Patient advocacy organizations oppose bill that threatens to repeal Iowa Medicaid expansion
Our organizations represent thousands of patients and their families facing serious health conditions and are committed to ensuring they have adequate, affordable, and accessible health care coverage at every stage of life. We are deeply concerned by HSB248/SF363. This proposal threatens to repeal Medicaid expansion – putting critical health care for Iowans at risk. Medicaid expansion has been a critical tool in providing thousands of Iowans with the coverage they need. Repealing or substantively changing Medicaid expansion would serve to strip health care from thousands of state residents, leading to economic stress and diminished health outcomes for many.
182,000 Iowans rely on Medicaid expansion, including workers in key industries that drive Iowa’s economy, such as agriculture, manufacturing, health care, and construction.i 45% of Medicaid expansion enrollees work for businesses with fewer than 50 employees, where employer-sponsored insurance is often unavailable or unaffordable.ii Repeal of Medicaid expansion coverage will increase uncompensated care costs, shifting the financial burden to hospitals, taxpayers, and businesses disproportionally affecting Iowa’s rural communities.
In addition, the bill creates new barriers to accessing health care by requiring people enrolled in the state’s Medicaid program to either prove they work a certain number of hours per week or meet exemptions. Requiring individuals enrolled in Medicaid to comply with extensive paperwork and administrative burdens, even if they are eligible for an exemption from work requirements, will result in qualified individuals losing Medicaid coverage.
Nearly 2 in 3 adults Medicaid enrollees aged 19-64 are already working. Of the remaining one third, nearly all members would fall under an exemption, which include caring for a family member, ill or disabled, or going to school. Proposals to take Medicaid away from people who don’t meet red tape requirements are based on the false premise that Medicaid enrollees do not work.iii
Forcing patients to prove the validity of their condition or their qualification for an exemption will create burdensome administrative barriers that stand between Iowans and the care they need. Missing a deadline or the mishandling of a single form could result in a loss of coverage or access to medications lasting months – time that is not a luxury for those battling serious, chronic, or life-threatening conditions. In Iowa, approximately 33-48% of Medicaid enrollees will lose coverage if Medicaid work and community engagement requirements were enacted.iv
Access to quality and affordable health care is critical to support a healthy workforce. For these reasons, we oppose SF363/HF248.
Sincerely,
American Cancer Society Cancer Action Network
American Diabetes Association
American Heart Association
American Lung Association
Black Women 4 Healthy Living
Common Good Iowa
Disability Rights Iowa
Iowa ACEs 360
Iowa Development Disabilities Council
Iowa Nurses Association
Kindheart Center
Leukemia and Lymphoma Society
National Association of Social Workers, Iowa Chapter
National Alliance on Mental Health Iowa
National Multiple Sclerosis Society
Postpartum Support International
Susan G. Komen
i https://hhs.iowa.gov/dashboard_welcome#iowa-medicaid
ii Aubrianna Osorio, “Research Update: It’s Simple—Medicaid Helps People Work”, Center for Children and Families, Georgetown University, May 2023, https://ccf.georgetown.edu/2023/05/22/research-update-its-simple-medicai...
iii Jennifer Tolbert, Sammy Cervantes, Robin Rudowitz, Alice Burns, “Understanding the Intersection of Medicaid and Work: An Update,” KFF, February 2025, https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-...
iv Gideon Lukens, Elizabeth Zhang, “Medicaid work requirements could put 36 million people at risk of losing health coverage,” Center on Budget and Policy Priorities. January 2025. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/medicaid-work-requirements-could-pu...