¶ Overview
- Rouzer voted for a bill that would kick 17 million Americans off their health insurance, including nearly 12 million Americans off of Medicaid. As a result of his vote, more than 52,000 North Carolinians in the 7th congressional district could lose their health insurance. Rouzer vote could also threaten North Carolina’s Medicaid expansion, which has helped 650,000 people in the state obtain health insurance.
- Rouzer has also vocally supported repealing the Affordable Care Act and has repeatedly voted in congress to do so. More than 760,000 North Carolinians had enrolled in ACA exchange plans for 2026, which was a 22 percent drop in enrollment compared to 2025 – the largest drop in the United States. The drop could be partially attributed to the expiration of the enhanced ACA premium tax credits, which Rouzer voted against extending.
¶ Rouzer Supported Policies That Would Strip Thousands Of North Carolinians Of Their ACA And Medicaid Coverage
¶ rouzer voted to take health coverage from North CArolinians
¶ July 2025: Rouzer Voted For The Final Version Of The Republican Reconciliation Bill
July 2025: Rouzer Voted For The Senate FY 2025 Budget Reconciliation Bill That Extended $4 Trillion In Expiring Tax Cuts, Added New Tax Breaks, Appropriated $448 Billion In Defense, Border, And Immigration Enforcement Funding, Increased The SALT Deduction To $40,000, And Cut Medicaid And Other Social Programs To Offset The Costs. In July 2025, Rouzer voted for, according to Congressional Quarterly, the “motion to concur in the Senate amendment to the bill that would permanently extend nearly $4 trillion in expiring individual and business tax cuts, create several new tax breaks and fund border and immigration enforcement and air traffic control upgrades. It would cut Medicaid and other safety net programs to partly offset the cost. Among other provisions, it would raise the statutory debt ceiling by $5 trillion and appropriate more than $448 billion in mandatory funding for Trump administration priorities and other needs, including $153 billion for defense, $89 billion for immigration enforcement, and $89.5 billion for border control and security. It also would increase the state and local tax deduction cap to $40,000 annually for five years for households making up to $500,000 a year until 2030, when it would permanently revert to $10,000.” The House passed the bill by a vote of 218 to 214. [House Vote 190, 7/3/25; Congressional Quarterly, 7/3/25; Congressional Actions, H.R. 1]
- HEADLINE: "At Least 17 Million Americans Would Lose Insurance Under Trump Plan" [Washington Post, 7/1/25]
- The Congressional Budget Office Estimated That 11.8 Million People Would Become Uninsured As A Result Of The Medicaid Cuts In Republicans’ Reconciliation Bill. According to the Washington Post, "The bill, which narrowly passed the Senate on Tuesday and now heads back to the House, would effectively accomplish what Republicans have long failed to do: unwind many of the key components of the ACA, President Barack Obama’s signature domestic achievement, which dramatically increased the number of Americans with access to health insurance. To start, the Congressional Budget Office estimated that the Senate version of the bill would result in 11.8 million more uninsured in 2034, mostly because of Medicaid cuts, compared with 10.9 million if the House version became law." [Washington Post, 7/1/25]
¶ May 2025: Rouzer Voted In Favor Of House Republicans’ Reconciliation Bill, Which Cut Medicaid
2025: Rouzer Voted For The FY 2025 Budget Reconciliation Bill That Included $3.8 Trillion In Tax Cuts Offset By $1.5 Trillion In Spending Reductions To Programs Like Medicaid And The Supplemental Nutrition Assistance Program. In May 2025, Rouzer voted for, according to Congressional Quarterly, “the bill that would provide for approximately $3.8 trillion in net tax cuts and $321 billion in military, border enforcement and judiciary spending, offset by $1.5 trillion in spending reductions, as instructed in the fiscal 2025 budget resolution (H Con Res 14). It would raise the statutory debt limit by $4 trillion and provide for increased spending on defense and border security, spending cuts on social safety net programs, such as Medicaid and the Supplemental Nutrition Assistance Program. It also includes a mix of tax breaks for businesses and individuals; tax increases on universities and foundations; and a phase-down of clean energy tax credits. […] It would reduce federal spending on the Supplemental Nutrition Assistance Program by requiring states to shoulder more of the cost, expand work requirements for SNAP, extend programs authorized under the 2018 farm bill, and prohibit the U.S. Department of Agriculture from increasing the cost of the Thrifty Food Program. As amended, it would cap state and local tax deductions at $40,000 for households with incomes below $500,000.” The House passed the bill by a vote of 215 to 214. [House Vote 145, 5/22/25; Congressional Quarterly, 5/22/25; Congressional Actions, H.R. 1]
- The House GOP Budget Bill Was Estimated To Increase The Uninsured Population By 8.6 Million By 2034. According to CNN, “The Medicaid and Affordable Care Act provisions in the package could result in 8.6 million more people being uninsured in 2034, according to an early CBO estimate released by Democratic lawmakers. That number is expected to grow with the latest changes.” [CNN, 5/28/25]
- HEADLINE: “House Republican Budget Takes Away Health Care, Food Aid To Pay For Expanded Tax Cuts For Wealthy” [Center on Budget and Policy Priorities, 2/21/25]
- HEADLINE: “CBO: 7.6 Million Would Go Uninsured Under GOP Medicaid Bill” [Politico, 5/13/25]
¶ February 2025: Rouzer Voted For House Republicans’ Budget Framework, Which Set Up Future Cuts To Medicaid
2/25/25: Rouzer Voted For The FY 2025 Budget Framework That Included $2 Trillion In Cuts, Raised The Statutory Debt Limit By $4 Trillion, And Required House Committees To Recommend Legislation That Would Implement Trump’s Agenda. In February 2025, Rouzer voted for, according to Congressional Quarterly, “the concurrent resolution that would recommend a budget for fiscal 2025 and budget levels through fiscal 2034. The resolution would assume minimum savings of $1.5 trillion over 10 years and 2.6 percent economic growth over the same period. It also would require the statutory debt limit to be raised by $4 trillion. It also would authorize the House Ways and Means Committee to increase deficits by $4.5 trillion over 10 years to extend the 2017 tax cuts and implement new tax cuts proposed by the White House. It also would provide instructions for the budget reconciliation process through which separate legislation could be considered and passed in the Senate via a simple majority vote. The measure would deliver instructions to 11 House committees to report legislation that would implement President Donald Trump’s agenda, such as expanding tax cuts and bolstering border security and immigration enforcement. The committees would be required to report their legislative recommendations to the House Budget Committee by March 27, 2025. It also would set a $2 trillion target for the spending cuts to be submitted to the House Budget Committee. The resolution also would stipulate that if the committees don't reach that target, the Ways and Means’ reconciliation instructions to increase the deficit by a maximum of $4.5 trillion would be decreased by the amount the other committees come in below the target. Similarly, it would stipulate that Ways and Means could increase the deficit above the $4.5 trillion level by the amount of savings the committees achieve above the $2 trillion target.” The vote was on passage. The House passed the resolution by a vote of 217 to 215. [House Vote 50, 2/25/25; Congressional Quarterly, 2/25/25; Congressional Actions, H. Con. Res. 14]
