Republican Congressman David Valadao is facing renewed scrutiny over his support for President Donald Trump's sweeping tax and spending legislation, which includes major reductions in federal Medicaid spending despite his earlier pledge to protect the program.
Valadao represents California's 22nd Congressional District, where approximately 64% of residents—more than 500,000 people—rely on Medi-Cal, California's Medicaid program. That is the highest Medicaid enrollment rate of any Republican-held congressional district in the country.
Before the legislation passed, Valadao publicly indicated he would oppose proposals that reduced Medicaid coverage. Nevertheless, he voted for Trump's massive spending package, providing the decisive vote during its initial 215–214 House passage in May 2025.
The legislation includes substantial Medicaid spending reductions and stricter eligibility requirements. California officials estimate the changes could eventually cause approximately two million state residents to lose health coverage.
Valadao has defended his vote, arguing that the legislation protects vulnerable patients while introducing reasonable work requirements. He also said he supported the bill to prevent tax increases resulting from the expiration of Trump's 2017 tax cuts.
His Democratic challenger, Randy Villegas, has made the vote a central issue in their November 3 congressional contest, arguing that Valadao broke his promise to Central Valley families.
The consequences extend beyond individual insurance policies. Hospitals and rural clinics serving low-income communities could face significant financial pressure as Medicaid funding declines.
Valadao's vote has become a defining issue in a district where hundreds of thousands of residents depend on the very health care program he previously promised to defend.
The controversy highlights the growing political debate over whether the Trump administration's tax and spending priorities are compatible with maintaining health coverage for low-income Americans.