"Well, we all are going to die," says Sen. Joni Ernst, a Republican from Iowa facing reelection in 2026, responding to voter concerns about potential Medicaid cuts.
The response came after an audience member during a town hall in Butler County, Iowa, warned that proposed reductions to Medicaid could result in people losing coverage and dying.
Following audible reactions from the audience, Ernst said, "So, for heaven’s sakes. For heaven’s sakes, folks."
The next day, the senator seemingly doubled down with a video on Instagram filmed in what appeared to be a cemetery, saying she had made "an incorrect assumption that everyone in the auditorium understood that, yes, we are all going to perish from this earth."
“So, I apologize, and I’m really, really glad that I did not have to bring up the subject of the tooth fairy as well,” Ernst said. She also added, “For those that would like to see eternal and everlasting life, I encourage you to embrace my lord and savior Jesus Christ.”
Ernst’s comments come as Senate Republicans prepare to begin work on the One Big Beautiful Bill, a measure previously passed by the House that would reduce federal spending on social safety net programs by more than $1 trillion over the next decade.
The bill includes proposed changes to Medicaid such as imposing work requirements for recipients, increasing out-of-pocket costs, and limiting retroactive coverage periods. The Congressional Budget Office projects that these changes could remove Medicaid coverage from 8.7 million people and increase the number of uninsured individuals by 7.6 million over 10 years.
The American Hospital Association (AHA) has previously sent out a statement expressing concerns about the bill and its potential impact.
“The sheer magnitude of the level of reductions to the Medicaid program alone will impact all patients, not just Medicaid beneficiaries, in every community across the nation,” AHA president and CEO Rick Pollack said.
In Iowa, where roughly 586,732 individuals are enrolled in Medicaid, the proposed federal cuts could have widespread effects. Medicaid currently covers about 38% of children and 50% of nursing home residents in the state.
Beyond healthcare, the One Big Beautiful Bill also proposes to extend tax cuts originally passed under the 2017 Tax Cuts and Jobs Act. These extensions, along with other measures in the bill, are estimated to add $2.3 trillion to the federal deficit over the next decade, according to projections.
Ernst’s reaction drew attention in her home state of Iowa, where she faces several challengers in the Republican primary. Nathan Sage, the only Democrat to formally enter the 2026 Senate race so far, posted on social media that his "jaw almost hit the floor" after hearing Ernst’s remarks.
Medicaid covers about one in five Iowa residents, including half of the state’s nursing home population, according to estimates from the nonprofit health policy research organization KFF.
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