- HEADLINE: "House Republican Budget Takes Away Health Care, Food Aid To Pay For Expanded Tax Cuts For Wealthy" [Center on Budget and Policy Priorities, 2/21/25]
- New York Times Reported The $880 Billion In Cuts Required By The Republican Budget Proposal Would Have To Come From Medicaid, Medicare, Or CHIP. According to the New York Times, "The budget resolution itself is silent on whether Congress cuts Medicaid, which provides health coverage to 72 million poor and disabled Americans. But it instructs the House Energy and Commerce Committee, which has jurisdiction over the program, to cut spending by $880 billion over the next decade. If the committee can’t save at least that much, the entire effort could be imperiled because of the special process Congress is using to avoid a Senate filibuster. Ten other committees have their own instructions to follow, though none have been assigned with cutting nearly as much. It’s not so simple as finding the cuts elsewhere. The special process, known as budget reconciliation, means Republicans will have to find all $880 billion from within the Energy and Commerce Committee’s jurisdiction. That leaves them with fewer options than one might think. […] If Republicans want to avoid major cuts to Medicaid, the largest pot of available money is in the other big government health insurance program: Medicare. […] Even if the committee cuts everything that’s not health care to $0, it will still be more than $600 billion short. The committee could also save around $200 billion by eliminating the Children’s Health Insurance Program, but that option has not been raised by the budget committee or anyone in House leadership. […] Even if all of these cuts, revenues and rule cancellations from outside health care can pass muster, the committee will still be left with hundreds of billions of dollars to cut to hit its goal. Mathematically, the budget committee’s instructions mean the committee would need to make major cuts to either Medicare, Medicaid or both." [New York Times, 2/25/25]
¶ Rouzer defended his support for the big beautiful bill, claiming it was a “win” for north carolinians
Rouzer In 2025: “The Truth Is We Want To Strengthen Medicaid By Eliminating The Almost $81 Billion Annually In Waste, Fraud, And Abuse As Identified By The General Accounting Office.” According to David Rouzer’s newsletter, “Since passing our Budget Resolution, Democrats and the mainstream media continue to say that Republicans in the House and Senate plan to cut Medicaid. The truth is we want to strengthen Medicaid by eliminating the almost $81 billion annually in waste, fraud, and abuse as identified by the General Accounting Office. This amount, over a ten year period (the period of time the Congressional Budget Office (CBO) uses to score legislation), equates to $810 billion in savings achieved just by closing those loopholes.” [Newsletter – Rep. David Rouzer, 3/23/25]
In Response To Federal Cuts Impacting North Carolina’s Medicaid Expansion Program, Rouzer Claimed He Was Working To “Strengthen Medicaid.” According to WECT News 6, “The House Committee on Energy and Commerce is discussing federal cuts that could affect North Carolina’s Medicaid Expansion Program. The state’s Medicaid Expansion Program extends coverage to low-income adults, but those people could lose coverage. […] The team for Republican Representative David Rouzer says they working to help patients. ‘Mr. Rouzer, along with Republicans in the House, is working to strengthen Medicaid and protect its core mission of providing a safety net to vulnerable Americans, especially mothers and children,’ says Rouzer’s team.” [WECT News 6, 4/24/25]
May 2025: Rouzer Touted The Big Beautiful Bill As A “Win” For Working Families And A “Historic Victory.” According to a press release from Rep. David Rouzer, "With support from Congressman David Rouzer, the U.S. House of Representatives passed One Big Beautiful Bill, furthering President Trump's America First Agenda. ‘Thursday morning marked an exciting and historic victory for the American people with House passage of President Trump’s One Big Beautiful Bill. This monumental legislation is a win for hardworking families in North Carolina and across the nation. It’s a testament to the unwavering commitment of House Republicans and President Trump to securing our borders, improving our economy, and ensuring American workers come first,’ said Congressman Rouzer. ‘I’m proud to support this bill which will boost job creation, reduce burdensome regulations, and strengthen our national security.’" [Press Release – Rep. David Rouzer, 5/23/25]
July 2025: Rouzer Touted The Big Beautiful Bill, Claiming It Had “Big Wins” For Americans Across The Country. According to a press release from Rep. David Rouzer, "With Congressman David Rouzer's support, the U.S. House of Representatives passed the One Big Beautiful Bill to provide historic tax relief to middle and working-class families and small businesses, and the largest investment in border security and our national defense in a generation. Fulfilling President Trump’s agenda will also rein in reckless spending, cut waste, fraud, and abuse as well as unleash energy dominance all of which will provide jet-fuel for the economy. ‘The One Big Beautiful Bill is historic legislation that delivers big wins to not just the fine citizens who live in North Carolina's Seventh Congressional District, but to Americans across the country,’ said Rep. Rouzer. ‘The bill prevents the largest tax hike in history by making permanent key tax cuts that will incentivize the investment and growth necessary to stimulate the economy and increase wages. It also secures our borders, strengthens our national defense, cuts waste, fraud, and abuse across the board, and supports American workers by excluding tips and overtime pay from being taxed, as well as providing tax rebates for seniors. Additionally, this bill enhances the safety net for our farm families critical to their ability to operate, provides a major infusion of funding for our great Coast Guard, and makes significant investments to modernize our Air Traffic Control, just to name a few of the many other key provisions.’" [Press Release – Rep. David Rouzer, 7/3/25]
MORE THAN 154,000 NORTH CAROLINIANS IN THE 7TH CONGRESSIONAL DISTRICT RELIED ON MEDICAID OR CHIP FOR HEALTH INSURANCE
2023: 154,583 North Carolinians In The 7th Congressional District Were Enrolled In Medicaid Or CHIP.
