David Rouzer and the One Big Beautiful Bill Act: His 18 House Roll Calls, Seven of Them Decisive, and the Medicaid Money North Carolina Loses

The bill for North Carolina comes to $22.5 billion in lost federal Medicaid money across ten years, by KFF's reckoning, and David Rouzer, the House member for North Carolina's 7th District, voted for the One Big Beautiful Bill Act at each stage of passage: the House version squeaked by 215 to 214 on May 22, 2025 with his aye, and the final law got his aye on July 3, 2025.

Seven of his 18 votes on the bill were decisive, among them both 2025 budget-resolution votes, which set deficit-reduction targets of at least $880 billion and $230 billion for the Medicaid and SNAP committees. In April 2026 he voted for a House resolution hailing the law's tax policies. North Carolina's tab includes 300,000 more uninsured residents by 2034 and some $52 million in fresh SNAP administrative costs for its counties.

David Rouzer's House Votes on the One Big Beautiful Bill Act, in Order

• February 2025: Rouzer's Aye Decided the House Budget Plan That Set $880 Billion and $230 Billion Savings Targets for the Medicaid and SNAP Committees. Three Rouzer ayes on February 25, 2025 moved the budget plan through the House: the first ordered the previous question on H.Res. 161, which governed debate, the second adopted that rule, and the third adopted H.Con.Res. 14 by 217 to 215, a two-vote margin that his no alone would have collapsed into a failing tie. By its terms, Medicaid's committee, Energy and Commerce, had to "reduce the deficit by not less than $880,000,000,000" over the decade; Agriculture, SNAP's committee, owed at least $230 billion; and Ways and Means could widen deficits by as much as $4.5 trillion for tax cuts.
• April 2025: Two More Deciding Rouzer Ayes Took Up and Adopted the Final Budget Plan and Its $880 Billion Savings Target for Medicaid's Committee. April 9, 2025 brought two Rouzer ayes on H.Res. 313, which brought the Senate's amended budget resolution to the floor: one to order the previous question, one to adopt the rule, which passed 216 to 215. A day later, the Senate text won House concurrence 216 to 214 with his aye, and both the rule and concurrence would have flipped had he alone voted no. The Senate text left the House committee instructions untouched, and the law that got Rouzer's aye on July 3, 2025 removes $911 billion of federal Medicaid funding over the decade, by the Congressional Budget Office's estimate as KFF reports it.
• May 2025: A One-Vote House Passage, With Rouzer Among the 215 Ayes. On May 22, 2025, H.R. 1 drew six Rouzer votes. Twice he voted to consider its rule, H.Res. 436, which carried 217 to 211 and then 216 to 211; he voted to order the previous question (213 to 211) and to adopt the rule itself (217 to 212). He also voted against the motion to recommit, whose tally was 212 for and 216 against. Then came passage, 215 to 214 with one present, and on both the previous question and passage his aye was the margin. Reworked by the Senate, it became a law whose Medicaid changes alone add 7.5 million uninsured Americans by 2034, KFF says, citing the Congressional Budget Office, and which stopped Planned Parenthood's Medicaid payments for a "1-year period".
• July 2025: Rouzer Voted for the Final Law That Leaves 10 Million More Uninsured, After Clearing Its Path With Two Procedural Ayes. Each of two July 2, 2025 procedural votes on H.Res. 566, which set terms for the Senate's text, needed Rouzer's aye: consideration won 212 to 211, and the previous question was ordered 214 to 212. His aye also went to the Foxx amendment (220 to 212), to the rule on July 3 (219 to 213), and to the motion to concur, final passage, 218 to 214. The president signed Public Law 119-21 on July 4, 2025. The final law's count, according to the Congressional Budget Office as reported by KFF: 10 million more people uninsured in 2034. SNAP loses $187 billion through 2034, roughly 20 percent, in CBPP's analysis.
• April 2026: Rouzer Voted for a Resolution Calling the Law Working Families' Tax Cuts, Though the Poorest Fifth Pay More. H.Res. 1156 passed the House 219 to 207 on April 16, 2026, Rouzer voting aye. The resolution dubs the law the "Working Families Tax Cuts" and claims it "will result in a 15 percent tax cut for Americans whose income is in the bottom 40 percent." ITEP's numbers point the other way at the bottom: "For the poorest fifth of Americans, the average tax change from OBBBA is a small tax increase" in 2026, even as the richest 1 percent see tax cuts averaging over $70,000.

