¶ Overview
- Murphy voted for a bill that would kick 17 million Americans off their health insurance, including nearly 12 million Americans off Medicaid. More than 46,000 North Carolinians could lose their health coverage because of his votes, and North Carolina’s Medicaid expansion was at risk of ending due to a lack of funding. A hospital executive in Murphy’s district said the Medicaid cuts he helped introduce would create a “desperate situation” for his constituents. Murphy even voted for the Big Ugly Bill after saying it was a “difficult pill for me to swallow” because he had to face people and “deal with the hospital issues that faced with cuts.”
- Murphy was a staunch advocate for repealing the Affordable Care Act. During his time in Congress, he has claimed the program was passed under “false promises” and “failed” to lower healthcare costs for Americans. Most recently, he opposed an extension of critical health care tax credits that help North Carolinians afford health insurance. As a result of the ACA enhanced tax credits expiring enrollment in North Carolina ACA plans fell 22.5 percent and premiums skyrocketed.
- Murphy, a doctor, claimed that he saw “plenty” of patients who “do not deserve to be on Medicaid.” He also claimed government intervention in health care was “destroying it.” He defended Medicaid cuts and said “there is places we can pare this down.” Asked about Republicans’ plans for $880 billion worth of cuts, Murphy claimed they wouldn’t all come from Medicaid and “there's going to be a lot of savings that are coming from other programs that are in that.”
¶ Murphy Voted To Kick More Than 46,000 Of His Constituents And Nearly 12 Million Americans Off Medicaid
¶ murphy claimed he saw “plenty” of patients who “do not deserve to be on medicaid”
VIDEO: Murphy Claimed He Saw “Plenty” Of Medicaid Patients Who “Do Not Deserve To Be On Medicaid.” According to an interview Rep Greg Murphy gave on NewsNation, “MURPHY: As someone who still sees patients, I still see really a majority, seemingly, of patients on Medicaid. Most of whom, absolutely are eligible. But the fact that the Biden administration only allowed once a year, if that, to go and audit their Medicaid rolls? I see plenty of people who I know do not deserve to be on Medicaid but come in with their Medicaid card.” [NewsNation, 3/21/25] (video)
¶ Murphy Claimed Government Intervention In Health Care Was “Destroying It”
Murphy Claimed Government Intervention In Healthcare Was “Destroying It.” According to an interview Rep. Greg Murphy gave with Washington Watch with Tony Perkins, “MUPRHY: Tony, I've been in medicine for over 30 years. I've run practices with, with my surgical practice. I actually still take care of patients. I operated yesterday and took care of some patients this morning. I have seen the meteoric rise in health, in government intervention in health care, which is destroying it. This is the reason it costs so much today is because of so much government intervention.” [Washington Watch with Tony Perkins, 9/17/22] (video)
Murphy Defended Medicaid Cuts: “There Is Places We Can Pare Down This.” According to an interview Rep. Greg Murphy gave on NBC, “MURPHY: “I've taken care of Medicaid patients for 35 years. I've worked in a hospital that we have a terrible payer mix where 74% are Medicare and Medicaid and no insurance. This is challenging. We look at what's gone on with the Medicaid system and some of the taxes that states have really abused in some of these regards to gain money from the system. I look at the fraud, waste, and abuse, and I see it every time I see patients. People who are on Medicaid who honestly shouldn't they should be working and they should be having health insurance with some of their, some other company. There is places that we can pare down this. I think really slowing the growth of Medicaid is going to be critical to this entire endeavor.” [NBC: Meet the Press Now, 5/13/25] (video)
- Murphy Called Medicaid A “Fiscal Behemoth” With An “Unsustainable Growth Trajectory.” According to an opinion by Rep. Greg Murphy published in the Washington Times, “Despite their differences, both have become fiscal behemoths with unsustainable growth trajectories. The ratio of the number of individuals paying into Medicare relative to beneficiaries continues to shrink, and according to the latest Medicare Trustees Report, the program will reach insolvency in 2033. Prior to the passage of H.R. 1, the One Big Beautiful Bill Act (OBBB), Medicaid expenditures were projected to grow approximately 5% annually through 2032. The reconciliation bill curbed this growth with modest and reasonable eligibility requirements designed to encourage work for able-bodied adults and protect benefits for vulnerable Americans rather than illegal immigrants and those who are not actually eligible for the program.” [Rep. Greg Murphy Opinion – Washington Times, 7/29/25]
