Dear Iowans: Health Care Cuts Threaten Us All
As a group of community health and medical providers, we are deeply disturbed by the continuing threats to our health care system and the long-term ripple effect that we will face as a result. Lost coverage from work requirements in Medicaid, and public health funding cuts through the CDC and NIH are not abstract; they are cuts that threaten to destabilize critical infrastructures needed for the health of our community and reduce access for thousands of low-income people.
The results could be catastrophic, including increases in cost of care, restrictions on accessing care, and even the closures of hospitals and health systems vital to so many Iowans. It does not only impact ‘other people,’ it impacts everyone.
From your county public health office to your community clinic, to your local hospital and emergency room, our health care system is deeply interconnected and interdependent.
The ripple effects will begin with Medicaid. The bill passed by the House of Representatives in May would establish a national work requirement for certain recipients. In June, Iowa Gov. Kim Reynolds signed legislation implementing work requirements for the state’s Medicaid program. While the Trump administration must approve this request, this means many Iowans on Medicaid could lose access to benefits regardless of any federal changes.
We know from the example in the state of Georgia that work requirements create costly bureaucratic systems that deny coverage to eligible people, not because those individuals aren't working, but because of red tape and paperwork hurdles. Here are other ways Medicaid cuts will impact Iowans:
According to the latest CBO projections, by 2034 approximately 10.9 million Americans would see their benefits eliminated
This includes around 90,000 Iowans according to KFF, a leading U.S. health care policy organization
About 20% of Iowa residents in all 99 counties are on Medicaid
A study by the Commonwealth Fund projects a loss of $865-million in economic activity, over 33,000 jobs lost, and a reduction of $177-million in lost state and local revenue should cuts to Medicaid become reality
As health care professionals, we know firsthand what happens when people lose their benefits. The need for care doesn’t disappear—it just shows up in different, more costly places.
Emergency rooms become the safety net of last resort, driving up wait times and straining resources for everyone, including those with private insurance.
While it may appear on paper that taxpayers are saving money, the reality is far different. The cost doesn’t vanish—it’s simply shifted onto patients, providers, and already overburdened clinics and hospitals. When those patients can’t pay, and providers can’t absorb the loss, clinics and hospitals are forced to make devastating decisions: cut essential services, layoff staff, or close their doors altogether. A 2020 analysis by the Iowa Hospital Association estimated 17 Iowa hospitals are at a high financial risk of closure. This is approximately 18% of all rural hospitals in Iowa.
Health care in Iowa is already in a tenuous state, especially for its rural residents:
The University of Iowa Hospitals & Clinics found that 33% of counties have no OB providers and no facilities offering OB care
Nearly 60% of Iowa’s rural hospitals operated at a loss in 2022 according to the Common Sense Iowa Institute
Over the last 15 years, 250 more health care facilities in Iowa have closed than have opened, with mental health centers leading all provider types in net closings, again from the Common Sense Iowa Institute
Iowa ranks last for psychiatric beds available per 100,000 residents according to the Treatment Advocacy Center
Every Iowan deserves a health care system that guarantees timely access and high-quality care—without compromise. Restricting where and how patients receive care doesn’t lead to better health outcomes; it puts our most vulnerable communities at greater risk. Though the effects may not be immediately visible, the decisions made in Washington, D.C., and Des Moines will ripple through every neighborhood, every family, and every life in our state.
Health care is a human right—and it is foundational to the strength, stability, and success of our communities. A society cannot thrive when people are denied the care they need to live full and healthy lives.
As frontline health care providers, we are deeply committed to safeguarding the health and well- being of all Iowans. We cannot afford to overlook how public policy shapes the care we deliver. It is imperative that our elected leaders truly understand the real-world impact of their choices— and act boldly to build a stronger, fairer health care system for everyone.
Signees:
Caitlin Wells
Chief Executive Officer
The Project of the Quad Cities
Tow Bowman
Chief Executive Officer
Community Health Care, Inc.
Dr. Louis Katz, M.D.
Medical Director
The Project of the Quad Cities
Affiliations: Scott County Health Department, University of Iowa
Please note: Dr. Katz is signing this letter exclusively in his capacity as Medical Director for The Project of the Quad Cities.
About The Project
Established in 1986 in response to the HIV/AIDS epidemic, The Project of the Quad Cities has witnessed firsthand how disastrous funding cuts can be. TPQC was on the front lines of serving people with HIV/AIDS during a time when the Reagan administration reduced CDC funding by almost 60%, a direct attack on our nation’s public health infrastructure that contributed to the deaths of over 100,000 Americans by 1990. Today, TPQC provides care and support to people living with HIV and the LGBTQ+ community.