[Center for American Progress, 3/11/25]
¶ Rouzer’s Vote For The Big Ugly Bill Could Also Threaten North Carolina’s Medicaid Expansion, Which Has Helped More Than 600,000 People Gain Access To Health Insurance
¶ 2015: Rouzer PREVIOUSLY expressed opposition to medicaid expansion in north carolina
Rouzer In 2015: “When You Expand Medicaid You Are Losing More On It. It’s A Very Complicated Issue.” According to Bladen Journal, “Rouzer said the way to fix the system is to get government out of it and allow the states to have more flexibility. ‘North Carolina did not expand Medicaid because the state couldn’t afford to,’ said Rouzer, who also served in the N.C. General Assembly before seeking election to Congress. ‘When you expand Medicaid you are losing more on it. It’s a very complicated issue,’ said Rouzer.” [Bladen Journal, 2/19/15]
¶ the republican reconciliation bill could trigger a north carolina law that would discontinue medicaid expansion if the state was forced to pick up more costs
North Carolina Had A Trigger Law That Would Discontinue Medicaid Expansion If The State Was Forced To Pick Up Any Costs. According to North Carolina Health News, "Jay Ludlam, deputy secretary for NC Medicaid, explained that two key provisions of the version of the One Big Beautiful Bill that already passed the U.S. House — a work requirement for enrollees and a freeze on provider taxes — would jeopardize the North Carolina expansion program by creating an unfunded mandate for the state. Under the Affordable Care Act, the federal government pays 90 percent of the cost for beneficiaries of Medicaid expansion. Hospitals cover the remaining 10 percent of the state’s expansion costs through a special tax assessment. The General Assembly’s passage of expansion was contingent on that payment arrangement staying in place. State lawmakers designed the Access to Healthcare Options Act with a ‘trigger’ that discontinues Medicaid expansion if the state is forced to pick up any costs." [North Carolina Health News, 6/27/25]
- New Medicaid Requirements In The Republican Reconciliation Bill Could Require North Carolina To Invest In New Systems And Hire Additional Workers While Hamstringing Its Ability To Generate Revenue To Pay For The New System. According to North Carolina Health News, "The work requirement approved by the U.S. House and now up for consideration in the U.S. Senate would require states to verify that able-bodied Medicaid beneficiaries like Redfearn are working, volunteering or attending school for at least 80 hours a month. Ludlam said North Carolina would need to invest in new systems and hire additional workers to implement the requirement. But the state’s ability to generate revenue to pay for those systems and staff would be limited by the U.S. House’s proposed freeze on provider taxes that’s included in their version of the One Big Beautiful Bill. North Carolina uses the taxes — presently set at 6 percent of providers’ net revenue from patients — to draw down federal matching funds for Medicaid. The federal government reimburses North Carolina for about two-thirds of every Medicaid dollar the state spends on the program. The work verification effort would likely cost millions, if not tens of millions, of dollars to get started and to operate. If the state ends up spending money to check the work status of expansion beneficiaries, that could violate the condition placed on expansion by the General Assembly." [North Carolina Health News, 6/27/25]
- The Final Republican Reconciliation Bill Reduced The Maximum Amount That States That Had Expanded Medicaid Could Claim From Provider Taxes To 3.5 Percent From The Previous Six Percent.
[New York Times, 7/1/25]
- Opponents Of Restricting Provider Tax Authority Said It Would Create State Financing Gaps, Which Could Result In Higher State Taxes, Reductions In Coverage, And Fewer Benefits. According to KFF, "Opponents of such restrictions note that provider taxes are permissible under current law and help fund Medicaid; and restricting provider taxes will create financing gaps for states that could result in higher state taxes, reductions in Medicaid eligibility, lower provider payment rates, and fewer covered benefits. Both proponents and opponents of new restrictions agree that the limited data about provider taxes makes it difficult to assess states’ reliance on them as a funding source and to understand how they affect net payments to providers." [KFF, 3/26/25]
- KFF Said States Have Used Provider Tax Revenues To Fund Medicaid “Base” Rates And Supplemental Payments, Avoid Benefit Cuts, Expand Medicaid Benefits, And To Finance ACA Medicaid Expansion. According to KFF, "Medicaid provider taxes are defined as those for which at least 85% of the tax burden falls on health care items or services or entities that provide or pay for health care items or services (see Social Security Act, Section 1903(w)(3)(A)). States use provider tax revenues to fund Medicaid ‘base’ rates and supplemental payments, to avoid Medicaid benefit cuts, and to expand Medicaid benefits. Some states have used revenue from provider taxes to finance the ACA Medicaid expansion. Beyond helping finance the state share of Medicaid, permissible tax arrangements may have potential financial benefits for providers who are subject to the tax and serve a high volume of Medicaid patients." [KFF, 3/26/25]
¶ 650,000 north carolinians were able to obtain health insurance because of medicaid expansion
As Of April 2025, 650,000 North Carolinians Were Covered By Medicaid Expansion. According to a Governor Josh Stein press release, “Governor Josh Stein announced that as of today, 650,000 newly eligible North Carolinians have gained access to affordable health care through Medicaid expansion, including veterans and workers in child care, construction, hospitality, home health care and other industries essential to the state. ‘Medicaid expansion shows what is possible when our state’s leaders come together in a bipartisan effort to serve North Carolinians,’ said Governor Josh Stein. ’North Carolina’s Medicaid program is innovative and fiscally responsible. It delivers for taxpayers, helps keep people healthy, supports businesses and workforce and drives access to health care in rural communities. Medicaid strengthens North Carolina, and we need to protect it from damaging federal cuts.’” [Press Release – Governor Josh Stein, 4/9/25]
¶ Rouzer Vocally Supported Repealing The Affordable Care Act
¶ Rouzer vocally supported repealing the affordable care act
2016: Rouzer Promised The “Fight To Repeal Obamacare And Defund Planned Parenthood Is Not Over.” According to a press release from David Rouzer, "Since Obamacare was signed into law in 2010, it has been the goal of every conservative to get a bill that repeals this onerous law to the President's desk. Because of the change in control of the Senate resulting from the 2014 election, the House and Senate were able to put a bill on the President's desk repealing key provisions of Obamacare and preventing Planned Parenthood from receiving federal dollars through Medicaid reimbursements and other federal programs. Although the override vote was unsuccessful, the fight to repeal Obamacare and defund Planned Parenthood is not over." [Press Release – David Rouzer, 2/3/16]
- PRESS RELEASE: “Rep. Rouzer Supports Full Repeal of Obamacare.” [Press Release – David Rouzer, 2/3/15]
2012: Rouzer Put A Petition To Repeal The Affordable Care Act On His Campaign Website.
