California Rep. David Valadao has some explaining to do.<\/p>\n
Nearly two-thirds of constituents in his Central Valley district \u2014 approximately 527,000 Californians \u2014 are enrolled in Medi-Cal, the state Medicaid program that provides health care coverage to low-income Americans and those with disabilities. At 64%, Valadao\u2019s district has the\u00a0highest Medicaid enrollment rate<\/a>\u00a0of any Republican seat in the country.<\/p>\n Yet last year, the Republican cast what would become the decisive vote to pass President Donald Trump\u2019s domestic policy megabill, a law that slashed more than $1 trillion from Medicaid and other programs that help the poorest Americans to pay for tax cuts that will mostly\u00a0benefit the country\u2019s richest<\/a>. One of the most drastic changes is stricter eligibility requirements for Medicaid that California officials\u00a0estimate will kick two million Californians<\/a>\u00a0off their health care.<\/p>\n Republicans across the country will face an uphill battle in the midterms as they toil to defend \u2014 and sell \u2014 the record of their party\u2019s widely unpopular and polarizing president.\u00a0<\/p>\n But Valadao in particular has the unenviable task of justifying why he consistently supported \u2014 not just on final passage, but at each procedural step along the way \u2014 a measure that bears such dire consequences for so many of the constituents whose votes he\u2019ll need to win reelection.<\/p>\n His two Democratic opponents are already arguing that Valadao\u2019s vote in favor of the \u201cone big beautiful bill,\u201d which came after he suggested he wouldn\u2019t support cutting Medicaid, amounts to a breach of trust that should cost him his job.\u00a0<\/p>\n \u201cHe was the deciding vote. His one vote could have stopped that,\u201d said Assemblymember\u00a0Jasmeet Bains<\/a>, a Bakersfield physician who\u2019s challenging Valadao.\u00a0<\/p>\n Randy Villegas, a Visalia school board trustee and college professor who is also vying for the chance to unseat Valadao, put it more bluntly.\u00a0<\/p>\n He \u201clied to our faces,\u201d Villegas said, using an expletive for emphasis. \u201cWe have somebody in office who is willing to try and do or say whatever is politically convenient to save his own butt.\u201d<\/p>\n A spokesperson for the six-term congressman declined CalMatters\u2019 requests for an interview, saying his schedule was full.<\/p>\n \u201cCongressman David Valadao has consistently fought for Central Valley families and real solutions to strengthen rural health care, not played politics for headlines,\u201d wrote Christian Martinez, regional press secretary for the National Republican Congressional Committee, in a statement.<\/p>\n Shortly after his final vote on the megabill, Valadao stressed that even though he\u00a0still had concerns<\/a>\u00a0with the bill, he ultimately voted for it to avoid tax hikes that would result from the expiration of Trump\u2019s 2017 tax cuts. While Valadao and other Republicans have marketed those cuts as tax relief for middle- and low-income families, economists agree that they\u00a0disproportionately benefit wealthy Americans and corporations<\/a>.<\/p>\n Valadao co-hosted a roundtable last month with local health care industry leaders and advocates, Rep. Vince Fong and Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services under Trump. The event was closed to the press, and one attendee said there was little time to address specific questions or concerns.\u00a0<\/p>\n \u201cI would say that it felt performative,\u201d said Virginia Hedrick, CEO of the California Rural Indian Health Board. She said she was frustrated that the conversation was largely scripted and felt more like a sales pitch for Oz and the White House\u2019s agenda than a genuine discussion.\u00a0<\/p>\n \u201cThere was a great roundtable of people who would have loved to have a more robust conversation around true impacts and what solutions exist,\u201d Hedrick said. \u201cAnd those solutions would be congressional fixes.\u201d<\/p>\n But as much as Valadao\u2019s opponents hope to leverage the Medicaid cuts, political strategists warn that they should not fixate too much on health care.<\/p>\n \u201cIf I were running the campaign against him, I would not pin all my hopes on that,\u201d said Madrid. He argued that Democrats should tap into Americans\u2019 concerns about the economy and the cost of living, which consistently poll as the top issue for voters and are \u201cpolitically poisonous\u201d for Republicans given that prices have only risen since their party took control of Washington.\u00a0<\/p>\n Rob Stutzman, a veteran Republican political strategist, posited that Medicaid wouldn\u2019t be as strong a motivator as the Affordable Care Act was to get voters out. The people most affected by those cuts, low-income families and those with disabilities, are not the typical demographic of likely midterm voters.<\/p>\n \u201cHe\u2019s as equipped to weather a Trump midterm as a lot of Republicans in similar situations across the country,\u201d Stutzman said of Valadao. \u201cHe\u2019s now a long-term incumbent. He\u2019s got a lot of muscle and strength in that district.