Medicaid Cuts Divide California House Members as Budget Deadline Looms

Washington, D.C. — As Republicans in Congress debate how to cut as much as $880 billion over the next 10 years from Medicaid, which provides health coverage to about 72 million Americans who are low-income or disabled, the proposed cuts are putting swing district Republicans in a tough spot.

That’s not the case for their colleagues in safe seats on both sides of the aisle, who are doubling down on their respective party’s positions.

Given the partisan divide over nearly every policy issue at this moment, those positions shouldn’t be surprising. Case in point: A series of polls released this week from the UC Berkeley Institute for Governmental Studies found partisanship influencing voter views on virtually every policy area, including Medicaid — or as it’s known in California, Medi-Cal. About 15 million Californians are covered by Medi-Cal.

According to one IGS poll, more than half — 56% — of California voters believe Republicans’ proposed changes to Medi-Cal will negatively impact the state, while 21% think it will be positive. The number concerned about negative impacts skyrockets to 78% with Democrats, while 47% of GOP voters say the changes could have a positive effect.

Nearly half of voters say they are worried about their own health insurance coverage under President Donald Trump, though those views also break along party lines: Just 18% of Republicans are worried compared to 66% of Democrats, while no party preference voters are pretty evenly split on the question. Medi-Cal recipients are most worried, with more than two-thirds expressing concern.

“Voters, especially the Democrats, are very, very fearful of what’s going down in Washington, and I think this poll just pretty much verifies that,” said IGS poll director Mark DiCamillo. “Republicans seem to be rather blasé about it in terms of the impacts on the state.”

DiCamillo called the partisan divide on policy issues “extreme.”

“Republicans have very, very different views than Democrats on just about everything,” he said.

Those divergent views explain why Rep. Kevin Kiley, a Republican who won his Northern California district by a comfortable 10-point margin last year, supports his party’s plan to make deep cuts to Medicaid. Though the GOP hasn’t finalized which areas to cut, one idea involves tying Medicaid to work requirements.

“Work requirements, I think, absolutely make sense,” Kiley told KQED’s Political Breakdown podcast this week.

Studies show most Medicaid recipients who can work already do. Advocates for people with lower incomes warn that new work requirements are just a way to boot people off their health insurance. The California Budget and Policy Center estimates that more than 8 million Californians, or half of Medi-Cal recipients, could lose healthcare if work requirements are imposed, despite most adults enrolled in Medi-Cal already being employed.

An analysis by the Commonwealth Fund and Milken Institute of Public Health at George Washington University finds that work requirements don’t increase employment, they simply lead to coverage losses.

“They push people out of Medicaid not because they aren’t working, but because they can’t navigate complex paperwork and reporting rules,” said Sara R. Collins, a senior scholar and vice president for health care coverage and access at the Commonwealth Fund. “The result is more uninsured Americans and greater strain on families and the doctors, clinics and hospitals they depend on.”

Kiley also wants to prohibit undocumented immigrants from accessing Medi-Cal, even though their coverage is funded by the state rather than federal money. He noted that covering undocumented immigrants costs more than California officials expected, and argued that the funds could be used to cover citizens if federal Medi-Cal dollars decline under the GOP plan.

“Let’s say you extend that over the next 10 years,” he said. “That’s hundreds of billions of dollars potentially that could be going to supporting access to care for our own residents, but is instead being used as essentially an incentive for further illegal immigration.”

California Democrats are unapologetic about their support for Medi-Cal and say Republicans in Congress and Trump are making a political miscalculation by supporting cuts.

“There is not this magic bucket of waste, fraud, and abuse that Republicans are going to unlock and all the savings are going to emerge,” said Democratic Rep. Pete Aguilar. He added that even in his more centrist Inland Empire district, Medi-Cal is incredibly popular.

Aguilar warned that the cuts, if realized, wouldn’t just hurt individuals who lose their insurance but could have a ripple effect on the entire hospital and healthcare system, especially in more rural districts like Kiley’s.

“These are essential services that are being provided by the federal government,” he said.

That potential pain may be why two vulnerable House Republicans from California joined 10 other swing-state GOP members of Congress in sounding the alarm to House leadership over the proposed cuts.

California Reps. David Valadao (R-Hanford) and Young Kim (R-Anaheim Hills) recently signed a letter to Speaker Mike Johnson that said ”we cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.”

In Valadao’s Central Valley district, which has the highest percentage of Medicaid recipients, 67% of residents rely on the public program for their health insurance. In Kim’s Orange County district, one-fifth of residents are enrolled in the program, according to data from the California Health Care Foundation.

“Communities like ours won us the majority, and we have a responsibility to deliver on the promises we made,” the letter stated. “Balancing the federal budget must not come at the expense of those who depend on these benefits for their health and economic security.”

GOP leaders are still looking for a way to cut spending while assuaging the concerns of Republican members like Valadao and Kim. But they’ll need those swing district members to pass a budget by Memorial Day because House Republicans hold a slim majority and cannot afford to lose more than a few votes.