The Senate

State of Iowa
Eighty-seventh General Assembly
STATEHOUSE
Des Moines, IA 50319

July 18, 2017

Dear Governor Reynolds,

We write to urge you to join other Republican and Democratic Governors in speaking out against the healthcare bill
currently being debated in the US Senate.

In 2011, with bipartisan support and the participation of Governor Branstad and yourself, the Iowa Legislature voted
to expand Medicaid to cover 150,000 working Iowans who did not earn enough to purchase insurance on the open
market.

Iowas Medicaid expansion improved the health of working Iowans, reduced the cost of charity care at Iowas
hospitals, and increased the number of health care jobs across Iowa. The state of Iowa will pay no more than 10
percent of the overall cost. The benefits to Iowans are obvious and continue even though Medicaid has
been privatized.

Governor Reynolds, we know you are certainly aware that the United States Senate is debating legislation that
would negatively affect Medicaid expansion. The cost of unpaid charity care in Iowa could again reach the billion-
dollar-a-year level it had reached before the Medicaid expansion. This would increase the price of health insurance
generally and be especially harmful to hospitals and health care providers in Iowas rural communities. If Medicaid
is cut significantly, rural health care providers could be forced to close. That would have a devastating effect on
patient access to health care and would be a major blow to the continued viability of Iowas small towns.

In addition, some 72,000 Iowans on the individual market may soon be unable to buy health insurance at any price.
Youve stated that your administration is working on a stop-gap proposal to fix this problem for 2018. We want to
remind you of the urgent need to resolve this issue as soon as possible. Iowas U.S. Senators must work with the
Trump Administration to immediately eliminate the health care insecurity haunting these Iowa families.

Thats why we ask you to stand up for Iowa the way other Republican and Democratic Governors have stood up for
their states. Here are a few examples:

Nevada Governor Brian Sandoval has said Medicaid expansion has been a winner for the people of our
state.

Ohio Governor John Kasich has said that he has deep concerns with the details of the U.S. Senates plan to
fix Americas health care system and the resources needed to help our most vulnerable.

Vermont Governor Phil Scott said this about the Republican Senate changes to Medicaid: Even a small
tweak could have a devastating impact on us as a state.
Governor Reynolds, we urge you to speak up in defense of Iowa families, Iowa health care providers, Iowa jobs, and
the state budget. Specifically, we urge you to contact Senators Chuck Grassley and Joni Ernst as soon as
possible. Encourage them to speak out publicly against health care changes that would devastate Iowans and the
Iowa economy.

Sincerely,

Senator Amanda Ragan of Mason City

Ranking Member, Health and Human Services Appropriations Subcommittee

Senator Liz Mathis of Robins

Ranking Member, Human Resources Committee