Health care in America got a lot more expensive this year, and it wasn't an accident. Somebody voted for it.

The "One Big Beautiful Bill" that House Republicans passed on July 3, 2025 cuts more than $900 billion out of federal Medicaid spending over a decade — the Congressional Budget Office projects that alone will push about 7.5 million more people into the ranks of the uninsured. Then Congress let the enhanced ACA tax credits lapse at the end of 2025. The result showed up in January: the average person buying their own insurance saw their monthly premium payment jump 58%, deductibles hit a record $3,786, and roughly 4.8 million people dropped off marketplace coverage — the sharpest one-year drop since the ACA began.

Congress got one clean chance to undo the premium spike. On January 8, 2026, the House passed a three-year extension of the subsidies, 230–196 — 17 Republicans broke with their own leadership to do it. Every House Republican below voted no.

Here's who did the most damage, and what they told us while they did it.

Tim Moore spent a decade telling uninsured people to get a job

Before he came to Congress, Tim Moore ran the North Carolina House for ten years, and for most of them he personally kept Medicaid expansion off the table. His reason, in his own words: "the best thing that folks can do is to get a job." The same WRAL editorial put a price on that philosophy — roughly $20 billion in federal Medicaid money North Carolina walked away from since 2015, plus $5.7 billion in hospital reimbursements. In the meantime seven rural North Carolina hospitals closed, squeezed by patients who had no coverage and no way to pay.

He finally relented in 2023. Then he got to Congress and voted for the bill that could undo it all. North Carolina's expansion law contains a trigger: if federal funding drops below 90% of costs, the program automatically shuts off — for all 680,000 people who've gained coverage since 2023. A Chapel Hill doctor described what that means for her young Type 1 diabetes patients: "If they lose Medicaid, life is over. Like, it's just over. They're not going to make it to 30."

In July 2025, about a hundred clergy and neighbors carried an empty black casket to Moore's Gastonia office. It bore a portrait of Michael Danforth, who died at 33 after waiting 37 months for Medicaid disability assistance. "Blood is on the hands of the people who voted for the big bill," said his mother.

Chuck Edwards reassured a town hall, then complained the cuts were too small

In March 2025, Chuck Edwards stood in a packed auditorium in Asheville and told a furious crowd that the budget resolution he'd voted for "did not mention cutting those programs" and that there was "no intent from President Trump nor from the Congress" to disrupt anyone's benefits. The resolution required $880 billion in savings from the committee that runs Medicaid. There was no arithmetic that got there without cutting it.

Two months later, in the Budget Committee markup, Edwards said the quiet part out loud: "the flaw of this bill is that it doesn't go far enough, fast enough." He voted for it anyway, and voted for the final version, and then voted against restoring the ACA subsidies in January.

North Carolina paid for it faster than anywhere else in the country. ACA enrollment in the state fell about 22% for 2026 — roughly 214,000 fewer people covered, the largest drop in the United States.

David Schweikert called the people losing coverage bedwetters

David Schweikert voted for the bill, and when Arizonans got scared about what it would do to them, he went on a conservative radio show and said: "Think of the whining and the bedwetting over the Medicaid changes." More than 300,000 Arizonans are projected to lose health insurance because of the bill, including over 30,000 in his own district.

It isn't only coverage. Five rural Arizona hospitals — in Page, Winslow, Bisbee, Nogales, and Globe — are at risk of closing as the Medicaid money dries up. "Those people aren't going to get their care, and it's going to be a crisis," said the CEO of Cobre Valley Regional Medical Center. Schweikert also voted no on restoring the ACA subsidies. He is now running for governor of Arizona.

Abraham Hamadeh put "no cuts to Medicaid" in writing

The day the House sent the bill to Trump, Abraham Hamadeh issued a press release listing what he'd just voted for. Bullet point five: "Includes no cuts to Medicaid."

The CBO scored the same bill as cutting more than $900 billion from federal Medicaid spending. PolitiFact rated the "we're not changing Medicaid" line False, pointing to new work requirements, new copays, and a shortened retroactive coverage window — none of which is fraud enforcement.

Hamadeh voted no on the January subsidy extension too, while his constituents opened their 2026 renewal notices. The University of Arizona's Center for Rural Health documented one retired Scottsdale couple whose bronze plan went from $513 a month to $2,218.

Tony Wied promised he would never touch it

Running for the seat in 2024, Tony Wied was asked about the Affordable Care Act and said: "I would never do anything to pull that." In February 2025 he added, of Medicaid, "I would never be in favor of cutting benefits to those that need it" — the budget had merely "unlocked the potential to look into waste, fraud and abuse."

Five months later he voted for the bill, and in January he voted against putting the subsidies back. About 277,000 Wisconsin marketplace enrollees were getting those subsidies. One Milwaukee County enrollee described the new bill for the identical plan: "Instead of paying about $400, I'll be paying over a thousand dollars" a month — roughly $8,000 more a year.

Dan Sullivan and Susan Collins: the senators who objected once it was safe

Dan Sullivan voted for the bill and then told Alaskans — where about 260,000 people, one in three residents, are on Medicaid — that "the only people objectively and factually trying to cut Medicaid for Alaskans are Chuck Schumer and Senate Democrats." In December, with premiums about to spike and his own re-election coming, he finally voted to advance a subsidy extension — one that everybody in the room already knew was short of the 60 votes it needed. It failed.

Susan Collins runs the same play with better press. She let the big bill clear an early test vote while she negotiated for rural-hospital protections she never got, then cast the 50th and final "no" — which simply handed the tiebreaker to Vice President Vance and passed the bill 51–50. TIME's read: her protest votes are "as strategic as they are symbolic." Four months earlier she'd voted to confirm Robert F. Kennedy Jr. as Secretary of Health and Human Services, 52–48, on his assurance that he wouldn't restrict the polio vaccine.

The excuse doesn't survive contact with the receipts

Seven politicians, five states, one script. Promise nobody will lose coverage. Vote for the bill. Put "no cuts to Medicaid" in a press release. When the bills arrive, call the people opening them bedwetters, or cast a no vote timed to land after it can't change anything.

The tell is January 8. Seventeen Republicans looked at what the expired subsidies were doing to their constituents and voted to fix it. It wasn't impossible, and it wasn't disloyal — it was a choice. Every person on this page made the other one, and 4.8 million Americans lost their coverage.

They'll be asking for our votes with the receipts already printed.