John McGuire's two House votes for the One Big Beautiful Bill Act, the first on May 22, 2025, when it passed by one vote, and the second for the final law on July 3, 2025, carry a $28.6 billion cut to Virginia's federal Medicaid funding over ten years, according to KFF.
Before the bill existed, McGuire's votes decided both rounds of the 2025 budget resolution, which ordered the committee that writes Medicaid law to produce at least $880 billion in deficit reduction. The Medicaid cuts in the law he voted for in July reach a program that covered 169,200 people in Virginia's 5th District in 2025, about one resident in five.
John McGuire's Votes on Medicaid and Health Coverage
- A $28.6 Billion Drop in Virginia's Federal Medicaid Funds Follows the House Bill McGuire Passed by One Vote and the Law He Voted For in July 2025. The House roll call on H.R. 1 of May 22, 2025 ended 215 to 214, a single present vote aside, and John McGuire's yes was part of that 215; subtract it and the bill dies. Six weeks later, on July 3, 2025, McGuire said yes once more, and the final law cleared 218 to 214 on its way to the president. Across the country, the Congressional Budget Office projects that federal Medicaid spending drops by $911 billion over ten years and that 10 million more people will be uninsured in 2034. Virginia's portion of the cut comes to $28.6 billion in KFF's state allocation, equal to 18% of what Washington would otherwise have sent the state for Medicaid.
- McGuire's Deciding Budget Votes Set a Savings Target for Medicaid's Committee in 2025, and the Law He Voted For in July Caps Hospital Payments. Two tallies on H.Con.Res. 14 show how close the budget plan came: 217 to 215 on February 25, 2025, and 216 to 214 for its final form on April 10, 2025. McGuire voted yes both times; had he alone flipped, the result would have been a tie, and a tie fails. Its order to the Energy and Commerce Committee, the panel with Medicaid in its jurisdiction, was to "reduce the deficit by not less than $880,000,000,000". He went on to vote for the rule that governed the H.R. 1 debate in May 2025. Among the Medicaid changes in the law McGuire voted for on July 3, 2025 are a ceiling on the provider taxes through which states raise their portion of Medicaid costs, scored by the Congressional Budget Office at $191 billion less federal Medicaid funding over ten years on its own, and tighter limits on state-directed payments to hospitals. KFF's reading of those limits is that "payment rates for hospital services will decrease in at least 37 states" starting January 1, 2028.
What John McGuire's Medicaid Votes Cost Virginia's 5th District and the State
- One in five 5th District residents, 169,200 people, count on the Medicaid program McGuire's votes cut. The 2025 KFF tally for Virginia's 5th District is 169,200 people on Medicaid, 21% of the population, among them 60,700 adults in Virginia's Medicaid expansion, 51,300 children, 22,400 other adults, 17,800 people with disabilities and 17,000 seniors. The pediatric visits, nursing care and prescriptions they depend on are paid for partly with the federal Medicaid money the law cuts.
- 310,000 more Virginians will have no health insurance in 2034 because of the law. KFF's projection has the law, by itself, leaving 310,000 additional Virginians without coverage in 2034, a 3-point rise in the share of the state without insurance; for those people a sick visit, an inhaler refill or an emergency room trip turns into a bill they pay themselves or put off.
- Rural Virginia's federal Medicaid funding falls $5.95 billion over ten years. Over ten years, rural Virginia's federal Medicaid funding falls by $5.95 billion, KFF estimates, money that pays for care at the hospitals and clinics serving the state's rural counties.
Frequently Asked Questions About John McGuire on Health Care
What is John McGuire's record on health care under Trump?
John McGuire was among the 215 members whose votes moved H.R. 1, the One Big Beautiful Bill Act, past the House 215 to 214 in May 2025, and voted for the final version that July, a law that lowers federal Medicaid outlays by $911 billion in its first decade, per the Congressional Budget Office. KFF assigns Virginia $28.6 billion of that reduction. McGuire's votes also decided the February and April 2025 budget resolution votes, which demanded at least $880 billion from the Medicaid committee.
When do Medicaid work requirements start in Virginia because of John McGuire's vote?
Virginia, as a Medicaid expansion state, has to switch the requirement on "no later than January 1, 2027," according to the CMS rule carrying out the law that John McGuire approved with his July 3, 2025 vote. From then on an expansion adult who fits no exemption needs 80 hours a month of a job, volunteer work, job training or half-time classes to stay covered, and the state must review eligibility "once every 6 months." There are 60,700 such adults on Medicaid in Virginia's 5th District, by KFF's count.
Are Virginia hospitals losing federal money because of John McGuire's votes?
By KFF's numbers, yes: the law John McGuire voted for on July 3, 2025, after his deciding budget votes, limits state-directed hospital payments, and KFF calculates that $2.36 billion a year of federal state-directed payments for Virginia hospitals is over the new limits. KFF also lists Virginia's hospital provider tax among those the law is expected to shrink, a second hit to the money hospitals in the state receive.
Last updated: 2026-10-27