House Republicans face a dilemma over their budget plan, particularly evident in California’s Representative David Valadao’s district, where nearly two-thirds rely on Medicaid. Valadao, vulnerable politically, is hesitant to support budget cuts that would significantly impact healthcare access in his predominantly Hispanic district. His constituents expressed anger over potential cuts during recent town halls, emphasizing the dire consequences for those reliant on Medicaid for essential services. With the GOP needing unanimous support to pass the budget, Valadao risks backlash from both party leadership and his constituents, caught between upholding campaign promises and aligning with party agendas.
To grasp the predicament House Republicans find themselves in while attempting to advance their budget proposal next week, one need only look at Representative David Valadao from California.
His district in the Central Valley is one of the most reliant on Medicaid in the country, with nearly two-thirds of residents depending on the program for healthcare—ranging from low-income nursing home residents to parents with developmentally disabled children and veterans facing chronic health issues.
It’s not surprising that Mr. Valadao, one of the most vulnerable Republicans politically, seems hesitant about endorsing his party’s budget framework, which plans to fund $4.5 trillion in tax cuts partially through significant Medicaid reductions.
To secure passage of their budget plan and facilitate President Trump’s ambitious agenda, House Republican leaders will need nearly unanimous support from their members. The proposed cut outlines that Medicaid reductions would need to account for nearly half of the $2 trillion in cuts, assuming Medicare remains unchanged as Republicans assert.
However, they are realizing that discussing spending cuts in theory is markedly different from asking lawmakers to make votes that could have tangible effects in their districts.
In a recent communication to House G.O.P. leaders, Mr. Valadao and fellow Hispanic lawmakers expressed concerns that these cuts “would have serious implications, especially in rural and primarily Hispanic areas where hospitals and nursing homes are already struggling to remain operational.”
Although Mr. Valadao declined to comment directly, the pressure from constituents is palpable. He missed a town hall meeting this week in Bakersfield organized by a local healthcare advocacy group focused on the potential fallout from Medicaid cuts. The event was packed, with attendees—some in cowboy hats and boots, others in scrubs, and many representing veterans—filling the community room of a senior living facility, many expressing their frustration.
“Right now, we are counting on you to be the champion that you truly are,” said Grace Huerta, addressing Mr. Valadao. The mother of two adult children with autism shared how the congressman had promised to advocate for those with disabilities after meeting her daughter.
“You stand by your word,” she stated. “Then why would you go back on it now, when you pledged to help my children?”
Mr. Valadao is not alone in facing backlash from constituents for his support of the G.O.P. budget. With the House in recess this week, constituents nationwide, even in strongly Republican districts, confronted their representatives regarding the significant cuts being proposed, including those affecting every sector of government.
In Virginia Beach, constituents protested the termination of federal employees outside Representative Jen Kiggans’s office. In Georgia’s northeast suburbs, a town hall audience booed Representative Rich McCormick over spending cuts influenced by Elon Musk. Meanwhile, in Pennsylvania, activists urged Republicans to safeguard Medicaid as they marched in front of Representatives Ryan Mackenzie and Scott Perry’s offices.
Yet as early as Tuesday, when House Republicans aim to vote on the budget, they will be pressing their colleagues to officially back cuts to that program and many others.
According to the plan, the Energy and Commerce Committee, responsible for Medicaid and Medicare, is tasked with identifying $880 billion in cuts. If all reductions were drawn from Medicaid alone, it would equate to an average 11 percent spending decrease over ten years.
The G.O.P. Budget Committee estimated earlier this year that implementing work requirements for Medicaid would lead to $100 billion in cuts—implying that lawmakers may need to pursue more extreme measures, such as shifting additional costs to the states, to meet spending goals.
Adding to the Republicans’ challenges, Mr. Trump had previously vowed during his campaign not to alter Medicare and, in a recently aired interview, expressed a desire to avoid affecting Medicaid as well. Yet the day after, he endorsed the House budget framework that proposes precisely those cuts.
This scenario leaves Mr. Valadao, who represents a predominantly Democratic district and is often one of the most politically vulnerable members of the House, in a tight spot with limited options.
He could oppose the budget and disrupt its passage, risking Mr. Trump’s ire and likely facing a serious primary challenger. Alternatively, he could support the plan, which would likely lead to a barrage of criticisms from Democrats and could alienate voters like Angel Galvez, who is the chief executive of the Bakersfield American Indian Health Project.
Mr. Galvez, who supported Mr. Valadao’s campaign last year, leads a clinic providing care to approximately 6,800 American Indians and Alaska Natives—90 percent of whom he states are Medicaid recipients. His clientele includes Indian children in foster care, veterans, and seniors with chronic illnesses.
“The services we offer are those that many cannot afford otherwise,” Mr. Galvez shared in an interview, noting that his clinic prioritizes mental health services for the American Indian community in Bakersfield.
“What you’re doing is saving someone’s life, while at the same time reducing costs to the system,” he explained, “because if people are healthy, they won’t need emergency services, hospital visits, psychiatric holds—things that can cost managed care plans billions of dollars. So as a leader of this organization, I find it perplexing that they would target such a beneficial health plan for funding cuts.”
Mr. Valadao fully understands the political risks associated with supporting legislation aimed at dismantling health policies that enjoy broad public support. After being first elected in 2012, he lost his seat in 2018, a year when Democrats regained control of the House by focusing their campaign on Republican attempts to repeal and replace the Affordable Care Act.
Democratic leaders have indicated in recent days that they plan to employ a similar strategy. During the 2018 midterm election campaign, they intentionally concentrated on illustrating how G.O.P. initiatives to dismantle healthcare provisions and offer tax breaks to the wealthy would adversely affect Americans, as Representative Hakeem Jeffries of New York, the minority leader, noted in a recent MSNBC interview.
“Those were the pivotal issues that enabled us to reclaim the House in November 2018,” he stated. “And that’s a lesson we can draw from that experience.”
Mr. Valadao’s seat has long been a top target for Democrats. Though his district has a Democratic lean, he has managed to win here multiple times, navigating challenges from the right after voting to impeach Mr. Trump in 2020 and successfully fending off efforts from the left to unseat him.
However, the issue of Medicaid cuts could prove uniquely mobilizing.
At the town hall, Kelly Kulzer-Reyes, a community college professor, spoke about her family’s reliance on Medicaid for the services her 12-year-old daughter, Amelia, who has Down syndrome, requires. These services include support staff who help her learn essential skills with the hope that she can live independently as an adult once her parents can no longer provide care.
“I need a world where I can pass away knowing that she’ll be okay, and losing Medicaid jeopardizes that,” Ms. Kulzer-Reyes expressed. “I have to ensure that she is taken care of.”
Marbella Calderon, a nurse employed at a nursing home in Bakersfield, voiced her concerns that Medicaid cuts could leave her patients without much-needed care and threaten her job.
“If Medicaid is cut, many of the residents we care for in these nursing homes—these facilities will likely operate at significantly reduced capacity,” Ms. Calderon noted. “And if we have fewer patients, there won’t be enough hours for employees.”
Her straightforward message for Mr. Valadao was clear: “You would be jeopardizing the healthcare community by eliminating Medicaid.”