The Big Beautiful Bill cut nearly $1 trillion from Medicaid. Here is every disclosed congressional trade in health insurers around it.
On May 15, 2025, Rep. Rob Bresnahan sold up to $130,000 in Centene, Elevance, UnitedHealth, and CVS, one week before voting yes on the deepest Medicaid cut in the program's history. He was not alone in the window. This is the bill's full life cycle, with the disclosed trades overlaid.
$911B
net Medicaid spending reduction over ten years (CBO final score of the enacted OBBBA, July 2025)
10.9M
additional uninsured Americans projected by 2034 across all OBBBA health provisions, including roughly 7.5 million losing Medicaid
215-214
House vote on May 22, 2025 that sent OBBBA to the Senate. One vote either way reverses the outcome.
~40%
Centene's drop from its May 20 fifty-two-week high to its August low, the steepest move in any insurer that summer
Trade dollar values throughout this page reflect the upper end of the STOCK Act disclosed-amount brackets. Exact transaction values are not made public.
What the Big Beautiful Bill actually changed for Medicaid
The One Big Beautiful Bill Act, signed into law on July 4, 2025, is the largest reduction in Medicaid spending in the program's sixty-year history. The Congressional Budget Office's final enacted-law score put the net Medicaid cut at $911 billion over ten years, with gross Medicaid and CHIP reductions of approximately $990 billion. KFF's allocation across states confirmed the same figure. The total OBBBA health package is projected to leave 10.9 million more Americans uninsured by 2034, including roughly 7.5 million losing Medicaid coverage specifically.
The cuts are layered. Five provisions do most of the work.
Provider tax phase-down
The Medicaid provider-tax safe-harbor threshold drops from 6.0 percent to 3.5 percent in expansion states, phased in 0.5 percentage points per year starting October 1, 2027 and ending in fiscal year 2032. Nursing facilities and intermediate-care facilities are exempt. CBO scored this single provision at $175 billion over ten years. It is the SALT-on-hospitals provision.
Work requirements
Adults aged 19 to 64 in the Medicaid expansion population must work, volunteer, or attend school at least 80 hours per month. Parents of children 14 and under are exempt. Implementation by January 1, 2027, with a two-year good-faith waiver option. The CBO assumes most coverage loss is administrative: eligible enrollees losing coverage through paperwork rather than ineligibility.
Six-month redeterminations
Eligibility verification for the Medicaid expansion population doubles in frequency, from once a year to every six months. The added paperwork churn produces additional administrative disenrollments, leaving the remaining enrolled population with a sicker risk pool at the same capitation rate. This is the mechanism that previously broke Centene's earnings in 2024 to 2025.
State Directed Payment caps
Capped at 100 percent of Medicare rates in expansion states and 110 percent in non-expansion states. This compresses the program-level economics that flow through managed-care organizations and tightens state Medicaid budgets, which then constrain MCO capitation rates downstream.
Retroactive coverage
Cut from three months to one month for expansion adults, two months for traditional eligibility groups. This shifts hospital uncompensated-care risk and reduces the catch-up Medicaid revenue that flows to providers and managed-care plans for late-enrolled patients.
ACA premium tax credits
Not directly cut by OBBBA, but the enhanced ACA premium tax credits expired at the end of 2025, an outcome OBBBA's overall fiscal framework relied on. The fight over restoration produced the 43-day government shutdown in late 2025, the longest in U.S. history.
The five publicly traded conglomerates that dominate the Medicaid managed-care market (Centene, Elevance, UnitedHealth, Molina, CVS-Aetna) together cover roughly half of all national Medicaid MCO enrollees. Every line above flows through their unit economics. The sector-wide context is covered in our editorial on congress and health insurance stock trades.
The bill's life cycle, with the disclosed trades overlaid
From the day the House introduced a stock-trading ban to the day the president signed the Medicaid cut, sixty days elapsed. Public disclosures show at least nine House members and one Senate-side household trust executed trades in the four major Medicaid managed-care insurers during the window.
2025
H.R. 3182 introduced
Rep. Rob Bresnahan (R-PA-08) introduces the Transparency in Representation through Uniform Stock Trading Ban Act. The bill would prohibit members of Congress and their spouses from buying or selling individual stocks while in office. The press release the next day announces Bresnahan also intends to put his existing portfolio into a blind trust. Existing reform bills and how they compare are in our scorecard of the active ban bills.
