¶ Overview
Nunn voted for a bill that was estimated to kick 17 million Americans off their health insurance, including nearly 12 million Americans who rely on Medicaid. Nunn had previously claimed he was “fully committed” to protecting Medicaid. An estimated 27,293 Iowans could lose their health insurance as a result of his vote.
Nunn opposed the Inflation Reduction Act, which lowered prescription drugs costs and capped the cost of insulin at $35 per month for seniors. More than 88,000 Iowans on Medicare took prescription drugs that were selected for price negotiation under the Inflation Reduction Act’s provisions.
¶ Nunn Voted For And Defended Devastating Cuts To Health Care
¶ Nunn Claimed He Was “Fully Committed” To Protecting Medicaid Benefits
Nunn: “The Same Is True For Medicaid. I Am Fully Committed And I'm Leading Legislation To Make Sure That Whatever Cuts Take Place In Washington, That Medicaid Recipients Don't Bear The Brunt Of That.” According to an interview Zach Nunn gave with KCCI, “ANCHOR 1: Democrats have raised concerns that the plan could make cuts to benefits. ANCHOR 2: Do you foresee there being cuts to Medicaid? NUNN: Well, let's be very clear. I have always been fully committed to Social Security and Medicare. And going forward, that's not going to change. The same is true for Medicaid. I am fully committed and I'm leading legislation to make sure that whatever cuts take place in Washington, that Medicaid recipients don't bear the brunt of that.” [KCCI, 4/27/25] (video)
¶ Nunn Voted Three Times to Take Health Insurance Away from Iowans
¶ July 2025: Nunn Voted For The Final Version Of The Republican Reconciliation Bill
July 2025: Nunn Voted For The Senate FY 2025 Budget Reconciliation Bill That 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, Nunn 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. [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]
- 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]
¶ May 2025: Nunn Voted In Favor Of House Republicans’ Reconciliation Bill, Which Cut Medicaid
2025: Nunn Voted For The FY 2025 Budget Reconciliation Bill That 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, Nunn 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 (H Con Res 14). 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]
- 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]
- HEADLINE: “CBO: 7.6 Million Would Go Uninsured Under GOP Medicaid Bill” [Politico, 5/13/25]
¶ February 2025: Nunn Voted For House Republicans’ Budget Framework, Which Set Up Future Cuts To Medicaid
2/25/25: Nunn 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, Nunn 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]
¶ Nunn Defended his votes to cut medicaid
¶ Nunn Called House Republicans’ Budget Resolution A “Necessary Step”
Nunn Called House Republicans’ Budget Bill A “Necessary Step.” According to a post on Rep. Zach Nunn’s Twitter,
[Twitter, @ZachNunn, 2/25/25]
¶ Nunn Claimed The Republican Budget Bill Was A “Win” For Iowa
May 2025: Nunn Called The House Republican Budget Bill A “Win” For Iowa. According to a press release from Rep. Zach Nunn’s office, "Representative Zach Nunn (IA-03) voted in favor of a comprehensive reconciliation package that permanently extends middle-class tax cuts, secures critical wins for Iowa’s farmers, strengthens health and safety-net programs by rooting out waste and fraud, and provides certainty for small businesses. ‘This package is a win for Iowa. It extends the largest tax cut in history for working families, delivers historic relief for our farmers and producers, and gives Main Street the confidence it needs to invest, grow, and hire,’ said Rep. Nunn. ‘The bill also safeguards key benefit programs for vulnerable Iowans while eliminating waste, fraud, and abuse. It bolsters border security, restores accountability, and invests in American energy dominance—where Iowa is already leading the charge.’" [Press Release – Rep. Zach Nunn, 5/22/25]
July 2025: Nunn Touting Voting For Republicans’ Budget Bill. According to a press release from Rep. Zach Nunn’s office, "Representative Zach Nunn (IA-03) today voted in favor of the reconciliation package to deliver permanent middle-class tax relief, promote a pro-growth tax code, invest in American defense and national security, and strengthen American energy dominance. ‘The bill we’re sending to the President’s desk locks in the largest middle-class tax cut in American history. It rewards hard work, fuels growth on Main Street, and puts more money back in the pockets of Iowa families,’ said Rep. Nunn. ‘It protects benefits for our most vulnerable by cutting out waste and fraud, strengthens our national defense by investing in border security, and positions Iowa farmers and producers to lead the charge in delivering affordable, American-made energy.’" [Press Release – Rep. Zach Nunn, 7/3/25]
¶ While in The Iowa State House, Nunn Defended Iowa’s Disastrous Medicaid Privatization, Which Was Described as A “Fiasco”