¶ Murphy voted Three Times to take health coverage AWAY from North carolinians
¶ July 2025: Murphy Voted For The Final Version Of Republicans’ Reconciliation Bill
7/3/25: Murphy Voted For The Senate FY 2025 Budget Reconciliation Bill That Cut Medicaid And Other Social Programs To Offset The Bill’s Costs. In July 2025, Murphy 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: Murphy Voted For House Republicans’ Budget Bill, Which Would Kick Millions Of People Off Medicaid
5/22/25: Murphy 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, Murphy 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]
- The House GOP Budget Bill Codified A Trump Administration Proposal That Restricted Access To The Affordable Care Act. According to CNN, “The bill also calls for codifying a Trump administration proposal that would make changes to the Affordable Care Act enrollment process, including shortening the open enrollment period and eliminating the ability of low-income Americans to sign up year-round.” [CNN, 5/28/25]
¶ February 2025: Murphy Voted For A Budget Resolution That Spelled Out Future Medicaid Cuts
2/25/25: Murphy 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, Murphy 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: “What Can House Republicans Cut Instead Of Medicaid? Not Much.” [New York Times, 2/25/25]
- 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]
Asked About Republicans’ Plans For $880 Billion Worth Of Cuts, Murphy Claimed They Wouldn’t All Come From Medicaid And “There's Going To Be A Lot Of Savings That Are Coming From Other Programs That Are In That.” According to an interview Rep. Greg Murphy gave on NBC, “NOBLES: I don't think anyone would disagree with you that there are numerous examples of fraud, waste, and abuse in the health care system. But I've yet to find somebody that can identify $800 billion worth of fraud, waste, and abuse in the Medicaid system. Do you really think you can get to that number just by trying to rein in and reform the process? Or will it mean that individuals right now are receiving that care are going to lose it? MURPHY: Well, Ryan, it's it's not going to be that much. As we're talking with Chairman Guthrie the other evening, it's not going to be nearly that much coming out of Medicaid. There's going to be a lot of savings that are coming from other programs that are in that. So that $880 billion, to my understanding, is not fully coming from Medicaid.” [NBC, Meet the Press Now, 5/13/25] (video)
- 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]
¶ Murphy Defended The Republican Budget Bill Despite Saying It Was A “Difficult Pill To Swallow” And That Hospitals Would Face Cuts
Murphy Said The Big Beautiful Bill Was A “Difficult Pill For Me To Swallow” Because He Had To Face People And “Deal With The Hospital Issues That Faced With Cuts” According to an interview Rep. Greg Murphy gave on Newsmax, “MURPHY: I'm a practicing physician in a rural part of eastern North Carolina, which relies heavily on Medicaid, Medicare, to keep our doors open. And we really don't, we're not able to do that so much with, with so many of the different payment schemes that go on. You know, we're trying to fix the system in one swoop, one swoop, that is really terribly broken. And that's the Medicaid system where the Biden administration enrolled millions of people who should not be eligible on Medicaid. I don't know where I am right now. This is a difficult pill for me to swallow. I'm probably more than anybody else in the US. Congress has to face these people and to look at these people, and deal with the hospital issues that faced with cuts. But we desperately need to reform a system that is terribly broken.” [NewsmaxTV, National Report, 7/2/25] (video)
¶ Murphy Said He Was “Proud” To Support The Republican Budget Bill And Claimed It “Protects” Medicaid
