Medicaid cuts could become an issue for these swing-district Pa. Republicans -- and Democrats see an opportunity

President Donald Trump’s so-called “one big beautiful bill” could be one big pain for the Pennsylvania Republicans who voted for it, hoping to hold onto their seats next year.

The bill, which is unpopular among voters who have heard of it, according to polling, passed the House 218-214 on Thursday and now heads to Trump’s desk, where he is expected to sign the sweeping domestic spending package at a July 4 celebratory event.

All but one of Pennsylvania’s Republican House members voted for the bill. U.S. Rep. Brian Fitzpatrick, a moderate who represents purple Bucks County, voted against the bill and underscored the possible blowback to come to his colleagues in his reason: Medicaid.

Fitzpatrick said in a statement “it was the Senate’s amendments to Medicaid, in addition to several other Senate provisions,” that changed his mind from previously supporting the House version of the legislation.

For months, Pa. Democrats, all of whom voted against the bill, have pointed to the bill’s cuts to Medicaid and SNAP, and an elimination of energy tax credits in a state with thousands of energy jobs, as potentially devastating to Pennsylvanians. Even some Republican members of Congress sounded alarms that legislatively and politically the bill could be bad news for the party.

“It is inescapable this bill will betray the promise Donald Trump made,” Republican Sen. Thom Tillis said on the Senate floor, specifically citing the Medicaid reductions. “I’m telling the president that you have been misinformed. You supporting the Senate mark will hurt people who are eligible and qualified for Medicaid.”

Tillis, who drew Trump’s ire for his opposition, announced shortly thereafter that he wouldn’t run for reelection.

A recent Quinnipiac poll showed 53% of voters oppose the legislation, compared to 27% who support it. One in five voters polled, meanwhile, had not heard of the megabill. And only 10% of voters polled think funding to Medicaid should decrease.

Among Republicans, only 18% said they thought federal funding for Medicaid should decrease.

Now, Democrats see an opportunity in the four districts where Republicans won by the lowest margins in the state last year. They point to the 12 million individuals projected by nonpartisan analysts at the Congressional Budget Office to lose healthcare, and describe the bill as cruel, and potentially deadly. They’re eyeing freshmen U.S. Reps. Rob Bresnahan, in the Northeast and Ryan Mackenzie in the Lehigh Valley and incumbent Scott Perry in York. Democratic operatives weren’t letting Fitzpatrick off the hook, either, noting his earlier support for the bill in the House.

U.S. Rep. Suzan DelBene, chair of the Democratic Campaign Committee, said the vote would be central to the fight to retake the House.

“This Big, Ugly Bill is a laundry list of Republicans’ betrayal to the American people,” DelBene said in a statement. “The DCCC will make sure every battleground voter knows how vulnerable House Republicans — including Mackenzie, Bresnahan, and Perry — abandoned them by passing the most unpopular piece of legislation in modern American history.”

Republicans think they can sell the bill on its expansion of tax cuts and amped-up defense and border spending. They argue the Medicaid changes eliminate fraud and that work requirements are generally popular.

With most of the changes to the program not taking effect until 2027 or 2028, it’s also unclear if average voters will feel the impact ahead of the midterm election.

But even GOP analysts note Republicans have an upward battle on selling the bill to voters.

“Everyone wants to eliminate waste, fraud and abuse ... and everyone wants some sort of work requirements. Those things message well,” Pennsylvania GOP consultant Chris Nicholas said.

“But unfortunately for Republicans, ‘don’t cut Medicaid’ also tests well.”

A Democratic offensive

Shortly before the bill’s final passage, Gov. Josh Shapiro called out each Republican House member on social media, along with the state’s projections of how many people in their district would lose Medicaid or SNAP benefits under the bill.

“To our members of Congress considering voting for this bill: if you do, you are doing so knowing the consequences it will have across Pennsylvania and in your districts,” Shapiro said.

The “big beautiful bill” could also play into the gubernatorial race, in which at least one GOP House member, U.S. Rep. Dan Meuser, has expressed interest. With Shapiro up for reelection in 2026, he will likely becomes a key spokesperson for Democrats railing against House members who voted for the bill.

Shapiro has said that of the 3 million Pennsylvanians enrolled in SNAP, 140,000 could lose benefits. On Monday, Shapiro went so far as to question whether SNAP could continue to exist in the state amid the changes.

