More than 70 million Americans are on Medicaid. This is where they live.

In the stretch of rural Kentucky that borders West Virginia, voters reliably send Republicans to Congress. Rep. Hal Rogers, who represents the area, did not even face a Democratic challenger in 2024. More than 40% of the population there relies on Medicaid, the public health insurance plan for low-income Americans.

In Eastern Louisiana, where Rep. Julia Letlow, a Republican, was elected in 2024 by a wide margin, about one-third of the population is enrolled in the program.

And in California’s Central Valley, Republicans control a district where two-thirds of the population is on Medicaid, one of the highest rates in the nation, according to an analysis of federal enrollment data by the Center on Budget and Policy Priorities, a liberal think tank.

Some of those places could bear the brunt of steep Medicaid cuts that are expected to be central to Republicans’ budget plans. The budget that House Republicans passed last week directs Energy and Commerce, the committee that oversees Medicaid, to cut spending by $880 billion over the next decade, which would amount to an 11% reduction in the program’s planned spending.

In its 60 years, Medicaid has swelled from a small program that provided medical care to poor Americans receiving cash assistance to the largest source of public insurance. It covers 72 million Americans, about one-fifth of the population. It pays for about half of all nursing care in the United States, and 40% of all births.

The program has grown especially quickly over the past 15 years, as millions joined through the expansion of the Affordable Care Act to cover healthy adults who earn less than 138% of the federal poverty line, about $21,597 for an individual and $36,777 for a family of three. The rolls swelled again during the coronavirus pandemic, when Medicaid extended emergency coverage to millions.

Republicans have not yet specified what policy changes they would make to Medicaid. Options discussed include requiring enrollees to be employed, or dialing down funding for the Affordable Care Act’s expansion, which made millions of adults eligible for coverage. A work requirement would be expected to cut Medicaid spending by about $100 billion over the next decade, as those unable to comply — or to file the correct paperwork showing their employment — would lose coverage.

In a statement, Rogers described claims his party would gut the program as “lies promoted by House Democrats.”

“We are on a mission to cut waste, fraud and abuse of taxpayer dollars, so that we can protect the future of programs like Medicaid for years to come,” he said.

Large cuts to Medicaid would probably hit dense urban areas that tend to vote for Democrats. The congressional district that covers part of the Bronx in New York, for example, has one of the highest Medicaid enrollment rates in the country, with the program covering 67% of the people who live there. A district that covers part of Los Angeles has more than half its residents enrolled in the program.

Of the 10 congressional districts with the highest share of residents enrolled in Medicaid, nine are held by Democratic legislators.

© 2025 The New York Times Company