¶ Overview
In 2025, Randy Feenstra voted for a bill that is estimated to kick 17 million Americans off their health insurance, including nearly 12 million Americans who rely on Medicaid. Nearly 107,000 Iowans could lose their health insurance as a result of Feenstra’s vote. Randy Feenstra supported work requirements for Medicaid under Trump’s “One Big Beautiful Bill,” even though 58,721 Medicaid recipients in Iowa were expected to lose their coverage by 2034.
Randy Feenstra opposed Affordable Care Act tax credits that reduced insurance costs for middle-income families, and instead promoted market competition and cash-payer discounts without a plan to protect people with pre-existing conditions. Nearly 137,000 Iowans were enrolled in Affordable Care Act Marketplace health insurance plans. The “One Big Beautiful Bill” and expiring ACA tax credits would result in 106,000 uninsured Iowans by 2034.
¶ Randy Feenstra Voted To Take Health Insurance Away From Millions Of Americans Who Relied On Medicaid
¶ Randy Feenstra Voted For The “One Big Beautiful Bill,” Which Included Devastating Health Care Cuts To Fund Tax Cuts For The Wealthy
¶ July 2025: Randy Feenstra Voted For The Final Version Of The “One Big Beautiful Bill,” Which Would Cause 17 Million Americans To Lose Their Health Care
July 2025: Randy Feenstra Voted For The Senate FY 2025 Budget Reconciliation Bill, The “One Big Beautiful Bill,” Which Extended $4 Trillion In Expiring Tax Cuts, Added New Tax Breaks, Appropriated $448 Billion In Defense, Border, And Immigration Enforcement Funding, Increased The SALT Deduction To $40,000, And Cut Medicaid And Other Social Programs To Offset The Costs. In July 2025, Randy Feenstra voted for, according to Congressional Quarterly, the “motion to concur in the Senate amendment to the bill that would permanently extend nearly $4 trillion in expiring individual and business tax cuts, create several new tax breaks and fund border and immigration enforcement and air traffic control upgrades. It would cut Medicaid and other safety net programs to partly offset the cost. Among other provisions, it would raise the statutory debt ceiling by $5 trillion and appropriate more than $448 billion in mandatory funding for Trump administration priorities and other needs, including $153 billion for defense, $89 billion for immigration enforcement, and $89.5 billion for border control and security. It also would increase the state and local tax deduction cap to $40,000 annually for five years for households making up to $500,000 a year until 2030, when it would permanently revert to $10,000.” The House passed the bill by a vote of 218 to 214. The bill was ultimately signed into law. [House Vote 190, 7/3/25; Congressional Quarterly, 7/3/25; Congressional Actions, H.R. 1]
- HEADLINE: "At Least 17 Million Americans Would Lose Insurance Under Trump Plan" [Washington Post, 7/1/25]
- HEADLINE: “By The Numbers: Harmful Republican Megabill Favors The Wealthy And Leaves Millions Of Working Families Behind” [Center On Budget And Policy Priorities, 8/1/25]
- The Congressional Budget Office Estimated That 11.8 Million People Would Become Uninsured As A Result Of The Medicaid Cuts In Republicans’ Reconciliation Bill. According to the Washington Post, "The bill, which narrowly passed the Senate on Tuesday and now heads back to the House, would effectively accomplish what Republicans have long failed to do: unwind many of the key components of the ACA, President Barack Obama’s signature domestic achievement, which dramatically increased the number of Americans with access to health insurance. To start, the Congressional Budget Office estimated that the Senate version of the bill would result in 11.8 million more uninsured in 2034, mostly because of Medicaid cuts, compared with 10.9 million if the House version became law." [Washington Post, 7/1/25]