7/3/25: Murphy Said He Was “Proud” To Support The Republican Budget Bill. According to a press release from Rep. Greg Murphy, “Congressman Greg Murphy, M.D., applauds the passage of H.R. 1, the One Big Beautiful Bill Act: ‘After over a year of diligent work crafting a budget reconciliation package that extends the successful 2017 tax cuts, strengthens border security and our military, and cuts waste, fraud, and abuse, I was proud to support the final passage of H.R. 1, the One Big Beautiful Bill Act,’ said Congressman Greg Murphy, M.D. ’As a physician of over 30 years serving rural Eastern North Carolina, and as a member of the House Ways and Means Committee, I vigorously advocated for a package that protects hardworking families, helps our country flourish, and preserves the fiscal viability of the United States. We achieved this and more while delivering on President Trump's and Republicans' vision to put the American people first.” [Press Release – Rep. Greg Murphy, 7/3/25]
- Murphy Called The Current Medicaid System “Broken” And Claimed The Republican Budget Bill “Protects” Medicaid For Americans. According to a press release from Rep. Greg Murphy, “‘The Medicaid system, as we now know it, is broken. It desperately needs reform so that it can be a strong program for those who are eligible to receive the benefits. Throughout the bill-making process, I engaged in innumerable dynamic and spirited conversations with the Trump Administration to protect rural patients, doctors, and hospitals. As the only individual in Congress who continues to see patients covered by Medicaid, I have firsthand knowledge of how this program impacts our communities. This bill protects Medicaid benefits for those who are most vulnerable in our society, not able-bodied individuals capable of participating in the workforce, illegal immigrants, and those ineligible for benefits. The $50 billion Rural Health Transformation Program, included in the package, ensures the sustainability of rural health providers with an immediate impact beginning next year. I look forward to working with President Trump and CMS Administrator Oz, as well as healthcare leaders across the beautiful State of North Carolina, on the successful implementation of this law.’” [Press Release – Rep. Greg Murphy, 7/3/25]
Murphy Claimed Medicaid And Medicare Cuts In The One Big Beautiful Bill Would “Strengthen These Programs.” According to an interview Rep. Greg Murphy gave on NewsNation, “HOST: Are you concerned that this bill will cut some of those services to constituents who need them the most? MURPHY: You know, Nick, this is what we want to do. We want to strengthen these programs for the people who do need them the most. You know, I still see patients, and most of the patients I see are on Medicaid because I can't get paid for what I do. But that said, you know, I still see a few patients now and then that are on Medicaid who truly, Nick, should not be on Medicaid. And what that does is it hurts the individuals who should be receiving those benefits. We want to make this, as a system that government intended this to be, that is strong for the individuals, the safety net system that it is intended to be.” [NewsNation, 7/3/25] (video)
Murphy Claimed The Republican Budget Bill “Delivered Meaningful Improvements” To Medicaid. According to an opinion by Rep. Greg Murphy published in the Washington Times, “During the bill-making process for OBBB, I had the opportunity to tell the story of Eastern North Carolina and share how our work reforming Medicaid could impact people’s lives. Throughout the process, I worked alongside my GOP Doctors Caucus colleagues to call balls and strikes objectively on the provisions under consideration. In the end, we delivered meaningful improvements that protect benefits for Americans in need. The government simply cannot be everything for everybody.” [Rep. Greg Murphy Opinion – Washington Times, 7/29/25]
Murphy Claimed The Republican Budget Bill “Acted To Preserve The Financial Viability” Of Medicaid. According to an opinion by Rep. Greg Murphy published in The Raleigh News & Observer, “Regrettably, the intensity of America’s political environment perversely incentivizes politicians, media outlets and influencers to stoke fear. Without shame, Democrats breathlessly attacked Republicans as soulless miscreants who wish to strip access to health care for millions of needy Americans. In reality, we acted to preserve the financial viability of a critical program, which has seen costs grow by 51% since 2019, that our constituents rely on. The Medicaid reforms accomplished through OBBB targeted three areas where recent lax eligibility enforcement has caused Medicaid to balloon in recent years: eligibility verification, illegal immigrants and able-bodied Americans without dependents who refuse to work. Just this month, the Center for Medicare and Medicaid Services announced they have identified 2.8 million Americans who are enrolled in two or more government subsidized health care plans across different states, costing taxpayers an extra $14 billion a year. Basic safeguards and eligibility checks will save taxpayers billions.” [Rep. Greg Murphy Opinion – Raleigh News & Observer, 8/1/25]
