Trump’s Health Care Checks Fall Short as Iowans Face Higher Costs

One-time payments do little to offset health care costs after ACA tax credits expired

DES MOINES, Iowa — After cutting billions from Medicaid and letting health tax credits expire, the Trump administration is sending one-time health care payments to Medicare and Affordable Care Act marketplace enrollees. For Iowa families paying more each month, taking thousands from annual family budgets, the $90 Medicare and $500 ACA checks are a drop in the bucket. 

These one-time payments only provide relief for some ACA marketplace enrollees and Medicare beneficiaries as health care costs continue to skyrocket. The premium increase at the beginning of the year meant that some previous enrollees dropped coverage and were forced to pay out-of- pocket costs for any medical expenses. And with the enhanced ACA premium tax credits expired, many current marketplace enrollees are paying significantly more for coverage, and a one-time payment does not replace the savings those credits provided. The enhanced ACA premium tax credits expired at the end of 2025, and Congresswoman Mariannette Miller-Meeks voted against extending them.

Bo of Des Moines, whose family received a check from the Trump administration, said the payment does not address the ongoing cost of health insurance.

“We appreciate getting the check, but it doesn't change the fact that our health care costs are going up year after year. A one-time payment can help with one bill, but it doesn't make our insurance affordable again. What our family needs is predictable, affordable health care coverage that we can actually budget for.”

Representatives Mariannette Miller-Meeks and Zach Nunn both voted for the Republican Tax Law, which cut billions of dollars from Medicaid and SNAP and did not extend the enhanced credits. An analysis by the Center on Budget and Policy Priorities projected that the law’s provisions and the failure to extend enhanced ACA premium tax credits could leave 96,000 Iowans uninsured by 2034. Meanwhile, Centers for Medicare & Medicaid Services data shows that Iowa ACA marketplace plan selections fell by approximately 13,500 between the 2025 and 2026 enrollment periods, while an estimated 68,000 Iowans are at risk of losing Medicaid coverage because of the Republican Tax Law.

For Medicare beneficiaries, the administration's $90 payment also comes as Part B premiums have increased. About 40 million Medicare beneficiaries do not qualify for the payment, including people enrolled in Medicare Advantage and some beneficiaries whose premiums are paid through Medicaid.

For Iowa families like Bo’s the question is not simply whether a check is helpful. It is whether votes cast by their Representatives, like Nunn and Miller-Meeks, make health care affordable or more expensive in the long run.