- The Bill’s $50 Billion In Rural Hospital Relief Funding Would Not Come Close To The Gap Created By Medicaid Cuts, With 300 Rural Hospitals At “Immediate Risk” Of Closure. According to the Center For American Progress, “The OBBBA includes $50 billion in relief funding for rural hospitals over a five-year period to help reduce the disastrous impacts of the bill’s roughly $1 trillion in Medicaid cuts. As of May 2025, there were approximately 2,086 rural hospitals receiving $12.2 billion a year in net revenue from Medicaid. At the median, rural hospitals’ revenue from Medicaid is $3.9 million a year.Rural hospitals have some of the lowest operating margins in the nation, especially compared with urban hospitals, meaning that any reductions in revenue could lead to closures. The average operating margin for rural hospitals was 3.1 percent in 2023, with 44 percent of rural hospitals operating with negative margins. As a result, more than 300 rural hospitals are currently at ‘immediate risk’ of closure, especially now that the OBBBA is projected to cut Medicaid spending by $1.02 trillion. The relief fund designed to blunt the negative impacts caused by the bill would not come close to filling that gap. If every rural hospital in the country received an even share of the $50 billion in relief support, it would amount to only $4.5 million every year for five years. At the close of those five years, that funding would disappear altogether.” [Center For American Progress, 7/3/25]
¶ May 2025: Randy Feenstra Voted For The House FY 2025 Budget Reconciliation Bill, Which Was Estimated To Increase The Uninsured Population By 8.6 Million By 2034
May 2025: Randy Feenstra Voted For The House FY 2025 Budget Reconciliation Bill, Which Included $3.8 Trillion In Tax Cuts Offset By $1.5 Trillion In Spending Reductions To Programs Like Medicaid And The Supplemental Nutrition Assistance Program. In May 2025, Randy Feenstra voted for, according to Congressional Quarterly, “the bill that would provide for approximately $3.8 trillion in net tax cuts and $321 billion in military, border enforcement and judiciary spending, offset by $1.5 trillion in spending reductions, as instructed in the fiscal 2025 budget resolution. It would raise the statutory debt limit by $4 trillion and provide for increased spending on defense and border security, spending cuts on social safety net programs, such as Medicaid and the Supplemental Nutrition Assistance Program. It also includes a mix of tax breaks for businesses and individuals; tax increases on universities and foundations; and a phase-down of clean energy tax credits. […] It would reduce federal spending on the Supplemental Nutrition Assistance Program by requiring states to shoulder more of the cost, expand work requirements for SNAP, extend programs authorized under the 2018 farm bill, and prohibit the U.S. Department of Agriculture from increasing the cost of the Thrifty Food Program. As amended, it would cap state and local tax deductions at $40,000 for households with incomes below $500,000.” The House passed the bill by a vote of 215 to 214. [House Vote 145, 5/22/25; Congressional Quarterly, 5/22/25; Congressional Actions, H.R. 1]
- The House GOP Budget Bill Was Estimated To Increase The Uninsured Population By 8.6 Million By 2034. According to CNN, “The Medicaid and Affordable Care Act provisions in the package could result in 8.6 million more people being uninsured in 2034, according to an early CBO estimate released by Democratic lawmakers. That number is expected to grow with the latest changes.” [CNN, 5/28/25]
- The House GOP Budget Bill Codified A Trump Administration Proposal That Restricted Access To The Affordable Care Act. According to CNN, “The bill also calls for codifying a Trump administration proposal that would make changes to the Affordable Care Act enrollment process, including shortening the open enrollment period and eliminating the ability of low-income Americans to sign up year-round.” [CNN, 5/28/25]
- The House GOP Budget Bill Made The 2017 Income Tax Breaks Permanent And Added An Estimated $3.8 Trillion To The National Debt Over 10 Years. According to CNN, “The package includes several controversial measures that would deeply cut into two of the nation’s key safety net programs – Medicaid and food stamps – while making permanent essentially all of the trillions of dollars of individual income tax breaks contained in the GOP’s 2017 Tax Cuts and Jobs Act. What’s more, it would fulfill Trump’s campaign promises to cut taxes on tips and overtime, albeit temporarily. The magnitude of the measures is evident in the estimates of the cost they would incur or the savings they would produce. […] The tax changes in the package would add $3.8 trillion to the nation’s debt over a decade, according to a Congressional Budget Office analysis released before last-minute changes were made to the bill.” [CNN, 5/28/25]
