Fact Checker: What is Cindy Axne’s record on affordable health care?

A screen shot from a Protect Our Care advertisement, which first ran on April 13, 2022, praised Axne’s record on affordable health care legislation in Congress. (Submitted)

On April 13, Protect Our Care launched a new ad praising Democratic US Rep. Cindy Axne of Iowa’s 3rd Congressional district for her work to reduce health care costs for families.

the 30-second ad is part of a $5 million campaign on television and streaming services in eight key districts around the country from the left-leaning health care advocacy organization. Protect Our Carea 501(c)(4) project under incubator Sixteen Thirty Fundlobbies for the preservation of the Patient Protection and Affordable Care Act, popularly known as “Obamacare,” and describes itself as a “dedicated war room” for the act launched at the beginning of the pandemic in March 2020. The ad has been replicated with identical claims for other representatives in Congress as well.

Let’s take a look at the claims in the ad, which introduces Axne with this statement before launching into three claims:

“Too many families worry about the cost of health care and prescription drugs. So Congresswoman Cindy Axne did something about it.”

Claim: “… Passing a bipartisan bill banning surprise medical bills.”

Protect Our Care cited a CNN Politics article published in December 2020 about Congress moving to stop surprise medical billing as part of a spending deal.

Surprise medical billing used to happen when patients with health insurance received care from out-of-network doctors and hospitals, or from out-of-network health care providers while receiving care at in-network facilities, often for emergencies.

The new rules have aimed to protect patients by limiting excessive out-of-pocket costs and ensuring emergency services are continued without prior authorizations, regardless of whether patients are within their insurance network.

“Previously, if consumers had health coverage and got care from an out-of-network provider, their health plan usually wouldn’t cover the entire out-of-network cost,” said an explanation from the Centers for Medicare & Medicaid Services. “In many cases, the out-of-network provider could bill consumers for the difference between the charges the provider billed, and the amount paid by the consumer’s health plan. This is known as balance billing.”

The idea was first introduced with HR 3630, the No Surprises Actwhich was forwarded to full committee via voice vote in July 2019. After that, no action was taken on the idea until it was rolled into HR 133, the Consolidated Appropriations Actwhich was signed by President Donald Trump on Dec. 27, 2020.

Though the Consolidated Appropriations Act was significantly broader than protections for surprise medical billing, Axne did vote yes on HR 133 alongside many other Democrats and Republicans.

Though Axne did not, by herself, pass this bill, her vote did help to pass it. Grade: A

Claim: “Now, Congresswoman Axne is working to lower costs even more by giving Medicare the power to negotiate lower drug prices, and capping the cost of insulin.”

This claim is broken into two parts, one for Medicare drug negotiation and one for capping the cost of insulin.

For the former, Protect Our Care cited a vox article about House Democrats passing the Build Back Better Act, a $185 trillion social spending bill.

Among many other things on the Democratic Party’s wish list, the bill included provisions requiring the Department of Health and Human Services, which administers Medicare and Medicaid, to negotiate maximum prices for certain brand-name drugs under Medicare.

Axne voted yes on this bill, which passed largely along party lines in the House in November 2021. It’s worth noting that the Build Back Better Act stalled in the Senate, with little chance of passing.

For the latter, Protect Our Care cited articles on the House passing HR 6833, the Affordable Insulin Now Actwhich would cap insulin prices for patients at either $35 a month or 25 percent of an insurance plan’s negotiated price, whichever is lower.

Axne voted yes on this bill, too, which passed the House with a somewhat higher margin than the Build Back Better Act.

Insulin costs in Iowa has been a hot topic. On April 1, the Iowa Democratic Party criticized Republican US Reps. Randy Feenstra and Ashley Hinson for their votes on the insulin cost-capping measure.

The Affordable Insulin Now Act was received in the Senate on April 4, where it has been sitting without further action ever since.

Grade: A


Based solely on her votes on the three bills in question, the advertisement gets a relatively straightforward A on all measurable claims raised.

Axne’s election in 2018, when she defeated incumbent US Rep. David Young, found success in part with her message on Young’s health care record. Young’s vote to repeal and replace the Affordable Care Act in 2017 was a highlight in the race.


The Fact Checker team checks statements made by an Iowa political candidate or officeholder or a national candidate/officeholder about Iowa, or in political or public policy ads that appear in our market.

Claims must be independently verifiable. We give statements grades from A to F based on accuracy and context.

If you spot a claim you think needs checking, email us at

Members of the Fact Checker team are Elijah Decious, Erin Jordan, Marissa Payne and Michaela Ramm. This Fact Checker was researched and written by Elijah Decious.

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