Californians Worried About Medi-Cal as Congressional Republicans Consider Cuts

Californians are expressing widespread worry about the future of Medicaid, as Republicans in Congress weigh cuts to the program that covers health care for Americans with low incomes and disabilities.

GOP leaders are looking for budget savings to pay for the extension of tax cuts favored by President Donald Trump, but the idea of cutting Medicaid has raised alarm among some in the party — including California Republicans who represent districts with high numbers of Medicaid recipients. A pair of surveys released this week by the UC Berkeley Institute of Governmental Studies found broad concern about Medi-Cal, the state’s Medicaid program, among California voters.

A full two-thirds, 67%, of registered voters who receive coverage through Medi-Cal are worried that they, or a family member, will lose insurance due to changes being pursued by the Trump administration. In a separate survey, 56% of voters polled said that the Trump administration’s proposed changes to Medi-Cal will have a “negative impact” on California.

Only tariffs ranked higher on voters’ lists of issues facing negative headwinds from Washington, said Mark DiCamillo, the poll’s director.

“Medi-Cal was right up there, so it’s one of the areas where most voters have concerns,” he said.

The program has emerged as a key inflection point in House Republicans’ budget talks this week. House Speaker Mike Johnson has been meeting privately in his office with groups of Republicans, as he works to enact the president’s legislative agenda with a slim seven-seat majority.

The IGS surveys did not ask specifically about the budget plan, which sets a target of $880 billion in spending cuts over the next decade from the committee that oversees Medicaid spending. Trump has supported the budget framework, but told NBC last week that House Republicans are “not cutting [Medicaid]. They’re looking at fraud, waste and abuse.”

An analysis by the nonpartisan Congressional Budget Office shows that there is no way to reach the spending target without cutting Medicaid.

For most enrollees, Medi-Cal costs are shared evenly between California and the federal government. However, the federal government picks up 90% of the tab for the Medicaid expansion authorized through the Affordable Care Act, which covers Californians making up to $21,597.

Fiscal conservatives in the GOP caucus have floated ideas such as reducing the federal cost-share for expansion enrollees or enacting a per-enrollee cap on federal spending. Those proposals would generate significant savings in the range of $700 billion, according to the Congressional Budget Office, but also result in millions of Americans losing their health insurance.

Supporters of Medi-Cal warn that the impact of cuts will ripple beyond the patients who lose insurance. A report from the UC Berkeley Labor Center found that reductions to the healthcare program could result in the loss of up to 217,000 jobs.

In the rural Central Valley community of Visalia, Kaweah Health Center receives more than 30% of its revenue from Medi-Cal. The hospital is also the largest employer in Tulare County.

“When a healthcare job is lost, that healthcare worker has less money to spend in their community, at the stores they normally shop at,” said Laurel Lucia, director of the Health Care Program at the Labor Center. “That in turn could lead to job losses in those other non-healthcare industries.”

The potential cuts could also slow Republican momentum in California heading into the 2026 midterm elections. A KQED analysis found the congressional districts that shifted most toward Trump between 2020 and 2024 rely disproportionately on Medi-Cal. Enrollment is especially high in a pair of Central Valley swing districts held by Republican Rep. David Valadao and Democratic Rep. Adam Gray.

Republicans may be backing away from changes to the federal matching fund rates provided to the states.

New Jersey Republican Rep. Jeff Van Drew said those Medicaid changes “are dead.”

Instead, moderate Republicans have emphasized support for a different suite of ideas, such as restricting Medicaid access for undocumented immigrants and adults without jobs — ideas that would likely result in fewer savings, but generate less political blowback.

California has expanded Medi-Cal enrollment to residents without citizenship, a move that appears broadly popular in the new IGS polling. Support for providing Medi-Cal coverage for undocumented Californians stands at 61% for undocumented children, 49% for adults up to age 49, and 53% for those over age 50.

This story includes reporting from The Associated Press and KQED’s Madi Bolaños.