policies that made it through both chambers in 2023, or failed to reach the governor’s desk.


As the Iowa House and Senate debated one appropriations bill after another last week, Democrats repeatedly objected to plans that imposed status quo budgets or small increases (well below the rate of inflation) on services for disadvantaged Iowans.

Iowans with disabilities or special needs were not a priority in the education and health and human services budgets that top Republican lawmakers negotiated behind closed doors.

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What's done, what's left as Iowa legislature's 2023 session winds down

The Iowa House and Senate finished work this week on several priority bills for Republicans, and leaders are closer to agreement on the next state budget.

The accelerating pace raises the prospect that the Iowa legislature may adjourn for the year close to the session’s scheduled end date of April 28. Stalemates over policies related to education and COVID-19 vaccines pushed the last two legislative sessions well into overtime; the 2021 session ended on May 19, and last year’s work wrapped up on May 24.

This piece highlights where things stand with high-profile bills approved in either the House or Senate this week, and other legislation that will likely be part of late deal-making. Forthcoming Bleeding Heartland posts will focus on many of those bills separately.

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Democrats must offer a vision for children and families

Charles Bruner served in the Iowa legislature from 1978 to 1990 and was founding director of the Child and Family Policy Center from 1989 through 2016. For the last six years, he headed a Health Equity and Young Children initiative focusing on primary child health care for the Robert Wood Johnson Foundation.

Democrats prioritize investing in children but don’t stress the importance of parents in raising the next generation. Republicans do the opposite.

The electorate wants both.

Until we make children’s issues part of our political dialogue, we will not do either.

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Where things stand with bills targeting Iowans on public assistance

Proposals that would cause thousands of Iowans to lose Medicaid coverage or federal food assistance through the Supplemental Nutrition Assistance Program (SNAP) are eligible for floor debate in both the Iowa House and Senate.

Republicans in each chamber’s Health and Human Services Committee changed some provisions in the bills, now numbered House File 613 and Senate File 494, then approved the legislation before the March 3 “funnel” deadline. However, the amended versions would still threaten health care or food assistance for many Iowans who now qualify.

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What Iowa's remarkable medical malpractice debate revealed

“Medical Malpractice Reform gets Iowa back in the game of recruiting and retaining physicians to care for Iowans!” Governor Kim Reynolds tweeted on February 16. She had just signed House File 161, a bill limiting damages in medical malpractice lawsuits.

Reynolds waited a long time for that moment. Two years running, similar proposals failed to reach her desk for lack of support in the GOP-controlled state House.

The bill signing capped one of the most dramatic debates in recent Iowa political memory.

It’s rare for more than a handful of Republican lawmakers to go on record against any bill that’s a priority for leadership. Not only did seventeen GOP lawmakers oppose passage of House File 161, six members of the majority party explained their objections during the hours-long debates in the House and Senate on February 8.

In addition to exposing divisions within Republican ranks, some remarks from the legislative proceedings may become important if the new law is challenged in court.

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