Editor’s note: The following op-ed was published Sunday in the Dubuque Telegraph Herald.
I recently ran into Senator Charles Grassley in the U.S. Capitol. Senator Grassley and I have known each other for years. He refers to me as “that nun from Dubuque.”

Senator Grassley and I have always had a cordial relationship, but on this day I was not feeling particularly charitable toward him. I had just seen a news story on Iowa Public Radio’s website in which Grassley defended the secrecy with which GOP senators are trying to push through health care repeal.

There have been no hearings, no public testimony, no amendments, and no debate on the bill. Even Grassley said he had not seen it.

Grassley tried to justify the GOP’s closed-door sessions by claiming that, in 2010, then-Senate-majority leader Harry Reid, D-Nevada, acted secretly to push through the Affordable Care Act (ACA).

This is not true. I know, because I was in Washington working for passage of the ACA. Senator Grassley was a member of the “Gang of Six” – three Republican and three Democratic senators – who spent months negotiating health care legislation. Ultimately, their work was in vain because no compromise was reached. Every Republican, included Grassley, voted against passage of the ACA, even though thousands of Iowans benefited from its passage.

The ACA helped 150,000 lower-income Iowans gain health care coverage through the Medicaid expansion and helped 45,000 moderate-income Iowans pay premiums on their private insurance policies. It also provided key consumer protections, outlawing the practice of denying treatment for pre-existing conditions, banning annual or lifetime caps on benefits, and ensuring that certain essentials were part of any health insurance plan, such as doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, prenatal and infant care, mental health services, and more.

Our country, and Iowa in particular, needs a robust health care system. The ACA can be improved. We read, for example, about health insurance companies leaving the Iowa marketplace, in part, because the current Administration has not provided assurance that they will continue to receive the cost-sharing subsidies in the ACA.

Given the complexity of health care, debate over health care changes should be open and transparent, not secret. No new legislation should leave Iowans worse off than they are now, which would happen under the bill passed by the House and now under consideration by the Senate

The proposed cuts to Medicaid are a direct attack on the interests of the people of Iowa. Medicaid enables 634,000 Iowans to receive comprehensive, affordable health care including 90,000 Iowans with disabilities, 15,600 babies, and 46,000 Iowa seniors who get health care through Medicaid including nursing home care and services that help them live at home.  The federal government covers 57 percent of Iowa’s Medicaid costs.

Under the health care legislation already approved by the House, the cuts to Iowa’s federal Medicaid budget would begin this fall, and would quickly drop by almost 20 percent by 2018 and 33 percent by 2026. How will Iowa replace the lost dollars? How many Iowans will lose access to health care? How many will die as a result because they could not get preventative treatment or the CAT scan or mammogram they need?

The proposed cuts to Medicaid are not an effort to improve Iowa’s health care system. Rather, they are a key part of the plan to pass large tax cuts for the wealthiest Americans. Perversely, we could end up with a system where fewer Iowans are covered by health insurance than before the ACA was enacted.

Tough questions deserve open and thoughtful consideration, and Senator Grassley should help provide solutions. This nun from Dubuque demands no less.

Friedman is a Sister of the Presentation of the Blessed Virgin Mary from Dubuque and serves as the Director of Public Policy at the Coalition on Human Needs in Washington, D.C.