(Radio Iowa) – A new report ranks Iowa’s health system 18th out of the 50 states. The report by the nonpartisan Commonwealth Fund finds Iowa has low rates of drug overdose deaths and adults who go without care because of the cost, but it shows Iowa also has some of the nation’s highest obesity rates.

The fund’s Sara Collins says current federal proposals to add work requirements to Medicaid could cause Iowa’s uninsured rate to rise, as most people on Medicaid already work. “The reporting requirements will be the thing that really does lead to people dis-enrolling and becoming uninsured,” Collins says. “People really have no other options.”

While Iowa placed 18th overall, the report ranked the state 11th for access and affordability. The report found Iowa’s uninsured rate dropped from more than 12-percent in 2013 to about seven-percent a decade later. Collins says proposed cuts to the Affordable Care Act and Medicaid at the federal level could reverse that trend. “As we make it harder for people to access both of those, we’re likely to see people just becoming uninsured because the reality is, they still don’t have access to employer-based coverage,” she says.

Republican lawmakers proposed cuts to federal health programs to offset revenue loss from large tax cuts proposed under the budget reconciliation bill. Iowa lawmakers also passed Medicaid work requirements at the state level last session and are waiting on federal approval to implement them.