Medicaid pays Medicare premiums and copays for many seniors with low incomes, and two Biden-era rules made that help easier to get; the One Big Beautiful Bill Act halts most of both, a step that an earlier Congressional Budget Office estimate, made before the Senate's changes, linked to 1.3 million fewer Medicare enrollees holding Medicaid coverage in 2034. Ann Wagner, who represents Missouri's 2nd District, cast one of the 215 votes the House bill needed on May 22, 2025, and voted for the final law on July 3.
The same law cuts off Medicare for some immigrants who are in the country legally and paid into the program, and it lets more orphan drugs escape price negotiation. Its tax cut on Social Security benefits, which fit within the tax room set by the budget resolution Wagner's April 2025 vote decided, leaves less money flowing into Medicare's hospital trust fund, whose reserves the trustees expect to be gone in 2033, one quarter earlier than last year's projection. Missouri had 1,331,378 people on Medicare in 2024.
Ann Wagner's Votes on Medicare
- Wagner's Deciding Vote Passed a Freeze on Premium-Help Rules That CBO Earlier Tied to 1.3 Million Fewer Medicare Enrollees With Medicaid. Ann Wagner voted yes on May 22, 2025 as H.R. 1 cleared the House 215 to 214, one member voting present, so it would have failed had she voted no. The bill, and the final law she voted for on July 3, 2025, put a moratorium on most of two Biden-era rules that simplified signing up for the programs through which Medicaid covers Medicare premiums and cost sharing for seniors with little income. Delaying those rules, by an earlier Congressional Budget Office count, would mean 1.3 million fewer Medicare enrollees also covered by Medicaid in 2034. A senior who loses that help could end up "paying $185 per month in Medicare premiums, or about 20% of income," KFF calculates.
- Section 71201 of the Law Wagner Voted For Ends Medicare for Legal Immigrants Without Green Cards, Starting February 2027 Under CMS's Proposed Timeline. Wagner also voted for the Senate-amended bill on July 3, 2025, when the House concurred 218 to 214. Its section 71201 ends Medicare for people lawfully in the United States who are not citizens or green-card holders, outside a few named groups, even though they keep paying Medicare payroll taxes. Under CMS's proposed timeline, as the Center for Medicare Advocacy describes it, coverage for enrollees identified during the grace period ends on February 1, 2027. KFF notes "this is the first time that Congress has eliminated Medicare coverage" from legally residing people who qualified, and the Congressional Budget Office counts 0.1 million beneficiaries losing coverage by 2034. A separate section widens the orphan-drug exemption from price negotiation, which costs Medicare an additional $8.8 billion and delays negotiation on the cancer drugs Keytruda and Opdivo.
- Wagner's Deciding Budget Vote Opened Tax Room, and the Benefits Tax Cut in the Law She Voted For in July Starves Medicare's Hospital Fund. On April 10, 2025, Wagner voted to adopt the final H.Con.Res. 14, which passed 216 to 214. Reverse her vote and it is 215 apiece, an even split that defeats a resolution. Under it, Ways and Means could draft tax cuts that "increase the deficit by not more than $4,500,000,000,000". One of them, in the final law she voted for on July 3, 2025, lowers the income tax retirees owe on Social Security, and part of that tax is credited to the fund for Medicare hospital coverage, so that money shrinks. The trustees now project the Part A trust fund running out in 2033, a quarter sooner than before, primarily because that revenue is "lower than previously projected due to changes in the 2025 budget reconciliation bill," KFF reports; at that point hospital payments face an 11% cut, according to the Committee for a Responsible Federal Budget.
What Ann Wagner's Medicare Votes Mean for Missouri's 1.33 Million Enrollees
- Low-income seniors in Missouri's 2nd District stand to lose help with Medicare costs. Medicaid covered 7,300 seniors in Missouri's 2nd District in 2025, KFF data show. Freezing the rules that eased enrollment in Medicare premium help means fewer poor seniors like them get it, and one who goes without could pay about $185 a month in Medicare premiums; KFF puts that at roughly a fifth of the income of a senior living on $967 a month.
- 1.33 million Missourians on Medicare face hospital payment cuts sooner because of the law. Of Missouri's 1,331,378 Medicare enrollees in 2024, KFF counts 625,185 in the traditional program and the rest in private Medicare Advantage plans. With the hospital trust fund now expected to run out in 2033, a quarter earlier than before, payments for their hospital stays face an 11% cut that year unless Congress acts.
- Legally present Missouri immigrants on Medicare stand to lose coverage in 2027, under CMS's proposed timeline, after paying into it. Missouri residents on Medicare who are lawfully present but not green-card holders, citizens or members of the law's few protected groups would receive termination notices in late December 2026, with coverage ending February 1, 2027, under the CMS proposed timeline the Center for Medicare Advocacy describes; they then pay for hospital and doctor care with no Medicare at all.
- Missouri Medicare patients on drugs like Keytruda wait longer for negotiated prices. By widening the orphan-drug exemption, the law pushes back price negotiation on Keytruda and Opdivo by at least a year; Medicare and its enrollees spent $5.6 billion on Keytruda in 2023, so Missouri cancer patients on it keep paying coinsurance on an unnegotiated price longer.
Frequently Asked Questions About Ann Wagner on Medicare
What is Ann Wagner's record on Medicare under Trump?
Ann Wagner cast a deciding House vote in May 2025 for the One Big Beautiful Bill Act and voted for the final law in July; it freezes rules that eased low-income seniors' access to help with Medicare costs, ends Medicare for some legally present immigrants, and widens a drug-pricing exemption that costs Medicare $8.8 billion. That law's tax change, which fit in room her deciding April 2025 budget vote had opened, is behind the hospital fund's depletion one quarter earlier, in 2033, a concern for the 1.33 million Medicare enrollees in Missouri.
How would the rule freeze Ann Wagner voted for change Medicare costs for a low-income Missouri senior?
Ann Wagner voted for a law that stops most of two rules from taking effect; they were written so seniors with low incomes could more easily get Medicaid to pick up their Medicare premiums and cost sharing. A Missouri senior who misses out on that help could pay "$185 per month in Medicare premiums," about a fifth of income for someone on $967 a month, KFF estimates, plus deductibles and copays the programs would have covered.
For a legal immigrant in Missouri already on Medicare, what does the cutoff Ann Wagner voted for do?
Under section 71201 of the law Ann Wagner voted for, a Missouri enrollee who is lawfully present but not a citizen or green-card holder, and not in one of the few exempt groups, loses Medicare even after paying Medicare payroll taxes. Those flagged during the grace period get preliminary notices from August through November 2026 under the timeline CMS has proposed, and their coverage would end with January 2027.
What does the earlier Medicare shortfall from Ann Wagner's votes mean for a Missouri hospital patient?
On July 3, 2025, Ann Wagner voted for the final law and its lower tax on Social Security benefits, which reduces money for Medicare's hospital trust fund, after her deciding vote on the April 2025 budget resolution had made room for that tax cut; the trustees now expect that fund to be depleted in 2033, a quarter earlier than they projected a year before. If it is, the Committee for a Responsible Federal Budget says hospital payments would be cut 11%, growing to 16% by 2040, and that cut could delay or deny payments to the providers treating Missouri patients.
Last updated: 2026-10-27