¶ February 2025: Randy Feenstra Voted For A Budget Resolution That Set Up Future Medicaid Cuts
February 2025: Randy Feenstra Voted For The FY 2025 Budget Framework That Included $2 Trillion In Cuts, Raised The Statutory Debt Limit By $4 Trillion, And Required House Committees To Recommend Legislation That Would Implement Trump’s Agenda. In February 2025, Randy Feenstra voted for, according to Congressional Quarterly, “the concurrent resolution that would recommend a budget for fiscal 2025 and budget levels through fiscal 2034. The resolution would assume minimum savings of $1.5 trillion over 10 years and 2.6 percent economic growth over the same period. It also would require the statutory debt limit to be raised by $4 trillion. It also would authorize the House Ways and Means Committee to increase deficits by $4.5 trillion over 10 years to extend the 2017 tax cuts and implement new tax cuts proposed by the White House. It also would provide instructions for the budget reconciliation process through which separate legislation could be considered and passed in the Senate via a simple majority vote. The measure would deliver instructions to 11 House committees to report legislation that would implement President Donald Trump’s agenda, such as expanding tax cuts and bolstering border security and immigration enforcement. The committees would be required to report their legislative recommendations to the House Budget Committee by March 27, 2025. It also would set a $2 trillion target for the spending cuts to be submitted to the House Budget Committee. The resolution also would stipulate that if the committees don't reach that target, the Ways and Means’ reconciliation instructions to increase the deficit by a maximum of $4.5 trillion would be decreased by the amount the other committees come in below the target. Similarly, it would stipulate that Ways and Means could increase the deficit above the $4.5 trillion level by the amount of savings the committees achieve above the $2 trillion target.” The vote was on passage. The House passed the resolution by a vote of 217 to 215. [House Vote 50, 2/25/25; Congressional Quarterly, 2/25/25; Congressional Actions, H. Con. Res. 14]
- HEADLINE: "House Republican Budget Takes Away Health Care, Food Aid To Pay For Expanded Tax Cuts For Wealthy" [Center on Budget and Policy Priorities, 2/21/25]
- New York Times Reported The $880 Billion In Cuts Required By The Republican Budget Proposal Would Have To Come From Medicaid, Medicare, Or CHIP. According to the New York Times, "The budget resolution itself is silent on whether Congress cuts Medicaid, which provides health coverage to 72 million poor and disabled Americans. But it instructs the House Energy and Commerce Committee, which has jurisdiction over the program, to cut spending by $880 billion over the next decade. If the committee can’t save at least that much, the entire effort could be imperiled because of the special process Congress is using to avoid a Senate filibuster. Ten other committees have their own instructions to follow, though none have been assigned with cutting nearly as much. It’s not so simple as finding the cuts elsewhere. The special process, known as budget reconciliation, means Republicans will have to find all $880 billion from within the Energy and Commerce Committee’s jurisdiction. That leaves them with fewer options than one might think. […] If Republicans want to avoid major cuts to Medicaid, the largest pot of available money is in the other big government health insurance program: Medicare. […] Even if the committee cuts everything that’s not health care to $0, it will still be more than $600 billion short. The committee could also save around $200 billion by eliminating the Children’s Health Insurance Program, but that option has not been raised by the budget committee or anyone in House leadership. […] Even if all of these cuts, revenues and rule cancellations from outside health care can pass muster, the committee will still be left with hundreds of billions of dollars to cut to hit its goal. Mathematically, the budget committee’s instructions mean the committee would need to make major cuts to either Medicare, Medicaid or both." [New York Times, 2/25/25]
