House Republicans in 29 competitive districts are about to rip healthcare away from up to 29% of their constituents.

I recently posted Congressional District-level breakouts of total enrollment in ACA Exchange Qualified Health Plans & Basic Health Plans, Medicaid/CHIP programs as well as Medicare. You can view the master spreadsheet here.

Tomorrow (Tuesday, 2/25/25), U.S. House Republicans are expected to vote on their 2025 - 2034 Budget Resolution.

As I've written about before, the GOP House Budget Resolution, if passed, signed into law and implemented, would include horrific, draconian gutting of huge chunks of the U.S. public healthcare system, which, between Medicare, Medicaid, CHIP, the ACA and the VA provides healthcare coverage for nearly HALF the entire U.S. population.

Among the programs which would be gutted, the biggest damage would be to Medicaid (which they want to slash by a stunning $880 BILLION over the next decade), with the ACA running a close second (they plan on allowing the improved subsidies for ACA enrollees provided by the Inflation Reduction Act to expire, which would mean slashing ACA subsidies by roughly $250 BILLION over the next decade).

Earlier today, Politico posted an article which looked at the 11 vulnerable House Republicans who they found to have the highest percent of residents enrolled in Medicaid. Their list includes:

• Nick Begich (AK-AL)
• Eli Crane (AZ-02)
• Juan Ciscomani (AZ-06)
• David Valadao (CA-22)
• Ken Calvert (CA-41)
• Jeff Hurd (CO-03)
• Gabe Evans (CO-08)
• John James (MI-10)
• Mike Lawler (NY-17)
• Robert Bresnahan (PA-08)
• Dan Newhouse (WA-04)

While this list is reasonable, I have to note that I have a few problems with it: First, the Medicaid enrollment data is as of March 2024, so it's nearly a year out of date. This is important because Medicaid enrollment has dropped a bit since then as the post-pandemic "Unwinding" process wound down. Second, it doesn't include CHIP enrollment, which, while funded separately from Medicaid, is closely tied to it in practice in many states; any cuts to Medicaid would inevitably also cause cuts to CHIP enrollment.

In addition, Politico's list only focuses on Medicaid, which is fine, but since ACA subsidies are also under direct threat and since the fate of the ACA & Medicaid are also intertwined in some ways, I've decided to add ACA exchange Qualified Health Plan (QHP) & Basic Health Plan (BHP) enrollment to the mix.

I then looked at the Cook Political Report's 2026 House Race Ratings to see which Republican-held House districts are considered competitive and compare those to the total enrollment in the ACA exchange, BHP, Medicaid & CHIP programs. 

While all 11 names above are on that page, there's actually 29 House seats held by Republicans which Cook Report considers either Tossups or at least somewhat competitive.

Overall, it ranges from 14.4% of the total population in NJ-07 (Thomas Kean) to as high as a stunning 64.1% in CA-22 (David Valadao). In the latter, in fact, a whopping 61.1% of the total population is enrolled in Medicaid or CHIP alone.

• AK-AL Nick Begich: 38.0%
• AZ-01 David Schweikert: 21.3%
• AZ-02 Eli Crane: 37.1%
• AZ-06 Juan Ciscomani: 28.6%
• CA-03 Kevin Kiley: 27.3%
• CA-22 David Valadao: 64.1%
• CA-40 Young Kim: 26.3%
• CA-41 Ken Calvert: 35.3%
• CO-03 Jeff Hurd: 34.1%
• CO-08 Gabe Evans: 26.5%
• FL-13 Anna Paulina Luna: 27.4%
• IA-01 Mariannette Miller-Meeks: 24.4%
• IA-03 Zach Nunn: 25.3%
• MI-04 Bill Huizenga: 24.3%
• MI-07 Tom Barrett: 20.9%
• MI-10 John James: 29.1%
• MT-01 Ryan Zinke: 27.6%
• NE-02 Don Bacon: 22.8%
• NJ-07 Thomas Kean: 14.4%
• NY-17 Michael Lawler: 34.6%
• PA-01 Brian Fitzpatrick: 20.0%
• PA-07 Ryan Mackenzie: 27.4%
• PA-08 Robert Bresnahan: 33.5%
• PA-10 Scott Perry: 28.8%
• TX-15 Monica De La Cruz: 40.4%
• VA-01 Robert Wittman: 19.3%
• VA-02 Jennifer Kiggans: 22.0%
• WI-01 Bryan Steil: 27.1%
• WI-03 Derrick Van Orden: 24.7%

Click below for a higher-resolution version.