Roger Marshall on Health Care: The Medicaid Cuts, the Rural Hospital Votes, and the Lapsed ACA Tax Credits in Kansas

Roger Marshall, the Republican U.S. senator from Kansas, cast a deciding vote on July 1, 2025 for the One Big Beautiful Bill Act, which the Congressional Budget Office says will cut federal health spending by more than $1 trillion and add 10 million people to the uninsured. The bill passed 50 to 50 with the Vice President breaking the tie. In Kansas, the REACH Healthcare Foundation projected 13,000 Kansans would lose Medicaid coverage and Kansas hospitals would lose $2.65 billion over 10 years.

Marshall also voted against a motion to protect rural hospitals from the bill and, in December 2025, against advancing a bill to extend the enhanced ACA premium tax credits. After the credits lapsed, the number of Kansans with marketplace coverage fell 20 percent. Marshall said the law's $50 billion rural health fund was "more than enough" to offset hospital losses from the Medicaid cuts; KFF found the fund will not offset reductions in federal Medicaid support.

Roger Marshall's Votes on Medicaid, Rural Hospitals and Health Insurance Costs

• Marshall Cast a Deciding Vote for the Law That Leaves 10 Million More Uninsured. On July 1, 2025, Roger Marshall voted yes on H.R. 1, which passed 50 to 50 with the Vice President's tie-breaking vote. CBO estimates the law reduces federal health spending by more than $1 trillion and increases the uninsured population by 10 million; its Medicaid changes alone cut federal Medicaid spending by $911 billion over 10 years.
• Marshall Voted Against Protecting Rural Hospitals From the Medicaid Cuts in June 2025. On June 30, 2025, Marshall voted no on Senator Ed Markey's motion on rural hospitals, which failed 49 to 51. Markey's motion sought to cut any provision of the bill that would make it more likely that rural hospitals close or cut services. In Kansas, 67 of 100 rural hospitals are at risk of closing, more than in any other state.
• Marshall Voted Against Striking the Medicaid Cuts and Spoke Against the Motion. On June 30, 2025, Marshall voted no on Senator Ron Wyden's motion to commit the bill on Medicaid, which failed 47 to 53, after he spoke on the floor against it. He also voted against motions on red tape, state provider taxes and hospital labor and delivery units, each of which failed 48 to 52.
• Marshall Voted Against Extending the ACA Premium Tax Credits in December 2025. On December 11, 2025, Marshall voted no on cloture for S. 3385, a bill to extend the enhanced health care premium tax credit; it got 51 votes but fell short of the 60 needed. He had also voted on June 30, 2025 against an amendment to extend the credits in the reconciliation bill. In 2026, average marketplace premium payments rose 58 percent, from $113 to $178 a month, and deductibles rose 37 percent to a record $3,786.
• Marshall Voted Against an April 2025 Budget Measure on Rural Hospital Closures. On April 5, 2025, Marshall voted no on a reserve fund to prevent Medicaid cuts that could lead to rural hospital closures, cost increases for people with other insurance, or more uncompensated care; it failed 49 to 50. He then voted for the budget resolution whose instructions produced the Medicaid cuts.
• Marshall Called the Rural Health Fund More Than Enough. Asked by the Emporia Gazette in an interview published July 10, 2025 whether the $50 billion rural hospital fund would offset Medicaid losses, Marshall said: "Yeah, I really do. I think it's more than enough." KFF found that the fund's grants will not offset reductions in federal Medicaid support, and the REACH Healthcare Foundation estimated the fund would bring Kansas hospitals $811 million against $2.65 billion in losses.
• Marshall Said the Bill Was Increasing Medicaid Funding. On the Senate floor on June 30, 2025, Marshall said, "We're increasing funding for Medicaid." CBO estimates the same law cuts federal Medicaid spending by $911 billion over 10 years, KFF reports.

What the Health Cuts Roger Marshall Voted For Mean for Kansas

• Thousands of Kansans have already lost Medicaid. Lacey Kennett of the Alliance for a Healthy Kansas said in July 2026 that about 20,000 to 30,000 Kansans have lost Medicaid, which covers children, pregnant women, people with disabilities and seniors; people without coverage skip preventive care and medicines until problems become emergencies, she said.
• Kansas hospitals face billions in lost Medicaid revenue. Kansas hospitals stand to lose $2.65 billion over 10 years, and United Methodist Health Ministry Fund chief David Jordan said they "cannot afford to absorb billions of dollars in Medicaid cuts without cutting services and or possibly closing their doors."
• A fifth of Kansas marketplace enrollees dropped coverage. After the enhanced tax credits expired, Kansans with marketplace coverage fell 20 percent from February 2025 to February 2026, and the share of Kansas enrollees in bronze plans rose from 34 percent to 47 percent, meaning higher deductibles for those who stayed insured.
• Rural Kansas hospitals already operate on thin margins. Of rural Kansas hospitals, 30 face immediate risk of closure and 87 percent operate in the red, so a loss of Medicaid revenue raises the chance a community loses its emergency room.

Frequently Asked Questions Roger Marshall on Health Care

Last updated: 2026-10-28

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