Monday, March 23, was the 16th anniversary of the signing of the Affordable Care Act (ACA) into law. Roughly 50 million Americans have gained health insurance coverage either through the ACA marketplace or Medicaid expansion. Since 2013, the number of Americans uninsured decreased by nearly half, from about 14.5% to just under 8%.

I think most of us would agree that our healthcare system, including the ACA, is imperfect and that we could do more to ensure access to healthcare for all Americans. But programs like the ACA and Medicaid have made strides in closing some of the gaps in access to care for millions.

Yet instead of taking more steps forward to ensuring care, we seem to be sliding backwards, and rather quickly. Because of Trump’s “Big, Ugly Bill” passed last summer, approximately 114,000 Iowans are estimated to lose Medicaid or ACA coverage. Nearly the same number of Iowans on the ACA marketplace are now paying double or more for their health insurance due to the continued failure by Congress to extend the ACA tax credits at the end of 2025.

Another anniversary is on the horizon. April 1 marks the 10-year anniversary of when Iowa privatized its entire Medicaid program. The cruel joke that this occurred on April Fools’ Day is not lost on thousands of Iowans dependent on for-profit managed care organizations like Iowa Total Care to approve the care they need.

One doesn’t have to look far to know Iowa’s privatized Medicaid hasn’t been a success by many measures. Either from someone in your own family, a neighbor, or friend at church we’ve heard ten years of stories of delays in needed care or outright denials of service. Support groups on Facebook for those dealing with Iowa’s Medicaid program are littered with phrases like “Iowa Total Care sucks,” “How do we fight the fight without getting mentally drained,” and more.

So what are our current crop of elected officials doing in response? At least it appears they’ve abandoned their attempt to lock us into privatized Medicaid for years to come. But care is still being denied.

I read an article in KFF Health News recently about a family in Ottumwa who is fighting a decision by Iowa Total Care to cut their adult child’s in-home care coverage by about a third of what they were covering. A manager for Iowa Total Care testified that state officials advised the company to focus mainly on “skill building” time, not supervision.

Reading between the lines, this sounds a lot like advice on how to cut costs, not provide the care our loved ones, neighbors, and others need. And it’s in large part because of the massive cuts to Medicaid in the Big, Ugly Bill last summer so billionaires could get more tax breaks.

Our rural hospitals, our nursing homes, people we love rely on Medicaid and the ACA to access the care we need, when and where we need it. They can be lifelines to a fulfilling life and vibrant communities. And they should be strengthened, not gutted to line the pockets of people who barely know the value of a hard day’s work.

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Barb Kalbach is a fourth generation family farmer, retired registered nurse, and board member of Iowa CCI Action. She can be reached at barbnealkalbach@gmail.com.