Nunn Promised That No Iowa Medicaid Recipients Would Lose Their Coverage As Iowa Transitioned To Its Managed Care System. According to an op-ed Zach Nunn wrote in the Des Moines Register, "In the past weeks, I've met with dozens of families, patients, medical providers and small business case managers who have voiced valid concerns about Iowa's Medicaid modernization plan. This is a priority for so many Iowans. It requires clear implementation and organized communication for all parties involved to enable everyone's success. Over the past decade, Medicaid spending in Iowa increased 234 percent - billions of dollars that quickly crowded out funding for education, public safety and state infrastructure. As costs continue to increase, patient outcomes have not improved. This challenge is not confined to Iowa, every state is working to address the soaring costs of Medicaid. In response to growing expense and flat results, the governor took steps to transition Iowa's Medicaid program to a managed care model: this means rather than state employees administering the program, competitive insurance companies will now do so. […] Two of the biggest concerns I've heard from patients and providers is that the transition timeline is too aggressive. Taking these community priorities to Iowa's Department of Human Services or DHS, I've worked with affected families to ensure Medicaid recipient experience minimal disruption. First, no Medicaid recipient will lose their coverage, physical and mental health services will be transitioned over a six month period through July 1, and nursing homes will have a two year transition period through Jan. 1, 2018." [Zach Nunn Op-Ed – Des Moines Register, 12/30/15]
Nunn Opposed Moving Iowa’s Medicaid Program Back To A Government-Managed System. According to the Des Moines Register, "On the future of Medicaid in Iowa, state lawmakers should: We absolutely must reform Medicaid. I led legislation holding MCOs accountable to patients and providers while bringing even stronger oversight to managed care. This law is going into effect now. I reject the opposition’s plan to transitions tens of thousands of vulnerable Iowans to yet another ‘government managed’ health care plan. It didn’t work before and the state is not equipped to transition these patients, forcing them to start-over once again with no road-map for success." [Des Moines Register, 10/25/18]
¶ Iowa’s Medicaid Privatization Was A “Fiasco” That Reduced Services And Care For Iowans And Caused Headaches For Health Care Providers
HEADLINE: "Auditor: Iowa's Privatized Medicaid Illegally Denies Care" [Associated Press via ABC News, 10/20/21]
Des Moines Register Editorial Board Described Iowa’s Privatized Medicaid System As A “Fiasco.” According to the Des Moines Register editorial board, "Iowa Total Care is one of the for-profit insurers hired by the state to participate in the fiasco known as privatized Medicaid. The company was not among Iowa’s first picks for a contract. It landed a gig here only after two other insurers abruptly jumped ship during the first three years of privatization." [Editorial – Des Moines Register, 1/16/20]
Des Moines Register Editorial Board: “Privatized Medicaid Is Not Working. It Will Not Work Going Forward […] The Answer Is Saying Goodbye To These Insurers And Returning The Medicaid Program To State Management — Where It Worked Well For 50 Years And Where It Belongs Today." According to the Des Moines Register editorial board, "Privatized Medicaid is not working. It will not work going forward. Temporarily withholding public money from Iowa Total Care is, ultimately, not the answer. Neither is changing administrative rules or state law to supposedly give the state more teeth in dealing with private insurers. The answer is saying goodbye to these insurers and returning the Medicaid program to state management — where it worked well for 50 years and where it belongs today." [Editorial – Des Moines Register, 1/16/20]
¶ Des Moines Register On Iowa’s Privatized Medicaid System: “Medicaid Patients And Health Providers Have Reported Reduced Services Under The Privatized System Over The Years, Including Problems With The Appeals Process”
Since Iowa Privatized Its Medicaid Program In 2016, Health Care Providers And Medicaid Recipients Had Filed Complaints About Reduced Services And Delayed Reimbursements. According to the Associated Press, "Iowa privatized its roughly $4 billion Medicaid program, which serves about 600,000 residents, in 2016. At the time, former Gov. Terry Branstad argued the new setup would be more efficient and save the state money. Since then, health care providers and Medicaid recipients have filed complaints about reduced services and delayed reimbursements. Data on costs also shows the state hasn’t reached its intended goal on savings." [Associated Press, 2/11/18]