What the One Big Beautiful Bill Act Costs North Carolina, Area by Area, After David Rouzer's Votes

• $22.5 billion in federal Medicaid funds leaves North Carolina. KFF assigns North Carolina $22.5 billion of the Congressional Budget Office's Medicaid cut, 11% of the federal share the state expected over ten years, the money behind checkups, hospital stays and nursing care, including for 253,600 enrollees in the 7th District. Rouzer's votes are laid out on David Rouzer's health care page.
• North Carolina hospitals forfeit about $32 billion in HASP support and carry $3.44 billion a year above the new caps. Because the law caps provider taxes, North Carolina's HASP hospital payments, worth about $32 billion in federal support over ten years, go away, the North Carolina Medical Journal reported. KFF tallies about $3.44 billion a year of federal spending on the state's hospital care over the new state-directed payment limits, and rural North Carolina's Medicaid funding falls $6.37 billion over ten years; services at Medicaid-dependent hospitals are what give.
• Medicare's hospital fund, relied on by 2.2 million North Carolinians, now runs out a quarter sooner, in mid-2033. Some 2,228,458 North Carolinians were on Medicare in 2024; under the law, the hospital trust fund is exhausted one quarter sooner, in the second quarter of 2033, and Medicare ends outright for some lawfully present immigrants. Details are on David Rouzer's Medicare page.
• Six in ten North Carolina nursing-home residents depend on Medicaid, and the 2024 staffing standard is blocked until 2034. Six in ten of North Carolina's 35,329 nursing-facility residents rely on Medicaid as their main payer, and the 2024 federal staffing standard for those facilities is on hold until 2034 under the law, as David Rouzer's elder care page explains.
• Disabled expansion adults in North Carolina will have to prove exemptions; 31,600 disabled enrollees are on Medicaid in the 7th District. KFF counts 31,600 Medicaid enrollees with disabilities in North Carolina's 7th District in 2025, and 22,300 North Carolinians sit on Medicaid home care waiting lists, while from 2027 the law requires disabled expansion adults to qualify for an exemption or log hours; David Rouzer's disability rights page has the votes.
• 16,568 North Carolinians got opioid medication through the Medicaid program the law cuts. Medicaid in North Carolina paid for opioid medication for 16,568 adults in 2021, out of 31,882 diagnosed, and starting by January 1, 2027 the work requirement reaches expansion adults, with exemptions for a substance use disorder or a disabling mental disorder; the exemptions are covered on David Rouzer's mental health and addiction page.
• $52 million in county SNAP costs now, and about $140 million in state benefit costs in fiscal 2028. Running SNAP falls to North Carolina's counties, which must cover about $52 million in added first-year administrative costs with no state help, NC Health News reported; in fiscal 2028, the state's error rate translates into about $140 million toward benefits by CBPP's estimate. See David Rouzer's food assistance page.
• North Carolina's SNAP caseload has dropped by more than 110,000 people. Between September 2025 and August 2026, North Carolina SNAP participation shrank by more than 110,000 people, according to NC Health News, and some 47,000 childless North Carolinians between 55 and 64 were at risk in CBPP's June 2025 estimate covering the Senate Agriculture Committee's plan, which had the same time-limit expansions; the record is on David Rouzer's homelessness and poverty page.
• Low earnings keep 56,000 children in North Carolina's 7th District from the whole child tax credit. The Columbia poverty center puts 56,000 children in North Carolina's 7th District, 37% of them, in families earning too little to collect the entire credit as the law writes it. David Rouzer's child care and families page has more.
• At insolvency, now a quarter sooner, North Carolina beneficiaries would lose $501 a month. The law costs Social Security a net $168.6 billion through 2034, its chief actuary estimates. When the retirement fund gives out, an across-the-board cut would average $501 a month for North Carolina beneficiaries, by CRFB's math, and the 7th District had 163,186 retired workers drawing benefits in December 2024. See David Rouzer's Social Security page.
• Leaving SAVE costs a North Carolina borrower $1,767 a year. CAP estimates that North Carolina borrowers switched from SAVE to the Repayment Assistance Plan owe an extra $1,767 per year on average; the votes behind it are on David Rouzer's student debt page.
• 300,000 more uninsured North Carolinians, and $13,600 a year for the top tenth. The law by itself pushes the number of uninsured North Carolinians up 300,000 by 2034, KFF projects, as the richest tenth of households nationwide gain roughly $13,600 a year in the Congressional Budget Office's estimate. His tax votes are on David Rouzer's taxes and deficit page.
• Working-age veterans among North Carolina's 47,000 in food-aid households lost their SNAP time-limit exemption. Averaged over 2021 to 2023, 47,000 North Carolina veterans lived in SNAP households, CBPP found, and those 18 to 64 with no child under 14 at home and no other exemption now face the three-month limit. More is on David Rouzer's veterans page.
• A North Carolina household's energy costs could climb by about $490 a year. Higher bills follow from the law's energy provisions: in Energy Innovation's projection, reported by CNBC, a typical North Carolina household's energy spending could run about $490 more a year by 2035.

Frequently Asked Questions About David Rouzer on One Big Beautiful Bill

Last updated: 2026-10-27

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