A new report ranked Iowa’s health system 18th in the nation, but experts said gains made in reducing the state's uninsured rate could be affected by federal proposals to cut health safety net programs.
The Commonwealth Fund's Scorecard on State Health System Performance rates states on indicators such as affordability, prevention and treatment and potentially avoidable hospital visits.
The nonpartisan nonprofit that studies health care issues found Iowa has low rates of drug overdose deaths and adults who go without care because of the cost. However, it also has some of the nation’s highest obesity rates.
It ranked the state 11th in the nation for "access and affordability," and found Iowa’s uninsured rate dropped from more than 12.4% in 2013 to about 7.2% in 2023.
"The coverage gains can largely be attributed to provisions in the Affordable Care Act that made Medicaid available to more people and that helped many low and middle income people afford the cost of health coverage purchased from federal and state run health insurance marketplaces," said David Radley, senior scientist for the Commonwealth Fund’s Tracking Health System Performance initiative.
How would proposed cuts to Medicaid affect Iowa's health system?
Experts said proposed cuts to the Affordable Care Act and Medicaid under President Donald Trump's federal budget reconciliation bill, which is making its way through Congress, could reverse that trend.
"As we make it harder for people to access both of those, we're likely to see people just becoming uninsured because ... the reality is they still don't have access to employer-based coverage," said Sara Collins, senior scholar and vice president for health care coverage for the Commonwealth Fund.
Republican lawmakers have proposed significant cuts to the federal health programs as a way to offset revenue loss from large tax cuts proposed under the bill.
Collins said the federal proposals to add work requirements to Medicaid could also affect the uninsured rate, as most people on Medicaid already work.
"The reporting requirements will be the thing that really does lead to people disenrolling and becoming uninsured. People really have no other options," Collins said.
Iowa Republican lawmakers also passed Medicaid work requirements at the state level last session that they said are aimed at making sure abled-bodied adults without disabilities or dependents are working to receive benefits. The state is waiting on federal approval to implement them.
On Tuesday, Iowa Republican Sen. Chuck Grassley told reporters the deep spending cuts proposed in the federal bill are necessary.
"The bill will prevent the largest tax hike in history — provide critical support for American families and businesses," he said.
Grassley said the changes to Medicaid shouldn't affect those who need the program.
"Republicans are preserving Medicaid, ensuring it serves the people who need it and removing disincentives that keep abled-bodied people from joining the workforce," he said. "The needy who rely on Medicaid — grandma and nursing homes, people with disabilities, kids and more — I want to make clear, will not lose coverage."