[David Rouzer for Congress, 7/11/12 via archive.org]
¶ Rouzer has repeatedly voted to repeal the affordable care act
2017: Rouzer Voted For The FY 2018 Republican Study Committee Budget Resolution Which In Part Called For Fully Repealing Obamacare. In October 2017, Rouzer voted for a budget resolution that would in part, according to Congressional Quarterly, “provide for $2.9 trillion in new budget authority in fiscal 2018. It would balance the budget by fiscal 2023 by reducing spending by $10.1 trillion over 10 years. It would cap total discretionary spending at $1.06 trillion for fiscal 2018 and would assume no separate Overseas Contingency Operations funding for fiscal 2018 or subsequent years and would incorporate funding related to war or terror into the base defense account. It would assume repeal of the 2010 health care overhaul and would convert Medicaid and the Children’s Health Insurance Program into a single block grant program. It would require that off budget programs, such as Social Security, the U.S. Postal Service, and Fannie Mae and Freddie Mac, be included in the budget.” The underlying legislation was an FY 2018 House GOP budget resolution. The House rejected the RSC budget by a vote of 139 to 281. [House Vote 555, 10/5/17; Congressional Quarterly, 10/5/17; Congressional Actions, H. Amdt. 455; Congressional Actions, H. Con. Res. 71]
- Legislation Called For Repealing The ACA And Replacing It With Parts Of AHCA. According to the Republican Study Committee FY 2018 Budget, “Obamacare is a failed experiment and cannot be reformed; it must be fully repealed. […] The RSC budget fully repeals Obamacare and its distortionary and destructive tax increases. […] On January 4, 2017, the RSC reintroduced the American Health Care Reform Act (AHCRA), the updated version of the patient-centered health care reform legislation that the RSC has sponsored since the 113th Congress. Introducing AHCRA on the second day of the 115th Congress kick-started a process by which the House has begun to fulfill the promise of repealing and replacing Obamacare. The American Health Care Act (AHCA) passed the House on May 4, 2017. This reconciliation bill, while not perfect by any standards, includes many of the principles and policies first put forward in legislation by the RSC.” [Republican Study Committee, Accessed 10/17/17]
2017: Rouzer Voted For The American Health Care Act That Which Would Result In 23 Million Fewer Americans With Health Insurance By 2026. In May 2017, Rouzer voted for the American Health Care Act which would have significantly repealed portions of the Affordable Care Act by cutting Medicaid, cutting taxes on the rich, removing safeguard for pre-existing conditions and defunding Planned Parenthood. The overall legislation would have in part, also according to Congressional Quarterly, “ma[d]e extensive changes to the 2010 health care overhaul law, by effectively repealing the individual and employer mandates as well as most of the taxes that finance the current system. It would [have], in 2020, convert[ed] Medicaid into a capped entitlement that would provide[d] fixed federal payments to states and end[ed] additional federal funding for the 2010 law’s joint federal-state Medicaid expansion. It would prohibit federal funding to any entity, such as Planned Parenthood, that performs abortions and receives more than $350 million a year in Medicaid funds. […] It would [have] allow[ed] states to receive waivers to exempt insurers from having to provide certain minimum benefits.” The vote was on passage. The House passed the bill by a vote of 217 to 213. The bill, in modified forms, died in the Senate. [House Vote 256, 5/4/17; Congressional Quarterly, 5/4/17; Kaiser Family Foundation, 5/17; Congressional Actions, H.R. 1628]
- HEADLINE: "The American Health Care Act: The Obamacare Repeal Bill The House Just Passed, Explained" [Vox, 5/4/17]
- The American Health Care Act Would Have Resulted In 14 Million Additional Uninsured Americans In 2018, Rising To 23 Million In 2026. According to the New York Times, “A bill to dismantle the Affordable Care Act that narrowly passed the House this month would leave 14 million more people uninsured next year than under President Barack Obama’s health law — and 23 million more in 2026, the Congressional Budget Office said Wednesday. Some of the nation’s sickest would pay much more for health care. Under the House bill, the number of uninsured would be slightly lower, but deficits would be somewhat higher, than the budget office estimated before Republican leaders made a series of changes to win enough votes for passage. Beneath the headline-grabbing numbers, those legislative tweaks would bring huge changes to the American health care system.” [New York Times, 5/24/17]
- The American Health Care Act Would Have Cut Medicaid By $834 Billon Over Ten Years, Including A Roll Back Of The Medicaid Expansion. According to the New York Times, “The House repeal bill was approved on May 4 by a vote of 217 to 213, with no support from Democrats. It would eliminate tax penalties for people who go without health insurance and roll back state-by-state expansions of Medicaid, which have provided coverage to millions of low-income people. And in place of government-subsidized insurance policies offered exclusively on the Affordable Care Act’s marketplaces, the bill would offer tax credits of $2,000 to $4,000 a year, depending on age. […] The bill would reduce projected spending on Medicaid, the program for low-income people, by $834 billion over 10 years, and 14 million fewer people would be covered by Medicaid in 2026 — a reduction of about 17 percent from the enrollment expected under current law, the budget office said.” [New York Times, 5/24/17]
