In 2021, I opened an independent bookstore in downtown Des Moines. My husband, also a small business owner, and I have had two children since moving back to Iowa in 2020 and we work full time running our businesses.

Like many other small business owners and self-employed Iowans, our family resides in the gap between barely affordable, mediocre, private individual health insurance and Medicaid – a gap that will only widen after the most painful provisions of the OBBBA (One Big Beautiful Bill Act) are fully implemented. Every Iowa Congressional Representative voted in favor of the bill, which makes historic cuts to Medicaid while providing big tax breaks for the wealthy and new tax loopholes for big corporations like health insurance and prescription drug companies.

Rather than address the harm that will result from thousands losing their coverage, Congressman Zach Nunn and all of our Iowa representatives are side-stepping the issues by touting tax breaks that ultimately amount to pocket change compared with the rising cost of insurance premiums, deductibles and out-of-pocket medical expenses that will hit my neighbors and family hard.

Let’s be clear: no average income working Iowans are getting new tax breaks under this law. Instead it extends the tax breaks that were already in place while cutting healthcare, food assistance and other resources that families need to make ends meet as the cost of everything continues to go up thanks to inflation and tariffs.

In the last five years, I have intersected with just about every option for health insurance out there.

In 2021, with insurance through the marketplace, I paid $10,000 in medical bills to give birth to our first child with no serious complications. I was insured by Medicaid during my second pregnancy and for the first year after my child’s birth which covered complications including a preeclampsia scare and urgent care visits during my newborn’s first flu season.

Currently, our kids remain insured under Medicaid through Hawki, a Medicaid program which is affordable and when medical issues come up-like our son’s common ear tube surgery-we didn’t have to worry about affording groceries or childcare that month.

Unfortunately, that’s not the case with our adult coverage. Like so many Wellmark, our insurance company, sent us a letter that premium prices will increase by 10% next year.

Republicans in Congress have refused to extend premium tax credits that help over 90% of people who have marketplace coverage. Iowa’s two Senators voted against a bill that would have extended these tax credits that make coverage more affordable for small businesses like mine. As a result, the federal government has shut down in the wake of the GOP’s refusal to include tax credits for affordable coverage as well as their July passage of $1 trillion in cuts to Medicaid over the next decade. Between the cuts to Medicaid and the enhanced premium tax credits for ACA coverage, over 106,000 Iowans will lose coverage and thousands more of us will end up paying way more than we can afford. Small business people like my husband and I will be heavily impacted because over half of people who have ACA marketplace coverage are self-employed or work for small businesses with fewer than 25 employees.

This is healthcare in America right now — complicated, frustrating, expensive, precarious — and it feels like our representatives are patting us on the head, claiming the middle class will be saving money during tax season while spreading the idea that the there is a large population somehow abusing the system and wasting money, when the reality is that Medicaid directly benefits 1 in 5 Iowans — mostly working families, children, seniors, and people with disabilities and indirectly benefits everyone.

Small business is the backbone of rural economies but rather than support affordable healthcare for us, our Iowa Members of Congress are giving more breaks to large corporations and Wall Street kingpins who already have every advantage in today’s economy. Rather than support Iowa’s struggling families who elected them to fix the economy, these lawmakers are fighting for wealthy people who do not have to weigh the cost of taking their kid with a fever to the doctor against the cost of groceries that month.

As a small business owner I’m asking our representatives to listen to us. And we need to pay attention to what our representatives are doing, not just what they’re saying. Small businesses everywhere risk losing staff, stalling growth, and falling behind big competitors if healthcare costs soar. The public is with us–let’s make sure Congress hears us too.

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Abbey Paxton is the owner of Storyhouse Bookpub

in Des Moines.