The advocacy group Protect Our Care released state-by-state fact sheets this week putting a number on what the past year of Republican health policy has actually done.

Roughly $900 billion in cuts to Medicaid, plus the decision to let the enhanced Affordable Care Act subsidies expire at the end of 2025, has meant "stripping insurance coverage from around 8 million Americans total."

Eight million is a hard number to feel. So here is what it looks like at the level of the people who voted for it — seven Republicans, none of whom we featured the last time we did this.

They fall into four groups, and the groups are the story.

They wrote the rules: Aaron Bean and Ashley Hinson

The Medicaid work requirement — 80 hours a month or you lose coverage — didn't appear out of nowhere in the budget bill.

Aaron Bean filed it first, in December 2024, and again in February 2025, months before it became law. His version was broader than the one that ultimately passed.

Ashley Hinson defended the policy at the Plymouth County Fair with the line that always gets applause: "If you're going to take a taxpayer benefit, you should be working." She also suggested people here illegally are getting benefits — which federal law already bars.

Here is the number that makes both of these arguments collapse: 92% of the adults under 65 on Medicaid, setting aside those already on federal disability benefits, are working, caregiving, sick, disabled, or in school.

Work requirements don't move people into jobs they already have. They add paperwork, and people lose coverage when the paperwork fails. That is not a side effect. It's the mechanism.

He promised in writing: Jeff Hurd

In April 2025, Jeff Hurd signed a letter vowing he could not and would not support any bill that cut Medicaid coverage for vulnerable people.

Five weeks later he voted for it. Then he voted for it again.

More than 32,000 people in his district are projected to lose coverage.

A politician who never made the promise can at least claim you knew what you were getting. Hurd put it in writing, in a letter designed to reassure exactly the people who are now losing their insurance.

He told them they shouldn't have it: Russell Fry

At an April 2025 telephone town hall, Russell Fry called Medicaid vital, then said a lot of people on it "quite frankly shouldn't be."

Then he voted for the bill. 37,124 people in his district are projected to lose coverage — 33,500 off Affordable Care Act plans, 3,624 off Medicaid.

South Carolina's 7th District is projected to lose more health coverage than any other district in the state. Average marketplace premiums in the state are up 235% since 2025, by Protect Our Care's count.

Fry is not confused about what the bill does. He told his own constituents, on a call they had phoned in to, that too many of them were on it.

They voted for the damage, then backed bills to fix it: Mark Alford and Shelley Moore Capito

This is the pattern that shows up most, and it is the most cynical one.

Mark Alford voted in July 2025 for the budget law. In his own district, 27,243 people are projected to lose coverage — 14,043 off Medicaid, 13,200 off Affordable Care Act plans. Nearly eight months later, in February 2026, he introduced a bill to keep rural hospitals open. "It's very important that we keep our rural hospitals open for business," he told Missourinet a couple of weeks later.

That rescue bill has three cosponsors and has never moved.

Shelley Moore Capito cast one of the 50 votes for the budget bill — a 50–50 vote, meaning she personally could have stopped it. The head of the West Virginia Hospital Association says the state's hospitals will lose more than $1 billion a year once the law is fully in effect, and seven West Virginia rural hospitals are named most at risk of closing.

On July 29, 2026, she cosponsored legislation to prevent rural hospital closures.

Both of them are running the same play: cast the vote that does the damage, wait for the local coverage about hospitals closing, then sponsor the fix and issue the press release. The vote was binding. The rescue bill is optional, and it isn't moving.

He let the subsidies lapse: Jon Husted

Ohio just lost a bigger share of its Affordable Care Act enrollment than any state in America — nearly a third of its enrollees gone.

Jon Husted and Ohio's other senator let the enhanced health subsidies expire and voted for the budget bill.

The subsidy expiration is the quiet half of the 8 million. Medicaid cuts get argued about. Letting a tax credit lapse requires no vote at all in the public's mind — you just don't renew it, premiums jump, and people quietly stop paying for a plan they can no longer afford. Nobody has to stand up and say "I'm taking your insurance."

The pattern

Read those seven together and the defense falls apart.

They knew what the work requirements would do, because two of them wrote them. They were warned what the vote would do to districts like their own before they cast it — Hurd signed a letter saying so, five weeks out. And several of them knew immediately afterward, because they started filing rural hospital rescue bills that go nowhere.

Not one of these is a story about a member who was misled. It's a story about members who did the arithmetic, voted anyway, and then went looking for something to put in the newsletter.

Eight million people. Both bills to fix it are still sitting in committee.