GOP Runs Healthcare Ads After Backing Medicaid Cuts

Republicans campaigning in swing districts are airing healthcare-focused ads just months before the 2026 midterm elections, even as the party faces criticism over the roughly $1 trillion in Medicaid and Medicare cuts enacted in the One Big Beautiful Bill Act. An NPR analysis of video ads in competitive races found GOP candidates concentrating on three themes: Medicaid fraud, rural hospitals, and affordability.

Why It Matters

Healthcare is shaping up to be one of the defining issues of the November campaign. The One Big Beautiful Bill Act, signed by President Trump on July 4, 2025, is projected to leave about 10 million fewer people with health insurance by 2034, according to the Congressional Budget Office. Only a third of voters approve of the administration’s handling of healthcare costs, while 67 percent disapprove, and Democrats hold a double-digit trust advantage on the issue, according to KFF’s April Health Tracking Poll.

Roughly nine in ten voters say healthcare costs will influence their midterm vote, with 61 percent saying the issue will have a “major impact” on which party’s candidate they support, KFF found. Democrats are trusted more on addressing the cost of care (37 percent versus 26 percent for Republicans), while Republicans hold the edge on tackling fraud and waste in government health programs (34 percent versus 26 percent).

From Repeal to Reform

The ad push marks a significant strategic shift for Republicans. Jonathan Oberlander, a healthcare policy expert at the University of North Carolina, noted that repealing the Affordable Care Act was the party’s “target No. 1” after President Trump’s first election in 2016. When the Senate failed to repeal the law, voters punished Republicans anyway.

“[The repeal is] probably one of the factors that led them to lose their majority in the House,” he said of the 2018 midterms, when Democrats won a decisive majority. “It was extraordinarily unpopular, the least popular major legislation of the past 40 years.”

This cycle, Republican candidates are trying to get ahead of the attack. “[Congressional Republicans] know that that’s going to be a potent line of attack from their challengers and they have to get in front of it and defend it,” said Daniel Hopkins, a professor of political science at the University of Pennsylvania.

Reforming Medicaid as a Strength

Rep. Mike Lawler, a Republican running for reelection in a toss-up New York seat, ran ads casting the law — which he voted for — as a reform that reduced the number of able-bodied individuals in Medicaid. He also raised the false claim that undocumented immigrants can no longer receive benefits; they were never eligible.

Focusing on reform plays to a Republican strength. According to KFF, voters trust Republicans over Democrats on “addressing fraud and waste in government health care programs.” “What Republican voters want to see from their lawmakers is changes to the Medicaid program,” said Ashley Kirzinger, KFF’s director of survey methodology. “They don’t want the program to go away, but they want it to reduce fraud so that the program is more sustainable.” Notably, around a third of independents say they trust neither party on most healthcare issues.

Funds Into Rural Hospitals

Rural hospitals face the highest risk because they rely heavily on funding tied to Medicaid expansion. The One Big Beautiful Bill Act included $50 billion for the Rural Healthcare Transformation Act, but a KFF analysis found that does not offset the $137 billion in Medicaid cuts that directly affect rural areas.

Maine Sen. Susan Collins, who faces reelection, has released ads touting the $190 million she directed to Maine’s rural hospitals. More than 60 percent of Maine’s hospitals are in rural areas, and more than 4 in 10 rural hospitals nationally are in debt.

“They’re sources of safety, economic prosperity and jobs,” Kirzinger said. “People in rural areas have a really strong connection to their hospital.”

The Nebraska Bellwether

The political stakes are becoming visible. On Aug. 1, Nebraska will become the first state to remove people from Medicaid for failing to meet new work requirements, with roughly 200 people set to lose coverage, according to NPR and Tradeoffs. Under new federal rules, about 20 million people in 44 states must work or volunteer 80 hours per month, attend school, or participate in job training to keep their benefits. Estimates vary widely, with as few as 3 million and as many as 8.6 million people projected to lose coverage by 2028.

Making Healthcare Affordable

Three Republicans — Rep. Ashley Hinson, running for Senate in Iowa, and Reps. Mariannette Miller-Meeks of Iowa and David Valadao of California, both running for reelection in toss-up districts — have made affordability central to their campaigns. Hinson and Miller-Meeks blame insurance and pharmaceutical companies for high costs, while Valadao’s ads promise to lower costs and protect Medicare and Medicaid. ACA premiums rose 21.7 percent nationwide between 2025 and 2026, according to an Urban Institute report cited in the NPR analysis.

Oberlander said Republican policy has made coverage harder to obtain and more expensive to keep. “When you take Medicaid away from people, when you take those enhanced subsidies away, it really increases the costs that they face,” he said.

A Delayed Reckoning

Experts say the ads are a defensive maneuver — and the full political cost of the cuts has been deliberately deferred. Most One Big Beautiful Bill changes, including reduced Medicaid funding and frequent redeterminations of eligibility, are scheduled to take effect after the midterms. Some cuts, such as the removal of ACA premium tax credits, have already arrived.

“That phasing provides a bit of a buffer for Republicans from the political pain of these cuts,” Oberlander said, predicting the fallout “will be fully exposed in 2028.” Hopkins described a “time disconnect” that makes it hard for voters to tangibly react to changes that lie in the future.

Kirzinger, meanwhile, sees an opening for either party to claim the economic-healthcare lane. “Democratic lawmakers were more trusted on healthcare, and Republican lawmakers were more trusted on the economy, so what happens when it’s an economic healthcare issue?” she said. “There is an opportunity to gain that lane and be the party that people trust.”

What’s Next

Democrats are already training their fire on vulnerable Republicans, and healthcare is expected to become a top issue for the 2028 election, when the deepest cuts will be fully in effect and both parties face open presidential primaries. The question for November is whether voters punish Republicans for cuts they have not yet felt — or accept the party’s argument that it is fixing a broken system.