¶ Nearly 107,000 Iowans Were Expected To Lose Health Care Coverage Under Trump’s “One Big Beautiful Bill”
Under The “One Big Beautiful Bill,” 106,721 Iowans Were Expected To Lose Their Health Care By 2034, Including 48,000 ACA Enrollees And 58,721 Medicaid Recipients. According to the Joint Economic Committee Minority,
| District | State |
Est. # Losing ACA Coverage |
Est. # Losing Medicaid Coverage |
Est. Total # Losing Insurance |
|
IA-01 |
Iowa |
11,600 |
13,096 |
24,696 |
|
IA-02 |
Iowa |
12,400 |
14,486 |
26,886 |
|
IA-03 |
Iowa |
12,000 |
15,293 |
27,293 |
|
IA-04 |
Iowa |
12,000 |
15,846 |
27,846 |
|
All |
Totals |
48,000 |
58,721 |
106,721 |
[Joint Economic Committee Minority, 6/25]
¶ Feenstra Supported Work Requirements For Medicaid Under The “One Big Beautiful Bill,” Even As It Threatened The Health Care Of 58,721 Medicaid Recipients In Iowa
¶ Feenstra Falsely Claimed The “One Big Beautiful Bill” “Protected” Medicaid And Supported Medicaid Work Requirements
2025: Feenstra Falsely Claimed The “One Big Beautiful Bill” “Protected” Medicaid And Endorsed Work Requirements For Medicaid Recipients. According to Feenstra’s Twitter, “Democrats are lying about the ‘One, Big, Beautiful Bill.’ We are protecting Medicaid and SNAP for the most vulnerable in our communities. We are asking able-bodied adults without young children to work or volunteer a modest 20 hours per week to receive taxpayer-funded benefits.”
[Twitter, @RepFeenstra, 7/7/25]
¶ Under The “One Big Beautiful Bill,” 58,721 Medicaid Recipients In Iowa Were Expected To Their Health Care By 2034
Under The “One Big Beautiful Bill,” 106,721 In Iowa Were Expected To Lose Their Health Care By 2034, Including 48,000 ACA Enrollees And 58,721 Medicaid Recipients. [Joint Economic Committee Minority, 6/25]
2025: There Were Approximately 181,000 Medicaid Recipients In Iowa. According to the Gazette, “Many of the roughly 181,000 Iowans in the state’s version of Medicaid expansion would be subject to work requirements, and the entire program could be eliminated if the federal government ever disallows work requirements, under legislation approved this week by Republican state lawmakers. Medicaid is the government’s health care program for people with low income or disabilities. Iowa in 2013 expanded its Medicaid coverage to include individuals up to 133 percent of the federal poverty level, up from the previous threshold of 100 percent.” [Gazette, 3/26/25]
- 2013: Iowa Expanded Medicaid To Include Iowans Up To 133 Percent Of The Federal Poverty Level. According to the Gazette, “Many of the roughly 181,000 Iowans in the state’s version of Medicaid expansion would be subject to work requirements, and the entire program could be eliminated if the federal government ever disallows work requirements, under legislation approved this week by Republican state lawmakers. Medicaid is the government’s health care program for people with low income or disabilities. Iowa in 2013 expanded its Medicaid coverage to include individuals up to 133 percent of the federal poverty level, up from the previous threshold of 100 percent.” [Gazette, 3/26/25]
Iowa Had A Trigger Law To Automatically Review Medicaid Expansion If Federal Funding Was Cut. According to Stateline, “If Congress reduces the 90% federal match rate for Medicaid expansion, more than 3 million adults could immediately lose their health coverage. That’s because nine states have so-called trigger laws that would automatically end Medicaid expansion if federal funding is cut: Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah and Virginia. Three additional states — Iowa, Idaho and New Mexico — would require the government to take cost-saving steps to ease the financial impact of federal cuts.” [Stateline, 2/10/25]
¶ Randy Feenstra Opposed Affordable Care Act Subsidies As The Expiring Subsidies And Trump’s “One Big Beautiful Bill” Were Projected To Leave Up To 106,000 Iowans Uninsured
