More than a year has passed since President Donald Trump signed the massive tax and spending package, known as the One Big Beautiful Bill Act, into law. As spending cuts, new restrictions and tax benefits have gone into effect over the ensuing months, the law has become a top talking point in midterm races including in Iowa's 3rd Congressional District.
Speaking at Viking Lake State Park in southwest Iowa, Democrat Sarah Trone Garriott told a crowd with the Montgomery County Democrats that she’ll reverse Medicaid cuts made in the One Big Beautiful Bill Act.
“We need someone who is going to protect our healthcare and restore it, not cut it,” she said. “We need someone who is going to make life more affordable, not jack up the costs.”
Trone Garriott, a state senator from West Des Moines, is running against incumbent Republican Rep. Zach Nunn of Ankeny for Iowa’s 3rd District Congressional seat. It primarily covers south-central Iowa, including the communities of Des Moines, West Des Moines, Winterset and Ottumwa. Nineteen percent of the district is on Medicaid.
The nonpartisan Cook Political Report recently moved the race from “toss-up” to “lean Democrat.” And if flipped, the seat could help Democrats regain a majority in the U.S. House of Representatives.
On the campaign trail, Trone Garriott and Nunn have both made the massive tax and spending law a key part of their messaging. But while Nunn touts the law for its tax cuts and money for rural health, Trone Garriott said his vote is leaving Iowans with fewer healthcare options.
Candidates diverge on healthcare
The nonpartisan health policy group KFF estimates roughly 80,000 Iowans could be uninsured in 2034 due to the One Big Beautiful Bill Act, with 68,000 of that number being uninsured due to Medicaid changes.
At Viking Lake, Trone Garriott urged voters to tie Nunn’s vote for the law to clinic closures in Ottumwa, as well as Centerville and Des Moines.
“Our neighbors need help right now,” she said. “I think of my neighbors in Ottumwa who now have to drive over an hour each way to see a doctor because Zach Nunn's Medicaid cuts have closed clinics in their community.”
MercyOne pointed to changing demographics and needs as reasons for the Ottumwa closure. Nunn has said MercyOne noted Medicaid reimbursements were “not going to fulfill them going forward.” He made his comments at a cancer roundtable in July.
And Nunn, along with other Republicans, has said the law protects benefits for the most vulnerable while cutting waste and fraud.
“Personally, I've been a strong champion for making sure that we have a Medicare, a Medicaid and a Social Security program that are able to exist well past 2030,” Nunn said at the roundtable event. “It also means that anyone who's on a Medicaid program because they're a senior or a single parent or a child continues to get that funding. It also means that we don't just have a one-size-fits-all government solution and what I mean by that is a government takeover of healthcare.”
In his pitch to voters, Nunn has pointed to the law’s $50 billion Rural Health Transformation Program as a boon for rural health infrastructure. He’s also advocated for more funds to go to Iowa in the upcoming funding round.
Iowa received $209 million in the first year of the program. Nunn said the money is already being used for preventative services across the state in places like Ottumwa.
“These are the things that help drive down healthcare costs on the front end, so that we don't have just a process of taking care of folks once they're either sick or broken,” Nunn said at the roundtable. “I think this is a smart long-term investment.”
A spokesperson from the Iowa Department of Health and Human Services confirmed an existing health center in Ottumwa, Ottumwa Regional Health Center, is receiving funds from the Rural Health Transformation Program.
Nationally, KFF notes the funding will offset 37% in estimated cuts to federal Medicaid spending in rural areas. Some Iowa health officials have also said the funding will do little to offset cuts in the law.
Republicans lean into law’s tax cuts
The law makes tax cuts signed into law in 2017 permanent. The cuts were set to expire at the end of 2025.
Nunn said the law’s tax cuts and benefits for individuals help bolster communities.
“I'll tell you what Iowans do with it — they spend it on their families, they spend it on their farm, they spend it on their businesses, but most importantly, they invest right here,” he said at the Des Moines Register Political Soapbox at the state fair. “That's how you grow an economy.”
On the campaign trail, Nunn has pointed to the temporary no tax on tips and no tax on overtime parts of the law as proof Republicans are helping workers' bottom lines.
