Valadao’s Medicaid vote could cost him his seat in California

from Maya S. MillerCalMatters

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California Rep. David Valladao has some explaining to do.

Nearly two-thirds of voters in his Central Valley district — roughly 527,000 Californians — are enrolled in Medi-Cal, the state Medicaid program that provides health coverage to low-income and disabled Americans. At 64%, Valladão district has highest Medicaid enrollment rate in every Republican place in the country.

Yet last year, the Republican cast what would become the deciding vote to pass President Donald Trump’s domestic policy mega-bill, a law that slashed more than $1 trillion from Medicaid and other programs that help the poorest Americans pay for tax cuts that would mostly in favor of the richest in the country. One of the most drastic changes is the stricter eligibility requirements for Medicaid from California officials estimate will kick out two million Californians outside of their health care.

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

But Valladão, in particular, has the unenviable task of justifying why he has consistently supported — not only on final passage but at every procedural step along the way — a measure that carries such dire consequences for so many of the voters whose votes he will need to win re-election.

His two Democratic opponents have already argued that Valadao’s vote in favor of “one big beautiful bill,” which came after he suggested he would not support Medicaid cuts, amounted to a breach of trust that should cost him his job.

“He was the deciding vote. His one vote could have stopped this,” said an MP Jasmeet Bainsa Bakersfield physician who challenges Valadao.

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

He “lied to our eyes,” Villegas said, using an expletive for emphasis. “We have someone in office who is willing to try to do or say whatever is politically convenient to save their ass.”

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

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

Shortly after his final vote on the mega-law, Valadao stressed that although he there were still concerns with the bill he ultimately voted for to avoid tax increases that would have resulted from Trump’s tax cuts expiring in 2017. While Valladão and other Republicans tout the cuts as tax relief for middle- and low-income families, economists agree that disproportionately benefit wealthy Americans and corporations.

Can the Democrats repeat 2018?

In seven elections, Valladão has lost just once, in 2018, as part of a decisive “blue wave” that swept control of the House during Trump’s first midterm.

This year, Democrats have capitalized on the GOP’s numerous failed attempts to repeal the Affordable Care Act, a program that has become widely popular with Americans across the political spectrum since its inception. Then came the controversial White House 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 — Trump’s midterm elections defined by Republican attacks on health care and aggressive immigration enforcement — and 2026. And national Democrats have said for months they plan to run the same book as they push to turn the house.

Republican strategists agree it will be the toughest re-election incumbent House Republicans have faced since Trump was last in office, even for someone like Valladao, who has consistently performed better as a Republican in a Democratic-leaning district.

“I really think this is the year Valladao is in big trouble,” said Mike Madrid, a Republican political consultant and co-founder of the Lincoln Against Trump Project. “Nine times out of 10, I don’t say that. But this year is going to look a lot like 2018 — probably more so.”

Since Valladao won back the seat in 2020, he has twice fended off challenges from former Democratic Rep. Rudy Salas, a moderate with strong support from national Democrats. (Salas submitted application documents but recently stated he has not yet decided whether he will enter the race.)

He also sought to further burnish his reputation as a moderate and independent thinker rather than a Trump acolyte. Of the 10 defecting Republicans who voted with Democrats in 2021 to impeach Trump for sedition on Jan. 6, Valladão is the only one left in Congress.

Will the Medicaid vote cost Valadao his job?

After Trump won re-election in 2024 and congressional Republicans began crafting the president’s first major legislative package, Valadao has repeatedly signaled that he would not support a bill that threatens Medicaid.

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

But he ended up voting several times to advance Trump’s domestic policy agenda, which health care advocates and constituents criticized.

“I think there really was a sense of betrayal among at least some of his constituents who thought, ‘You know, this is not what I elected him to Congress for — 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 Valladão and other California House Republicans to vote against the cuts.

Valadao’s vote was particularly significant given that the 22nd congressional district he represents is home to a higher percentage of Medicaid enrollees than any other Republican district in the US

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

Critics say stricter eligibility requirements will cause patients of all ages to lose coverage because proving eligibility can be a confusing and time-consuming process.

“I know how important the program is to my constituents,” Valadao said in a statement after voting to approve the bill. He added that several of the most troubling policy changes that “would have devastated health care in my district” had been removed as a result of his “months of meetings” with Republican leadership.

Valadao is in damage control

Since the vote, Valadao has appeared to work 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 in opposing House GOP leadership in a token vote to extend the now-expired Affordable Care Act tax subsidies. More than 85,000 of his constituents in ACA plans saw their health premiums jump by an average of $85 a month, according to health advocates.

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

“It felt performative.”

Virginia Hedrick, CEO of the California Rural Indian Health Council.

Valadao hosted a roundtable discussion last month with local health 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 it felt performative,” said Virginia Hedrick, CEO of the California Rural Indian Health Council. She said she was disappointed that the conversation was largely scripted and seemed more like a sales pitch for Oz and the White House agenda than a real discussion.

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

But as much as Valladao’s opponents hope to take advantage of the Medicaid cuts, political strategists caution against getting too fixated on health care.

“If I was campaigning against him, I wouldn’t be pinning all my hopes on it,” Madrid said. He argued that Democrats need to tap into Americans’ concerns about the economy and the cost of living, which have consistently been a 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, said Medicaid won’t be as strong a motivator as the Affordable Care Act to get voters to turn out. The people most affected by these cuts, low-income families and people with disabilities, are not the typical demographic of likely midterm voters.

“He’s as prepared to withstand Trump in the midterms as many Republicans in similar situations across the country,” Stutzman said of Valadao. “He’s a long-term starter now. He’s got a lot of muscle and strength in that area.”

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.