- Des Moines Register: “Medicaid Patients And Health Providers Have Reported Reduced Services Under The Privatized System Over The Years, Including Problems With The Appeals Process.” According to the Des Moines Register, "Medicaid patients and health providers have reported reduced services under the privatized system over the years, including problems with the appeals process. Representatives for the carriers have defended the care, including to lawmakers during periodic meetings at the state Capitol." [Des Moines Register, 1/3/20]
2021: The Gazette Reported That Iowans Who Relied On Medicaid Still Struggled To Get The Services They Needed From The Managed-Care Organizations. According to the Gazette via archive.org, "Early on, Iowans claimed they were denied necessary health care and providers complained they failed to receive full or partial reimbursement for their services. At one stage, the Iowa Ombudsman’s Office assigned a full-time staff member to respond to Iowans’ complaints about the managed-care program, Ombudsman Kristie Hirschman said in 2017. Now, five years later, some Iowans say they aren’t able to get the services they need from the managed-care organizations. For Garrett Frey, a quadriplegic who relies on a ventilator to breathe, it’s been a challenge to get the in-home nursing to help with his personal care needs. As a result, he’s had to rely more on his mother to fill the gaps, which he said has taken a heavy toll on his family." [The Gazette, 5/11/21 via archive.org]
- Audit Found An 891 Percent Increase In The Number Of Cases Where A Judge Had To Restore Services To A Medicaid Participant Under Iowa’s Privatized Medicaid System. According to the Associated Press via ABC News, "Sand said after privatization, there was an 891% increase in the number of cases in which a judge restored services to a Medicaid participant, concluding services were unlawfully denied by the private insurers managing the program. He promised after his election in 2018 that he would conduct a compliance report on Medicaid after service providers and recipients complained about the new system failing to provide comparable care and payment." [Associated Press via ABC News, 10/20/21]
¶ Health Care Providers Said They Received Low Reimbursement Rates Under Iowa’s Privatized Medicaid System
2021: The Gazette Reported That Providers Were Still Complaining About Low Reimbursement Rates From Iowa’s Privatized Medicaid System And Medicaid Members Struggled To Get The Care They Needed. According to the Gazette via archive.org, "Despite that, criticism of the program has not stopped. Complaints from providers about low reimbursement are reminiscent of the same complaints voiced four and five years ago. Advocates say Medicaid members, particularly those who require long-term supports, struggle to obtain the care they need. ‘Iowans were made more vulnerable by privatization,’ said Jenn Wolff, a disability advocate behind the #UpgradeMedicaid initiative." [The Gazette, 5/11/21 via archive.org]
- Hospitals, Doctors, And Mental Health Providers Reportedly Said They Were Not Paid In A Timely Manner Under Iowa’s Privatized Medicaid System And They Often Had To Fight To Get Paid. According to the Associated Press, "Jochum and others have complained Medicaid recipient care has deteriorated under the privatized system. Hospitals, doctors and mental health care providers have said they’re not paid in a timely manner and must often fight to get paid. Jochum called on Reynolds to return Iowa to a publicly managed system." [Associated Press, 11/26/18]
Iowa’s Department Of Health And Human Services Had To Pour More Money Into Medicaid Because Insurance Providers Claimed They Were Sustaining Losses. According to the Associated Press, "Democratic critics and some health care providers have questioned whether the Medicaid change really is producing any savings. DHS has poured more money into Medicaid because insurance providers claimed they were sustaining losses. Iowa officials said in August they were giving Amerigroup and UnitedHealthcare, the two companies that manage the program, an additional $103 million over last year’s funding." [Associated Press, 11/26/18]
¶ An Audit Also Found That The Two Companies Managing Iowa’s Privatized Medicaid System Had Violated Their Contracts
Audit Found The Two Companies Managing Iowa’s Privatized Medicaid System Violated Their Contracts. According to the Associated Press via ABC News, "Sand also reported that the two companies managing the Medicaid program, Amerigroup and Centene Corp., operating as Iowa Total Care, violated provisions of the contract established with the DHS. He said Amerigroup failed to comply with one provision of the contract, and ITC failed to comply with numerous provisions. For example, in multiple documented instances, both companies failed to comply with the contract clause requiring Home and Community Based Services providers to continue providing services to a member switching from one provider to another." [Associated Press via ABC News, 10/20/21]
¶ 169,000 Iowans in Nunn’s District Relied on Medicaid or Chip for Health Insurance
169,000 Iowans In The 3rd Congressional District Relied On Medicaid Or CHIP For Health Insurance.