2017: Rouzer Voted For A Budget Resolution Designed To Begin The Process Of Repealing The Affordable Care Act, Which Also Assumes A $9 Trillion Increase In The Federal Debt Over The Next Ten Years. In January 2017, Rouzer voted for a budget resolution designed to begin reconciliation instructions to repeal the Affordable Care Act. According to Congressional Quarterly, “the proposed 10-year spending framework culminates in a $1 trillion annual deficit and adds about $9 trillion to the national debt.” The vote was on passage. The House passed the budget resolution by a vote of 227 to 198. The Senate had already passed the resolution. [House Vote 58, 1/13/17; Congressional Quarterly, 1/4/17; Congressional Actions, S. Con. Res. 3]
2015: Rouzer Voted To Repeal The Affordable Care Act, As Part Of The FY 2016 Conference Report Budget Resolution. In April 2015, Rouzer voted to repeal the Affordable Care Act as part of the FY 2016 Conference Report budget resolution. According to Congressional Quarterly, “Adoption of the conference report on the concurrent resolution that would reduce spending by $5.3 trillion over the next 10 years, including $2 trillion in reductions from repeal of the 2010 health care overhaul.” The vote was on the Conference Report; the Conference Report passed by a vote of 226 to 197. The Senate also passed the budget resolution. [House Vote 183, 4/30/15; Congressional Quarterly, 5/5/15; Congressional Actions, S. Con. Res. 11]
- Center For Budget And Policy Priorities Said The Budget Would Eliminate Health Coverage For Millions Of Americans. According to the Center for Budget and Policy Priorities, “The House-passed budget agreement that the Senate will consider next week would repeal health reform and cut Medicaid over the coming decade by roughly half a trillion dollars on top, making tens of millions more Americans uninsured.” [Center for Budget and Policy Priorities, 5/1/15]
2015: Rouzer Voted For The FY 2016 Budget Resolution Which Called For Repealing Most Of The Affordable Care Act. In March 2015, Rouzer voted for the FY 2016 budget resolution which called repealing most of the Affordable Care Act. According to Congressional Quarterly, the resolution, “assumes […] that the 2010 health care overhaul is repealed — including its expansion of Medicaid to cover more Americans under the program.” In addition, also according to Congressional Quarterly, the budget resolution calls for the “repeal the Independent Payment Advisory Board. […] In repealing the health care law, however, the budget assumes that the reductions made to Medicare by that law would not be repealed; instead, those savings and others would be retained, with the budget calling for them to be used to shore up Medicare rather than ‘paying for new entitlements.’” The vote was on the budget resolution. The House passed the resolution 228 to 199. The budget resolution died in the Senate, but a similar concurrent resolution did pass both Houses. [House Vote 142, 3/25/15; Congressional Quarterly, 3/23/15; Congressional Actions, S. Con. Res. 11; Congressional Actions, H. Con. Res. 27]
2015: Rouzer Voted For A FY 2016 Budget Resolution Which Called For Repealing Most Of The Affordable Care Act. In March 2015, Rouzer voted for a FY 2016 Budget Resolution which called repealing most of the Affordable Care Act. According to Congressional Quarterly, the resolution, “assumes […] that the 2010 health care overhaul is repealed — including its expansion of Medicaid to cover more Americans under the program.” In addition, also according to Congressional Quarterly, the budget resolution calls for the “repeal the Independent Payment Advisory Board. […] In repealing the health care law, however, the budget assumes that the reductions made to Medicare by that law would not be repealed; instead, those savings and others would be retained, with the budget calling for them to be used to shore up Medicare rather than ‘paying for new entitlements.’” The vote was on the adopting the substitute amendment. The House passed the amendment 219 to 208 and later passed the budget resolution. The budget resolution died in the Senate, but a similar concurrent resolution did pass both Houses. [House Vote 141, 3/25/15; Congressional Quarterly, 3/23/15; Congressional Actions, S. Con. Res. 11; Congressional Actions, H. Amdt. 86; Congressional Actions, H. Con. Res. 27]
2015: Rouzer Voted For A Bill Repealing The Affordable Care Act And Requiring Congressional Committees To Come Up With A Replacement In No Specified Time. In February 2015, Rouzer voted for a bill repealing the Affordable Care Act and directing four Congressional Committees to come up with a replacement, without specifying when this must be done. According to Congressional Quarterly, “this bill repeals the 2010 health care overhaul […] and requires House committees to report legislation to replace the health care law. Under the measure, the repeal would be effective 180 days after enactment (rather than retroactively repealed to a date in 2010, as in the introduced version), and it provides that the provisions of law that were amended or repealed by the health care overhaul would be restored or revived as if the overhaul had not been enacted. […] The bill requires four House committees to report legislation within each of their jurisdictions to replace the 2010 health care overhaul: Education and the Workforce, Energy and Commerce, Judiciary, and Ways and Means. It does not, however, specify a time frame or deadline for those committees to act.” The vote was on passage. The House passed the bill 239 to 186. The Senate took no substantive action on the legislation. [House Vote 58, 2/3/15; Congressional Quarterly, 1/30/15; Congressional Quarterly, Accessed 10/1/15; Congressional Actions, H.R. 596]
¶ Rouzer Voted Against Condemning Lawsuits That Attacked The Affordable Care Act
4/3/19: Rouzer Voted Against Condemning The Trump Administration For Pushing Legal Action To Attack The Affordable Care Act. According to the Clerk of the U.S. House of Representatives, Rouzer voted against, "This resolution urges the Department of Justice (DOJ) to cease its efforts against the Patient Protection and Affordable Care Act (PPACA) and reverse its position in Texas v. United States. (On March 25, 2019, DOJ submitted a letter to the appellate court agreeing with the lower court's decision that PPACA should be struck in its entirety)." [U.S. House of Representatives, H.R. 271, Vote 146, 4/3/19]
