In rural Kentucky and eastern Louisiana, Republican representatives win elections despite high Medicaid enrollment—over 40% in Kentucky and about a third in Louisiana. Many Republican-controlled districts, including California’s Central Valley, show significant reliance on Medicaid, which covers 72 million Americans. Proposed House budget cuts of $880 billion could drastically affect Medicaid, impacting areas with high enrollment often represented by Democrats. Republicans consider adjustments like work requirements to decrease spending. Some GOP members express concern over potential Medicaid cuts, highlighting its importance to constituents, even as health care ranks low among voter priorities in recent polls.
In rural Kentucky, adjacent to West Virginia, voters consistently elect Republicans to Congress. In 2024, Representative Hal Rogers, who serves this region, did not encounter a Democratic opponent. Over 40% of the local population depends on Medicaid, the health insurance program available for low-income Americans.
In eastern Louisiana, Representative Julia Letlow, a Republican, was elected with a significant margin in 2024, where approximately one-third of the population is enrolled in Medicaid.
Proportion of population enrolled in Medicaid
States such as Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming have not implemented the Medicaid expansion under the Affordable Care Act.
The New York Times
In California’s Central Valley, a Republican-controlled district features a Medicaid enrollment rate of two-thirds of the population, one of the highest in the country, according to analysis by the Center on Budget and Policy Priorities, a progressive think tank.
Certain regions may be adversely affected by substantial Medicaid reductions anticipated as key elements of Republicans’ budget strategies. The budget approved by House Republicans mandates the Energy and Commerce Committee—which oversees Medicaid—to trim $880 billion from spending over the next ten years, translating to an 11% cut in the program’s proposed expenditures.
Since its inception 60 years ago, Medicaid has evolved from a modest initiative offering healthcare to low-income Americans on cash assistance to becoming the largest provider of public insurance. It now covers 72 million Americans—about one-fifth of the population—and finances nearly half of all nursing care in the U.S., along with 40% of all births.
Over the past 15 years, Medicaid has seen rapid growth as millions gained access through the Affordable Care Act’s expansion, which extended coverage to healthy adults earning below 138% of the federal poverty level—approximately $21,597 for individuals and $36,777 for a family of three. The enrollment surged further during the COVID-19 pandemic when Medicaid provided emergency coverage to millions.
Republicans have not disclosed specific policy alterations they plan for Medicaid. Proposed strategies include mandating enrollees to be employed or reducing funding for the Affordable Care Act’s expansion, which granted coverage to millions of adults. Implementing a work requirement is estimated to decrease Medicaid expenditures by around $100 billion over the following decade, potentially leading to coverage loss for those unable to comply or submit the correct employment documentation.
In a statement, Representative Rogers from Kentucky labeled accusations that the Republican party would dismantle the program as “falsehoods propagated by House Democrats.”
“We are committed to eliminating waste, fraud, and abuse of taxpayer resources to safeguard programs like Medicaid for future generations,” he stated.
Medicaid enrollment statistics, sorted by congressional district
Significant reductions in Medicaid are likely to impact densely populated urban regions that predominantly support Democratic candidates. For example, the congressional district encompassing part of the Bronx in New York has one of the highest Medicaid enrollment rates in the nation, covering 67% of its residents. Additionally, a district in Los Angeles boasts over half of its residents enrolled in the program.
Of the ten congressional districts with the highest proportions of Medicaid recipients, nine are represented by Democratic lawmakers.
Districts with the highest Medicaid enrollment percentages
| District | Representative |
Medicaid enrollment |
Margin | |
|---|---|---|---|---|
| Calif. 22nd |
David Valadao |
68% | +7 | |
| N.Y. 15th |
 Ritchie Torres |
67% | +55 | |
| Calif. 21st |
 Jim Costa |
61% | +5 | |
| Calif. 37th |
 Sydney Kamlager-Dove |
56% | +57 | |
| Calif. 25th |
 Raul Ruiz |
55% | +13 | |
| Calif. 13th |
 Adam Gray |
55% | +0.09 | |
| N.Y. 14th |
 Alexandria Ocasio-Cortez |
53% | +38 | |
| Calif. 34th |
 Jimmy Gomez |
53% | — | |
| Calif. 29th |
 Luz Rivas |
52% | +40 | |
| N.Y. 13th |
 Adriano Espaillat |
52% | +67 | |
Note: Margins of victory are not indicated for representatives who faced another member of the same party on the November ballot.
There exist areas across the U.S. that have significant reliance on Medicaid where voters still lean Republican. Out of the 218 congressional seats held by Republicans, 26 are situated in districts where Medicaid enrollment surpasses 30% of the population, as per a New York Times evaluation of federal data.
Each of those 26 representatives showed support for the House budget this past week.
Republican districts with the highest Medicaid enrollment percentages
| District | Representative |
Medicaid enrollment |
Republican Margin | |
|---|---|---|---|---|
| Calif. 22nd |
 David Valadao |
68% | +7 | |
| Calif. 23rd |
 Jay Obernolte |
47% | +20 | |
| Ky. 5th |
 Hal Rogers |
44% | Uncontested | |
| Calif. 1st |
 Doug LaMalfa |
42% | +31 | |
| Ore. 2nd |
 Cliff Bentz |
40% | +31 | |
| Wash. 4th |
 Dan Newhouse |
38% | — | |
| Alaska At-Large |
 Nick Begich |
36% | +2 | |
| N.Y. 11th |
 Nicole Malliotakis |
34% | +28 | |
| La. 5th |
 Julia Letlow |
34% | — | |
| La. 3rd |
 Clay Higgins |
34% | — | |
| Calif. 20th |
 Vince Fong |
33% | — | |
| La. 4th |
 Mike Johnson |
33% | — | |
Note: Margins of victory are not shown for Republican representatives who faced another Republican in the November election.
Republican districts span the nation, extending from Alaska to West Virginia, including the Louisiana district represented by Speaker Mike Johnson, where 33% of residents are Medicaid beneficiaries. All these areas are located in states participating in the Medicaid expansion. While Republicans have contemplated reducing funds for this program, this could save the federal government around $500 billion in the next decade but also leave numerous citizens without insurance.
Despite President Trump’s consistent assertion that he would not cut Medicaid, Republican lawmakers are presented with limited alternatives to locate cuts elsewhere. Several have voiced apprehensions about possible reductions to the program, highlighted by seven Republican members of the Congressional Hispanic Conference who sent a letter to Speaker Johnson, cautioning that “cutting Medicaid could have severe repercussions, especially in rural and mainly Hispanic regions.”
As the second term of the Trump administration commences, healthcare doesn’t appear to be a pressing concern for the president’s voter base. It ranked as the fifth most significant issue in a January poll by The New York Times and Ipsos, trailing behind immigration, the economy, inflation, and taxation.
In January, Michael Perry, a co-founder of the polling firm PerryUndem, conducted three focus group discussions with Medicaid enrollees who supported President Trump. He observed that most did not consider healthcare to be among their primary voting concerns.
When he broached the subject of potential Medicare cuts by Republicans, some participants expressed confidence that the president would seek to avoid backlash and hence would not cut their healthcare coverage. Nevertheless, a segment of voters expressed apprehension. “They appreciated Medicaid, stating it was impactful in their lives,” said Mr. Perry. “They could readily identify how Medicaid benefited them.”