[Center for American Progress, 3/11/25]
¶ Nunn Opposed Legislation That Lowered The Cost Of Prescription Drugs For More Than 88,000 Iowans
¶ Nunn Opposed the Inflation Reduction Act, Which Allowed Medicare to Negotiate Drug Prices and Capped the Cost of Insulin at $35 Per Month
Nunn Opposed The Inflation Reduction Act Despite Its Provisions To Lower The Cost Of Prescription Drugs. According to the Iowa Capital Dispatch, "Republican congressional candidate Zach Nunn said Saturday the Inflation Reduction Act passed Friday will hurt Iowans and small businesses. Nunn, a state senator running against U.S. Rep. Cindy Axne in Iowa’s 3rd District, spoke at the Register’s Political Soapbox at the Iowa State Fair. […] The $740 billion spending bill includes measures like hiring more IRS agents, lowering pharmaceutical costs and creating incentives for the purchase of electric vehicles. Nunn said these investments increase government spending, but do not help reduce everyday costs for Iowans." [Iowa Capital Dispatch, 8/20/22]
HEADLINE: “Nunn Assails Inflation Reduction Act At State Fair Soapbox” [KMA Land, 8/15/22]
¶ The Inflation Reduction Act Capped Prescription Drug Costs Under Medicare, Which Benefited More Than 88,000 Iowans
The Inflation Reduction Act Allowed Medicare To Negotiate Prices For Certain Prescription Drugs. According to the U.S. Department of Health and Human Services, "Negotiations are underway between HHS and the participating drug companies of the first 10 prescription drugs selected for negotiation in the first cycle of the Medicare Drug Price Negotiation Program. The first 10 drugs selected treat conditions such as blood clots, diabetes, heart disease, heart failure, autoimmune diseases, and chronic kidney disease." [U.S. Health and Human Services, Inflation Reduction Act Of 2022, Viewed 7/1/24]
The Inflation Reduction Act Required Drug Companies To Pay A Rebate To Medicare If They Raised Prices Faster Than The Rate Of Inflation. According to the U.S. Department of Health and Human Services, "Allowing Medicare to negotiate with participating drug companies to get lower drug prices for certain drugs covered under Medicare Beginning negotiations with the participating drug companies that manufacture all 10 drugs selected for the first cycle of negotiations" [U.S. Health and Human Services, Inflation Reduction Act Of 2022, Viewed 7/1/24]
The Inflation Reduction Act Capped The Price Of Insulin To $35 A Month For Many People On Medicare. According to KFF, "In 2022, President Biden signed into law the Inflation Reduction Act, which included a provision that requires all Part D plans to charge no more than $35 per month for all covered insulin products, and also limits cost sharing for insulin covered under Part B to $35 per month. Deductibles no longer apply to insulins under Part D or Part B. These provisions took effect in 2023 (January 1 for Part D; July 1 for Part B)." [KFF, 6/12/24]
More Than 88,000 Iowa Medicare Enrollees Were Prescribed Drugs Selected For Price Negotiation Under The Inflation Reduction Act. According to the U.S. Department of Health and Human Services,
[U.S. Department of Health and Human Services, Lowering Prescription Drug Costs for Iowa, Viewed 5/6/25]