Section 71201 of the One Big Beautiful Bill Act ends Medicare eligibility for lawfully present immigrants who do not hold green cards, and Brad Knott, who represents North Carolina's 13th District, voted for that law on July 3, 2025, the first time Congress has taken Medicare from people who qualified for it; the Congressional Budget Office projects "0.1 million Medicare beneficiaries losing their Medicare coverage as of 2034."
Knott's deciding May 2025 vote passed a House bill freezing two enrollment rules, including one that eased low-income seniors' sign-up for the programs covering their Medicare premiums, a freeze the final law kept, and his deciding April 2025 budget vote cleared room for tax cuts that bring Medicare's hospital fund to depletion a quarter earlier. North Carolina had 2,228,458 people on Medicare in 2024.
Brad Knott's Votes on Medicare Eligibility, Premium Help and the Hospital Trust Fund
- Knott Voted for Section 71201, Which Ends Medicare for Refugees, Asylees and Other Lawfully Present Immigrants Without Green Cards. Brad Knott's July 3, 2025 yes helped pass the final One Big Beautiful Bill Act, 218-214. In section 71201, the law narrows Medicare to citizens, permanent residents and a short list of other categories, which cuts off lawfully present immigrants such as refugees and asylees. KFF notes "This is the first time that Congress has eliminated Medicare coverage" for people who were legally eligible; enrollees flagged in the grace period lose coverage on February 1, 2027 under CMS's proposed timeline. In another section, drugs for rare diseases get a wider shield from price negotiation, and CBO pegs the added Medicare spending at $8.8 billion.
- Knott's Deciding Vote Passed a House Bill Freezing Enrollment Rules, Including One That Helps Low-Income Seniors Get Premium Assistance. The House version of H.R. 1 needed Knott's May 22, 2025 yes to pass, 215-214 with one member voting present. Carried into the final law, it placed a moratorium on most of two rules: one that simplified enrollment in the Medicare Savings Programs, the Medicaid-run programs that pay Medicare premiums for low-income enrollees, and a broader one streamlining Medicaid enrollment. CBO had earlier estimated that pausing the rules means 1.3 million fewer Medicare beneficiaries on Medicaid in 2034, and KFF calculates that a senior who loses the help could end up "paying $185 per month in Medicare premiums, or about 20% of income."
- Knott's Deciding Budget Vote Made Room for Tax Cuts That Pull Revenue From Medicare's Hospital Trust Fund, in April 2025. Knott's April 10, 2025 yes adopted the final budget resolution, H.Con.Res. 14, 216-214, a margin his switch would have turned into a failing tie. It cleared Ways and Means to draft tax cuts that would "increase the deficit by not more than $4,500,000,000,000". Retirees now owe less income tax on their Social Security checks, and because a share of that tax flows into Medicare's hospital insurance trust fund, the fund takes in less: the Medicare trustees now date its exhaustion to the second quarter of 2033, earlier by one quarter than in last year's report, primarily as a result of revenue from that tax coming in "lower than previously projected due to changes in the 2025 budget reconciliation bill," KFF reports.
What the Medicare Changes Brad Knott Voted For Mean for North Carolina Enrollees
- 20,900 seniors in North Carolina's 13th District are on Medicaid, the program that pays premiums the frozen rules were meant to reach. KFF counts 20,900 seniors among Medicaid enrollees in North Carolina's 13th District in 2025. Low-income seniors get help with Medicare premiums and cost sharing through Medicaid, and with the enrollment rules frozen, an eligible senior who is not signed up keeps paying the full premium out of a fixed income.
- 2.2 million North Carolinians on Medicare depend on a hospital fund now projected to run short a quarter sooner. In 2024, 2,228,458 North Carolinians were enrolled in Medicare, including 994,906 in the traditional program, KFF reports. Their Medicare hospital coverage draws on the hospital insurance fund that the trustees now expect to be depleted in 2033, a quarter sooner than before the law.
Frequently Asked Questions About Brad Knott on Medicare
What is Brad Knott's record on Medicare under Trump?
Brad Knott's yes on July 3, 2025 helped pass a law that strips Medicare from lawfully present immigrants without green cards, the first such cut to people already eligible. His May 2025 vote was needed to pass the House bill that froze a rule helping low-income seniors pay Medicare premiums, and his April 2025 vote decided the budget resolution behind tax cuts that bring the hospital trust fund's projected depletion a quarter sooner, into the second quarter of 2033. Medicare covered 2,228,458 North Carolinians in 2024.
How does the Medicare cutoff Brad Knott voted for work for a refugee in North Carolina?
Under the law Brad Knott voted for, a refugee, asylee or other lawfully present immigrant in North Carolina who has Medicare but no green card loses eligibility, because section 71201 restricts the program to citizens, permanent residents and a few narrow groups. For people already identified during the grace period, coverage ends February 1, 2027 under the CMS proposal the Center for Medicare Advocacy describes, after which their hospital and doctor bills are no longer paid by Medicare.
How would the premium-help freeze Brad Knott voted for affect a low-income senior in North Carolina?
Brad Knott cast a deciding vote on May 22, 2025 for the House bill that, like the final law, freezes a rule that made it easier to enroll in the Medicaid programs that pay Medicare premiums. A North Carolina senior who would have been enrolled under those rules but is not could be left paying $185 a month in premiums, about a fifth of income, by KFF's estimate, and an earlier Congressional Budget Office analysis found 1.3 million fewer beneficiaries would have Medicaid coverage in 2034.
Does the law Brad Knott voted for slow Medicare drug price negotiation?
Yes. Passed with Brad Knott's yes on July 3, 2025, the law widens the exemption for orphan drugs, which treat rare diseases, from Medicare price negotiation, adding $8.8 billion to Medicare's costs by the Congressional Budget Office's estimate. KFF expects Keytruda and Opdivo, two cancer drugs, to come up for negotiation later, "by at least one year"; in 2023, "Medicare and beneficiaries spent $5.6 billion on Keytruda and $2.0 billion on Opdivo."
Last updated: 2026-10-27