California Rep. David Valadao Voted for Medi-Cal Cuts. Will Voters Hold It Against Him?

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California Rep. David Valadao has some explaining to do.

Nearly two-thirds of constituents in his Central Valley district — approximately 527,000 Californians — 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’s district has the highest Medicaid enrollment rate of any Republican seat in the country.

Yet last year, the Republican cast what would become the decisive vote to pass President Donald Trump’s 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 benefit the country’s richest. One of the most drastic changes is stricter eligibility requirements for Medicaid that California officials estimate will kick two million Californians off their health care.

Republicans across the country will face an uphill battle in the midterms as they toil to defend — and sell — the record of their party’s widely unpopular and polarizing president.

But Valadao in particular has the unenviable task of justifying why he consistently supported — not just on final passage, but at each procedural step along the way — a measure that bears such dire consequences for so many of the constituents whose votes he’ll need to win reelection.

His two Democratic opponents are already arguing that Valadao’s vote in favor of the “one big beautiful bill,” which came after he suggested he wouldn’t support cutting Medicaid, amounts to a breach of trust that should cost him his job.

“He was the deciding vote. His one vote could have stopped that,” said Assemblymember Jasmeet Bains, a Bakersfield physician who’s challenging Valadao.

Randy Villegas, a Visalia school board trustee and college professor who is also vying for the chance to unseat Valadao, put it more bluntly.

He “lied to our faces,” Villegas said, using an expletive for emphasis. “We have somebody in office who is willing to try and do or say whatever is politically convenient to save his own butt.”

A spokesperson for the six-term congressman declined CalMatters’ requests for an interview, saying his schedule was full.

“Congressman David Valadao has consistently fought for Central Valley families and real solutions to strengthen rural health care, not played politics for headlines,” wrote Christian Martinez, regional press secretary for the National Republican Congressional Committee, in a statement.

Shortly after his final vote on the megabill, Valadao stressed that even though he still had concerns with the bill, he ultimately voted for it to avoid tax hikes that would result from the expiration of Trump’s 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 disproportionately benefit wealthy Americans and corporations.

Can Democrats replicate 2018?

Out of seven elections, Valadao has only lost once – in 2018, as part of the decisive “blue wave” that flipped control of the House during Trump’s first midterm.

That year, Democrats leveraged the GOP’s 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’s controversial practice of separating immigrant children from their parents and detaining them to deter border crossings.

Even casual observers of politics can draw the parallels between 2018 — a Trump midterm election defined by Republican attacks on health care and aggressive immigration enforcement — and 2026. And national Democrats for months have said they plan to run the same playbook as they push to flip the House.

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.

“I do think this is the year that Valadao is in deep trouble,” said Mike Madrid, Republican political consultant and cofounder of the anti-Trump Lincoln Project. “Nine times out of 10, I don’t say that. But this year is going to look a lot like 2018 — probably more.”

Since Valadao reclaimed his seat in 2020, he’s twice fended off challenges from former Democratic Assemblyman Rudy Salas, a moderate with strong backing from national Democrats. (Salas filed candidate paperwork but recently stated he has not yet decided whether he’ll enter the race.)

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.

Will Medicaid vote cost Valadao his job?

After Trump won reelection in 2024 and congressional Republicans started crafting the president’s first big legislative package, Valadao repeatedly signaled that he wouldn’t support a bill that threatened Medicaid.

In one letter to House leadership, Valadao and some Hispanic lawmakers argued that such cuts “would have serious consequences, particularly in rural and predominantly Hispanic communities where hospitals and nursing homes are already struggling to keep their doors open.”

But ultimately, he voted several times to advance Trump’s domestic policy agenda, which health care advocates and constituents lambasted.

“I do think there was really a sense of betrayal among at least some of his voters, who thought, ‘You know, this is not what I elected him to Congress to do — I thought he was a different kind of Republican who would represent the needs of the district,’” said Amanda McAllister-Wallner, executive director of Health Access. She helped lead the coalition known as “Fight for Our Health,” which lobbied Valadao and other California House Republicans to vote against the cuts.

Valadao’s 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.

Valadao has defended his votes and said he ultimately supported the legislation because it preserved the Medicaid program “for its intended recipients — children, pregnant women, the disabled and elderly.”

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.

“I know how important the program is for my constituents,” Valadao wrote in a statement after he voted to approve the bill. He added that several of the most concerning policy changes that “would have devastated healthcare in my district,” were removed as a result of his “many months of meetings” with Republican leadership.

Valadao does damage control

Since the vote, Valadao has seemingly worked to insulate himself from potentially difficult questions, declining multiple interviews with CalMatters for several different stories.

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, according to health advocates.

When he has received questions about Medicaid funding, he has pointed repeatedly to the “Rural Health Transformation Project,” a $50 billion fund tucked into the Trump megabill designed to help some rural hospitals keep their doors open as they prepare to lose billions in Medicaid revenue. Critics have pointed out that California would only receive $230 million from the program in 2026, a fraction of the estimated $15 billion the state’s hospitals would have received in Medicaid dollars this year.

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.

“I would say that it felt performative,” 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’s agenda than a genuine discussion.

“There was a great roundtable of people who would have loved to have a more robust conversation around true impacts and what solutions exist,” Hedrick said. “And those solutions would be congressional fixes.”

But as much as Valadao’s opponents hope to leverage the Medicaid cuts, political strategists warn that they should not fixate too much on health care.

“If I were running the campaign against him, I would not pin all my hopes on that,” said Madrid. He argued that Democrats should tap into Americans’ concerns about the economy and the cost of living, which consistently poll as the top issue for voters and are “politically poisonous” for Republicans given that prices have only risen since their party took control of Washington.

Rob Stutzman, a veteran Republican political strategist, posited that Medicaid wouldn’t 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.

“He’s as equipped to weather a Trump midterm as a lot of Republicans in similar situations across the country,” Stutzman said of Valadao. “He’s now a long-term incumbent. He’s got a lot of muscle and strength in that district.”

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.