Murphy Claimed That Reforming Medicaid Was “Really Critical” And Called The Program “Terribly Broken”
Murphy: “Reforming Medicaid Was Really Critical.” According to an interview Rep. Greg Murphy gave with WCTI, “MURPHY: They have insurance through their businesses, and when they leave, a lot of that income for hospitals goes away. And so they have to rely on Medicare and Medicaid. Trying to strengthen Medicare, for example, trying to make sure reimbursement rates are okay for hospitals to be able to survive on those things. Reforming Medicaid was really critical, what we've done this past year.” [WCTI, 3/26/26] (video)
Murphy On Medicaid Cuts In The One Big Beautiful Bill: “This Reform Is A Long Time Incoming.” According to an interview Rep. Greg Murphy gave on NewsNation, “MUPRHY: I've been a physician and take care of folks in rural eastern North Carolina for the last 30, 30 years. There are some challenges with the Medicaid issue. But, you know, I've gone through this, and I've had, gosh, 50, 60 conversations over the last several days with health care leaders across the state as well as in the administration. And we're able to move forward and do this in the right way. You know…Medicaid has grown way, way, way out of proportion to what it should be doing; it's not giving the benefits to those who really, truly deserve it. And this reform is a long time in coming. Democrats have grown administration and agencies are way, way out of control, and it's a painful thing for the adults to come back in the room and try to shrink government to where it should be.” [NewsNation, 7/3/25] (video)
Murphy: “Our Country Needed The Medicaid Reform The Big Beautiful Bill Provided.” According to an opinion by Rep. Greg Murphy published in The Raleigh News & Observer, “As the only practicing physician in Congress, no one better understands the stakes of Medicaid reform than I do. I have served Medicare, Medicaid and uninsured patients from across our rural referral area for over 30 years and now represent many of them in Congress. Throughout the legislative process of H.R. 1, the One Big Beautiful Bill (OBBB), I fiercely advocated for a targeted approach to protect benefits for those who are most vulnerable and deserve a helping hand; the very type of people Medicaid is designed for. In fact, the day before we passed the budget reconciliation package, I spoke with President Donald Trump to share Eastern North Carolina’s story and the challenges our communities face.” [Rep. Greg Murphy Opinion – Raleigh News & Observer, 8/1/25]
¶ More Than 46,000 North Carolinians In Murphy’s District Could Lose Health Coverage As A Result Of His Votes
An Estimated 46,011 People In Murphy’s District On The Affordable Care Act And Medicaid Could Lose Coverage Due To Republican Budget Bill Health Care Cuts. According to the Joint Economic Committee,
[Joint Economic Committee, Viewed 4/13/26]
2023: 170,500 North Carolinians In The 3rd Congressional District Were Enrolled In Medicaid Or CHIP. According to the Center for American Progress,
[Center for American Progress, 3/11/25]
¶ Muphy’s Vote Could Also Threaten North Carolina’s Medicaid Expansion, Which Has Helped More Than 600,000 North Carolinians Gain Access To Health Insurance
¶ Murphy Claimed The Existing Medicaid Provider Tax System Was A “Sham”
Murphy Said There Was “Sham” In Medicaid That Needed To Be Reformed. According to an interview Rep. Greg Murphy gave on CNN, “MURPHY: Now, so that was approached in the House: the waste, fraud, and abuse. The Senate is taking a different approach, looking at some of the problems that have occurred with hospital reimbursements. The fact that they tax themselves, send money to the state, and the state draws down $2 from, from the federal government for every dollar that they get taxed. And there's some, there's some sham in that system. And it's grown, it's grown, it's grown over the last decade. We have to get back to where we have resources that are for the population of Medicaid, that are for the population of Medicaid, and not for individuals who don't need to be on that. I'm going to be studying their, their final proposal a lot more this afternoon, and I'll make a decision this afternoon or this evening.” [CNN, News Central, 7/1/25] (video)
¶ 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]
