How a vote for Trump’s ‘big, beautiful bill’ put Republican David Valadao in danger of losing his seat

By Arit John, CNN

Bakersfield, California (CNN) — Even when he was a child, healthcare was top of mind for Humberto Rico.

Like many children who grew up in the Central Valley — known for having some of the worst air quality in the country — he had asthma that would sometimes leave him bedridden for days. He still helps his immigrant parents schedule their doctors’ appointments. And he has family members who depend on Medicaid for health insurance.

“In the Central Valley, it’s not really something we have the privilege to ignore,” said Rico, a 26-year-old Bakersfield native who works with farm workers as an organizer.

Healthcare is also a key issue shaping his support in California’s 22nd Congressional District. Rico spent a recent Saturday afternoon canvassing for Randy Villegas, a pro-Medicare for All progressive and one of two Democrats seeking to unseat GOP Rep. David Valadao. State Assemblywoman Jasmeet Bains, who recently won the support of House Democrats’ campaign arm, is also running.

Since Valadao was first elected in 2012, Democrats have only been able to beat him once: in 2018, after he voted for his party’s failed effort to repeal the Affordable Care Act.

This year, Democrats are betting voters in the district — which was redrawn last year to slightly favor their party — will be equally frustrated with his vote in 2025 for President Donald Trump’s sweeping tax and spending cuts legislation, also known as the “One Big Beautiful Bill Act.” Starting next year, the law increases the frequency of Medicaid eligibility verifications and imposes a new work requirement. Those changes will impact California’s 22nd District, which has one of the highest concentrations of Medicaid enrollees in the country.

Fifty-nine percent of residents in the district are insured by the program, according to data collected by the New York University Grossman School of Medicine and the Robert Wood Johnson Foundation based on the seat’s 2025 boundaries. Nearly 57,000 people in the district could lose their Medicaid coverage once the new eligibility requirements go into effect, according to an analysis of Congressional Budget Office data by Democrats on the Joint Economic Committee.

Republicans argue that critics are misrepresenting the impact of the changes to Medicaid, which they say are meant to push able-bodied people into the workforce. The law provides exemptions from work requirements, including for people with substance abuse, severe mental health or other significant medical issues, and pregnant people. States may also request a temporary exemption for enrollees in counties where the unemployment rate is either 8% or 1.5 times the national average. Much of the district currently meets that threshold — Kern County, which makes up the largest part of it, had an unemployment rate of 9.5% in March.

Valadao said in a statement to CNN that the legislation was designed to preserve Medicaid long-term.

“One of my goals representing the Central Valley is to protect Medicaid for those who truly need it the most: seniors, vulnerable children, and disabled Americans,” the statement reads. “That’s why I voted to include commonsense exemptions for Californians facing serious medical issues, economic hardship, or high unemployment.”

But healthcare providers who work in the district warn that they’re already feeling the impact of Trump’s agenda bill, as hospitals and healthcare centers begin making changes to their budgets.

“What’s happening now is that they’re facing reductions in resources, reductions in options in medications, reductions in options in physicians and programs,” said Tina Croxton, a behavioral health nurse and member of the Service Employees International Union California, which has backed Bains.

Diana Alvarado, a 29-year-old medical interpreter and translator who was visited by the Villegas campaign, said she’s already seeing changes at her workplace. She’s also worried about undocumented migrants. California, which pays the full cost of Medicaid coverage for income-eligible undocumented people, paused new enrollment for undocumented patients ages 19 and up this year.

While she’s planning to vote for a Democrat in the June 2 non-partisan primary, she hasn’t decided on which one.

Two dueling Democratic visions

Before Democrats can take on Valadao, they have to choose between two candidates with different bases of support.

Villegas is running a populist campaign backed by Vermont independent Sen. Bernie Sanders. He’s talked about his personal experience depending on the social safety net programs hit by last year’s tax and spending cuts law. On the campaign trail, he frames the race as a fight – not between the left and the right – but between the top and the bottom.

