At the Plymouth County Fair in Le Mars on Friday, KTIV asked Ashley Hinson a direct question: has healthcare access actually improved under the changes she voted for?

Here is what she said:

"Benefits are designed for people who absolutely need them, and we want to make sure people who need Medicaid get it. But we want to make sure people who are gaming the system or people who are here illegally are not getting those benefits. So that's the change we made, and I think work requirements are very popular amongst the Iowans I've been out talking to in the state. If you're going to take a taxpayer benefit, you should be working."

She also said Republicans have made it "very, very easy" to qualify for Medicaid and for food assistance.

Let's take that answer apart, piece by piece, against the record.

"If you're going to take a taxpayer benefit, you should be working"

Almost everyone on Medicaid already is.

KFF, the nonpartisan health research organization, breaks down every non-elderly adult on Medicaid who isn't on disability benefits or Medicare:

• 64% are working full-time or part-time
• 12% are not working because they're caring for someone — a child, a parent, a spouse
• 10% are not working because of illness or disability
• 7% are in school

That's 92% either working or with a documented reason they can't. The remaining 8% are retired, can't find work, or something else.

So Hinson's rule — if you take the benefit, you should be working — describes what nearly all of these people are already doing. The policy isn't aimed at a problem of people refusing to work. There isn't one, at any scale that would justify this.

What work requirements actually do

We know what they do, because a state already ran the experiment.

Arkansas imposed Medicaid work-reporting requirements with real consequences from June 2018 through March 2019. KFF's account of the result:

"More than 18,000 people lost coverage, or about 25% of the population subject to the requirement."

And the effect on employment?

"…associated with losses in Medicaid coverage, an increase in the percentage of adults who were uninsured, and no significant change in employment — as nearly everyone targeted by the policy met the requirements already or qualified for an exemption."

Read that carefully. A quarter of the affected population lost their health insurance. Nobody went to work who wasn't already working. The people who lost coverage lost it mostly because they failed to file paperwork proving something that was already true.

That's the design. It's a reporting requirement dressed up as a work requirement, and the paperwork is the point. A federal court later ruled Arkansas's version unlawful.

The part about people "here illegally"

Hinson framed the change as stopping people "who are here illegally" from getting Medicaid.

Undocumented immigrants are already ineligible for Medicaid. They cannot enroll in Medicaid, CHIP, or Medicare, and they cannot buy coverage on the ACA marketplaces. Federal money cannot be used to cover them. This is longstanding federal law and it did not need fixing.

The only exception is Emergency Medicaid, which reimburses hospitals for emergency care they are legally obligated to provide to anyone who walks through the door.

So the picture Hinson is painting at the county fair — that people here illegally have been collecting Medicaid, and Republicans just stopped it — describes something that wasn't happening. It's a story that makes a cut feel like enforcement.

The people who will actually lose coverage are U.S. citizens in Plymouth County and everywhere else in Iowa.

What it costs Iowa

This isn't theoretical for the state Hinson wants to represent in the Senate.

Iowa's Medicaid budget is projected to be cut by more than 15% under the budget law — one of only three states hit that hard. About 90,000 Iowans are projected to lose Medicaid coverage by 2034, and roughly 69,000 of them are expected to end up with no health insurance at all.

Those aren't people gaming a system. Overwhelmingly, they're the 92% — working parents, people caring for a sick relative, people in school, people too ill to work.

"Very, very easy to qualify"

Hinson's other claim on Friday was that Republicans have made it "very, very easy" to qualify for Medicaid and SNAP.

Ask anyone who's been through it. Medicaid and SNAP already require income verification, documentation, and regular renewals. Adding a monthly work-reporting rule on top of that doesn't make it easy — it adds another form that, in Arkansas, knocked one in four people off their coverage.

If the requirement were as easy to satisfy as Hinson suggests, 18,000 Arkansans wouldn't have lost their insurance to it.

Where she's been on the rest of it

The KTIV piece notes the broader position: Hinson has opposed the Affordable Care Act status quo, voted against extending the premium tax subsidies, and instead points people toward health savings accounts.

Health savings accounts help if you have spare money to save. For a family on Medicaid, an HSA is not a plan. It's a suggestion to be less poor.

The fair is the right place to ask

There's something clarifying about this exchange happening at a county fair — a reporter with a microphone, a congresswoman between events, an unscripted answer.

She was asked whether healthcare got better. She didn't say it did. She talked about people gaming the system and people here illegally, and about how popular the change is with the Iowans she talks to.

Ninety thousand Iowans are projected to lose their coverage. Some of them were at that fair.

We deserve better.

Source

Sophie Wyckoff and Acacia Killian, Rep. Ashley Hinson Defends Medicaid Work Requirements During Plymouth County Fair Visit, KTIV, July 31, 2026.