In 2018, Democrats won back the House, flipping 41 seats including in conservative-leaning places like the suburbs of Utah and Oklahoma by focusing narrowly on a single issue: Republican efforts to overturn a popular health care program, the Affordable Care Act.
Now, as Republicans push a budget resolution through Congress that will almost certainly require some kind of cuts to Medicaid to finance a huge tax reduction, Democrats see an opening to use the same strategy.
“I don’t know why Republicans are doubling down on the same playbook,” said Senator Ben Ray Luján of New Mexico, who in 2018 served as the chairman of House Democrats’ campaign arm.
“The town halls, people coming forward, showing up in communities all across America, filling the phone lines here in Washington, D.C.,” Mr. Luján continued, “I think you can draw a direct comparison to the outcome of what happened in 2018.”
In the early weeks of President Trump’s second term, Democrats labored to pick their political targets amid a near-daily barrage of executive orders and moves by Elon Musk’s Department of Government Efficiency to defund and dismantle federal programs and fire government employees. But in the prospect of cuts to Medicaid, which covers more than 70 million Americans, they see a clarifying issue that they hope can help them capture the same kind of energy that catapulted them back to power in 2018.
“The American people were upset in 2005 when Republicans tried to privatize Social Security. The American people were upset in 2017 when Republicans tried to repeal the Affordable Care Act,” Representative Hakeem Jeffries of New York, the Democratic leader, said in an interview, citing two campaign cycles in which his party wrested back control of the House under a Republican president. “The American people are very upset right now, including in the communities I represent, about the Republican effort to take away their health care and enact the largest cut to Medicaid in our country’s history.”
He said Democrats would continue to hammer away at the “clear contrast” that they emphasized in the past to maximum political advantage.
They are already putting money behind the message. House Democrats’ political action committee announced on Friday that they had bought advertising time in over 20 districts across the country savaging Republicans for opening the door to $880 billion in Medicaid cuts.
“They claimed they’d lower costs,” the narrator says. “Instead, Trump and Speaker Johnson are set to kick millions off of health insurance.”
In 2017, protesters swarmed Republican town halls across the country and urged their lawmakers not to vote to replace the Affordable Care Act.
“When it comes to health care, all politics is personal,” Representative Nancy Pelosi of California, the Democratic leader, said in 2018 the day after her party reclaimed the House. “We made our own environment. While the G.O.P. tried relentlessly to distract and divide, our candidates kept their focus on that subject.”
Similar scenes have played out in recent days as lawmakers have been pressed by their constituents on the scope of Mr. Trump’s budget cuts. In both cases, Republicans have dismissed the protests as being coordinated by liberal activist groups and argued that the protests are not representative of average voter sentiment.
Still, Republicans who have witnessed some of the backlash firsthand are already warning their colleagues to adjust their messaging.
Representative Rich McCormick of Georgia had constituents shout, jeer and boo at him at a recent town hall where he faced questions about the firings of federal workers and the Musk team’s access to taxpayer information.
“We have a message that’s about saving Medicaid, Medicare,” Mr. McCormick said, referring to Mr. Trump’s promises not to touch either program. “But you can lose that message with one attitude, and if nothing else, we have to be careful how we message this so it doesn’t come across as dispassionate.”
One of the Republicans who ultimately opposed the repeal effort, Senator Lisa Murkowski of Alaska, said she saw parallels between the 2017 push and current attempts to cut Medicaid.
“I feel like we are going back to the days of the A.C.A. when I was trying to explain to colleagues how Alaska was so disproportionately impacted,” Ms. Murkowski said.
House Republicans have yet to write legislation laying out specific spending reductions and tax cuts that would fulfill their budget plan. Speaker Mike Johnson has insisted in recent days that they want to find “efficiencies” in Medicaid — “not cutting benefits for people who rightly deserve that.”
“You don’t want able-bodied workers on a program that is intended, for example, for single mothers with two small children who’s just trying to make it,” Mr. Johnson said in an interview on CNN. “That’s what Medicaid is for. Not for 29-year-old males sitting on their couches playing video games.”
He said Republicans would not fundamentally change the structure of the program, as some conservatives have long proposed, and would not establish a cap on federal funding for Medicaid.
Many Republicans are comfortable with establishing work requirements for the program, but that change is estimated to save only around $100 billion. House Republicans’ budget plan requires the committee that oversees Medicaid and Medicare to find more than eight times that in savings.
Getting to that number, even among Republicans, will be extraordinarily politically fraught. And because many states have expanded their Medicaid programs under the Affordable Care Act, doing so is likely to affect a broad swath of the population in states around the country.
“I’m not going to vote for Medicaid cuts,” said Senator Josh Hawley, Republican of Missouri, who was elected in 2018. “Work requirements are fine, but 21 percent of the residents in my state receive Medicaid or CHIP,” he said, referring to the program that provides health coverage options for children whose families earn too much to qualify for Medicaid.
One of the Republicans who will almost certainly be squeezed in the process is Representative David Valadao of California, who represents a district where almost two in three people rely on Medicaid.
Since he was elected to Congress in 2012, he has won re-election in every cycle but one — in 2018.
Before he voted to approve the G.O.P. budget resolution this week, Mr. Valadao rose on the House floor to lay out the stakes of potential cuts — and to deliver his party leaders a warning. Achieving $880 billion in budget cuts, he said, “is not an easy task.”
“I’ve heard from countless constituents who tell me the only way they can afford health care is through programs like Medicaid,” Mr. Valadao continued, “and I will not support a final reconciliation bill that risks leaving them behind.”
“Medicaid cuts,” he said, “are deeply unpopular with the American families who sent us here to deliver on President Trump’s agenda.”
