One year ago, on July 4, 2025, President Trump signed HR 1 — the bill he called the "One Big Beautiful Bill." Mariannette Miller-Meeks voted for it. Twice, actually: once when the House first passed it in May, and again on final passage in July.
This week, the DCCC marked the anniversary by tallying up what that vote has cost Iowa. The list is long: clinics closing, premiums jumping, and thousands of Iowans losing help buying groceries.
Here's what makes Miller-Meeks different from most of the Republicans who voted yes: she's a doctor. An ophthalmologist. She chairs the House Veterans' Affairs Subcommittee on Health. If anyone in Congress should have understood what cutting health care funding does to a rural state, it was her.
She voted for it anyway.
What the bill did
HR 1 paired massive tax cuts with the largest Medicaid cut in history. It's expected to strip health insurance from 17 million Americans. It made the largest cut to SNAP food assistance in history.
In Iowa, the congressional Joint Economic Committee estimates the health care cuts will cost more than 106,000 Iowans their coverage across the state's four districts. In Miller-Meeks' own district — Iowa's 1st — that's about 24,700 people: 11,600 losing ACA marketplace coverage and 13,100 losing Medicaid.
The damage in her district
This isn't a forecast anymore. It's happening.
In March, MercyOne announced its Clinton Medical Center — in Miller-Meeks' district — would stop delivering babies. The last delivery was in May. The hospital blamed increasing costs, staffing shortages, and "reimbursements that do not cover the full cost of care." Medicaid pays for 40% of all births in the United States — and the National Rural Hospital Association has blamed rising costs and Medicaid cuts for closures like this across the country.
So in Clinton, Iowa, the local hospital no longer offers labor and delivery. Expecting mothers have to go somewhere else to have their babies.
Health insurance is getting more expensive too. The Iowa Insurance Division says carriers filed 2026 rate increases ranging from 12.6% to more than 25%, and the enhanced subsidies that kept coverage affordable reverted to lower levels — meaning higher premiums for nearly everyone who buys their own insurance.
And it's not just health care. In the twelve months after the law passed, nearly 25,000 Iowans lost SNAP food assistance — enrollment fell from 272,747 in June 2025 to 247,907 in May 2026. Food pantries are swamped: one Iowa pantry reports a 36% jump in households served since the law was signed, with demand outpacing what it saw during COVID-19.
What she says when Iowans ask about it
Miller-Meeks spent months avoiding her constituents entirely — she told local Republicans she'd hold an in-person town hall "when hell freezes over."
When she finally held one in November, a constituent asked her directly: "Why did you allow your committee to put in place the largest cuts to Medicaid in the program's entire history?"
Her answer:
"Thank you for the applause for the Energy and Commerce Committee voting to strengthen and preserve Medicaid."
The room booed. People walked out shaking their heads. After 50 minutes, she left the stage to more boos.
That's her story, one year in: the largest Medicaid cut in history was actually "strengthening" it. Tell that to the mothers in Clinton.
Who actually won?
The Congressional Budget Office ran the numbers on who gains and who loses from the law. The answer is blunt: the poorest 10% of households lose about $1,200 a year, because the Medicaid and SNAP cuts take away more than the tax cuts give back. The richest 10% gain about $13,600 a year.
That's the trade Miller-Meeks made: groceries and health coverage for her constituents, in exchange for tax cuts tilted to people at the top. It's worth remembering who funds her campaigns: medical industry PACs are among her biggest donors.
A year later, voters haven't come around. Battleground-district polling by Navigator Research finds the law still underwater by 11 points — and unpopular even in districts Trump won by more than 10 points.
Miller-Meeks is a physician who took an oath to do no harm. Then she voted — twice — for a bill that is closing delivery rooms and taking food assistance from her own patients' neighbors. And when they asked her why, she thanked them for their applause.
We deserve better.
Source
This post is based on the DCCC release: "One Year Later: Mariannette Miller-Meeks and Zach Nunn's Big, Ugly Bill Remains Deeply Unpopular As Iowans Suffer" (July 2, 2026), with additional reporting from Iowa Public Radio, KWQC, The Gazette, and federal data linked above.