2025
UnitedHealth CEO exit and the 17.8 percent crash
Andrew Witty notifies the UnitedHealth board on May 12 and the company announces his resignation before market open on May 13. Stephen Hemsley, CEO from 2006 to 2017, returns to the role. UNH falls roughly 17.8 percent in the session, opening near $341 after a pre-market plunge. The drop alone accounts for about 1,938 points off the Dow given UNH's price-weighted index weight. The DOJ Medicare Advantage criminal probe surfaces in the same week. UNH had already lost roughly $120 billion in market cap on April 17 when guidance was slashed. Cumulative value destruction reaches roughly $280 billion by mid-2025.
2025
MTG buys the dip on UNH
Rep. Marjorie Taylor Greene (R-GA-14) purchases UnitedHealth in the $15,001 to $50,000 bracket. It is her first-ever disclosed UNH position. The transaction price tracks the May 13 crashed level. She buys again on May 16 ($1,001 to $15,000), and continues accumulating UNH through August. Rep. David Taylor (R-OH-2) sells UNH across two subholdings, combined $18,004 to $95,000, the same day.
2025
The Bresnahan four-stock sweep
Bresnahan's brokerage executes four health-insurer sales in a single day: Centene ($1,001-$15,000, sold at $60.06 per share), CVS Health ($1,001-$15,000), Elevance Health ($15,001-$50,000), and UnitedHealth ($15,001-$50,000). Combined upper-bracket math: up to $130,000. Combined lower-bracket math: at least $32,004. The same day, public disclosures show the account also sells seven clean-energy positions and purchases six oil and gas positions, alongside approximately 50 other trades totaling $432,000 in volume. The PTRs are filed on May 31 and June 9, both within the 45-day STOCK Act window. The full timeline is at our Rob Bresnahan stock tracker.
2025
McCaul accumulates, Khanna household rotates
Rep. Michael T. McCaul (R-TX) buys UNH on May 16 ($15,001 to $50,000) and again on May 20 ($50,001 to $100,000). The Khanna household trust, held in his spouse's name, sells UNH on May 16 and May 19 (each $15,001 to $50,000), then buys back on May 28. Rep. Ro Khanna himself is a long-standing reform-bill sponsor; the household trust trades under the spouse loophole that his own Ban Conflicted Trading Act left open.
2025
House passes OBBBA 215-214
The House passes the One Big Beautiful Bill Act by a single vote. Republican no-votes come from Reps. Thomas Massie (R-KY) and Warren Davidson (R-OH). Rep. Andy Harris (R-MD) votes present. All Democrats oppose. Bresnahan votes yes. The bill goes to the Senate.
2025
Senate Finance unveils a deeper cut
Senate Finance Committee releases its reconciliation text. The Senate version layers the provider-tax safe-harbor reduction (6 to 3.5 percent in expansion states) on top of the House moratorium. Senate hospital cuts run over $100 billion deeper than the House version. The Senate Parliamentarian later strikes multiple Medicaid provisions under the Byrd Rule, including the original Section 71120 provider-tax limit, the FMAP penalty on states covering undocumented immigrants, and a Murkowski-backed Alaska FMAP boost. Republicans rewrite the provider-tax provision to delay implementation to 2028, which then complies with Byrd.
2025
Senate passes 51-50; Centene withdraws guidance
Vice President JD Vance breaks the tie to pass OBBBA in the Senate. Republican no-votes: Rand Paul (R-KY), Thom Tillis (R-NC), Susan Collins (R-ME). Lisa Murkowski (R-AK) votes yes after extracting Alaska-specific carve-outs. Sen. Collins's floor statement: "My vote against this bill stems primarily from the harmful impact it will have on Medicaid." Hours later, post-market, Centene files an 8-K withdrawing its 2025 guidance entirely. The trigger is preliminary 2025 ACA Marketplace data from independent actuary Wakely covering 22 of Centene's 29 Marketplace states, showing aggregate market morbidity "significantly higher than, and materially inconsistent with" the company's risk-adjustment assumptions. Estimated hit: $1.8 billion in risk-adjustment revenue, $2.75 per share in adjusted diluted EPS.
2025
Centene crashes 40 percent
Centene shares fall approximately 40 percent in a single session, wiping out over $11 billion in shareholder value. The maximum drawdown reaches 59.93 percent by August 6. Q2 2025 produces a $253 million loss. Q3 brings a $6.7 billion non-cash goodwill impairment. The proximate cause is the ACA Marketplace acuity data, not the OBBBA Medicaid cuts themselves (which do not take effect until 2027 to 2028). The two stories converge in narrative but are technically distinct.
2025
Final passage and the Jeffries floor speech
The House adopts the Senate-amended OBBBA 218-214. House Minority Leader Hakeem Jeffries holds the floor for 8 hours and 44 minutes, breaking Kevin McCarthy's 2021 record by 12 minutes. He names Bresnahan during a July 2 press conference: "Why would Rob Bresnahan vote for this bill? More than 30,000 people would lose access to their health care in his community in Pennsylvania. Almost 60,000 households could lose access to food assistance in his community." Sen. Elizabeth Warren posts: "Protecting his stock portfolio while ripping away health care from 17 million Americans." Bresnahan's same-day statement frames the bill as "the largest working-class tax cuts in American history."
