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UI researcher: Medicaid cuts could complicate care in rural Iowa • Iowa Capital Dispatch [1]
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Date: 2025-07-16
A University of Iowa researcher with experience studying rural health care says cuts to Medicaid will only complicate care for those who already face less access and place a new roadblock in the way of those trying to coordinate care throughout the state.
Tom Gruca, a professor of marketing at the UI, has experience studying Iowa’s health care system, specifically hospitals and clinics in the state’s rural areas. Using what he’s learned from researching rural maternity ward closures and how they have affected care, Gruca said changes to Medicaid signed into law by President Donald Trump will only make Iowa health care more complicated.
“When you complicate things, when you put barriers to coordination in, things get worse,” Gruca said. “And it’s interesting, because, if you think about the trend in health care throughout our state, we’re doing more and more to try to coordinate care, not make it less coordinated. And this, I think, is going to make it less coordinated.”
Gruca focused his research on the effect on mothers receiving prenatal care after a rural labor and delivery unit closed, even if prenatal care was still generally available through other means. His study, published in March 2023, found that among the seven rural counties that lost their labor and delivery units in 2018, fewer patients received adequate prenatal care, even when other prenatal options were available through family practices.
Those living in these areas were 24% more likely to have inadequate prenatal care than their neighbors, and Gruca said outcomes for people utilizing Medicaid were affected even more than those with other insurance, with the likelihood of not receiving adequate care jumping to 38%.
“It was bad for the ones who lost it, and it was even worse for those who were on Medicaid,” Gruca said.
According to data from the state on Medicaid enrollments, there were more than 703,000 Iowans enrolled in a Medicaid plan between January and March of this year. More than 45% of recipients were younger than 18 years old, and the 22-64 age range made up another 40% of the group.
The tax and spending bill signed by Trump on July 4 included cuts to Medicaid amounting to more than $1 trillion, which health policy nonprofit KFF reported would mainly come from implementing new work and reporting requirements for certain Medicaid recipients, repealing Biden administration rules simplifying the Medicaid application and renewal processes, limiting state directed payments and more. Nearly 12 million people across the U.S. would lose their insurance.
Cuts, which will take place over a decade, represent a projected decrease of $11 billion in federal spending in Iowa, according to KFF. Gruca said these changes could adversely affect Iowans’ coverage and compensation health care providers receive for accepting Medicaid patients, ultimately reducing access for those who already face barriers to receiving health care.
Nearly $4.5 billion of the projected cuts for Iowa will come from its rural areas, KFF reported, one portion of $155 billion in total to be stripped from rural areas across the country.
Iowa Gov. Kim Reynolds said during an interview for a radio program Iowa will be able to weather these cuts more easily than other states with legislation passed this year aimed at creating a “hub-and-spoke” model for regional rural health care and increasing medical residency slots, though it would rely on federal funding to do so.
The state government also requested a federal waiver for, and passed legislation codifying, similar Medicaid work requirements as the federal bill, forcing those enrolled in the Iowa Health and Wellness Plan to complete at least 80 hours of work monthly.
Iowa GOP chair Jeff Kaufmann told journalists at a Trump visit to the Iowa State Fairgrounds July 3 that Republicans should stand by the bill and the Medicaid cuts embedded within it, despite opposition.
“Listen to this very carefully, folks: Do not cede an inch when you’re talking to your neighbors and friends,” Kaufmann said. “And it says this – if you work and if you’re legal, you’re not going to get kicked off Medicaid, that’s a lie. It’s a lie for desperate people.”
While GOP advocates have denied the level of risk to Americans touted by opponents to the legislation, Gruca said people need to look at long-term consequences rather than immediate impacts and think about how less coordination of care could lead to increased expenditures as well as worse health outcomes.
Whenever care for a patient becomes more complicated, Gruca said, whether through the closure of a labor and delivery unit forcing a mother to find a different doctor for prenatal care or making Medicaid harder to enroll in, keep and find providers who take it, patients and their health outcomes feel the hit.
“It isn’t going to make things better, because when things are less coordinated, they don’t run better,” Gruca said. “That’s really the most common sense thing there is, but, you know, those are choices people make.”
There are efforts in Iowa to better coordinate care for hospitals and patients, Gruca said, including work from the UI providing resources and training to hospitals still offering prenatal care throughout the state. However, with the Medicaid changes possibly forcing more providers to stop taking the insurance, Medicaid patients could have an even harder time finding care they qualify for in the future.
“If we’re serious, and we keep saying we’re serious about keeping rural communities vital, we have to make sure that we’re providing services in the rural communities where people live,” Gruca said. “Can’t just say, ‘Well, it’s great that you live there, thanks for that, but get in a car to drive 45 minutes for your appointment.’ It just doesn’t really work, and we already see that before the most recent changes. I don’t think the most recent changes will make this situation better.”
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