Rep. Mariannette Miller-Meeks, R-Iowa, walks from a closed door Republican conference meeting at the Capitol in Washington, Thursday, Oct. 19, 2023. (AP Photo/J. Scott Applewhite)

U.S. Rep. Mariannette Miller-Meeks’ (R-IA) campaign finance records show she took at least $45,500 from the insurance and pharmaceutical lobby after repeatedly opposing extending the Affordable Care Act’s (ACA) premium tax credits.

Miller-Meeks’ donations reported with the Federal Election Commission (FEC) show that several insurance and pharmaceutical political action committees (PACs) contributed to the representative’s 2026 reelection campaign in the fourth quarter of 2025, while she routinely advocated against extending the tax credits and lowering health care costs for roughly 24 million Americans.

Miller-Meeks firmly against ACA subsidies 

The donations came in after Miller-Meeks spent months advocating against extending the ACA premium tax credits, which expired at the end of last year. The premium tax credits were introduced under President Joe Biden in the Inflation Reduction Act to increase financial assistance for ACA enrollees in the midst of the COVID-19 pandemic. 

Miller-Meeks and the majority of Republicans in Congress refused to extend the tax credits, arguing that they are a bailout for insurance companies and “taxpayer-funded blank checks to large insurance companies.” Debate on the issue led to the government shutdown last November. Initially, Democrats pledged to negotiate an extension. However, eight Democrats in the Senate folded and voted to reopen the government without forcing Republicans to extend the credits. 

The Kaiser Family Foundation (KFF), a nonpartisan nonprofit organization that researches health policy, projects that the average ACA enrollee will see their health insurance premiums double now that the tax credits have expired. As of last year, 24.3 Americans were enrolled in the ACA, and an estimated 92% of them were receiving support from the tax credits. 

During a contentious town hall on Nov. 11, 2025, Miller-Meeks said that the premium tax credits were not changed when Congress voted to reopen the government with a continuing resolution, and she again labeled them as handouts to insurance companies. Several constituents in the audience reacted negatively, with one man yelling “Medicare for All!”

Republicans have routinely failed to propose a health care plan that would lower costs for consumers. Many moderate Democrats continue to advocate for strengthening the ACA, while an increasing number of progressives and others are supporting the Medicare for All Act. 

Democratic Congressional Campaign Committee spokesperson Katie Smith told Heartland Signal that the donations show that Miller-Meeks’ loyalty is with special interests instead of her constituents.

“Mariannette Miller-Meeks took tens of thousands of dollars from insurance and pharmaceutical companies at the same time that she crusaded against tax credits to help Iowans afford their health care,” Smith said. “Typical for Miller-Meeks, who does the bidding of special interests while telling Iowans they should pay more for health care and ‘gargle with salt water’ instead of seeing a doctor.”

Miller-Meeks’ office did not respond to a request to comment on the donations and whether Iowans should be concerned about them.