5 ways Trump’s ‘Big Beautiful Bill’ would change life in Iowa

What happens when a 940-page law tries to reshape America? Let’s see how it would play out in the Hawkeye State.

Iowa’s Republican Congressional delegation is primed to provide a stamp of approval to President Donald Trump’s “One Big Beautiful Bill,” despite the potentially devastating impacts it stands to have on Iowa. The legislation slashes Medicaid, goes after food assistance, and adds trillions to the national deficit, all to pay for massive tax cuts for the extremely wealthy. 

Trump’s massive bill cleared a key Senate vote 51-49 on Saturday night. Senate Republicans want to see it passed Tuesday. If it passes, it would then go back to the House for final passage. Here’s what Iowa can expect if the bill is ultimately signed into law:

1. Your local hospital might reduce service or close its door

The legislation appears on track to cut Medicaid and Children’s Health Insurance Program (CHIP) by about $1 trillion. These cuts are driven by restrictions on so-called “provider taxes,” which are fees paid to the government for healthcare to help finance Medicaid. For Medicaid expansion states like Iowa, restricting provider taxes will mean a massive drop in funding for rural hospitals. 

That could prove particularly harmful in Iowa, where 42% of the state’s 700,000-plus Medicaid enrollees live in rural areas.

For months, rural hospitals have been raising the alarm about how the bill would reduce services and even shut down some providers. Washington County Hospitals and Clinics CEO Todd Patterson wrote in a letter to the editor that appeared in the Southeast Iowa Union that when Medicaid reimbursements fall short, hospitals absorb the loss. But hospitals have limits. 

“Cuts to Medicaid don’t just affect our ability to offer new programs or upgrade equipment; they force decisions about whether we can keep our maternity ward open, retain emergency services, or offer mental health care. These aren’t just services—they are lifelines,” Patterson wrote.

2. Working families could lose health insurance and food assistance

Because Iowa was among the states to adopt Medicaid expansion under the Affordable Care Act, it’s among the states most impacted by cuts. The bill’s cuts to Medicaid include adding work requirements for recipients, increasing the frequency of eligibility checks, and adding cost-sharing for some expansion enrollees. 

Under this bill, many people would lose their health insurance. According to a KFF analysis, an estimated 86,000 Iowans would lose Medicaid coverage under the Senate’s version of the bill. Around 56,000 people in Iowa would become uninsured if the House’s version of the bill passed.

The Congressional Budget Office estimates the bill would increase the number of uninsured people by 11.8 million nationwide. An earlier KFF estimate found Medicaid enrollment in Iowa could drop by about 90,000 by 2034. It found that the number of uninsured Iowans would increase by an estimated 69,000 by the same year.

3. Iowa’s renewable energy projects cut; energy prices increase

As things stand, Iowa is a national leader in wind energy. Nearly three-fifths of Iowa’s total electricity generation comes from wind. And part of that has been the explosion of growth in Iowa’s blustery corridors. 

Trump’s ‘Big Beautiful Bill’ would decimate clean energy incentives that have spurred investment in wind, solar, and other forms of green energy. 

Companies that begin construction under the Inflation Reduction Act’s subsidies for wind and solar power will still qualify for the full tax break. But that drops to 60% if they begin in 2026 and 20% if they start in 2027. By 2028, the tax credit will completely disappear. 

Repealing most of the the Inflation Reduction Act’s energy tax credits, as the bill would do, would dash wind and solar projects in Iowa and could lead to increases in utility bills as it slashes the state’s ability to produce energy from renewables. Analysis from think tank Energy Innovation found that  by 2034 the bill will have made energy costs in Iowa 10% more expensive.

The bill also imposes a new tax on existing wind and solar farms if they use materials from a foreign entity like China—a huge blow for the renewables industry, which incorporates many materials from China across its supply chain. 

Even US Sen. Chuck Grassley, who was called “the father of the modern wind industry,” told Radio Iowa this could “kill future wind projects.”

4. ‘Cuts’ add trillions to the national debt

Despite cutting billions from the social safety net for poor families, Trump’s tax bill is estimated to still raise the debt by $3 trillion over the next decade. A Tax Foundation estimate said the Senate bill decreased federal tax revenue by $4.7 trillion over the next decade. 

Republicans in Iowa have said reducing the deficit is a priority, but the bill supported here doesn’t accomplish that goal.

“Many provisions in this bill are not even ‘pro-growth’ but only serve as temporary political goodies that will add to the economic ball and chain of debt that will be a drag on our economic vitality for generations to come,” Carolyn Bourdeaux, executive director of the deficit-reduction group Concord Action, said in a statement reported by Axios.

The trillions in added debt come after trillions in cuts to programs like Medicaid, food assistance and renewable energy. It begs the question, who gets to benefit? 

5. Tax benefits distributed unequally across income categories

The bill would increase the state and local tax (SALT) deduction cap to $40,000 and make permanent and increase the 20% qualified business income deduction, increasing it to 23% of business income starting in 2026.

The bill extends tax cuts from Trump’s first term that disproportionately benefited high earners, according to the nonpartisan Congressional Budget Office and other analyses. The estate tax exemption rises to $15 million per person and is adjusted for inflation going forward—a change that only affects the wealthiest families since most Americans never come close to owing estate taxes.

Meanwhile, families with low incomes, especially those that rely on SNAP and Medicaid, would take a financial hit from cuts to safety net programs.