Derek Schmidt's deciding House vote on May 22, 2025 and his vote for the final law on July 3 put through a One Big Beautiful Bill Act that removes $3.351 billion of Kansas's federal Medicaid funding over ten years, 9% of its expected federal share.
Months earlier, the budget blueprint telling Medicaid's House committee to come up with $880 billion or more in deficit reduction had passed in February and again in April 2025 by margins Schmidt's yes decided. The final law he voted for in July caps the extra payments states route to hospitals, and in Kansas KFF counts about $256.8 million a year of federal hospital spending above those caps.
The patients behind those dollars are concentrated in his own district: in Kansas's 2nd District, 116,700 people, roughly one resident in six, were enrolled in Medicaid in 2025.
Derek Schmidt's Votes on Medicaid and Hospital Funding
- Kansas Loses $3.35 Billion in Federal Medicaid Funds Under the Law Schmidt Voted For, Starting With a Single-Vote House Margin in May 2025. H.R. 1 got through the House on May 22, 2025 by a single vote, 215 to 214, and Derek Schmidt's yes was part of that margin. Six weeks later, on July 3, 2025, he voted for the final One Big Beautiful Bill Act as it passed 218 to 214. Congressional Budget Office estimates show the law will pull an estimated $911 billion out of federal Medicaid over a decade and leave 10 million more people uninsured in 2034. Allocated by KFF state by state, the cut costs Kansas $3.351 billion over ten years, somewhere between $2.513 billion and $4.189 billion, equal to 9% of the federal Medicaid money it was due.
- Kansas Hospitals Face Payment Caps in the July 2025 Law That Followed the Budget Plan Schmidt's Deciding Votes Adopted. The House budget blueprint, H.Con.Res. 14, won 217 to 215 on February 25, 2025, and House members took up the Senate's rewrite, approving it 216 to 214 on April 10. Derek Schmidt voted yes both times, and a no from him on either day would have tied the vote, and a tie fails. The resolution ordered the Energy and Commerce Committee, which controls Medicaid law, to "reduce the deficit by not less than $880,000,000,000". In May he also voted for the rule that put H.R. 1 on the floor. The law that followed, which Schmidt voted for on July 3, 2025, cut Medicaid: tighter limits on provider taxes, the charges on hospitals and other providers that states use to fund their share of Medicaid, account for $191 billion over ten years by the Congressional Budget Office's estimate, and caps on state-directed payments mean, KFF found, that "payment rates for hospital services will decrease in at least 37 states" beginning in 2028.
What Derek Schmidt's Medicaid Votes Mean for Kansas Patients and Hospitals
- Medicaid covers 116,700 people in Kansas's 2nd District, the most of any Kansas district. With 116,700 people on Medicaid in 2025, Kansas's 2nd District has more enrollees than any of the state's other three districts, by KFF's count: 59,100 children, 23,800 adults, 21,000 people with disabilities and 12,800 seniors. Their doctors, nursing homes and hospitals are paid from federal Medicaid dollars that shrink under the law Derek Schmidt voted for in July 2025.
- 26,000 more Kansans will go without health insurance by 2034. The law on its own will leave 26,000 more Kansans uninsured in 2034, KFF projects, within a range of 19,000 to 32,000. Kansas never expanded Medicaid, but the law's end of Medicaid for many lawfully present immigrants, from October 1, 2026, and its shorter look-back for retroactive coverage, from January 1, 2027, which leaves patients and hospitals holding more bills run up before an application, both take effect in Kansas, according to KFF's guide to the law.
- Rural Kansas hospitals lose Medicaid money in a state already leading the nation in at-risk hospitals. Rural Kansas alone loses $1.083 billion in federal Medicaid money over the decade, according to KFF. Kansas leads every state in the number of rural hospitals at risk of closing, and starting in 2028 the law lowers hospitals' Medicaid payments by a tenth each year until they fall to the new cap, KCUR reported, leaving less money for emergency rooms and labor and delivery units in small towns.
- A $168 million hospital planned for southeast Kansas will not be built. On October 8, 2025, Freeman Health System said it would not build a planned hospital in southeast Kansas, a $168 million facility near Frontenac that had been designed for 50 beds. The Kansas Reflector reported that Freeman listed the law's "unpredictable impact" as one reason it called off the project.
Frequently Asked Questions About Derek Schmidt on Health Care
What is Derek Schmidt's record on health care under Trump?
Derek Schmidt's votes decided the 2025 budget blueprint in February and April and House passage of the One Big Beautiful Bill Act that May, and in July he voted for the final law. The law cuts federal Medicaid spending by $911 billion nationally and by $3.351 billion in Kansas over ten years. KFF projects it leaves 26,000 more Kansans uninsured in 2034, and its caps on hospital payments begin cutting rates in 2028.
Did Derek Schmidt's vote decide whether the Medicaid cuts passed the House?
Yes. H.R. 1 cleared the House 215 to 214 on May 22, 2025 with Derek Schmidt voting for it, so his no alone would have defeated it. His votes for the budget resolution, adopted 217 to 215 in February and 216 to 214 in April, were also each enough to change the result.
How much could Kansas hospitals lose under the Medicaid law Derek Schmidt voted for?
Derek Schmidt voted for a law under which Kansas hospitals lose $2.65 billion over a decade, the REACH Healthcare Foundation estimates. A Kansas Reflector report, carried by HPPR, cited a United Methodist Health Ministry Fund finding that total Medicaid reimbursement to rural Kansas hospitals falls 15% under the law, and it said 5,000 rural Kansans on Medicaid are expected to lose their coverage.
Does the health care law Derek Schmidt voted for take Medicaid away from immigrants in Kansas?
Derek Schmidt voted for a law on July 3, 2025 that, from October 1, 2026, limits Medicaid to green-card holders and a few other groups, so refugees and people granted asylum no longer qualify; many lawfully present immigrants lose eligibility. KFF's state table shows that restriction applies in Kansas even though the state never expanded Medicaid.
Last updated: 2026-10-27