The One Big Beautiful Bill Act shrinks Medicaid two ways, squeezing the provider taxes that states collect to pay their part of the program and requiring adults to file monthly proof of work, and together its changes trim federal Medicaid outlays by $911 billion in ten years. Ann Wagner, Republican of Missouri's 2nd District, was among the 215 who outvoted 214 on May 22, 2025, and when the Senate's rewrite came back she voted for the finished law on July 3. Missouri's portion, as KFF divides the cut, comes to $14.3 billion.
Months earlier, her votes in February and April 2025 were each the margin for H.Con.Res. 14, the budget blueprint that handed the Medicaid committee an $880 billion savings target. Of the 75,500 Medicaid enrollees counted in her district in 2025, 24,400 qualify through Missouri's expansion, the group the new reporting rule targets.
Ann Wagner's Votes on the Medicaid Cuts
- Wagner Was One of 215 Votes the House Bill Needed; the Final Law's Medicaid Cuts Cost Missouri $14.3 Billion, KFF Estimates. Ann Wagner's yes on May 22, 2025 was one of 215, against 214 noes and one present, that sent H.R. 1 out of the House; without her it would have died there. Six weeks later, on July 3, 2025, she voted yes again, and the final text passed 218 to 214. Congressional Budget Office scoring shows federal Medicaid dollars falling $911 billion over 2025 to 2034 under the law, with the uninsured count up by 10 million in 2034. Spread across the states by KFF, Missouri's slice is $14.3 billion, a figure KFF brackets between $10.7 billion and $17.9 billion, or 12% of what Washington would have sent.
- Wagner's Deciding Budget Votes Set the $880 Billion Savings Target Handed to the Committee Over Medicaid. Twice Wagner's vote was the margin on H.Con.Res. 14: on February 25, 2025, adoption by 217 to 215, and on April 10, 2025, the Senate-amended version by 216 to 214. Flip her alone and each ends in a tie, which defeats a resolution. Its text directed Energy and Commerce, the Medicaid committee, to "reduce the deficit by not less than $880,000,000,000". In May 2025 she also voted for the rule setting debate terms for H.R. 1. The final law she voted for on July 3 limits provider taxes, which are fees a state charges hospitals and nursing homes and then spends as its Medicaid match; the Congressional Budget Office prices that provision alone at $191 billion over a decade. The same law caps state-directed payments to hospitals, and KFF expects that "payment rates for hospital services will decrease in at least 37 states" once the caps start in 2028.
- The Work Rule in the Law Wagner Voted For Demands 80 Hours a Month From Expansion Adults and a Recheck Twice a Year. In the final law Wagner voted for, an adult enrolled through Medicaid expansion keeps coverage only by showing 80 hours each month on the job, doing community service, joining a work program, or carrying at least a half-time course load, unless an exemption fits. Eligibility gets reviewed "once every 6 months." Each state has to switch the rule on "no later than January 1, 2027." Federal Medicaid officials at CMS project that "enrollment would be reduced by 2.3 million individuals in FY 2027" from this rule.
How the Medicaid Cuts Ann Wagner Voted For Reach Missouri's 2nd District and the State
- One in ten residents of Missouri's 2nd District, 75,500 people, relies on the Medicaid program the law cuts. Missouri's 2nd District had 75,500 Medicaid enrollees in 2025, a tenth of its population, KFF counts: 28,800 children, 24,400 expansion adults, 7,900 other adults, 7,300 seniors and 7,200 people with disabilities. Each of them sees a doctor, fills a prescription or stays in a hospital on money drawn partly from the federal share the law reduces by $14.3 billion statewide, by KFF's estimate.
- 24,400 expansion adults in Wagner's district will have to report work hours from 2027 or risk being dropped, unless exempt. Missouri took up Medicaid expansion, which puts its expansion adults under the work rule, 24,400 of them in the 2nd District. Someone on unpredictable hours, or out of work for a stretch, who cannot document 80 hours in a given month can be cut off, and those who clear the bar face another round of paperwork six months on.
- 160,000 more Missourians go without insurance in 2034 because of the law. Looking only at the law, KFF projects Missouri's uninsured population rising by 160,000 people in 2034 (between 120,000 and 200,000), lifting the uninsured rate 3 points. For those households an ER trip or a mammogram turns into an out-of-pocket bill, or a skipped appointment.
- Rural Missouri gives up $4.53 billion of federal Medicaid funding over ten years. Missouri's rural areas lose $4.53 billion of federal Medicaid spending over a decade, by KFF's estimate. As a result, small-town hospitals and clinics with many Medicaid patients have far less coming in to pay nurses and keep units open.
- Missouri's hospital provider tax is projected to shrink under the new caps. KFF places Missouri's hospital tax on its list of provider taxes the law is expected to push down. For expansion states, the ceiling on those taxes steps down half a point every year starting October 1, 2027, cutting into the revenue Missouri uses to unlock federal Medicaid matching dollars for hospital care.
Frequently Asked Questions About Ann Wagner on Health Care
What is Ann Wagner's record on health care under Trump?
Ann Wagner supplied one of the votes the bill's House version needed in May 2025, then voted for the final law in July; Congressional Budget Office figures show it takes $911 billion out of federal Medicaid over ten years. Of that, KFF's allocation charges Missouri $14.3 billion. Her votes were also the margin on both versions of the budget resolution that set the $880 billion savings target for the committee over Medicaid. In her district, 24,400 expansion adults will face the work rule, which starts by January 1, 2027.
How does the Medicaid work requirement Ann Wagner voted for apply to a Missouri parent covered through expansion?
Ann Wagner voted on July 3, 2025 for a law under which a Missouri expansion enrollee must log 80 hours a month at a job, in community service or a work program, or attending school half-time or more, unless an exemption applies, such as being the parent or caretaker of "a dependent child 13 years of age and under". Once the youngest child turns 14, the parent has to report hours, and the state reviews eligibility every six months, with the rule live no later than January 1, 2027.
How do the provider-tax limits Ann Wagner voted for affect patients at Missouri hospitals?
Ann Wagner voted on July 3, 2025 for the law's limits on provider taxes, the charges Missouri puts on hospitals to raise its Medicaid match, and KFF expects Missouri's hospital tax to get smaller as the limit drops each year from October 1, 2027. On its own, the Congressional Budget Office estimates, the provider-tax provision leaves 1.1 million more people uninsured nationally in 2034, because states have less money to put up for federal matching funds.
What does Ann Wagner's vote mean for a Missouri family that loses Medicaid?
Ann Wagner voted for a law that removes $14.3 billion from Missouri's federal Medicaid funding over ten years by KFF's estimate, and KFF projects 160,000 more uninsured Missourians in 2034 from the law alone. A family that loses coverage pays for doctor visits and prescriptions itself or goes without them; in her district, 75,500 people were enrolled in 2025.
Last updated: 2026-10-27