Republicans Tried To Punt Health Care Cuts Until After The Midterms. It Didn’t Work.

The political bill for Republicans’ health care agenda is coming due earlier than they’d hoped.

Republicans’ signature legislation from Trump 2.0 — 2025’s One Big Beautiful Bill Act — ensured that its tax cuts were immediate while its controversial cuts to Medicaid and other health care programs wouldn’t take effect until after the midterm elections.

Democrats worried last year that this delayed implementation would defang their attacks on the campaign trail, leaving voters unmoved by the message that a health care apocalypse was just around the corner.

But for many, it has already arrived. Millions of people have lost their Obamacare insurance following Republicans’ decision to allow Covid-era subsidies to expire last year, and the premiums for many of those who remained have skyrocketed.

Millions more have lost Medicaid coverage, a trend fueled by post-pandemic eligibility checks. And a $50 billion rural health fund Republicans tucked into the megabill last-minute to help ensure its passage has not stopped the drumbeat of hospitals cutting services or closing up shop. In the final stretch of the midterms campaign, Democratic candidates in close races say the high cost of health care has become one of Republicans' biggest liabilities.

Despite recent polling showing voters trust Democrats over Republicans on health care by 22 points, some GOP candidates in close races insist that Democrats’ health agenda — particularly the calls for a Medicare for All-style government-run health system — will prove more unpopular with voters than the Republican-backed cuts now underway.

At an event in late September, Michigan Senate candidate Mike Rogers said his Democratic challenger Abdul El-Sayed’s embrace of Medicare for All has “created a rift” among centrist and progressive voters and boosted support for his campaign.

“This is why our ‘Democrats for Rogers’ [group] is growing bigger than we imagined,” he said. “They don't believe that the Democratic Party should slide into this big government socialism solution to all your problems, taking a lot of money away, less opportunity, no upward mobility.”

Yet there are signs Democrats’ attacks could be helping the party’s prospects. In battleground states like Michigan, Maine, Iowa and Georgia, Democratic challengers are tied with or leading their GOP rivals in races that will decide control of Congress, according to polls. Democrats in those states have hammered their Republican opponents in ads, debates and town halls for approving deep cuts to Medicaid, failing to renew Obamacare subsidies, and failing to stop insurance companies and hospitals from continuing to raise prices.

“No amount of spin can erase the pain of being unable to afford health care. And I think people are going to hold those who are responsible for this accountable — they're going to hold Republicans accountable," Sen. Rafael Warnock (D-Ga.) said in an interview with POLITICO.

"People are feeling this right now."

The impact has been wide — hitting even those who get private insurance through their jobs — and deep, with large segments of the population curtailing spending on basic necessities in order to afford care or pay off medical debt.

Even amid the rising cost of food, gas and housing, polling shows these health trends remain top of mind for voters, and their frustrations with the party currently in power may drive them towards Democrats in November.

Still, some Republican candidates and strategists insist their own health care message — a pledge to crack down on waste and fraud in Medicaid and other insurance programs and bring down costs through encouraging market competition — will prevail with voters, while others say Democrats are hyperfocused on the wrong issues.

“I think gas and groceries tend to be more impactful on voting behavior because that's something you deal with on a weekly basis, while you pay your premiums on a monthly basis, and your increases only come annually," said GOP consultant Jason Roe, who is working on Republican Rep. Tom Barrett’s campaign to hold onto his Michigan seat.

Roe added, however, that “there is a segment of swing voters who would like to vote Republican but are feeling the squeeze on the cost of health care.”

That squeeze is hitting many Americans now due to a combination of state and federal moves. And while the biggest changes to Medicaid won’t land until after the midterms, state lawmakers and hospitals are making deep cuts to benefits and services now as they brace for a dropoff in federal funding.

Idaho, for instance, cut programs to feed its low-income elderly residents, hire seasonal firefighters and help place children in foster care. Colorado, facing a $1.5 billion shortfall, cut reimbursements to doctors who treat Medicaid patients and limited services for immigrant children and pregnant women.

“States have to balance their budgets for next year this year, so all of that pain is already in the system,” said Leslie Dach, a former senior counselor at HHS who now leads the liberal advocacy group Protect Our Care, which is working to elect Democrats who support restoring Medicaid and Obamacare funding.

“Hospitals are a business, so they’ve got to get ahead of this too. And every insurance company has to decide now what the price hikes are going to be for next year," Dach said.

"We're seeing the reality now that hospitals are closing, people are losing their coverage, people who were able to afford the first few months of health care have now dropped their health care because they can't afford it anymore. The receipts are coming in.”