- HEADLINE: "House Condemns Trump Administration For Legal Attack On Health Law" [New York Times, 4/3/19]
2019: Rouzer Voted Against Directing The Office Of The General Counsel Of The House To Represent The House In The Texas ACA Case Which Sought To Overturn The Entire ACA. In January 2019, Rouzer voted against rules for the 116th Congress. According to Congressional Quarterly, “Adoption of the resolution that would establish the rules of the House for the 116th Congress. Title III of the resolution would authorize the speaker, on behalf of the House of Representatives, to intervene in the Texas court case that found the 2010 healthcare law unconstitutional and other cases related to the law. It would also direct the Office of General Counsel to represent the House in any such litigation.” The House passed the resolution by a vote of 235 to 192. [House Vote 19, 1/9/19; Congressional Quarterly, 1/9/19; Congressional Actions, H. Res. 6]
- House Democrats Sought To Allow The Speaker And The House To Intervene In A Court Case Where A Texas Judge Had Ruled The Affordable Care Act Was Unconstitutional. According to the Washington Post, "House Democrats used their new majority on Thursday to squeeze Republicans on health care, taking the first step to intervene in a court case in which a Texas judge has ruled the Affordable Care Act unconstitutional. That move will be followed by a vote next week designed to force GOP lawmakers into a political corner: agree to defend a law many members have spent years reviling or appear to oppose popular ACA protections for millions of Americans with preexisting medical conditions that many have pledged to uphold. […] Thursday’s authorization was part of a collection of rules the House adopted to guide its operation in the new Congress. It gives Pelosi permission to intervene in the Texas court case and allows the chamber’s counsel to work on the litigation." [Washington Post, 1/3/19]
¶ More than 761,000 north carolinians enrolled in aca marketplace plans
2026: 761,457 People In North Carolina Enrolled In Affordable Care Act Marketplace Health Insurance Plans.
[KFF, Viewed 4/9/26]
¶ 2025: Rouzer Opposed Extending Affordable Care Act Premium Subsidies
¶ Rouzer Voted Three Times Against Extending ACA Premium Tax Credits For Three Years
1/8/26: Rouzer Voted Against Extending The Affordable Care Act Tax Credits For Three Years. In January 2026, Rouzer voted against, according to Congressional Quarterly, “the bill, as amended, that would extend for three years, through the end of calendar year 2028, the enhanced tax credits to subsidize premiums for health insurance purchased on the Affordable Health Care Act health insurance markets. It would allow taxpayers whose household income exceeds 400 percent of the federal poverty line to receive tax credits for three more years. The measure would retroactively take effect Jan. 1, 2026.” The vote was on passage. The House passed the bill by a vote of 230 to 196. [House Vote 11, 1/8/26; Congressional Quarterly, 1/8/26; Congressional Actions. H.R. 1834]
- 17 Republicans Voted For Passage Of The “Clean” Extension, Following A Procedural Vote The Day Before That Had Support From Nine Republicans. According to Politico, “Seventeen Republicans joined Democrats in passing legislation Thursday that would revive enhanced Affordable Care Act subsidies for three years, rebuffing opposition from GOP leadership. The 230-196 vote follows a procedural vote Wednesday to advance the bill, where nine Republicans joined Democrats in favor of moving forward.” [Politico, 1/8/26]
- Speaker Johnson Called The Bill “Really Bad Policy.” According to Politico, “Johnson’s office, in a last-ditch effort Thursday morning to undermine the effort, blasted out a memo accusing ‘Democrats [of] want[ing] to expand a COVID subsidy system already flagged for massive fraud and abuse, with absolutely zero reforms.’ After the vote Thursday evening, Johnson said in an interview of the Republicans who defected, ‘I think it’s a really bad policy, and I wish they hadn’t, but everybody had a vote.’” [Politico, 1/8/26]
1/8/26: Rouzer Effectively Voted Against Extending The Affordable Care Act Tax Credits. In January 2026, Rouzer voted against, according to Congressional Quarterly, the “adoption of the rule (H Res 780) providing for consideration of the bill (HR 1834). It would consider as adopted the McGovern, D-Mass., substitute amendment that would extend, through 2028, the enhanced tax credits to subsidize premiums for health insurance purchased on the Affordable Health Care Act health insurance markets. The rule would direct the clerk to transmit to the Senate a message that the House has passed HR 1834 no later than one calendar day after passage.” The vote was on the adoption of the rule. The House agreed to the motion by a vote of 224 to 202. [House Vote 10, 1/8/26; Congressional Quarterly, 1/8/26; Congressional Actions, H.Res. 780; Congressional Actions. H.R. 1834]
1/7/26: Rouzer Effectively Voted Against Extending The Affordable Care Act Tax Credit. In January 2026, Rouzer voted against, according to Congressional Quarterly, the “motion to discharge from the House Rules Committee the rule (H Res 780) providing for consideration of the anticipated ACA tax credit extension vehicle (HR 1834).” The vote was on the motion to discharge the rule. The House agreed to the motion by a vote of 221 to 205. [House Vote 4, 1/7/26; Congressional Quarterly, 1/7/26; Congressional Actions, H.Res. 780; Congressional Actions. H.R. 1834]
¶ Rouzer Did Not Sign Discharge Petitions Aimed At Extending Premium ACA Tax Credits
Rouzer Was Not One Of The Republican Signers On A Discharge Petition Led By House Minority Leader Hakeem Jeffries.
