The House’s sweeping budget plan to advance President Donald Trump’s agenda could result in steep cuts to Medicaid and food stamps, putting a key group of Republicans in a politically difficult position ahead of a potential vote next week in the narrowly divided chamber.
There are a handful of House Republicans who represent parts of the country where sizable shares of the populations receive government assistance from Medicaid and the Supplemental Nutrition Assistance Program, according to an NBC News analysis of the most recently available Census Bureau data.
The lawmakers from the 10 GOP-held districts with the highest percentages of Medicaid or SNAP beneficiaries span the ideological and geographical spectrum. They include members from deep-red districts, such as Speaker Mike Johnson of Louisiana and veteran Rep. Hal Rogers of Kentucky, as well as those in competitive battlegrounds, such as Reps. David Valadao of California, Rob Bresnahan of Pennsylvania and Monica De La Cruz of Texas.
While Democrats represent more districts with the largest portions of adults receiving federal assistance, the prevalence of constituents who are dependent on anti-poverty programs in GOP-held seats could test Republicans who are on the hunt for steep spending cuts and under pressure to implement Trump’s agenda. And it underscores why the issue has become such a sticking point in the budget talks.
“There’s a little bit of frustration among those of us who do have large Medicaid populations that we have not been engaged [by leadership] as much as some of the members of the Freedom Caucus in this process,” Rep. Nicole Malliotakis, R-N.Y., told NBC News.
“And therefore, we are undecided on how we’re going to be voting,” she continued, referencing the GOP holdouts with concerns about Medicaid.
The House’s budget blueprint for a tax, energy and immigration package, which the Budget Committee advanced last week, calls for at least $1.5 trillion in spending cuts. That includes $880 billion in spending cuts from the House Energy and Commerce Committee, which has Medicaid in its jurisdiction, and $230 billion from the House Agriculture Committee, which oversees SNAP.
House GOP leaders are aiming to bring the Trump-endorsed budget resolution to the floor next week and, if it passes, committees will begin drafting the policy portion of the package.
Medicaid covers health care costs for those with low incomes or disabilities, while SNAP provides food benefits to low-income Americans. Republicans are considering imposing work requirements and other policies that would raise the bar to access benefits for Medicaid, as well as attempting to eliminate instances of waste, fraud and abuse, in an attempt to find savings and pay for other pieces of their agenda.
Census data lumps its estimates of people receiving coverage from Medicaid in with those receiving other means-tested public health coverage. But Medicaid, which had more than 72 million enrollees as of October, is far and away the most popular type of means-tested public health coverage.
While Trump has insisted that Medicaid won’t be “touched,” a Republican lawmaker on a key committee and a senior GOP aide said they believe it’s mathematically difficult to achieve the goal of $2 trillion in savings without making substantial cuts to Medicaid and SNAP. Party leaders may seek to sell any changes to Medicaid policy as an attempt to reform the program rather than one to slash benefits. Still, even under that scenario, there could be an impact on services.
Valadao, who represents a key swing seat for Republicans that could determine control of the House in 2026, has been one of the loudest voices in the House GOP warning against potential cuts to Medicaid and SNAP.
In Valadao’s San Joaquin Valley district in central California, 38.5% of adults under the age of 65 use Medicaid or other forms of means-tested public coverage as their sole form of health care. That makes Valadao the member of Congress who represents the second-highest number of Medicaid recipients in the entire country, only behind Democratic Rep. Ritchie Torres of New York.
Meanwhile, 27.9% of households in the agriculture-rich district, which is majority Hispanic, receive food stamps.
Valadao — along with Maltiotakis, Bresnahan and De La Cruz — signed on to a Congressional Hispanic Conference letter this week urging Johnson to protect Medicaid benefits, Pell grants and food stamps. All of them represent districts with large Hispanic populations. Valadao and Bresnahan, who is from a district where 19% of households receive SNAP benefits, are already getting hit with attack ads back home over the possibility of Medicaid cuts.
The Congressional Hispanic Conference is expected to meet with Johnson when they return to Washington next week. Johnson and other members of his leadership team have spent this week, with the House on recess, working the phones to see where members stand and win over potential holdouts, according to Rep. Don Bacon, R-Neb., who has been on the receiving end of such calls.
The issue also presents a unique dilemma for House Energy and Commerce Chair Brett Guthrie, R-Ky., who would be in charge of finding the requisite cuts. He represents a district with the 14th-largest share of Medicaid recipients of any Republican: 18.3% of non-elderly adults in his district rely on Medicaid or means-tested coverage as their only form of health care.
Guthrie’s office didn’t respond to a request for comment. But he, too, has been working to assuage the concerns of skeptics: Malliotakis said she was scheduled to speak with Guthrie on Thursday as she seeks more clarity about their plans.
If the final bill fails to include substantial cuts, the wafer-thin GOP majority risks losing decisive votes from conservatives who have made that a condition for their support.
Rep. Chip Roy, R-Texas, a Freedom Caucus member, said his decision on the bill will hinge on: “Are we going to get enough cuts, and how real are those?”
“You’ve got these Medicaid work requirements, potential SNAP work requirements,” Roy told NBC News, describing several spending cuts on which Republicans can agree. “And then there’s other issues that are a little bigger that we got to go wrestle with.”
Congressional Democrats plan to make potential Medicaid cuts a centerpiece of their attacks on the GOP budget plan.
“They’re cutting your Medicaid. Why? Why would they do that? Tax breaks for the rich,” Senate Minority Leader Chuck Schumer, D-N.Y. told NBC News. “It sort of hits them on both sides. And it has the advantage not only of being true, but the American people believe it.”
He argued that the impacts will be felt beyond the beneficiaries.
“The Medicaid cuts cut right to the bone,” Schumer said. “Medicaid cuts affect poor people … It also affects middle-income people, because about a third of all Medicaid goes to elderly people in assisted living and nursing homes."
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