Under the provisions, certain workers can deduct up to $25,000 of tip income on their federal income tax returns. And, workers can deduct up to $12,500 of overtime pay.
The no tax on tips and no tax on overtime components expire after the 2028 tax year. Speaking to reporters on Oct. 22, Trone Garriott said she’d work to make them permanent if elected to Congress. She criticized the law’s permanent changes that benefit wealthy Americans.
“We need to focus tax cuts and prioritize the hardworking people of Iowa,” she said. “It's the tax giveaways for billionaires that I do not support.”
According to an analysis from the Urban Institute & Brookings Institution Tax Policy Center, households making between $460,000 and $1.1 million would benefit the most from the law’s tax cuts.
Those households would see an average tax cut of $21,000. Low-income households making less than around $35,000 would see an average tax cut of $150, according to the analysis.
Nunn highlights benefits for families, seniors
On the first day of early voting on Oct. 14 in Des Moines, Nunn told reporters his vote for the One Big Beautiful Bill Act lines up with his past support for state tax reform.
“We have had the largest tax cut in Iowa's history, and we've led a tax cut at the D.C. level to help more Iowans have money that they've earned back in their pockets,” he said.
Nunn has said families will get $3,000 back under the law and claimed it's the “largest tax cut in American history.”
That estimate is from the right-leaning Tax Foundation, which projects Iowa taxpayers will see an average tax cut of around $3,000 every year through 2028. The Foundation also ranks the law as not the largest tax in American history, but the sixth.
Nunn has also highlighted added benefits for families and seniors in the law. It permanently expands the child and dependent care tax credit, letting parents claim a credit on up to 50% of care expenses, up from the previous 35%.
But contrary to the “no taxes on social security” slogan, the law does not eliminate taxes on Social Security.
Instead, it offers an additional $6,000 tax deduction for seniors 65 and older which expires after the 2028 tax year. Trone Garriott has said she would support making the senior tax deduction permanent.
“I know that a lot of our seniors who are depending on Social Security are struggling and so any added benefit we can give to them, that helps them,” she said during an early voting event on Oct. 22.
Putting distance with the president
Meghan Goldberg, an associate professor of politics at Cornell College, said for Republicans like Nunn, leaning into messaging about the One, Big, Beautiful Bill Act recalls a strength on the campaign trail two years ago.
“It gives them sort of a thread to talk about that they felt like was really effective in 2024,” Goldberg said. “They felt like they were strong on economic issues, and so I think they're trying to tap into that strength.”
That’s particularly relevant for Nunn, who ousted incumbent Democrat Cindy Axne in 2022 on a campaign promise he would rein in inflation.
And, Goldberg said, the Big Beautiful Bill is a way for GOP candidates to distance themselves from the president’s unpopularity.
In recent New York Times/Siena polling, 36% of likely voters said they approved of the president’s job performance while 59% said they disapproved. It was the lowest approval rating recorded for the president by the Times/Siena poll.
Nunn has also taken steps to distance himself from the president in recent weeks.
In September, he broke with his party on a vote to limit the president’s war powers in Iran, after previously voting against the measure five times. And along with other members of Iowa’s congressional delegation, he did not appear at a rally in Council Bluffs on Sep. 18 with Vice President JD Vance. He also did not attend a rally with President Trump in Sioux City on Oct. 22.
But Goldberg said leaning on economic issues for Republicans can be a hard needle to thread when voters are paying 2026 prices. In September, diesel prices reached record-highs surging above $6 a gallon.
Goldberg said Iowa candidates are uniquely positioned to connect affordability issues and healthcare issues due to the state’s high cancer issues.
“It ties into, and I think gives some legitimacy to, shoring up healthcare provisions to make healthcare more accessible to more people and to make healthcare more affordable,” Goldberg said. “I don't want to say it's convenient for Democratic candidates, but one sort of like low hanging fruit policy is the restoration of a lot of benefits.”
Whether voters feel economic relief from the law or see it as another obstacle to healthcare, could decide how they vote in November. And, with a close race like the 3rd District, these perceptions could determine who is sworn into office next year.
Voters have already started weighing in with early voting now open. Election Day is Nov. 3.