North Carolina Health Officials And Hospital Executives Feared The Republican Budget Bill Could Trigger The End The State’s Medicaid Expansion By Lowering A Tax North Carolina Relied On To Pay For The Program. According to The New York Times, “In interviews last week, local health officials and chief executives of hospital systems across the state said that expanding Medicaid had helped create a lifeline for rural hospitals, allowing some to bounce back from financial deficits. And several North Carolina residents who became eligible for Medicaid through the expansion said they felt worried about the possibility of once again navigating life without health coverage. […] More concerning to state officials is that the Trump law could trigger the end of Medicaid expansion in North Carolina by lowering a tax the state depends on to cover its share of the cost. The new law may also force the state to end a related program that boosts federal payments for hospitals that treat Medicaid patients. Lawmakers could pass a legislative fix, but they have remained deadlocked over the state budget, and some health experts said they doubted a solution could be reached.” [New York Times, 7/6/25]
¶ Medicaid Cuts INtroduced Through The REpublican Budget BIll, In combination With State Budget Issues, Threatened The Future Of Medicaid In North Carolina
Medicaid Cuts Introduced Through The Republican Budget Bill Compounded State Budget Issues, Leaving North Carolina’s Medicaid Program At Risk Of Losing Funding. According to The Washington Post, “Roughly 650,000 people here have signed up for Medicaid since the legislature expanded it 18 months ago — the culmination of a years-long effort in this politically split state. But now they are in danger of losing it under provisions in President Donald Trump’s One Big Beautiful Bill Act. In signing that law, Trump approved more than $900 billion in cuts to Medicaid over the next decade. Those cuts are colliding with state budget challenges, imperiling the future of Medicaid in states such as North Carolina.” [Washington Post, 8/17/25]
August 2025: North Carolina’s Top Health Official Said The State Would Slash Medicaid Payments To Doctors, Hospitals And Other Providers Beginning October 1st Due To A Lack Of Funding. According to The Washington Post, “Devdutta Sangvai, the state’s top health official, told legislators in a letter last week that North Carolina will slash Medicaid payments to doctors, hospitals and other providers starting Oct. 1. He attributed the cuts to the GOP-led legislature declining to fully fund the program. New administrative costs to restrict eligibility under the federal law are among the long-term factors that risk ‘a fundamental erosion of the NC Medicaid program,’ he wrote. ‘Despite careful efforts to minimize harm, the reductions now required carry serious and far-reaching consequences,’ Sangvai wrote. He said that reduced rates ‘could drive providers out of the Medicaid program, threatening access to care for those who need it most.’” [Washington Post, 8/17/25]
- After North Carolina’s Medicaid Expansion Under The Affordable Care Act Enrollment In The Program Drastically Increased, But Those New Enrollees Were Now At Risk Of Losing Their Healthcare Due To The Republican Budget Bill. According to The Washington Post, “Cuts to Medicaid affect more North Carolinians than ever before. The state’s Medicaid rolls swelled nearly 30 percent, to 3 million people, after state Republicans dropped their decade-long opposition to expanding the program under the increasingly popular Affordable Care Act and worked with Democrats to broaden eligibility. […] Previously, these low-income earners had fallen through the cracks of a patchwork insurance system. Many had no employer-sponsored coverage and didn’t earn enough to qualify for subsidized plans sold on Affordable Care Act marketplaces. But under Trump’s new law, millions of Americans are projected to drop out of Medicaid under stricter rules to qualify for the insurance and stay enrolled. That in turn will result in states receiving fewer Medicaid dollars from the federal government, which covers about two-thirds of the costs.” [Washington Post, 8/17/25]
