Congressional Budget Office

Nearly 1,000 refugees in Iowa are expected to lose federally funded Medicaid coverage this week as provisions of last year's federal tax and budget law take effect. The Refugee Alliance of Central Iowa estimates at least 973 refugees in the state lack green cards and will fall out of eligibility under the Oct. 1 cutoff, though children legally residing in the U.S. will remain covered under a state-continued federal option.

The change rolls back a 1996 policy that allowed refugees, asylees, and other humanitarian immigrants to qualify for Medicaid. Republicans say the restrictions protect program funding and taxpayer dollars. The Congressional Budget Office estimates the federal government will save roughly $131 billion through 2034 from immigrant health-coverage restrictions overall, including about $6.2 billion from this specific change, though those figures don't capture potential added costs for hospitals, states, and counties. A coalition led by the Iowa Catholic Conference is pressing Gov. Kim Reynolds to adopt an option, used by 32 states, to preserve coverage for certain pregnant immigrants. Iowa also begins new Medicaid work requirements Dec. 1.

Harris County Commissioner Adrian Garcia says local property tax increases stem largely from federal and state policy decisions rather than county spending. He points to Texas's continued refusal to expand Medicaid under the Affordable Care Act, which has forfeited more than $184 billion in federal funds since 2016, according to the Urban Institute, leaving Harris Health, the county's safety-net hospital system, to absorb costs for uninsured patients.

Garcia also cites federal Medicaid cuts under Trump's tax and spending legislation, which the Kaiser Family Foundation estimates will reduce federal Medicaid spending by $911 billion over a decade, potentially adding 10 million uninsured Americans per the Congressional Budget Office. Harris Health reported $179 million in added indigent care costs last year. A new state law exempting billions in business property from taxation, plus unfunded state mandates on elections and courts despite a $24 billion state surplus, further shift costs to homeowners, Garcia argues, even as county leaders work to control spending.