In the stretch of rural Kentucky that borders West Virginia, voters reliably send Republicans to Congress. Representative Hal Rogers, who represents the area, did not even face a Democratic challenger in 2024. More than 40 percent of the population there relies on Medicaid, the public health insurance plan for low-income Americans.
In eastern Louisiana, where Representative Julia Letlow, a Republican, was elected in 2024 by a wide margin, about one-third of the population is enrolled in the program.
Share of population enrolled in Medicaid
Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming have not adopted the Affordable Care Act’s Medicaid expansion.
The New York Times
And in California’s Central Valley, Republicans control a district where two-thirds of the population is on Medicaid, one of the highest rates in the nation, according to an analysis of federal enrollment data by the Center on Budget and Policy Priorities, a liberal think tank.
Some of those places could bear the brunt of steep Medicaid cuts that are expected to be central to Republicans’ budget plans. The budget passed on Tuesday night by House Republicans directs Energy and Commerce, the committee that oversees Medicaid, to cut spending by $880 billion over the next decade, which would amount to an 11 percent reduction in the program’s planned spending.
In its 60 years, Medicaid has swelled from a small program that provided medical care to poor Americans receiving cash assistance to the largest source of public insurance. It covers 72 million Americans, about one-fifth of the population. It pays for about half of all nursing care in the United States, and 40 percent of all births.
The program has grown especially quickly over the last 15 years, as millions joined through the expansion of the Affordable Care Act to cover healthy adults who earn less than 138 percent of the federal poverty line, about $21,597 for an individual and $36,777 for a family of three. The rolls swelled again during the coronavirus pandemic, when Medicaid extended emergency coverage to millions.
Republicans have not yet specified what policy changes they would make to Medicaid. Options discussed include requiring enrollees to be employed, or dialing down funding for the Affordable Care Act’s expansion, which made millions of adults eligible for coverage. A work requirement would be expected to cut Medicaid spending by about $100 billion over the next decade, as those unable to comply — or to file the correct paperwork showing their employment — would lose coverage.
In a statement, Representative Rogers of Kentucky described claims his party would gut the program as “lies promoted by House Democrats.”
“We are on a mission to cut waste, fraud and abuse of taxpayer dollars, so that we can protect the future of programs like Medicaid for years to come,” he said.
Medicaid enrollment rates, by congressional district
Large cuts to Medicaid would likely hit dense urban areas that tend to vote for Democrats. The congressional district that covers part of the Bronx in New York, for example, has one of the highest Medicaid enrollment rates in the country, with the program covering 67 percent of the people who live there. A district that covers part of Los Angeles has more than half its residents enrolled in the program.
Of the 10 congressional districts with the highest share of residents enrolled in Medicaid, nine are held by Democratic legislators.
Districts with the highest Medicaid enrollment rates
| District | Representative |
Medicaid enrollment |
Margin | |
|---|---|---|---|---|
| Calif. 22nd |
David Valadao |
68% | R+7 | |
| N.Y. 15th |
 Ritchie Torres |
67% | D+55 | |
| Calif. 21st |
 Jim Costa |
61% | D+5 | |
| Calif. 37th |
 Sydney Kamlager-Dove |
56% | D+57 | |
| Calif. 25th |
 Raul Ruiz |
55% | D+13 | |
| Calif. 13th |
 Adam Gray |
55% | D+0.09 | |
| N.Y. 14th |
 Alexandria Ocasio-Cortez |
53% | D+38 | |
| Calif. 34th |
 Jimmy Gomez |
53% | D | |
| Calif. 29th |
 Luz Rivas |
52% | D+40 | |
| N.Y. 13th |
 Adriano Espaillat |
52% | D+67 | |
Note: Margin of victory not shown for representatives who faced another member of the same party on the November ballot.
There are also pockets of the country that rely significantly on the program where voters favor Republicans. Of the 218 seats Republicans control in Congress, 26 are in districts where Medicaid covers more than 30 percent of the population, according to a New York Times analysis of federal enrollment data.
All 26 of those representatives voted in favor of the House budget this week.
Republican districts with highest Medicaid enrollment rates
| District | Representative |
Medicaid enrollment |
Republican Margin | |
|---|---|---|---|---|
| Calif. 22nd |
 David Valadao |
68% | R+7 | |
| Calif. 23rd |
 Jay Obernolte |
47% | R+20 | |
| Ky. 5th |
 Hal Rogers |
44% |
R Uncontested |
|
| Calif. 1st |
 Doug LaMalfa |
42% | R+31 | |
| Ore. 2nd |
 Cliff Bentz |
40% | R+31 | |
| Wash. 4th |
 Dan Newhouse |
38% | R | |
| Alaska At-Large |
 Nick Begich |
36% | R+2 | |
| N.Y. 11th |
 Nicole Malliotakis |
34% | R+28 | |
| La. 5th |
 Julia Letlow |
34% | R | |
| La. 3rd |
 Clay Higgins |
34% | R | |
| Calif. 20th |
 Vince Fong |
33% | R | |
| La. 4th |
 Mike Johnson |
33% | R | |
Note: Margin of victory not shown for Republican representatives who faced another Republican on the November ballot.
Their districts are scattered across the country, from Alaska to West Virginia. The list includes the Louisiana district held by Speaker Mike Johnson, where 33 percent of residents are enrolled. All are in states that participate in the Medicaid expansion. Republicans have considered scaling back funding for that program, which would save the federal government about $500 billion over the next decade — but also leave people in many states without coverage.
While President Trump has repeatedly said over the last week he would not cut Medicaid, Republican legislators don’t have many options for looking for those cuts elsewhere. Some have already expressed concern about cuts to the program. Last week, seven Republican members of the Congressional Hispanic Conference sent Speaker Johnson a letter warning that “slashing Medicaid would have serious consequences, particularly in rural and predominantly Hispanic communities.”
As the second Trump administration has gotten underway, health care has not been a top issue for the president’s voters. It ranked as the fifth-most-important issue to them in a January poll from The New York Times and Ipsos, behind immigration, the economy, inflation and taxes.
In January, Michael Perry, a founder of the polling firm PerryUndem, conducted three focus groups with Medicaid enrollees who voted for President Trump, noting that most did not list health care among their top voting issues.
When he brought up the idea that Republicans were exploring cuts to Medicare, some said they did not think the president would ultimately cut their health coverage because he would want to avoid a backlash. But other voters, he said, expressed concern. “They liked Medicaid, said it made a difference in their lives,” Mr. Perry said. “It wasn’t hard for them to put their finger on what Medicaid had done.”