The Republican Budget Bill Required North Carolina Counties To Verify The Eligibility Of Medicaid Recipients Twice A Year Instead Of Annually, Exacerbating An Existing Paperwork Backlog. According to The Washington Post, “North Carolina’s 100 counties, each of which handle Medicaid enrollment differently, will need to verify the eligibility of beneficiaries twice a year instead of annually. More than half the counties already have a monthly backlog in processing new Medicaid applications and renewals, according to Jay Ludlam, deputy secretary for the state’s Medicaid program. As recently as two years ago, some counties lacked voicemail or had just one phone line. And keeping the county offices fully staffed has become much harder in recent years, Ludlam says. So he’s deeply worried about their ability to handle a new load of paperwork.” [Washington Post, 8/17/25]
¶ north carolina hospital executive said medicaid cuts would create a “desperate situation for the people who work here, our patients, and the entire community”
A Hospital Executive In Murphy’s District Said The Republican Budget Bill’s Medicaid Cuts Would Create A “Desperate Situation For The People Who Work Here, Our Patients And The Entire Community.” According to The New York Times, “At the last minute, Congress provided $50 billion in funding for rural hospitals in the Trump law. But many hospital executives have said it would not be nearly enough to make up for the cuts to Medicaid and other health programs. Penney Burlingame Deal, the president and chief executive of Onslow Memorial Hospital in Jacksonville, N.C., said the law ‘will create a desperate situation for the people who work here, our patients and the entire community.’” [New York Times, 7/6/25]
¶ more than 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]
¶ Murphy Was “Ravenous” To Overhaul Health Care And Allowed ACA Tax Credits To Expire, Causing Premiums To Spike On North Carolinians
¶ Murphy Said He Was “Ravenous” To Overhaul the Health Care System, Including The Affordable Care Act
Murphy Said He Had Been “Ravenous” For An Overhaul Of Health Care Since Entering Congress. According to Politico, “But by their own admission, House Republicans are only in the very nascent stages of negotiations, while Senate Republicans are already outlining detailed proposals to align with President Donald Trump’s vision for lowering the cost of health care by sending health funds ‘directly to the people.’ It’s causing anxiety in the House GOP ranks among members who don’t want to be forced to swallow whatever plan the Senate comes up with to extend the premium tax credits or some other alternative proposal. The chairs of the critical House committees have plans to hold listening sessions soon to hear members out on their wide-ranging views on health policy. But it’s promising to be a long, deliberative process — and the clock is ticking. ‘I don’t want to get jammed by the Senate. We have a lot of smart people in the House,’ said Rep. Greg Murphy (R-N.C.), a member of the House Ways and Means Committee. ‘I’ve been ravenous for [a health care overhaul] literally since the first day I was in Congress, so just working with the three different committees, and hopefully we can do something sooner than later.’” [Politico, 11/18/25]
¶ Murphy Claimed Government Intervention In Health Care Was “Destroying It”
Murphy Claimed Government Intervention In Healthcare Was “Destroying It.” According to an interview Rep. Greg Murphy gave with Washington Watch with Tony Perkins, “MUPRHY: Tony, I've been in medicine for over 30 years. I've run practices with, with my surgical practice. I actually still take care of patients. I operated yesterday and took care of some patients this morning. I have seen the meteoric rise in health, in government intervention in health care, which is destroying it. This is the reason it costs so much today is because of so much government intervention.” [Washington Watch with Tony Perkins, 9/17/22] (video) 220927_MM_163765_A
Murphy: “The Unfortunate Truth Is That The Affordable Care Act Failed In Its Promises To Lower Healthcare Costs.” According to ABC News 12, “Congressman Greg Murphy, M.D., issued this statement regarding the passing of H.R. 1834, extending temporary, COVID-era Obamacare subsidies, As a physician of 35 years, I have dedicated my life to serving others, primarily those in rural and underserved communities," said Congressman Greg Murphy, M.D. "The unfortunate truth is that the Affordable Care Act failed in its promises to lower healthcare costs. Instead, patients have faced skyrocketing premiums that have led to record profits by greedy insurance companies. The failed ACA has had to be bailed out again and again. The Enhanced Premium Tax Credits were supposed to be temporary subsidies that were to last only the length of the COVID-19 pandemic. Extending these insurance company bailouts does nothing to lower the cost of healthcare in America. It is simply a continuation of bad policy and only incentivizes bad behavior by insurers, the most powerful lobby in Washington.” [ABC News 12, 1/8/26]
