WASHINGTON — Early battle lines are forming over a centerpiece of the sprawling domestic policy bill that House Republicans narrowly passed, with Medicaid spending cuts emerging as a flash point that could define the 2026 midterm elections.

Democrats are fine-tuning their message as they blast the legislation, which now heads to the GOP-led Senate, as a tax cut for the wealthy that would be funded by cutting health care, after Republicans broadly promised they wouldn’t cut Medicaid.

A recent memo from the Democratic Congressional Campaign Committee vows to make the GOP’s “tax scam” and Medicaid cuts “the defining contrast of the 2026 election cycle” in its efforts to win the House majority next year.

The DCCC is advising Democratic candidates to criticize the Republican bill as a Trojan horse designed to throw millions off of Medicaid — not address waste — with new red tape, said a separate source with knowledge of the private conversations.

And Republicans are trying to frame the fight on their terms. The National Republican Congressional Committee is advising members to tout the bill as “strengthening Medicaid” by limiting the program to those who need it — “not fraudsters, able-bodied adults who refuse to work, or illegal immigrants.”

Underneath the clash is a wonky debate about what, exactly, constitutes a Medicaid “cut.”

Republicans insist they aren’t directly cutting benefits for low-income and disabled people, so their bill shouldn’t be defined as a cut. Democrats and outside critics say it would strip away coverage for millions of people, including those who need the program the most, who would fall through the cracks if they can’t meet the new bureaucratic requirements to keep proving their eligibility.

The bulk of the cost savings would come from strict new rules to maintain eligibility for Medicaid, which would require adult recipients to prove they’re working or engaging in “community service” for at least 80 hours per month, with limited exceptions that include pregnant women. That rule would kick in at the end of 2026. Other new rules would involve verifying addresses, proving lawful immigration status and screening eligibility more frequently, once every six months, instead of once a year.

The bill would impose about $700 billion in cuts to Medicaid relative to current law, according to the nonpartisan Congressional Budget Office, and rescind health coverage for about 8.6 million people. (The estimate was based on the work requirement’s beginning in 2029, before it was moved up in the revised bill, meaning the uninsured number could be larger.)

Still, Republicans are seeking to steer the debate toward the work requirements, which surveys say voters generally support for able-bodied adults, and selling the bill as an attempt to return Medicaid to those who need it the most.

Asked to respond to the GOP argument on the bill’s work requirements, DCCC spokesperson Viet Shelton said in an email: “House Republicans got caught lying about their vote to rip health care away from millions of people and are now scrambling to change the subject. Their tax scam bill was specifically designed to be the largest cut to Medicaid in history and Republicans are now stuck in a doomloop debating how many and how quickly people will get kicked off their health insurance — not if.”

The politics of the escalating fight could prompt Senate Republicans to make changes to the bill. Some have already expressed discomfort with the changes proposed for Medicaid, though they broadly favor work requirements and don’t count them as “cuts.”

President Donald Trump has similarly said he doesn’t want to cut Medicaid, yet he championed the House legislation. The Democratic Senatorial Campaign Committee released a digital ad last week describing the GOP Medicaid policies as “devastating.”

Americans favor work requirements, but the support is soft

A recent national survey by KFF, a nonpartisan health research group, highlights the nuances of the issue.

Overall, the poll found that 62% of U.S. adults support new legislation “requiring nearly all adults to work or be looking for work in order to get health insurance through Medicaid” — including 6 in 10 independents.

But the KFF poll found the support to be soft. It plummets to 32% when respondents hear the argument that most Medicaid recipients are already working or are unable to work. When respondents hear the argument that such new rules would raise administrative costs without significantly affecting the share of Medicaid recipients who are working, support drops to 40%.

There are other headwinds for Republicans.

Overall, the KFF poll found that Medicaid funding cuts are unpopular: 82% of respondents said they wanted Medicaid spending to increase or stay about the same, while just 17% said they want it to decrease. Even among Republican respondents, just 33% said Medicaid spending should be reduced.

The survey found that 3 in 4 U.S. adults said the legislation was about reducing government spending, while just one-fourth of them said it was about improving how Medicaid works.

Still, the GOP focus has tripped up at least one Democratic candidate. Manny Rutinel, who is eying the seat of freshman Rep. Gabe Evans, R-Colo., declined three times in an interview on NBC affiliate KUSA of Denver to say whether he favors work requirements for able-bodied adults.

“It was painful to watch,” said a national Democratic strategist, who spoke candidly on condition of anonymity.

The strategist said the onus is on Democrats to elevate the voices of regular people in their districts who would be harmed by the new rules and to make the case that “people who need Medicaid are going to lose it because of what Republicans are doing.”

As top Democrats echo their successful message from the 2018 election cycle, whereas Republicans tried to repeal the Affordable Care Act and enacted the Trump tax cuts, some in the party warn that the dynamics are different this time.

The Republican “message today is about requiring able-bodied Americans to work, preventing fraud and ensuring noncitizens are not covered,” said Ashley Schapitl, a former Democratic Senate communications aide. “While Medicaid cuts poll horribly, these individual policies poll well. Democrats can still win the argument, but members need a sharp message and discipline around the issues of work requirements and immigration, not to feel complacent around rerunning the exact 2017 playbook.”

House Majority Forward, a political group focused on electing Democrats, launched a six-figure ad campaign Wednesday in 26 Republican-held districts, accusing those lawmakers of voting to raise prices for ordinary people through Medicaid cuts.

An ad running in Pennsylvania’s 8th District says freshman GOP Rep. Rob Bresnahan “just cast the deciding vote to raise the cost of your groceries and cut your health care including Medicaid — to pay for tax cuts for the ultra-rich.” A similar script is used against other incumbents, all of whom were pivotal in the 215-214 vote to pass the legislation last week and send it to the Senate.

Republicans, notably, are focusing a new ad campaign of their own on touting the bill’s tax cuts, not its spending cuts.

The NRCC announced new ads Friday targeting 25 Democratic incumbents in competitive districts, saying they voted “for the largest U.S. tax hike in generations” by opposing the bill that extends the expiring 2017 Trump tax cuts. The ad obliquely refers to citizenship verification for benefits, saying that under the status quo, “illegals get freebies, you get the bill.”

The ad doesn’t mention Medicaid.