His office also estimated 310,000 of the 3 million Pennsylvanians who receive Medicaid would lose the benefit should the cuts proceed.

Other Democrats have fanned out to swing districts around the country. Sen. Chris Coons left his home state of Delaware this week to rail against Medicaid cuts in Luzerne County, Bresnahan’s district, before rallying in Harrisburg, near Perry’s district.

Seven groups, including Protect Our Care, House Majority Fund and the AARP, already have TV ads up in swing districts, including in Pennsylvania, blasting Republicans who support the bill.

Trump won Pennsylvania by continuing to increase his support with working-class Americans who thought prices were too high and the economy wasn’t working for them. Now, Democrats will point to votes for the bill as an attack on working class voters, specifically those covered on Medicaid expansion — a population of largely working, able-bodied adults whose income is low enough to get coverage.

The population is expected to bear the brunt of the Medicaid cuts, which Democrats in the Philadelphia region have warned for months could have an outsize impact on a city with a high poverty rate, where hundreds of thousands of residents also rely on SNAP.

Some Republican voters have already expressed frustration with the bill. During a recent telephone town hall with McCormick, a woman who described herself as a conservative said she was “not happy with the Big, Beautiful Bill,” specifically pointing to what a loss of energy tax credits might mean for the solar industry.

“It’s going to leave us with no subsidies which is gonna almost kill the industry,” she said.

Another self-described “lifelong Republican” told McCormick that he opposed Medicaid cuts as a mental health therapist. “Those cuts seem to cut across the entire program, which will affect people who I used to work with,” he said.

Mailers went out in Bresnahan’s Northeast Pennsylvania district shortly after his first vote advancing the bill. Bresnahan’s 8th district has the most Medicaid recipients of any Republican-led district and the third most overall. The freshman lawmaker has defended the widespread cuts.

“I’m actually receiving my own mail suggesting that I am cutting or stripping away these rights,” Bresnahan said in a spring telephone town hall. “I want you to know that I will fight to protect working-class families in northeastern Pennsylvania, and I also will stand with President Trump in opposing gutting Medicaid.”

Bresnahan, like many Republicans defending the Medicaid changes, has said he supports “removing illegal aliens from the rolls” and instituting work requirements for able-bodied adults.

But Pennsylvania is not among the 14 states that extends health insurance benefits to undocumented immigrants.

And on work requirements, the majority — about eight in 10 — of adults on Medicaid who would be subject to the rule are either already working or would qualify for an exemption under the law, according to nationwide statistics from KFF, a nonprofit health policy organization. That leaves a small population of people who aren’t working.

One in four Pennsylvanians who are subject to the work requirement could wrongly lose coverage, according to the nonprofit Pennsylvania Health Access Network, due to potentially cumbersome reporting requirements.

‘There are more taxpayers ... than people on Medicaid’

Mackenzie, the Republican lawmaker from the Lehigh Valley, said in an interview ahead of voting for the bill Thursday that he backed the legislation because “it provides historic tax relief, secures the border, invests in our future and makes significant positive government reforms.”

He called Medicaid a “very important program,” and the work requirements a “reasonable update.”

Asked if he felt confident that the 11 million people projected to lose their health insurance didn’t need it, Mackenzie didn’t directly answer. He did tout a $50 billion fund to help rural hospitals offset lost Medicaid payments, some of which he said would “definitely” come to Pennsylvania.

While the bill is unpopular among voters who have heard of it, a recent poll from Priorities USA found nearly half of Americans, 48%, hadn’t.

Republicans are planning an offensive in coming days to define the 900-page bill in their terms, focusing on other aspects of it, like sending a record-high amount of money toward border security and extending the 2017 tax cuts.

But they’re also prepared to defend themselves on Medicaid, said Mike Marinella, national press secretary of the National Republican Congressional Committee.

“Democrats see Medicaid as their silver bullet issue but we feel pretty comfortable walking into that arena,” he said, noting some of the key changes to program like eliminating fraud and instituting work requirements are popular with voters.

Ultimately, Republicans are betting that taxpayers are going to focus on tax relief, Nicholas, the GOP analyst from Pennsylvania said.

“Let’s face it,” he said. “There are more taxpayers in the country than people on Medicaid.”