Section 71201 of the One Big Beautiful Bill Act makes Medicare eligibility hinge on green-card status, so refugees, asylees and other lawfully present immigrants lose coverage even after enrolling; Derrick Van Orden, Wisconsin's 3rd District representative, voted for that law on July 3, 2025, and the Congressional Budget Office counts 0.1 million people losing Medicare because of it by 2034.
Van Orden's deciding House vote in May 2025 carried a freeze, which the final law kept, on two rules, one easing enrollment in the Medicare Savings Program and the other in Medicaid more broadly, with older adults and disabled people chiefly in mind. His deciding April 2025 vote for the budget resolution made room for tax changes that, by the Medicare trustees' reckoning, pull the hospital trust fund's projected depletion forward by one quarter, into the second quarter of 2033, a fund that 1,315,539 Wisconsin enrollees depended on in 2024.
Derrick Van Orden's Votes on Medicare Eligibility, Premium Help and the Hospital Trust Fund
- Section 71201's Green-Card Test Strips Medicare From Enrolled Refugees and Asylees, Enacted With Van Orden's July 2025 Vote. Derrick Van Orden was one of the 218 yeas, against 214 nays, that sent the Senate's version of H.R. 1 to the president on July 3, 2025. Its section 71201 withdraws Medicare from lawfully present immigrants without green cards, among them refugees and asylees, including people who were already enrolled. In KFF's words, "This is the first time that Congress has eliminated Medicare coverage" for people who qualified; the budget office foresees "0.1 million Medicare beneficiaries losing their Medicare coverage as of 2034," and anyone identified during the law's grace period loses coverage on February 1, 2027, if CMS finalizes the timeline the Center for Medicare Advocacy describes from its proposed rule. Elsewhere, the law lets more rare-disease drugs escape Medicare's price talks, a change the budget office says adds $8.8 billion to Medicare spending.
- A Freeze on Two Enrollment Rules Pulls Premium Help Away From Low-Income Seniors, Advanced by Van Orden's Deciding House Vote in May 2025. On May 22, 2025, H.R. 1 squeaked through the House 215 to 214 with Van Orden's yes, so his vote decided it. That bill, like the law it became, stopped most of two rules: a Medicare Savings Program enrollment rule, for the Medicaid help that pays Medicare premiums and cost sharing, and a broader Medicaid enrollment rule aimed especially at older adults and people with disabilities. Stopping those rules in the House bill, an earlier budget office analysis found, would leave 1.3 million fewer people on Medicare with Medicaid coverage in 2034, a figure KFF says could be smaller under the enacted law.
- Lower Taxes on Benefits Shrink Medicare's Hospital Fund Revenue, Enabled by Van Orden's Deciding Budget Vote in April 2025. The final budget resolution, H.Con.Res. 14, was adopted on April 10, 2025 by 216 to 214, Van Orden voting yes; a single switch by him ties it, and a tie fails. It gave the Ways and Means Committee room to write tax changes that "increase the deficit by not more than $4,500,000,000,000". On July 3, 2025, he voted for the final law that made those changes. One of those changes lowers the income tax owed on Social Security benefits, and that tax is one source of Medicare hospital funding. Medicare's trustees now date the hospital fund's depletion to the second quarter of 2033, one quarter ahead of last year's report, primarily because that revenue is "lower than previously projected due to changes in the 2025 budget reconciliation bill," according to KFF.
What Derrick Van Orden's Medicare Votes Mean for Wisconsin Enrollees
- 20,100 seniors in Wisconsin's 3rd District hold Medicaid, the help the enrollment freeze makes harder to get. KFF's district figures put Medicaid enrollment among seniors in Wisconsin's 3rd District at 20,100 in 2025. For a low-income senior, Medicaid is often what pays the Medicare premium, and the frozen rules were the ones meant to make that help easier to obtain and keep.
- Wisconsin's 1.3 million Medicare enrollees depend on a hospital fund the law drains faster. Medicare covered 1,315,539 Wisconsin residents in 2024, KFF reports: 749,070 through Medicare Advantage and other private plans and 566,468 through traditional Medicare. Their hospital coverage is paid from the trust fund whose projected depletion the law pulled three months earlier, into the second quarter of 2033.
Frequently Asked Questions About Derrick Van Orden on Medicare
What is Derrick Van Orden's record on Medicare under Trump?
Derrick Van Orden's July 3, 2025 vote helped enact a green-card test that pushes some enrolled immigrants with lawful status off Medicare, along with an orphan-drug change that raises Medicare's drug spending by $8.8 billion by sheltering more of those drugs from negotiation. His deciding House vote that May carried the pause on a Medicare Savings Program enrollment rule and a broader Medicaid enrollment rule. And in April 2025 his deciding budget vote opened the way for lower taxes on benefits, which the July law enacted and which move the projected depletion of Medicare's hospital fund one quarter earlier, into the second quarter of 2033.
How does the Medicare cutoff in Derrick Van Orden's vote work for a refugee in western Wisconsin who is already enrolled?
Under section 71201 of the law Derrick Van Orden voted for, an enrolled refugee or asylee in Wisconsin who has no green card no longer meets Medicare's eligibility rules. Under the timeline in CMS's proposed rule, as a Center for Medicare Advocacy fact sheet describes it, Medicare stops on February 1, 2027 for anyone the government flagged during the law's grace period.
What happens to a low-income senior in western Wisconsin who loses premium help after Derrick Van Orden's vote?
Derrick Van Orden's deciding May 22, 2025 vote advanced the freeze on two Medicaid enrollment rules, one of them for the programs that cover Medicare premiums for seniors with little income, and the final law kept it. A senior getting by on $967 a month who loses that help, KFF calculates, could be left "paying $185 per month in Medicare premiums, or about 20% of income."
Last updated: 2026-10-27