- Murphy Claimed The Affordable Care Act Was Passed Under “False Promises” And Claimed The Program Only “Increased Waste, Fraud, And Abuse.” Rep. Greg Murphy tweeted, “Obamacare was passed under false promises. This program has only jacked up costs, lined the pockets of insurance companies, and increased waste, fraud, and abuse. We don’t need a band-aid solution; we need real reform to put patients first.” [Twitter, @RepGregMurphy, 12/5/25] (video)
April 2025: Murphy Claimed The Affordable Care Act Failed To Help Americans And Was Rife With Waste, Fraud And Abuse. Rep. Greg Murphy tweeted, “Just to remind everyone who really benefited from ObamaCare in 2010. It wasn’t the patients. It wasn’t the doctors. It was the insurance companies. Fraud. Waste. Abuse.” [Twitter, @RepGregMurphy, 4/10/25]
¶ Murphy opposed the affordable care act’s enhanced premium tax credits
Murphy Claimed The ACA Premium Tax Credits Were “Rife With Waste, Fraud, And Abuse.” Rep. Greg Murphy tweeted, “During the Biden Administration, Democrats expanded Obamacare subsidies under an emergency and temporary basis. These subsidies cost taxpayers over $400 billion and are rife with waste, fraud, and abuse. Let me explain ⬇️” [Twitter, @RepGregMurphy, 11/4/25] (video)
¶ Murphy Did Not Sign Discharge Petitions Aimed At Extending Premium ACA Tax Credits
Murphy 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 Pulse, "House Democrats could move as soon as tomorrow to force a vote on extending the expired Obamacare subsidies for three years, Meredith Murphy 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 Pulse, 1/6/26]
Murphy 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]
Murphy 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]
¶ North Carolina Enrollment In ACA Plans Fell 22.5 Percent After the Premium Tax Credits Expired and north CAROLINIANS faced dramatic premium increases
¶ Enrollment In North Carolina’s ACA Plans Fell 22.5% After The ACA Premium Tax Credits Expired
Participation In The Federal Healthcare.gov Marketplace Fell 22.5 Percent In North Carolina During The 2026 Enrollment Period After The Expiration Of ACA Premium Tax Credits. According to the Winston-Salem Journal, “Participation in the federal HealthCare.gov marketplace plunged by 22.5% in North Carolina for the 2026 enrollment period that ended Thursday. The marketplace is a high-profile component of the federal Affordable Care Act, also known as ‘Obamacare,’ that has been at the heart of the nation's political tug-of-war over health insurance access since its debut in 2014. For those who enrolled before Dec. 16, the coverage started on Jan. 1. Coverage for those who enrolled by Jan. 15 begins on Feb. 1. According to a Centers for Medicare and Medicaid Services dashboard, as of Thursday, North Carolina has 755,919 enrollees for 2026, compared with 975,110 in 2025 and a record 1.03 million in 2024.” [Winston-Salem Journal, 1/16/26]
The Affordable Care Act Premium Tax Credits Expired On December 21, 2025. According to the Academy of Managed Care Pharmacy (AMCP), “Enhanced Patient Protection and Affordable Care Act (ACA) premium tax credits (PTCs) will expire on Dec. 31, 2025, threatening a loss of health insurance coverage and increased premium rates for millions of Americans.” [AMCP, Viewed 4/29/26]
- 2026: 761,457 Thousand North Carolinians Enrolled In ACA Marketplace Plans. According to the Kaiser Family Foundation, in 2026, 761,457 people in North Carolina enrolled in an Affordable Care Act marketplace health insurance plan. [Kaiser Family Foundation, Viewed 4/13/26]
- 2025: 975,110 Thousand North Carolinians Enrolled In ACA Marketplace Plans. According to the Kaiser Family Foundation, in 2025, 975,110 people in North Carolina enrolled in an Affordable Care Act marketplace health insurance plan. [Kaiser Family Foundation, Viewed 4/13/26]
¶ North Carolinians Faced Dramatic Premium Increases After Enhanced Premium Tax Credits Expired
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]
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]
¶ Murphy’s Inaction And Congress’ Failure To Extend The Enhanced ACA Tax Credits Created A Dramatic “Subsidy Cliff”
The Expiration Of Enhanced ACA Premium Tax Credits Re-Introduced A “Subsidy Cliff” Whereby If Households Earned Even $1 More Than A Specific Income Threshold They Could Lose All Eligibility For Insurance Subsidies. 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]