¶ Feenstra Opposed Affordable Care Act Subsidies And Offered Market-Based Proposals Without Concrete Protections For Patients
HEADLINE: “Feenstra Says GOP Stands Firm In Fight Over ACA Subsidies” [Radio Iowa, 10/24/25]
2025: Feenstra Opposed Affordable Care Act Tax Credits That Lowered Insurance Costs For Middle-Income Families. According to Radio Iowa, “Republican Congressman Randy Feenstra says tax credits for some of the middle income Americans who’ve been buying health insurance policies on the Affordable Care Act marketplace should be examined. ‘ObamaCare has always been very expensive. I mean, it continues to go up. It has never been affordable and when we had COVID, the tax credits were dramatically increased,’ Feenstra said during an interview with KIWA Radio. ‘…We’re saying, ‘No, we can’t do that.’” [Radio Iowa, 10/24/25]
2025: Feenstra Cited Market Competition And Cash-Payer Discounts As Health Care Reforms While Offering No Specific Plan To Protect People With Pre-Existing Conditions. According to Radio Iowa, “Feenstra has said protecting people with pre-existing conditions from losing their insurance should be part of any future health care legislation, but he says taking steps to inject competition in the system will reduce premium costs. Feenstra has also proposed that patients who pay with cash should get a discount on their health care bills.” [Radio Iowa, 10/24/25]
¶ The “One Big Beautiful Bill” And The Expiring Affordable Care Act Tax Credits Would Result In 106,000 Uninsured Iowans By 2034
The “One Big Beautiful Bill” And The Expiring Affordable Care Act Tax Credits Would Result In 106,000 Uninsured People In Iowa By 2034. According to the Center For American Progress, “The One Big Beautiful Bill Act will increase the number of Americans without health coverage in every state Estimated increase in the uninsured population due to the OBBBA and the expiration of the ACA’s enhanced premium tax credits, 2034”
[Center For American Progress, 9/5/25]
¶ December 2025: There Were 136,833 Iowans Enrolled In An Affordable Care Act Marketplace Plan
As Of December 2025, There Were 136,833 Individuals Enrolled In An Affordable Care Act Marketplace Plan In Iowa. According to KFF, in 2025, there were 136,833 individuals enrolled in affordable care act marketplace plan in Iowa.
[KFF, Accessed 12/15/25]
¶ The Affordable Care Act Allowed States To Expand Medicaid, Which Dramatically Lowered The Uninsured Rate Among Low-Income Workers
The Affordable Care Act Allowed States To Expand Medicaid, And States That Expanded Medicaid Dramatically Lowered The Number Of People Without Health Insurance. According to the Center on Budget and Policy Priorities, "The Affordable Care Act (ACA) permits states to expand Medicaid coverage to adults with incomes up to 138 percent of the poverty level (about $20,780 annually for an individual or $35,630 for a family of three). States that have adopted the expansion have dramatically lowered their uninsured rates. Extensive research finds that the people who gained coverage have grown healthier and more financially secure, while long-standing racial inequities in health outcomes, coverage, and access to care have shrunk." [Center On Budget And Policy Priorities, 6/14/24]
- The Uninsured Rate Among Low-Income Workers Fell From 38 Percent In 2013 To 17 Percent In 2022, Which Coincided With Implementation Of Medicaid Expansion. According to the Center on Budget and Policy Priorities, "Millions of workers have gained coverage through Medicaid expansion, including people working in industries that provide critical goods and services such as health care, transportation, grocery stores, food manufacturers, and child care. Many have no access to health coverage through their jobs. In expansion states, the uninsured rate among low-income workers fell from 38 percent in 2013 to 17 percent in 2022; this sharp decline coincided with a large increase in the share of low-income workers enrolled in Medicaid.[16] In non-expansion states, the uninsured rate among low-income workers fell much less, from 46 percent to 31 percent. (See Figure 3.)" [Center On Budget And Policy Priorities, 6/14/24]