\u201d<\/p>\n Can Democrats replicate 2018?<\/p>\n Out of seven elections, Valadao has only lost once \u2013 in 2018, as part of the decisive \u201cblue wave\u201d that flipped control of the House during Trump\u2019s first midterm.\u00a0<\/p>\n That year, Democrats leveraged the GOP\u2019s multiple failed attempts to repeal the Affordable Care Act, a program that since its creation has grown broadly popular with Americans across the political spectrum. Also looming then was the White House\u2019s controversial practice of separating immigrant children from their parents and detaining them to deter border crossings.<\/p>\n Even casual observers of politics can draw the parallels between 2018 \u2014 a Trump midterm election defined by Republican attacks on health care and aggressive immigration enforcement \u2014 and 2026. And national Democrats for months have said they plan to\u00a0run the same playbook<\/a>\u00a0as they push to flip the House.<\/p>\n Republican strategists agree this will be the most difficult reelection that incumbent House Republicans have faced since the last time Trump was in office, even for someone like Valadao who has consistently outperformed as a Republican in a Democratic-leaning district.\u00a0<\/p>\n \u201cI do think this is the year that Valadao is in deep trouble,\u201d said Mike Madrid, Republican political consultant and cofounder of the anti-Trump Lincoln Project. \u201cNine times out of 10, I don\u2019t say that. But this year is going to look a lot like 2018 \u2014 probably more.\u201d<\/p>\n Since Valadao reclaimed his seat in 2020, he\u2019s twice fended off challenges from former Democratic Assemblyman Rudy Salas, a moderate with strong backing from national Democrats. (Salas\u00a0filed candidate paperwork<\/a>\u00a0but\u00a0recently stated<\/a>\u00a0he has not yet decided whether he\u2019ll enter the race.)<\/p>\n He has also sought to further burnish his reputation as a moderate and an independent thinker rather than a Trump acolyte. Of the 10 Republican defectors who voted with Democrats in 2021 to impeach Trump for inciting an insurrection on Jan. 6, Valadao is the only one left in Congress.<\/p>\n Will Medicaid vote cost Valadao his job?<\/p>\n After Trump won reelection in 2024 and congressional Republicans started crafting the president\u2019s first big legislative package, Valadao repeatedly signaled that he wouldn\u2019t support a bill that threatened Medicaid.\u00a0<\/p>\n In one letter to House leadership, Valadao and some Hispanic lawmakers argued that such cuts \u201cwould have serious consequences, particularly in rural and predominantly Hispanic communities where hospitals and nursing homes are already struggling to keep their doors open.\u201d<\/p>\n But ultimately, he voted several times to advance Trump\u2019s domestic policy agenda, which health care advocates and constituents lambasted.<\/p>\n \u201cI do think there was really a sense of betrayal among at least some of his voters, who thought, \u2018You know, this is not what I elected him to Congress to do \u2014 I thought he was a different kind of Republican who would represent the needs of the district,\u2019\u201d said Amanda McAllister-Wallner, executive director of Health Access. She helped lead the coalition known as \u201cFight for Our Health,\u201d which lobbied Valadao and other California House Republicans to vote against the cuts.\u00a0<\/p>\n Valadao\u2019s vote was especially significant given that the 22nd Congressional District, which he represents, is home to a higher percentage of Medicaid enrollees than any other Republican district in the U.S.\u00a0<\/p>\n Valadao has defended his votes and said he ultimately supported the legislation because it preserved the Medicaid program \u201cfor its intended recipients \u2014 children, pregnant women, the disabled and elderly.\u201d\u00a0<\/p>\n Critics say the more stringent eligibility requirements will cause patients of all ages to lose coverage, since proving eligibility can be a confusing and laborious process.<\/p>\n \u201cI know how important the program is for my constituents,\u201d Valadao\u00a0wrote in a statement<\/a>\u00a0after he voted to approve the bill. He added that several of the most concerning policy changes that \u201cwould have devastated healthcare in my district,\u201d were removed as a result of his \u201cmany months of meetings\u201d with Republican leadership.<\/p>\n Valadao does damage control<\/p>\n Since the vote, Valadao has seemingly worked to insulate himself from potentially difficult questions, declining multiple interviews with CalMatters for several different stories.<\/p>\n In a nod to the issue that lost him the 2018 race, Valadao also joined Democrats and 16 other Republicans to buck House GOP leadership in a symbolic vote to extend the already-expired Affordable Care Act tax subsidies. More than 85,000 of his constituents on ACA plans saw their health premiums skyrocket by an average of $85 per month,\u00a0according to health advocates<\/a>.<\/p>\n