Ahead of schedule

Republicans’ 2025 megabill timed Medicaid work requirements — a policy government watchdogs estimated would save the government hundreds of billions by kicking millions of people off the safety-net program — to become mandatory on January 1, 2027, with strict enforcement for people seeking a medical exemption delayed until 2028.

But a few red states chose to pull the trigger months earlier, and are already disenrolling those who can’t prove they are working part time or are too sick to hold a job. Several more are requiring doctors’ notes or other evidence from people with chronic illnesses before the 2028 federal deadline set by Congress.

Even in states that are waiting until 2027 to enforce work requirements for low-income adults without children in Obamacare’s Medicaid expansion, millions of enrollees are already receiving notices that they could lose their coverage, sparking fear and frustration in the weeks before the midterms.

Those who get private insurance through their job have not been spared. An August survey of employers found that health costs are predicted to rise next year more than they have in the last two decades — by an average of 8.2%. And a September report from the progressive health care advocacy group the Commonwealth Fund found that about one-third of working-age adults with private insurance are trying to pay off medical debt, and that many reported being forced to cut back on food, heat or rent as a result.

“It is not in the top five issues that are being debated by candidates for governor or attorney general or the legislature. But when [the rising cost of health care] does come up, it exists as a negative for Republicans,” said Stan Barnes, a GOP consultant and former Republican lawmaker in the Arizona statehouse.

Less money coming from the federal government is already having a cascading effect on states, and a particularly negative effect on rural hospitals, Barnes said.

"But unless you're in that world, you may not know that, you may not feel that, you may not see it firsthand.”

Polling indicates, however, many are feeling the impact firsthand.

A June survey by the health policy think tank KFF found that the cost of health care is the top concern for families going into the midterms, with over half of voters calling it “extremely important” for candidates to address.

A March Gallup survey also found that “the availability and affordability of health care” ranked first among Americans’ economic worries, with half of U.S. adults reporting being unable to afford care.

And a September KFF-AP poll found these pressures were hitting the GOP base particularly hard, with rural voters, by a 2-to-1 margin saying the Trump administration’s policies have increased their health care costs and made it harder to get care.

Battleground Dems spotlight health care woes

Democratic candidates are putting these concerns at the forefront of their messaging in the home stretch before the midterms.

In Michigan, Democratic gubernatorial hopeful Jocelyn Benson is attacking her opponent Rep. John James for voting for the GOP megabill, saying his work passing its Medicaid cuts is “why we’re in this mess to begin with.”

“I’ve made health care the defining issue of this race,” she boasted at a health care roundtable.

In Maine, Democratic challenger Troy Jackson is running ads attacking GOP Sen. Susan Collins for “cast[ing] the deciding vote for Trump's cuts to Medicare and Medicaid to give tax cuts to billionaires.” Though Collins voted against the One Big Beautiful Bill, she voted to allow it to be debated on the Senate floor.

In Iowa, Democratic gubernatorial hopeful Rob Sand told a recent town hall crowd that health care is “the number one issue that has come up in every part of the state.”

And in Georgia, Sen. Jon Ossoff has spent more than a year reminding voters about the bill’s Medicaid cuts as he tries to fend off a GOP challenger.

Outside progressive groups like Dach’s are working to amplify these messages with a $5 million ad campaign tying Republicans to the impending Medicaid cuts and 40-stop bus tour across battleground states ahead of Election Day.

Some Republicans are responding to these attacks by pivoting away from health care to more politically comfortable territory — such as tax cuts, law enforcement and limiting immigration.

"Republican candidates, particularly high-profile ones, are seeking to get off the topic as much as possible,” said Barnes.

“That's the Consultant 101 advice: Talk about what you want to talk about, not what your opponent wants to talk about.”

But others in the GOP are urging candidates to fight back and defend the party’s health policies rather than changing the subject, and are lamenting that more haven’t been willing to do so.

“Some may not feel real comfortable with it, but I don't know why not. I think we have facts on our side,” said Ohio-based Republican strategist Bob Clegg, adding that GOP candidates should respond by touting Trump’s deals with drug companies to lower prices on some medications, and make the case that voters' health cost woes are a hangover from high inflation caused by the Biden administration.

Clegg agreed, however, with Democrats in his state who say it’s harder for Republicans to point fingers on health costs when they control government at the state and federal levels.

“I always like it when we're out of power because I can just slam away,” he said with a laugh. “It's a lot more trouble for me when we're in power and I have to defend.”