2025
Signed into law
President Trump signs OBBBA into law. The bill becomes the legislative spine of the second-term domestic agenda.
2025
Joe Rogan amplifies the story
Joe Rogan Experience episode #2352, guest Texas state Rep. James Talarico. Talarico raises the Bresnahan case unprompted. Rogan: "Because you knew it was coming. Crazy. Insider trading." And on the broader point: "Everyone wants to use Nancy Pelosi as an example. But if you look at the actual insider trading it's red and blue." The episode goes mainstream within days. CNN, Time, and Newsweek cover the Talarico appearance. The Bresnahan story breaks out of Pennsylvania political coverage and into national talk-radio and podcast pickups.
2025
McCaul takes profits
McCaul sells UNH twice on August 21, each tranche $50,001 to $100,000, after riding the May rebound. MTG continues accumulating on August 4 and August 28 ($1,001 to $15,000 each). The Khanna household trust executes two more UNH buys on August 26 ($15,001 to $50,000 each). The trading pattern around the bill stretches longer than the legislative window itself.
Why Centene actually fell, and why it still matters
A common pushback on the Bresnahan timeline is that Centene's July 2 collapse was driven by ACA Marketplace acuity data from independent actuary Wakely, not by the OBBBA Medicaid cuts. That pushback is technically correct on the proximate cause. The OBBBA Medicaid provisions do not begin to bite until 2027 at the earliest, with full implementation in 2032. Centene's July guidance withdrawal cited Marketplace morbidity, not Medicaid policy.
The trading-record analysis does not require the narrower claim. The case made by Jeffries, Warren, Talarico, and the editorial coverage is not that Bresnahan front-ran the July Wakely data. The case is that he sold his Medicaid managed-care exposure during the most legislatively hostile window in the sector's recent history, while sitting on the House floor preparing to vote yes on the bill driving that hostility. UnitedHealth had already crashed 17.8 percent two days earlier. Centene's own May 20 fifty-two-week high was about to be the last high for years. The structural drawdown for the sector was the broader story, and the Medicaid managed-care names were the specific exposure.
A second nuance: Centene's eventual 59.93 percent maximum drawdown reflected three layered headwinds. The Wakely Marketplace data was the trigger. The post-pandemic Medicaid redetermination unwinding left Centene with a sicker risk pool than its existing rates assumed. And the OBBBA work requirements and six-month redeterminations are designed to repeat that effect at scale starting in 2027. The bill the House passed on May 22 was the third leg of that stool. Whether the Bresnahan account anticipated the first leg (Marketplace) or the third leg (OBBBA) or both, the disclosed positioning ahead of all three is the story.
The hospital stocks under the provider-tax phase-down
The provider-tax phase-down is the OBBBA provision that hits hospitals most directly. Three for-profit hospital operators disclosed the impact in 2025 SEC filings.
Universal Health Services (UHS) quantified annual Medicaid revenue reductions of $432 million to $480 million by 2032 from the provider-tax and state-directed-payment provisions combined. It was the only for-profit hospital operator to provide a specific dollar disclosure. TD Cowen analysts flagged the same set of names as carrying disproportionate exposure to the safe-harbor reduction: Tenet Healthcare (THC), HCA Healthcare (HCA), and UHS.
In the short term, the hospital tape was scrambled by state-level offsets. HCA raised 2025 guidance alongside Q2 earnings after Tennessee approved its state-directed-payment program in June 2025, and management framed OBBBA's hospital impact as "manageable" in early years. Tenet booked a $79 million favorable Q2 pre-tax impact tied to the same Tennessee SDP approval. The long-term provider-tax phase-down is concentrated in expansion states and ramps in 2028 onward, so 2025 hospital trading did not reflect the full picture. The disclosure-system gap, between the long-dated OBBBA effect and the prompt market reactions to interim state-level SDP news, is itself useful information for anyone trying to read the sector. Hospital-specific congressional trades in the same window were not as concentrated as the insurer trades; the most visible was Bresnahan's March 27, 2025 sale of $100,001 to $250,000 in Allegheny County Hospital Development Authority bonds.
Who else traded the window, and what authority they had
Bresnahan is the lead character because of his ban-bill timing. The window contains seven other documented health-insurer trade clusters worth weighing on their own merit. Each was disclosed within the 45-day STOCK Act window. None has resulted in an enforcement action.
