Ulises Hernandez, of Bakersfield, Calif., has had health coverage through Medicaid for as long as he can remember.
But he had never waited as long for care as he did 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 to protest looming federal Medicaid cuts outside Republican U.S. Rep. David Valadao's Bakersfield office, 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," said Hernandez, who had been discharged from the hospital a few days before. "I'm livid."
Hernandez, 41, said Valadao "should be ashamed of himself" for voting for the Republicans' One Big Beautiful Bill Act. The law is expected to reduce Medicaid spending by more than $900 billion through 2034, with provisions such as stricter Medicaid eligibility rules and reducing federal money to states.
Hernandez plans to vote for challenger Randy Villegas in hopes that this Central Valley toss-up district, where roughly 6 in 10 of constituents are enrolled in Medicaid, can help give Democrats control of Congress.
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," since 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.
Valadao defends his vote on the GOP bill. During a televised Oct. 6 debate, he said "there are no actual cuts" to Medicaid.
An estimated 60,000 more residents of his 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, according to the left-leaning Center for American Progress think tank.
Researchers estimate that those new rules will push more than 2 million Californians statewide off their coverage and that the state stands to lose about $30 billion a year, more than any other state.
Fertile Ground, High Unemployment
Bakersfield is an oil town, and it wears that identity proudly. Pump jacks nod in the distance. Streets run wide. The Kern River's bed lies dry, its water siphoned to feed the agricultural fields.
Sitting partially in the southernmost portion of the contested congressional district, this city produces much from the land, but unemployment is high.
Democrats have outnumbered Republicans in voter registrations by double-digit percentage points in Valadao's district since he was first elected to the U.S. House in 2012, yet he has won six of his seven congressional elections.
Valadao has survived by focusing on local issues such as water infrastructure and distancing himself from the Trump administration, said Jeffrey Cummins, a political science professor at California State University-Fresno. Valadao is the last remaining Republican House incumbent who voted to impeach Trump after the Jan. 6, 2021, riot at the U.S. Capitol who is running for reelection to Congress.
"This is an area where, even when we see the registration advantage for Democrats, that they are moderate Democrats who tend to be concerned with agricultural issues, and Valadao in the past has successfully appeased those voters," Cummins said.
But California's congressional map was redrawn last year as part of a national mid-decade redistricting fight, and Valadao's Central Valley seat is considered more favorable for Democrats than before. Cummins said a different mix of voters, coupled with anger toward incumbents, could flip the seat.
"Valadao knows that he's on notice," Cummins said.
Nationwide, healthcare costs remain a top affordability concern for voters, and they trust Democrats over Republicans by a 2-to-1 margin on the issue, according to a September KFF poll. Valadao lost in 2018, when Democrats targeted his votes to repeal the ACA, as well as his alliance with Trump.
On Nov. 3, he faces Villegas, a populist backed by Sen. Bernie Sanders (I-Vt.) who favors a single-payer universal healthcare system.
"The system that we have now, we pay twice as much as other countries across the world, despite the fact that we have worse healthcare outcomes," Villegas said during the debate.
At campaign event, no mention of healthcare
On Sept. 30, Valadao held a $1,000-a-ticket fundraiser. It was hosted by House Speaker Mike Johnson, who is campaigning across 22 states in six weeks as Republicans try to hold the chamber.
Afterward, press were allowed at an invitation-only reelection event in Bakersfield, held in an office building just outside of the new district Valadao hopes to represent. Arches of red, white, and blue star-shaped balloons framed the small stage.
Neither lawmaker mentioned Medicaid or the rising cost of healthcare when they spoke to the audience.
After brief speeches, Valadao repeatedly refused to answer KFF Health News' questions about his vote for the One Big Beautiful Bill Act and its impact on his constituents' Medicaid coverage, saying, "I think you are distorting the truth."
Of the half dozen attendees KFF Health News approached among roughly 50 in the room, none lived in Valadao's district.
They came anyway. Retired nurse Charlotte Brandt lives in the neighboring Republican-held district but follows Valadao's votes closely. She called him "a hero for the Central Valley," citing his work on water, oil, and agriculture, which she said sustain Kern County as the "breadbasket of the world."
Her daughter, Allison Brandt Oliver, who also lives in Republican Vince Fong's district, said she favored the stricter Medicaid eligibility rules Republicans put into place, saying her concern is whether spending is going to U.S. citizens who contribute to the economy.
A few days later during the televised debate, Valadao said he was among the negotiators who secured community engagement provisions in the law, which will require certain adults on Medicaid to prove they're working or completing other activities such as job training or volunteering.
"It's not an actual cut," Valadao said. "We need people to actually put in and make a fair effort to try to cover their expenses and be a part of their community. This is not an unreasonable ask."
$32 million in campaign ads for one swing district
In a sign of how vital this district is, Republicans and Democrats have each booked more than $16 million in ads here through Election Day, according to data compiled by AdImpact.
"When you start getting over $10 million of spending total in the district, I would say that that's pretty high," Cummins said.
Some of the ads are reaching voters in unexpected ways.
Outside a local library, Seslie Maese, a stay-at-home mom from Bakersfield, said her 7-year-old, who often watches Lego videos on YouTube, runs to her whenever a certain ad plays.
"David Valadago is going on vacation again, Mom," he'll tell her, mispronouncing the congressman's name. Her son doesn't realize the ad, paid for by a Democratic political action committee, means that as a criticism.
Maese is undecided. Even though she's a registered Republican, she said what she has heard about Valadao doesn't sound positive, such as that he went back on his pledge not to cut Medicaid for vulnerable populations by voting for the federal tax-and-spending law.
For Maese, a politician who says one thing and does another is a deal-breaker.
"He just hasn't come through with anything he said," she said, "especially since he cut off a lot of Medicaid."
This story comes from NPR's health reporting partnership with KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
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