Iowa is among the first states to make significant changes to its Medicaid budget ahead of nearly $1 trillion in federal cuts. The changes stem from a GOP-backed overhaul aimed at slowing Medicaid spending growth over the next decade and shift more costs to states. The state's governor signed a bill last week to raise taxes on insurers, retroactively increasing premium taxes on HMOs from 0.925% to 3.5% between Jan.1 and Sept. 30, 2026, and using $89 million from its general fund to help address the Medicaid shortfalls. Critics warn this could raise premiums for Iowans, while Republicans argue it's temporary and necessary to draw down federal matching dollars.