Rep. Marjorie Taylor Greene (R-GA-14)
Buying the dip. House Oversight Committee, DOGE Subcommittee chair.
First-ever disclosed UNH purchase came on May 14, the day after Witty's resignation crashed shares. She continued accumulating through August. Greene does not sit on a committee with insurer rate-setting jurisdiction, but the Oversight DOGE subcommittee scrutinizes federal program contractors, which includes UNH's Medicare Advantage book and the active DOJ probe. No public reporting yet ties an Oversight hearing she led to UNH directly in the window.
Rep. Michael T. McCaul (R-TX)
Buy May 16-20, sell August 21. Foreign Affairs Committee chair.
McCaul executed the largest disclosed UNH round-trip in the window: two May buys totaling up to $150,000, two August sales each $50,001 to $100,000. He has no health-jurisdiction committee position. The trades read as event-driven equity timing against a dislocated single name rather than committee-aligned trading.
Rep. Ro Khanna household trust (D-CA-17)
Multiple in-and-out cycles May, June, July, August. Spouse loophole.
Khanna is the most prolific reform-bill sponsor of any Democrat: Ban Conflicted Trading Act, TRUST Act backing, multiple cosponsorships. His standing line is that he does not personally trade. His spouse Ritu Khanna's family trust executes more than one hundred corporate stock trades per month, including the multi-cycle UNH activity above. Khanna's own ban bill left the spouse loophole open. He has said it would close in the next Congress. The full profile is at our Ro Khanna stock tracker, with broader spouse-trading context in the spouse loophole at the heart of every active ban bill.
Rep. David Taylor (R-OH)
Sell, May 14, combined $18,004 to $95,000.
Taylor's account sold UNH across two subholdings, including a Sardinia Ready Mix 401(k) account, the day after the Witty crash. The structure suggests an external trustee or plan administrator rather than personally directed trading. Taylor is a freshman on the House Energy and Commerce Committee, which does have direct insurer jurisdiction. The committee assignment and the trade direction (selling into the crash, opposite of MTG's buy-the-dip) make this one of the trades worth a closer reading.
Rep. Gilbert Cisneros (D-CA)
Buy, May 30, $1,001 to $15,000.
A small-bracket buy by a Democrat after the House had already passed the bill. Less of a timing story, more a data point for a sector rotation, and useful as a counter-example to the "all timing is suspect" framing.
Senate side
No documented Senate Finance, HELP, or Banking insurer trades in the window.
Despite targeted searches across the standard aggregators, no Senate-side member of Senate Finance, Senate HELP, or Senate Banking surfaces with a disclosed UNH, CNC, ELV, CVS, HUM, or MOH trade between May and August 2025. Senate stock disclosures are filed through the Office of Public Records, separate from House PTRs, and are less actively tracked. The absence in aggregators is not proof of absence in disclosures.
The political response that did not materialize
The April 2025 Trump tariff window produced a wave of organized congressional letters demanding investigation. Sens. Schiff and Gallego wrote to the White House on April 10 calling for an insider-trading inquiry. Senate Banking sent a separate letter April 11. Schumer, Warren, Wyden, and Schiff wrote to SEC Chair Paul Atkins urging an SEC investigation. A parallel letter went to state attorneys general. The full pattern is mapped in our editorial on the April 2025 tariff trades.
The Medicaid window produced none of those letters. The Democratic response was floor speeches (Jeffries), press conferences (Stansbury), social-media calls (Warren), DCCC press releases naming Bresnahan, and a $150,000 NRDC Action Fund ad buy targeting Bresnahan's clean-energy and oil rotation. No formal Schiff or Senate Banking letter on Medicaid trades surfaces in available reporting. No public SEC referral. No publicly disclosed House Ethics Committee complaint. The closest official action is a letter from Bresnahan's own counsel to House Ethics Chairman Michael Guest on July 17, proposing self-imposed trading guardrails that the Ethics Committee rejected because House rules forbid members from instructing trustees.
Former Rep. James Greenwood (R-PA), who held PA-08 from 1993 to 2005, called for Bresnahan's resignation in a March 2026 Facebook post. The Bresnahan campaign dismissed Greenwood as "a washed-up political has-been." Sen. Josh Hawley's PELOSI Act (renamed the HONEST Act) advanced from the Senate Homeland Security and Governmental Affairs Committee on July 30, 2025 by an 8-7 vote, with Hawley and all Democrats in favor and all other Republicans opposed. As of writing it has not become law. The discharge petition on Rep. Tim Burchett's End Congressional Stock Trading Act sits at 71 signatures of the 218 needed. Bresnahan signed it himself on December 10, 2025, after seven months of news cycles. The trades did not move legislation. They moved the polls.
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