Medicaid is set to become a key issue in the battle over control of Congress in next year’s midterm elections now that President Trump’s “big, beautiful bill” has passed. 

Congress passed the largest Medicaid cuts in the program’s 60-year history through the GOP’s megabill right before the July 4th holiday, a $1 trillion reduction that’s projected to push more than 12 million low-income individuals off their health insurance over the next decade.  

Republicans argue the moves are necessary to address waste and fraud in the program, ensuring that “able-bodied” adults aren’t taking advantage of the system. 

But with 1 in 5 Americans enrolled in Medicaid, Democrats hope this massive slash spells political poison for Republicans in the midterms. GOP holdouts voiced concerns along these lines leading up to the vote. Sen. Thom Tillis (R-N.C.), who voted against the bill and won’t be seeking reelection, reportedly told Senate Majority Leader John Thune (R-S.D.) that the Medicaid cuts could cost Republicans control of both the House and Senate.

Heading into the 2026 election cycle, Republicans will have to get ahead of Democratic messaging on health coverage.

“The key here for Republicans going into the midterms is to clearly go on offense and define the debate around Medicaid in particular today, not tomorrow, not next month, not in the fall, not next year. They need to do it in a unified and aggressive way today, because Americans’ public opinion is on [the] Republican side,” Kristin Davison, partner at the GOP consulting firm Axiom Strategies, told The Hill. 

She pointed to polling that showed most Americans 62 percent, per polling from earlier this year are in favor of measures like adding work requirements to Medicaid. 

The legislation makes a wide range of changes to Medicaid, though the Senate’s parliamentarian struck some more extensive ones for being noncompliant with Senate rules. 

The law is set to require Medicare beneficiaries to prove for the first time they are working or in school at least 80 hours per month, equal to part-time employment, to keep their health insurance. That will take effect on Dec. 31, 2026, just after the midterms take place. 

It will also require more frequent eligibility checks and Medicaid recipients living above the poverty line to pay out-of-pocket copays for most services, including doctor visits and lab tests. 

Throughout the bill’s legislative process, Democrats have been quick to go after Republicans over the changes in Medicaid, as they have long warned that Trump and the GOP would seek to make cuts if they took power in Washington. 

House Minority Leader Hakeem Jeffries (D-N.Y.) gave a preview of what Democratic messaging could look like in his record-breaking House floor speech Thursday.

“Almost $1 trillion in cuts to Medicaid. This runs directly contrary to what President Trump indicated in January, which was that he was going to love and cherish Medicaid. Nothing about this bill loves and cherishes Medicaid,” said Jeffries. “It guts Medicaid in a way that it’s going to hurt children, hurt families, hurt seniors, hurt people with disabilities, hurt women, hurt everyday Americans.”

Senate Democrats’ campaign arm rolled out an ad in May, pulling together various news clips discussing the effects of potential Medicaid cuts. House Majority Forward, a PAC that works to elect Democrats to the House, launched digital ads at the same time in 26 congressional districts led by potentially vulnerable Republicans who will be targeted next year. 

The ads argued that the Republicans voted to increase grocery costs and cut health care. 

The Democratic National Committee highlighted effects of Medicaid cuts across the country in a release in late June, accusing the party of playing “political games with Americans’ lives.” 

The House Democrats’ campaign arm said a vote for the bill would be the “defining contrast” of the midterms and cost the GOP its majority. The organization also appears likely to hammer lawmakers for alleged hypocrisy, pointing in a memo to a letter that a dozen GOP lawmakers signed in April saying they wouldn’t support big cuts to Medicaid before they eventually supported the bill on Thursday. 

“Let’s be clear — vulnerable Republicans have admitted time and time again that even they know their bill would obliterate access to health care, raise costs, cut jobs, threaten rural hospitals, and lead to families going hungry, but they voted to pass it anyway,” said Rep. Suzan DelBene (D-Wash.), the chair of the Democratic Congressional Campaign Committee (DCCC), in a statement. 

“The DCCC will make sure every battleground voter knows how vulnerable House Republicans abandoned them by passing the most unpopular piece of legislation in modern American history, and we’re going to take back the House majority because of it,” she said. 

Democratic consultant Martha McKenna, who previously served as political director for Senate Democrats’ campaign arm, said the party must communicate to voters that the legislation will affect everyone’s health care costs regardless of whether they’re on Medicare. 

“People who are on Medicaid will still show up in hospitals and ERs, and they’re still going to get sick. It’s just going to drive the cost of health care up for everyone,” she said, arguing this will ensure that Republican arguments that the moves were necessary will fail. 

The impacts on health coverage are likely to be immense. Roughly 40 percent of U.S. births are paid for by Medicaid, and among children under 6 years old, more than 40 percent are either covered by Medicaid or the Children’s Health Insurance Program. 

According to estimates from the National Rural Health Association, rural hospitals will lose $70 billion over the next 10 years as a result of the “big, beautiful bill,” losing 21 cents from every Medicaid dollar they receive. 

A June KFF poll found that 74 percent of U.S. adults viewed the legislation unfavorably when informed that it would increase the number of uninsured people by 10 million, and 79 percent had the same view when informed it would decrease funding for local hospitals. Polling from The Washington Post found that roughly a third of Americans, including 42 percent of independents, had no opinion on the reconciliation package. Whichever party has the most convincing campaign message stands to claim this undecided cohort. 

A GOP operative acknowledged the bill gives Democrats a “silver bullet” in the upcoming elections but argued Republicans will be able to “neutralize” Medicaid concerns with the numerous other provisions passed in the legislation.  

“If you break it down into all these provisions that we’re actually pushing for with the legislation, you know, I do think it’s a win for us,” the operative told The Hill. “We can at least level the playing field, right? If that makes sense, where you can kind of neutralize the issue by talking about all those key provisions that we have.” 

These various provisions, most notably the work requirements, won’t take effect immediately, which will present an uphill battle for Democrats. 

Democrats acknowledged it may pose an extra challenge but expressed confidence they’ll still be able to communicate the pending changes to voters. 

One Democratic strategist who works on House races cited the 2010 and 2018 midterms, during which legislation either not yet in effect or that failed dominated the cycle. They noted that many provisions of the Affordable Care Act weren’t yet in effect by November 2010, but Democrats still sustained major losses because of its unpopularity at the time. 

And though congressional Republicans failed to repeal the law in 2018, they argued that year’s cycle was still about GOP efforts to repeal it, for which the party suffered. 

“There’s an argument to be made here that if voters believe, and it is true that the unpopular bill is really bad for them, it doesn’t matter if it’s going to be bad for them tomorrow or next year,” the strategist said. “If they believe it is bad for them, they will act on that opinion.”