The One Big Beautiful Bill Act pulls money out of Medicaid by making adults prove work hours to stay enrolled and by capping the provider taxes states use to pay their share, and Brad Knott, the House member for North Carolina's 13th District, voted for it twice: his yes on May 22, 2025 was one of the 215 that beat 214, and he was a yes on the final law on July 3. KFF's division of the national cut takes $22.5 billion in federal Medicaid funding from North Carolina over ten years.
Before the bill was written, Knott cast deciding votes in February and April 2025 for the budget resolution that ordered the committee over Medicaid to produce at least $880 billion in savings. In his district, KFF counts 216,400 Medicaid enrollees, about one resident in four.
Brad Knott's Votes for the Medicaid Cuts and Hospital Payment Limits
- Knott's Two Yes Votes Went to a $911 Billion Medicaid Cut That Takes $22.5 Billion From North Carolina. On May 22, 2025, Brad Knott voted yes on the House version of H.R. 1, which cleared the chamber 215 to 214 with one member answering present, so it needed his vote to pass. On July 3, 2025, Knott voted yes again as the final law passed 218 to 214. Mostly through work requirements, provider-tax and state-directed-payment limits, and more frequent eligibility checks, the law reduces federal Medicaid spending by $911 billion across ten years and leaves 10 million more Americans uninsured in 2034, by Congressional Budget Office estimates that KFF reports. North Carolina's slice, in KFF's state-by-state split, is $22.5 billion, or 11 cents of every federal Medicaid dollar it had been on track to collect.
- Knott's Deciding Budget Votes Gave Medicaid's Committee an $880 Billion Savings Target, Ahead of the Law's Caps on Provider Taxes and Hospital Payments. Knott's yes votes adopted H.Con.Res. 14 by 217-215 on February 25, 2025, and then its Senate-amended text by 216-214 on April 10, 2025; with his vote reversed, either one would have tied, and a tie fails in the House. The resolution instructed the Energy and Commerce Committee, which has jurisdiction over Medicaid, to "reduce the deficit by not less than $880,000,000,000". On May 22 he also voted for the rule under which the House took up H.R. 1. Knott's July 3, 2025 yes then went to a final law containing a cap on provider taxes, the levies on hospitals and other providers that states use to raise their share of Medicaid, a change CBO prices at $191 billion less in federal funding over ten years, and new ceilings on state-directed payments, under which KFF expects "payment rates for hospital services will decrease in at least 37 states" from 2028. In North Carolina, KFF calculates, roughly $3.44 billion of yearly federal hospital spending exceeds those ceilings.
How the Medicaid Law Brad Knott Voted For Reaches North Carolina's 13th District and Its Hospitals
- 216,400 people in North Carolina's 13th District depend on the Medicaid program the law shrinks. One in four residents of North Carolina's 13th District, 216,400 people, had Medicaid in 2025, by KFF's count: 80,000 of them children, 20,900 seniors and 24,000 people with disabilities, plus 42,600 adults in the expansion group. Each federal dollar the law removes is money that had paid for their checkups, prescriptions and hospital stays.
- As many as a quarter-million North Carolinians could lose Medicaid from 2027, and 300,000 more will be uninsured in 2034. WRAL reported in May 2026 that the law's changes could push up to a quarter-million people in North Carolina out of Medicaid beginning in 2027, and KFF projects the law by itself adds 300,000 North Carolinians to the uninsured in 2034, raising the state's uninsured rate 3 points. For those families, a clinic visit or an inhaler refill becomes a bill paid out of pocket or skipped.
- The cap on hospital taxes puts North Carolina's Medicaid expansion and its 685,000 enrollees at risk. North Carolina pays its part of expansion, which has covered more than 685,000 additional people, with hospital assessments, and the North Carolina Medical Journal reported that the law's lower cap costs the state and its hospitals the HASP payment program, roughly $32 billion in federal money across a decade. A state law written into the expansion deal ends that coverage if the state's share "cannot be fully funded through the sources described in subsection" (b), Carolina Journal reported.
- Over ten years, rural North Carolina's federal Medicaid funding falls $6.37 billion, and its hospitals warn of service cuts. Over ten years, KFF expects federal Medicaid dollars in rural North Carolina to fall by $6.37 billion. FirstHealth of the Carolinas, which runs four hospitals, told legislators in April 2026 it is projected to run at a loss by 2032, and its finance chief said the law affects "what services are going to remain locally," with obstetric, cancer, behavioral health and emergency care among the services that lost revenue could force it to reduce.
Frequently Asked Questions About Brad Knott on Health Care
What is Brad Knott's record on health care under Trump?
Both House votes on the One Big Beautiful Bill Act in 2025 drew a yes from Brad Knott, and his May 22 vote was one the House version could not pass without. By CBO's estimate the enacted law trims $911 billion from federal Medicaid over a decade, with $22.5 billion of that coming out of North Carolina, according to KFF. Earlier in 2025, the budget plan with the $880 billion instruction to the committee over Medicaid cleared the House twice by margins Knott's switch would have erased. KFF projects 300,000 more uninsured North Carolinians in 2034 as a result of the law.
How does the Medicaid work requirement Brad Knott voted for work for a parent in North Carolina?
Brad Knott's July 3, 2025 vote went to a law under which an adult in North Carolina's expansion group must log 80 hours a month of work, community service, a work program or half-time school, unless an exemption applies, and states must begin the rule "no later than January 1, 2027." A parent or caregiver is exempt only while caring for "a dependent child 13 years of age and under" or a disabled person, so a parent whose youngest child turns 14 must start reporting. The same law makes the state recheck expansion adults' eligibility "once every 6 months." In Knott's district, 42,600 people were enrolled through the expansion in 2025.
How do the hospital tax limits Brad Knott voted for affect North Carolina hospitals?
The law Brad Knott voted for lowers the ceiling on the provider taxes states charge hospitals from 6% in steps starting October 1, 2027, "settling at a new cap of 3.5% on October 1, 2031," the North Carolina Medical Journal reported, while North Carolina's existing taxes already sit around 4%. Those taxes fund the state's share of expansion and its HASP hospital payments. By KFF's count, roughly $3.44 billion of the federal money North Carolina directs to hospitals each year is over the law's new payment ceilings.
Could Brad Knott have stopped the Medicaid cuts in the House?
Yes, at more than one point: on May 22, 2025 the House version passed 215-214, so Brad Knott's yes was indispensable. Two July 2, 2025 procedural votes on taking up the final version, the question of consideration (212-211) and the previous question (214-212), also turned on him, since his switch would have sunk the first and tied the second. Final passage on July 3, 218-214, carried with his yes.
Last updated: 2026-10-27