Sen. Joni Ernst is facing scrutiny after her remark on Medicaid.

A one-sentence gaffe from Iowa’s junior senator has become a line of attack against Republicans nationally, with Democratic fundraising solicitations, political ads, social media and T-shirts now highlighting her words heading into the midterm elections.

Sen. Joni Ernst’s response of “we all are going to die” to a constituent who was complaining about proposed Medicaid cuts in President Trump’s “one big, beautiful bill” has also helped produce a 2026 GOP primary challenger for her and prompted several Iowa Democrats to announce bids for her seat.

The incident has shone a fresh spotlight on the Republican Party’s political vulnerabilities as well as Ernst’s uncertain political future, with some Iowa watchers wondering whether she will stand for re-election. She angered Trump’s MAGA allies last year, delayed her trademark summer motorcycle ride until the fall, and now has become the face of what Democrats paint as Republican cruelty toward poor people.

The nonpartisan Cook Political Report moved Ernst’s race from “solid Republican” to “likely Republican” in the wake of her remarks, even though the state has trended more red during Trump’s time on the national stage. More broadly, Republicans are defending a 53-47 majority in the Senate and are expected to retain it—as long as they don’t blow races in states like Iowa.

Democrats accuse Republicans of cutting Medicaid spending to pay for tax cuts for the wealthy, with Senate Minority Leader Chuck Schumer (D., N.Y.) playfully calling the GOP bill the “Well, We’re All Going to Die Act.”

Senate Minority Leader Chuck Schumer has given the ‘big, beautiful’ bill a different name.

Congressional candidates are expected to make the issue central to their midterm campaigns, and Ernst’s comment appeared in a recent Democratic fundraising solicitation for a Senate candidate in Michigan.

Ernst “has set the messaging tone for Democrats on this bill from here on out,” said Christina Freundlich, a Democratic strategist who has worked in Iowa.

GOP lawmakers said their legislation, which Trump wants on his desk by July 4, refocuses Medicaid to serve people they see as truly deserving while saving the federal government hundreds of billions of dollars. The program currently covers more than 70 million low-income adults and children, or about one in five Americans.

“Joni Ernst has done nothing but defend Medicaid for the Americans who need it most,” said Joanna Rodriguez, spokeswoman for the Senate Republicans’ campaign arm.

The Senate is aiming to vote soon on its changes to the House bill, which imposes work requirements on some recipients, among other changes. The Congressional Budget Office estimated that the bill that passed the House would push about 11 million people off Medicaid or other forms of health coverage.

Doubling down on a viral remark

Ernst’s utterance at a May 30 town hall was prompted by a Democrat in the audience who was yelling that people would die if the Medicaid cuts become law.

The senator doubled down on her original comment a day after she made it with a sarcastic apology video that appeared to be filmed in a cemetery. She said she assumed everyone knows “we are all going to perish from this Earth” and added that she was glad she didn’t have to bring up “the tooth fairy as well.”

A health-policy activist brought tombstone cutouts to Sen. Ernst’s office in Washington this month.

While the senator declined an interview request, aides suggested that Democrats were playing politics and pointed to her full remarks, which included that she wanted the program to focus on the most vulnerable.

“While Democrats fearmonger against strengthening the integrity of Medicaid, Sen. Ernst is focused on improving the lives of all Iowans, fighting to keep more of their hard-earned tax dollars in their own pockets, and ensuring their benefits are protected from waste, fraud, and abuse,” Palmer Brigham, an Ernst spokeswoman, said in a statement. She didn’t directly answer a question on whether Ernst would run next year.

Heading into the election, Ernst faces political pressure on both her left and right flanks. Former state Sen. Jim Carlin, a staunch conservative who failed in a 2022 primary challenge of Sen. Chuck Grassley, has announced plans to challenge her.

Democrats rush in

Several Democrats are competing ahead of a June 2026 primary for the right to challenge Ernst in November 2026.

Ernst’s “push to rip away Iowans’ healthcare—and then joke about it—makes her one of the most vulnerable Republican senators,” said Maeve Coyle, a spokeswoman for the Democratic Senatorial Campaign Committee.The best-known Democratic challenger so far is state Rep. J.D. Scholten, a minor-league baseball pitcher. Other announced Democrats are state Sen. Zach Wahls and Nathan Sage, former director of a local chamber of commerce and a Marine Corps veteran.A colorful phrase—“make ’em squeal”—helped send Ernst to Washington in 2015. A pledge in a campaign ad to do the same in Washington as she did as an Iowa farm kid castrating hogs gained her national attention.

Ten years later, Ernst’s political ascent within the GOP has stalled. The flap over her latest comments comes after she was easily beaten last year by Sen. Tom Cotton of Arkansas for the No. 3 spot in the Senate GOP hierarchy. Her political stock among Trump’s supporters fell after she raised concern about the nomination of his now-confirmed secretary of defense, Pete Hegseth. Ernst, a former Army National Guard commanding officer, ultimately backed him.While Ernst recently hired a manager for her 2026 campaign, speculation that she might not seek a third term is widespread in Washington and Iowa, according to several Republican consultants, aides and strategists who spoke to The Wall Street Journal.Adding to the uncertainty regarding Ernst is her decision to push back to the fall her annual “Roast and Ride” fundraising event, which is typically in early June.

In a state Trump won with 56% of the vote in 2024, Ernst would likely be favored to keep her seat if she moves forward and wins her primary.

The Ernst gaffe has triggered yet another candidacy: India May, the nurse and public library director who shouted at her that people would die if the Medicaid cuts are made, is now running for the state legislature.