“I’ve told people from day one — cancer, valley fever, diabetes doesn’t give a shit who you voted for in the last election,” Villegas told CNN. “It does not care what your party ID is, but we know that everybody gets sick, which is why we need health care for all.”

Villegas has been backed by National Nurses United, a progressive union that is also advocating for a single-payer government health care system. At a recent canvass launch and Mother’s Day celebration, Villegas was joined by about half a dozen members of the union and a few other supporters, including Olivia Calderón, the mayor of the nearby town of Arvin.

“This is a time where we don’t have the luxury of being on the sidelines,” she said. “We have to be out there and be very clear about what we stand for, what we are about, because our families and because our communities — there’s real suffering and fear and anxiety.”

Villegas has criticized Bains for not agreeing to a debate with him and for her campaign donations from the oil and gas and pharmaceutical industries as a state assembly member. Over the weekend, canvassers for his campaign told voters that pro-Israel money was flowing into the race to boost Bains. The Democratic Majority for Israel is planning to spend $500,000 attacking Villegas, according to a recent Federal Election Commission filing.

Bains, a medical doctor who still works at a clinic in her hometown of Delano treating Medicaid patients, has pointed to her years of experience as a doctor, a health policy expert and lawmaker as evidence she’s the most qualified to enact real change.

“She knows what the patients need here, and the needs are great,” Croxton said.

Bains has hit Villegas on not living in the district — Visalia, where he serves as a school board trustee, is just outside of the 22nd — and has defended her donations, saying her vote can’t be bought. She’s also expressed a broader frustration with the idea that a candidate who lacks the same legislative experience and professional background as her is arguing he is better suited for the job.

“I could have the medical degree. I could have the position in the assembly, yet there’s going to be a man that’s going to say he can do it better,” Bains told CNN. “I’m sorry. I’m fed up. I’m tired. I am exhausted.”

Valadao’s challenge

Regardless of which challenger advances, the Democratic Party’s messaging in the race is clear. Both candidates cited Valadao’s decision to vote for Trump’s agenda bill as a motivating factor in their campaigns.

“We’ve seen him stand up for the valley before, so I had full faith —everybody else had full faith — that he was going to do the right thing,” Bains told CNN. “And I didn’t jump in to run until after I saw him vote on my 40th birthday … it was the worst birthday in my life.”

While healthcare cost Valadao his seat in 2018, his allies say this time is different. The dairy farmer-turned-lawmaker has become even more of a household name in the district, said Brandon Herreman, the political director of the California Republican Party and a former Valadao aide.

To counter Democratic attacks, the congressman and his allies need to stress the Trump agenda law’s exemptions, particularly for counties in the district with high unemployment, Herreman said.

“They’re going to say Valadao slashed Medicaid, he’s not there for Central Valley families,” Herreman said. “But the messaging on this is crucial.”

Valadao has sought to frame himself as a protector of the district’s healthcare throughout Trump’s second term. He was one of a dozen Republicans who signed onto a letter in April 2025 opposing cuts to Medicaid, warning they could hurt vulnerable populations and hospitals, particularly in rural areas.

“Balancing the federal budget must not come at the expense of those who depend on these benefits for their health and economic security,” they wrote.

After the vote, Valadao said in a statement it wasn’t an easy decision, but that he’d worked to block provisions that would have been more harmful for his district. He also touted the $50 billion placed into the Rural Health Transformation Fund, a five-year grant program for states to modernize rural healthcare. The Centers for Medicare and Medicaid Services announced late last year that California would receive $233 million in 2026. Valadao appeared with the agency’s administrator, Mehmet Oz, to tout the funding earlier this year.

But half of the funding will be divided equally among the states, putting larger states like California at a disadvantage. And experts note that the $50 billion fund won’t fully cover the revenue states are expected to lose.

For some in the district, the efforts to limit the impact of the Trump agenda bill fall short. Nataly Santamaria, a community leader — known as a promotora — in the district who helps people access health care said Valadao hadn’t done enough to explain what the path forward looks like.

“As a constituent, because I am his constituent, I feel he betrayed us,” she said.

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