This week, Republican Rep. Jeff Van Drew from New Jersey reached out to President Donald Trump with a significant concern regarding the House GOP’s framework for enacting Trump’s agenda. Van Drew cautioned that advancing this framework would likely necessitate cuts to Medicaid, a move that could expose the party to severe political repercussions. “They’re going to go after you for this,” Van Drew recalled telling the president, emphasizing the potential risk of losing their majority. He expressed that pursuing such cuts would be a "mistake."
Despite his concerns, Van Drew, along with nearly all House Republicans, voted to progress with this framework, which aims to create what they call a “big, beautiful bill.” This decision has set the stage for a possible confrontation over health insurance for millions of lower-income Americans, a move that could have dire consequences for the GOP at the polls. Both Trump and House GOP leaders have maintained that they will not reduce Medicaid benefits but will instead focus on eliminating “fraud.” However, experts question how they plan to achieve their spending cut targets without implementing substantial changes.
The prospect of Medicaid cuts has become increasingly problematic for vulnerable Republicans in Congress, with some pledging to reject any final legislation that proposes these reductions. This issue has handed Democrats a strong talking point ahead of the 2026 midterm elections. As Republicans strive to finance Trump’s legislative agenda, they face the challenge of doing so without cutting into programs that their voters rely on, particularly as they aim to position themselves as the party of the working class.
Rep. Tony Gonzales (R-Texas) emphasized the importance of last night’s vote, stating it was just the beginning of a long negotiation process. He and other members of the Congressional Hispanic Conference are committed to ensuring that proposals detrimental to hardworking Americans don’t materialize. “I’m going to be very involved in the sausage-making process,” Gonzales said, urging leadership to steer clear of Medicaid cuts.
Republican leaders have suggested that they can reduce waste and fraud within Medicaid spending without cutting benefits for Americans. On Wednesday, Van Drew mentioned that he voted for the budget resolution because Trump appears “100 percent committed” to preserving Medicaid, aside from tackling waste and fraud. “We’re not going to touch it. Now, we are going to look for fraud,” Trump stated when asked about Medicaid, a sentiment echoed by House Speaker Mike Johnson (R-Louisiana).
Democrats have already begun to leverage the threat of Medicaid cuts against Republicans. The Democratic Congressional Campaign Committee has released numerous statements targeting the most politically vulnerable GOP lawmakers on this issue. Rep. Suzan DelBene (D-Washington) criticized Republicans for allegedly favoring the wealthy at the expense of working families, as they look to extend tax cuts from Trump’s first term. She dismissed claims that cuts to Medicaid could be avoided, stating, “The math doesn’t work.”
Medicaid provides critical health coverage for approximately 1 in 5 Americans, and significant reductions to social safety net programs could jeopardize the positions of swing-district House Republicans, especially those representing lower-income communities. Although Republicans assert that the budget resolution passed on Tuesday merely sets the stage for extensive negotiations, it calls for $880 billion in cuts to spending overseen by the House Energy and Commerce Committee, where Medicaid and Medicare comprise the bulk of potential cuts.
Both Republican and Democratic leadership have pledged to avoid cuts to Medicare, which provides health coverage for the elderly, leaving Medicaid as a likely target. Experts argue that even if the Energy and Commerce Committee eliminated all other spending under its jurisdiction, it would still fall short of the $880 billion goal.
Republicans have proposed various modifications to Medicaid, including shifting more financial responsibilities to states and introducing work requirements for beneficiaries. Sen. Josh Hawley (R-Missouri) argued that work requirements could be the most politically acceptable option, suggesting it might garner unanimous support from Republican lawmakers. Previous estimates from the Congressional Budget Office have indicated that implementing work requirements could save around $100 billion, but this figure would still fall significantly short of the Republicans’ $880 billion target.
Some Republican senators have expressed skepticism regarding potential cuts to Medicaid. Hawley has indicated openness to restructuring the program but expressed concern about any changes that might negatively impact beneficiaries. Similarly, Sen. Jim Justice (R-West Virginia) acknowledged the importance of Medicaid in his state but cautioned that it would be premature to act hastily.
In the House, certain GOP lawmakers who supported the budget resolution have firmly opposed any reductions to Medicaid. Rep. David G. Valadao (R-California), representing a district where over half of his constituents rely on Medicaid, stated, “I will not support a final reconciliation bill that risks leaving them behind.” Likewise, Rep. Derrick Van Orden (R-Wisconsin) echoed these sentiments, stressing that millions depend on programs like Social Security, Medicare, and Medicaid, and he would oppose any cuts.
As undecided lawmakers began to back the budget resolution, which ultimately passed with nearly unanimous Republican support, leadership reassured them that they would be involved in a process aimed at safeguarding Medicaid and other essential programs. Rep. Jodey Arrington (R-Texas), chair of the Budget Committee, noted that reforms are being discussed to prevent Medicaid from being exploited.
Republicans in the House are at the beginning stages of the legislative process that will shape Trump’s “big, beautiful bill,” which aims to extend tax cuts and implement his priorities on energy and border security. As House leaders, including Johnson and Senate Majority Leader John Thune (R-South Dakota), work to reconcile their budget proposals, they must ensure that both chambers agree on a unified set of spending parameters.
Rep. Nicole Malliotakis (R-New York) has also expressed caution regarding potential Medicaid cuts, stating that she received assurances that leadership is concentrating on eliminating Medicaid fraud. However, she indicated that if the final bill does include cuts to benefits as predicted by Democrats, she may reconsider her support for the budget. Currently, Republicans in the House can afford to lose only one vote, heightening the stakes of this legislative battle.
