The price tag for North Carolina is $22.5 billion: KFF reckons that is the federal Medicaid funding the state forgoes through 2034 once the One Big Beautiful Bill Act takes full effect, and David Rouzer of North Carolina's 7th District supplied one of the 215 ayes that beat 214 nays on May 22, 2025, then voted for the final law on July 3.
Before that, Rouzer's ayes in February and April 2025 were each indispensable to the budget resolution, which handed the committee over Medicaid an $880 billion savings target. A little under a third of his district, 253,600 people, had Medicaid in 2025.
David Rouzer's Votes on Medicaid and Health Coverage
- North Carolina Forgoes $22.5 Billion in Medicaid Funds Under the Law Rouzer Voted For in July 2025. On May 22, 2025, H.R. 1 squeaked through the House 215 to 214 while one member answered present, with David Rouzer's aye among the 215; with one fewer, it would have failed. On July 3, 2025, Rouzer was again an aye as the final version carried 218 to 214. Over ten years the law takes $911 billion out of federal Medicaid spending and, by 2034, leaves 10 million more people uninsured, the Congressional Budget Office projects. Split by state, KFF assigns North Carolina $22.5 billion of the cut, 11% of its expected federal Medicaid funding, and its estimate could run as low as $16.9 billion or as high as $28.2 billion.
- Rouzer Cast the Deciding Budget Votes Behind an $880 Billion Savings Target for Medicaid's Committee. Both votes on H.Con.Res. 14 hinged on Rouzer: the February 25, 2025 adoption was 217 to 215 and the April 10, 2025 agreement to the Senate's version was 216 to 214, so his no would have tied either vote, and a tie fails. Energy and Commerce, Medicaid's committee, was told to "reduce the deficit by not less than $880,000,000,000". In May 2025 Rouzer also voted for H.Res. 436, the rule for debating H.R. 1. The final law, which Rouzer voted for on July 3, 2025, limits state provider taxes, which alone cuts $191 billion in federal Medicaid funding over ten years in the Congressional Budget Office's score, and the new ceilings on state-directed payments mean "payment rates for hospital services will decrease in at least 37 states" from 2028, KFF found. For North Carolina, KFF puts about $3.44 billion a year of what Washington spends on the state's hospital care over those ceilings.
What David Rouzer's Medicaid Votes Cost North Carolina's 7th District, Its Hospitals and Its Expansion
- Nearly a third of North Carolina's 7th District, 253,600 people, depends on the Medicaid money the law cuts. Medicaid enrollment in North Carolina's 7th District stood at 253,600 in 2025, 31% of residents, by KFF's district data. Children make up 85,400 of them, alongside 25,700 seniors, 31,600 enrollees with disabilities and 56,500 expansion adults. Every one of them gets care paid partly with the federal share that the law shrinks.
- Up to a quarter-million North Carolinians could lose Medicaid, and 300,000 more will be uninsured in 2034. Starting in 2027, the law's changes could take Medicaid away from up to a quarter-million North Carolinians, according to WRAL's May 2026 reporting. Looking further out, the law on its own pushes 300,000 more North Carolinians into the uninsured column by 2034 in KFF's projection, 3 points on the state's uninsured rate, and for those households a sick visit or a night in the hospital becomes a debt.
- North Carolina's hospital-funded expansion stands to lose about $32 billion in federal support. By capping provider taxes, the law ends the benefit of the state's HASP hospital payments, about $32 billion in federal support across ten years, the North Carolina Medical Journal calculated. Hospital assessments also carry the state's share of the expansion, and North Carolina's 2023 expansion statute ends that coverage if the share "cannot be fully funded through the sources described in subsection (b)", the Carolina Journal pointed out. That threat reaches the 56,500 expansion enrollees in Rouzer's district.
- Rural North Carolina loses $6.37 billion in Medicaid funds over ten years. In rural North Carolina the law's ten-year Medicaid cut comes to $6.37 billion, KFF estimates. The gap shows up in what rural hospitals can keep open; FirstHealth of the Carolinas, which operates four hospitals, told legislators in April 2026 that "HR1 doesn't just affect our finances, but it affects what services are going to remain locally."
Frequently Asked Questions About David Rouzer on Health Care
What is David Rouzer's record on health care under Trump?
David Rouzer's health care record under Trump includes the One Big Beautiful Bill Act: the House version could not have passed on May 22, 2025 without his aye, and he cast an aye for the final law on July 3, 2025, a $911 billion, ten-year federal Medicaid reduction in the Congressional Budget Office's estimate. KFF puts North Carolina's piece at $22.5 billion. Rouzer's ayes also decided both 2025 budget-resolution votes that set the $880 billion savings target for Medicaid's committee.
What does David Rouzer's Medicaid vote cost North Carolina hospitals?
North Carolina hospitals take two hits from the law David Rouzer voted for. KFF expects the state's hospital provider tax to shrink, and it counts about $3.44 billion a year of federal payments for North Carolina hospital care above the new state-directed payment caps. The North Carolina Healthcare Association told WRAL that rural hospitals already lose money on Medicaid patients and that "Changes to state-directed payments will further widen this gap."
Will Medicaid patients in southeastern North Carolina's 7th District face work requirements because of David Rouzer's vote?
Yes. Under the law as finally passed with David Rouzer's July 3, 2025 aye, expansion adults keep Medicaid by logging 80 hours a month of a job, volunteer service or a work program, attending school half-time, a mix of these, or earning what 80 hours at the minimum wage pays, unless an exemption applies, and CMS says states must generally begin "no later than January 1, 2027." The 7th District had 56,500 expansion enrollees in 2025, and the federal rule projects national Medicaid enrollment dropping 2.3 million in fiscal 2027.
Last updated: 2026-10-27