Nearly 1 in 4 in rural areas rely on Medicaid. Could cuts help Democrats win some of them back?
Democrats have been bleeding rural voters for the past two decades. But major cuts to Medicaid in President Donald Trump's signature tax and policy bill, signed into law July 4, could hit voters in these areas especially hard, which party organizers say presents an opportunity to gain ground there -- and in some Trump-supporting states -- in the midterms.
Inroads in rural areas could be key in competitive House and statehouse races in 2025 and 2026, and could even help win back Senate seats in states with large rural populations and a high number of Medicaid recipients.
The Republican tax bill cuts around $1 trillion in Medicaid and Medicare spending and significantly impacts parts of the Affordable Care Act over the next decade. New Medicaid work requirements will go into effect as early as January 2027 while shortened Affordable Care Act enrollment windows and restrictions to subsidies would affect plans beginning in 2026.
The changes could leave nearly 12 million more Americans uninsured, according to projections by the nonpartisan Congressional Budget Office. Opponents of the law also worry the cuts could hamper rural hospitals' finances, with more than 300 identified as at risk for closure in an analysis by the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill.
"I'm not being hyperbolic when I say that [Medicaid] saved my life," Amy Hondo, a 45-year-old Medicaid recipient from Idaho with stage 4 breast cancer, told ABC News. "Being able to have early screenings and access care right away has added years to my life."
"People are angry, and it doesn't fall across political affiliation," Hondo added.
Early polling has shown that the law is largely unpopular -- though voters are split on support for new work requirements for Medicaid.
Both Republicans and Democrats are now working furiously to define its details and impacts on voters.
House Majority Forward, the nonprofit arm of the Democratic-aligned House Majority PAC, is targeting several Republican-held House districts with significant numbers of residents enrolled in Medicaid, running digital ads against Reps. David Valadao, R-California, Scott Perry, R-Pennsylvania, and Derrick Van Orden, R-Wisconsin.
The Democratic Congressional Campaign Committee also launched new digital ads in 35 districts Monday that claim House Republicans who voted for the bill put rural hospitals "at risk of closing." Last week, a rural medical clinic in southwest Nebraska said it would be shutting down, due in part to uncertainty around looming changes to Medicaid.
"It's hard to imagine a greater way to betray rural voters than this bill," said Luke Mayville, a progressive activist who successfully campaigned for a ballot measure to expand Medicaid in Idaho in 2018.
Republicans, however, have accused Democrats of fearmongering, pointing to polling that shows support for Medicaid work requirements, and the $50 billion rural hospital fund included in the law. In a statement released in June, the White House argued that "The One Big Beautiful Bill protects and strengthens Medicaid for those who rely on it...while eliminating waste, fraud, and abuse."
"Democrats' favorability numbers are at a historic low because they don't value the sacrifices working families make every day to make ends meet. Their opposition to the 'one big beautiful bill' shows Democrats are doubling down on their anti-work agenda," Chris Winkelman, president of the Congressional Leadership Fund, a super PAC affiliated with House GOP leadership, said in a statement.
The group is working to promote aspects of the legislation to voters and identify and motivate Republican voters who are less likely to turn out without Trump on the ballot.
Democrats are attempting "to distract voters from the fact that they just voted to raise taxes, kill jobs, gut national security, and allow wide open borders. We will use every tool to show voters that Republicans stood with them while House Democrats sold them out," echoed National Republican Congressional Committee spokesperson Mike Marinella in a statement to ABC News.
While Democrats, such as Kentucky Gov. Andy Beshear, have cast the bill as an "attack on rural America," their efforts to energize voters might have limits. For one, Trump carried voters in rural areas of the country by 40 percentage points, a durable margin even if the party is able to sway some people.
Rural voters have been drifting away from Democrats for more than 20 years, with 60% identifying as Republican by 2023, according to data from the Pew Research Center. The Democratic Party's strength in recent years has been with urban voters, and those in the suburbs remain split between the parties.
And the 2026 Senate map includes states like Maine and North Carolina, whose senators Susan Collins and Thom Tillis voted against the bill. Tillis also announced before his vote that he would retire at the end of his term in 2027.
"All of our representatives voted against the bill. And I couldn't be more grateful for that," Kelli Austin, a Medicaid recipient and advocate for a legal aid organization in Maine, told ABC News.
In the last couple decades in Virginia, which will hold its gubernatorial election next fall, Democrats have had "a challenge in communicating with rural areas and assuring them that we are working for them," Democratic Party chair Lamont Bagby told ABC News.
By contrast, Republicans "have been there physically, and they've shown up in those communities."
Bagby pointed to the weeklong bus tour conducted by Abigail Spanberger, the Democratic nominee for governor, in June as one example of how Democrats in the state were striving to reach rural voters.
"We plan to continue what our top of the ticket has done as it relates to the bus tour and making sure that we are showing up in rural Virginia," he said.
But, Virginia Republicans like Gov. Glenn Youngkin have downplayed the potential health care effects of the tax bill.
"I don't believe there will be people who need services who will have to go without," Youngkin told WUSA9 last week.
Anthony Flaccavento, a Virginia farmer who previously ran for Congress as a Democrat, argued that his party's campaigns cannot be focused solely on attacking Trump.
Instead, they must "couple the talk about Medicaid cuts -- and, for that matter, [Supplemental Nutrition Assistance Program] cuts and many other things in that bill -- with a clear commitment and platform for what they're going to do in rural and working class communities," Flaccavento said.
"That's what's missing right now," he added.
