California Congressman David Valadao faces intense scrutiny after voting for sweeping Medicaid cuts while simultaneously telling his constituents they might escape the law’s strictest requirements. The Republican representative, whose Central Valley district hosts one of the nation’s most competitive House races, defended his support for the One Big Beautiful Bill Act even as roughly six in ten of his voters rely on Medicaid coverage.

The legislation, which President Donald Trump signed into law last summer, projects $900 billion in reduced Medicaid spending through 2034. Starting in January, the law requires many nondisabled adults enrolled in Medicaid in 43 states and Washington, D.C., to work, volunteer, or attend school for at least 80 hours a month. The bill passed both chambers of Congress without a single Democratic vote.

Valadao called the work requirement “not an unreasonable ask” and emphasized his role in securing the provision. He has stated that enrollees in Medicaid-the federal-state program covering the poor and disabled-should “put in a fair day’s work” if they can. However, his campaign website now highlights a crucial exemption that could shield his entire district from the new mandate.

District-Wide Exemption Raises Questions About Vote

The law includes several carve-outs, including relief for residents in counties with high unemployment rates. Valadao’s website acknowledges this loophole with striking clarity, stating that “based on current numbers, every county in CA-22 would qualify for this exemption.” The congressman’s site explains that this waiver takes real-life situations into account, ensuring that people trying to work in areas with limited opportunities won’t face penalties.

The apparent contradiction between voting for strict work requirements while promoting district-wide exemptions has fueled criticism from both constituents and political opponents. Valadao declined an interview request through his campaign spokesperson Paige Ash, who also declined to comment on the exemption issue.

During a televised debate on October 6, Valadao defended his position by claiming “there are no actual cuts” to Medicaid. This assertion stands in sharp contrast to the Congressional Budget Office estimates projecting nearly 12 million more people will be without insurance by 2034 due to reductions in federal support for Medicaid and Affordable Care Act marketplaces.

Constituents Face Real-World Impact

Ulises Hernandez, a 41-year-old Medicaid enrollee from Bakersfield, has relied on the program for as long as he can remember. In September, after a dental crown slipped down his throat during a procedure, he spent eight hours in an emergency room waiting for care and more than two days without food. Sitting in his wheelchair outside Valadao’s Bakersfield office to protest the looming federal Medicaid cuts, Hernandez described his wait as a foreshadowing of what’s ahead.

“I couldn’t eat, I couldn’t drink, I couldn’t do anything, and I was in pain. I’m livid,” said Hernandez, who had been discharged from the hospital a few days before. “I’m livid.”

Hernandez declared that Valadao “should be ashamed of himself” for voting for the Republican legislation. He plans to vote for challenger Randy Villegas in hopes that this Central Valley toss-up district can help give Democrats control of Congress.

Political Stakes and Coverage Projections

Villegas, a political science professor, has embraced the progressive rallying cry for “Medicare for All” and called out Valadao for a vote “that is going to rip away healthcare from Valley families.” Many working-age adults may not satisfy new work requirements and twice-a-year eligibility checks that, by political design, start after the midterm elections. The challenger argues these provisions will systematically remove coverage from vulnerable constituents.

The left-leaning Center for American Progress think tank estimates that approximately 60,000 more residents of Valadao’s district could be without coverage by 2034 due to the tax and spending bill and the expiration of enhanced premium tax credits for Affordable Care Act insurance plans. Statewide, researchers estimate that new rules will push more than 2 million Californians off their coverage and that California stands to lose about $30 billion a year, more than any other state.

Work Requirements and Expected Outcomes

Health researchers predict the policy will have minimal impact on employment rates. Most working-age Medicaid enrollees who don’t receive disability benefits already work or are looking for work, or are unable to do so because they have a disability, attend school, or care for a family member, according to KFF, a health information nonprofit. The bill’s requirement doesn’t apply to people in the 10 largely GOP-led states that have not expanded Medicaid to nondisabled adults.

The Congressional Budget Office projects that reductions in federal support will undermine the finances of hospitals, nursing homes, and community health centers, which will have to absorb more of the cost of treating uninsured people. Some facilities may reduce services and employees or close altogether. Bakersfield, an oil town in the agricultural Central Valley, faces particularly acute challenges given its high unemployment rates and heavy reliance on Medicaid coverage.

As the midterm elections approach, Valadao’s race has emerged as one of the toughest in the country, with control of Congress potentially hinging on the outcome. The congressman must navigate the difficult terrain between defending his vote for significant Medicaid cuts and reassuring constituents that exemptions may protect them from the law’s harshest consequences. Whether voters accept this balance remains the central question facing this closely watched swing district.

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