[Clerk of the U.S. House of Representatives, Discharge Petition No. 10, 11/12/25]
- House Minority Leader Jeffries’ Discharge Petition Sought To Extend ACA Premium Tax Credits For Three Years. According to Politico, "House Democrats could move as soon as tomorrow to force a vote on extending the expired Obamacare subsidies for three years, Meredith Mast Hill reports. This measure follows last month’s major setback for Speaker Mike Johnson, when four House Republicans broke from the party to support a discharge petition backed by Minority Leader Hakeem Jeffries to hold a vote." [Politico, 1/6/26]
Rouzer Was Not One Of The Republican Signers On A Discharge Petition Led By Rep. Brian Fitzpatrick.
[Clerk of the U.S. House of Representatives, Discharge Petition No. 12, 12/10/25]
- December 2025: Fitzpatrick Filed A Discharge Petition Aimed At Extending ACA Premium Tax Credits For Two Years. According to a press release from Rep. Brian Fitzpatrick, "Today, Congressman Brian Fitzpatrick (PA-1) released the following statement after filing a discharge petition to bring his Bipartisan Health Insurance Affordability Act directly to the House floor for a vote, ensuring Congress takes action to prevent devastating health insurance premium increases when current protections expire at the end of the year: ‘Congress cannot sit idle while American families face a preventable crisis. Our job is to protect the people we serve, and that responsibility demands immediate action. […] Key Provisions of the Bipartisan Health Insurance Affordability Act The legislation advances five reforms designed to protect affordability, strengthen accountability, and ensure taxpayer value: Prevents premium spikes: Extends enhanced premium tax credits through 2027, to protect families from abrupt monthly cost increases. Restores Consumer Control: Stops unauthorized plan and subsidy changes by requiring consent and prompt notification before any modifications take effect. Shines Light on Middlemen: Ends hidden spread pricing, severs PBM profits from drug prices, and requires full rebate pass-through to ensure savings reach patients. Gives Families New Tools to Manage Costs: Expands access to Health Savings Accounts and simplifies premium payments to reduce disruptions in coverage. Smart Stewardship of Taxpayer Dollars: Modernizes eligibility and introduces a reasonable minimum contribution to protect long-term affordability and responsible stewardship of federal dollars." [Press Release – Rep. Brian Fitzpatrick, 12/10/25]
Rouzer Was Not One Of The Republican Signers On A Discharge Petition Led By Rep. Josh Gottheimer.
[Clerk of the U.S. House of Representatives, Discharge Petition No. 13, 12/10/25]
- December 2025: Gottheimer Filed A Discharge Petition Aimed At Extending ACA Premium Tax Credits For Two Years. According to a press release from Rep. Josh Gottheimer, "Today, December 11, 2025, U.S. Congressman Josh Gottheimer (NJ-5) released the following statement: ‘In less than three weeks, unless Congress acts now, Affordable Care Act tax credits will expire, and health insurance premiums will shoot up 175% — or $20,000 a year — for families in Jersey. This week, Congresswoman Jen Kiggans and I, with 36 of our Democratic and Republican colleagues, introduced new bipartisan legislation that includes a two-year extension of health insurance premium tax cuts for American families. It’s a commonsense proposal that will keep costs down and prevent families’ premiums from skyrocketing in January. But, the Speaker of the House is refusing to bring our legislation to the floor for a vote. So, our bipartisan group just launched a discharge petition to force an immediate vote in the House. We must get this done now. We must find common ground and lower health insurance premiums. Time is running out for families.’" [Press Release – Rep. Josh Gottheimer, 12/11/25]
¶ Rouzer voted for a bill that would weaken protections for people with pre-existing conditions and failed to address premium spikes
¶ December 2025: Rouzer Voted For The Lower Health Care Premiums For All Americans Act
2025: Rouzer Voted For The Lower Health Care Premiums For All Americans Act That Allowed The ACA Tax Credits To Expire. In December 2025, Rouzer voted for, according to Congressional Quarterly, “the bill that would expand the ability of small businesses to establish association health plans and bars states from preventing small businesses from obtaining stop-loss insurance for self-funded health insurance plans. It would codify and expand rules governing employer-funded health reimbursement arrangements and would allow employees in such arrangements to pay Affordable Care Act health insurance premiums through salary reductions. It would provide funding for ACA policy cost sharing reduction payments that reduce deductibles and copayments. It would prohibit plans from providing abortion-related care. It also would require pharmacy benefit managers to provide transparency regarding prescription drug costs and the drug rebates they receive.” The vote was on passage. The House passed the bill by a vote of 216 to 211. [House Vote 349, 12/17/25; Congressional Quarterly, 12/17/25; Congressional Actions, H.R. 6703]
¶ The Lower Health Care Premiums For All Americans Act Did Nothing To Address The Expiration Of ACA Enhanced Premium Tax Credits And Would Weaken Protections For People With Pre-Existing Conditions
The December 2025 Republican Health Care Bill Failed To Prevent Imminent Premium Spikes For More Than 20 Million People Who Relied On ACA Marketplace Plans. According to the Center on Budget and Policy Priorities, "The health bill House Republicans are preparing to bring to the floor this week not only fails to prevent imminent premium spikes for more than 20 million people in marketplace plans, but would raise costs even higher for many marketplace enrollees and weaken pre-existing condition protections for individuals and small businesses." [Center on Budget and Policy Priorities, 12/16/25]
- HEADLINE: "House Republicans Pass Health Care Plan Without Re-Upping Insurance Subsidies" [Politico, 12/17/25]
- HEADLINE: "House Passes GOP Health Bill Without Subsidies" [Axios, 12/17/25]
- HEADLINE: "House Passes GOP Health Care Bill Without Obamacare Subsidy Extension" [The Hill, 12/17/25]
- HEADLINE: "House Passes GOP Health Care Bill Without ACA Extension" [CBS News, 12/17/25]
