The Republican’s harmful megabill signed into law this past summer, makes significant cuts to health care, nutrition assistance, and other programs that help families meet basic needs. The legislation includes some of the largest proposed cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP) in history.

These changes would reshape health care and nutrition assistance across Iowa. An estimated 110,000 residents could lose health coverage due to cuts and the expiration of enhanced ACA premium tax credits. Another 68,000 people are expected to lose Medicaid coverage. About 23,000 residents may lose all or part of their SNAP benefits. The bill would also shift costs to the state, with Iowa potentially responsible for up to $26 million per year in new SNAP expenses tied to federal cost-sharing requirements.

Amber Gustafson, a 48-year-old mother of three in Ankeny, Iowa, knows exactly what’s at stake. Her husband runs a small manufacturing equipment company with about 10 employees, and their family depends on ACA tax credits to afford coverage—especially critical for their two children with disabilities. Currently receiving $250 per month in subsidies, the Gustafsons face a $500 monthly increase when Blue Cross Blue Shield raises rates next year if those credits disappear. “This will be a pinch for our family, for sure,” Gustafson said, noting they’ve already started cutting gym memberships and other nonessentials. She may soon face an impossible choice: higher premiums or higher deductibles. Read more about the Iowa residents for whom these changes mean uncertainty.

The bill’s provisions would affect working families like the Gustafsons who rely on the ACA marketplace, Medicaid recipients who depend on stable coverage, and households that use SNAP benefits to meet basic needs. These policy changes would reach an estimated 178,000 Iowa residents losing health coverage and 23,000 losing nutrition assistance, affecting household budgets, access to medical care, and family stability across the state.

Put simply, the bill reduces health care and food assistance while providing tax breaks to higher-income households. Additionally, the House Republicans bills propose further cuts, including reductions to housing assistance funding that could affect families’ ability to maintain stable housing. We urge Members of Congress to protect the millions who rely on these essential services by extending enhanced premium tax credits to prevent over 20 million Americans with Affordable Care Act health plans from seeing their premium costs skyrocket and opposing funding bills that further cut basic needs programs.