The December 2025 Republican Health Care Bill Would Expand Association Health Plans, Which Would Result In Higher Underlying Premiums For Individuals And Small Businesses That Remained In ACA-Regulated Markets. According to the Center on Budget and Policy Priorities, "It would expand association health plans (AHPs), a type of health plan that trade associations, professional groups, and other organizations may offer their members, to cover self-employed individuals and small businesses as if they were large employers. By allowing more people to enroll in coverage not subject to ACA standards and consumer protections, this would segment insurance risk pools: individuals who are younger and healthier, or small businesses with younger or healthier employees, could get plans with lower premiums because they would be priced separately from ACA-compliant coverage and wouldn’t have to meet ACA standards such as having to cover a set of essential health benefits. As a result, individuals and small businesses remaining in ACA-regulated markets would see higher underlying premiums." [Center on Budget and Policy Priorities, 12/16/25]
The December 2025 Republican Health Care Bill Would Likely Lead To Higher Premiums For Older And Sicker Small Groups And Self-Employed People, Thereby Undermining Protections For People With Pre-Existing Conditions. According to the Center on Budget and Policy Priorities, "In addition, the bill would undermine protections for people with pre-existing conditions. While it would bar AHPs from rejecting individuals or charging them more based on certain health factors, it would give them greater ability to base a small group’s or self-employed person’s costs on their health risk compared to individual or small-group coverage. This would likely lead to higher premiums for older and sicker small groups and self-employed individuals, making such arrangements more attractive to healthier individuals and groups." [Center on Budget and Policy Priorities, 12/16/25]
¶ North Carolinians faced dramatic premium increases as a result of the expiration of critical health care tax credits
HEADLINE: "NC Approves ACA Premium Hikes Up To 36%, Leaving Many To Face ‘Sticker Shock’" [News & Observer, 10/29/25]
- North Carolina Insurance Commissioner Said Republicans’ One Big Beautiful Bill Was Partially To Blame For Premium Increases. According to North Carolina Health News, "State Insurance Commissioner Mike Causey approved a nearly 30% average rate hike for ACA plans purchased through the federal marketplace, healthcare.gov. Causey said the increases were necessary due to rising healthcare costs and the One Big Beautiful Bill Act, which President Donald Trump signed into law July." [North Carolina Health News, 1/1/26]
2026: North Carolina Saw A 22 Percent Drop In The Number Of People Who Enrolled In ACA Exchange Plans, The Largest Enrollment Drop In The United States. According to NC Local, "Just 761,457 people enrolled in health coverage under the ACA in North Carolina for 2026, according to the latest figures from the Centers for Medicare & Medicaid Services. The decline is about 22%, or 214,000 fewer enrollments, than in 2025, the largest drop in the country. Last year, more than 975,000 North Carolina residents, about 9% of the state’s total population, enrolled in coverage under the ACA. Nationally, less than 23 million people enrolled in health coverage under the ACA for 2026, according to CMS data. In 2025, more than 24 million enrolled." [NC Local, 2/16/26]
HEADLINE: "'God Forbid Something Happens': North Carolina Residents Face 2026 Health Insurance Increases" [Daily Tar Heel, 12/2/25]
HEADLINE: "NC Residents Face Steep Health Insurance Hikes During Open Enrollment" [ABC 13 News, 11/4/25]
¶ Rouzer’s Inaction Created A Dramatic “Subsidy Cliff”
The Expiration Of Enhanced ACA Premium Tax Credits Created A “Subsidy Cliff” Whereby If Households Earned Even $1 More Than A Specific Income Threshold They Could Lose All Eligibility For Assistance. According to CNBC, "For the first time in years, many Americans enrolled in a health insurance plan via the Affordable Care Act marketplace will need to keep a careful accounting of their annual income — or risk a hefty federal tax bill. Enhanced ACA subsidies lapsed at the end of 2025, leaving millions of households on the hook for higher insurance premiums. The lapse also reintroduced the so-called subsidy cliff, whereby households that earn even $1 more than a specific income threshold will lose all eligibility for subsidies, also known as premium tax credits. That income cutoff, which varies by family size, is $62,600 for a single person, $84,600 for a two-person household and $128,600 for a family of four in 2026, for example." [CNBC, 1/6/26]
- More Than Two Million Americans Had Incomes Near A “Subsidy Cliff.” According to CNBC, "More than 2 million people enrolled in an ACA marketplace plan have an income near the subsidy cliff. ACA enrollees also tend to have relatively volatile incomes, making it hard to predict their annual earnings, experts said." [CNBC, 1/6/26]
Households That Went Over The Income Limit Would Have To Pay Back Any Federal Assistance They Received For Premiums, Which Could Cost Thousands Of Dollars, When They Filed Their Taxes. According to CNBC, "Households over the limit would have to pay back any federal subsidies they received for premiums — potentially worth thousands of dollars — when they file taxes next year for 2026." [CNBC, 1/6/26]
Republicans’ Big Beautiful Bill Exacerbated The Problem By Stripping Away Guardrails Capping The Amount Of Excess Subsidies Households Are Required To Repay. According to CNBC, "The potential financial impact is exacerbated by a multitrillion-dollar legislative package known as the ‘big beautiful bill’ that Republicans passed over the summer, which stripped away guardrails capping the amount of excess subsidies households must repay, experts said." [CNBC, 1/6/26]
¶ 22 Million Americans Relied On ACA Premium Tax Credits To Afford Health Insurance
Approximately 22 Million Americans Relied On ACA Premium Tax Credits To Afford Health Insurance. According to CNBC, "About 22 million Americans received premium subsidies, also known as premium tax credits, in 2025. Households can opt to receive the tax credit in one of two ways: As a lump sum during tax season or as an advanced payment. Under the latter option, by far the most popular, the federal government issues the tax credit directly to a consumer’s insurer, which then lowers the consumer’s out-of-pocket premium. Consumers receive those advanced ACA subsidies based on an estimated annual income they provide when signing up for insurance. They must reconcile those subsidies during tax season and repay any excess tax credits to the IRS." [CNBC, 1/6/26]