Around a dozen House Republicans are uneasy about the prospect of voting for their party’s budget proposal over potential cuts to Medicaid, according to several people familiar with the conversations. And with only a narrow majority in the House, GOP leaders are now navigating an increasingly volatile path, where the fate of the budget, and the possibility of a government shutdown, hinges on resolving these internal divisions.
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Rep. Jeff Van Drew, a former Democrat from New Jersey turned Trump-supporting Republican, tells TIME that he’s prepared to vote against the sweeping budget plan on Tuesday, claiming its proposed $880 billion in cuts to Medicaid are too extreme—even if it helps pay for tax cuts and new national security spending.
“Working class people receive Medicaid as they are working,” Van Drew says of the government health insurance program that serves over 72 million Americans. “This is not just lazy people who are sitting around not doing their job.”
Van Drew says he called President Donald Trump on Monday evening to express his opposition to the budget resolution: “I told him I very well may not vote for this, and I’m certainly waiting until the last minute to see if some changes can be made, because I’m very unhappy.” During that call, Van Drew says Trump did not ask him to change his mind and vote for the House GOP’s budget resolution or push back on his concerns about potential Medicaid cuts. “He listened and he understood my concerns,” Van Drew says. “I believe it’s bad for him because he made a commitment,” referring to Trump’s repeated pledges during his campaign and his presidency to protect Medicaid, a promise that many Republicans feel he is now at risk of breaking.
Trump has long positioned himself as a defender of entitlement programs, including Medicaid, which provides health care to low-income Americans. Throughout his political career, he has consistently vowed not to make cuts to Medicaid, even as his administration has pursued broader budget reductions. “We’re going to love and cherish Social Security, Medicare, Medicaid,” Trump told reporters on Jan. 31. Yet, only days later, he endorsed the GOP-led House budget proposal, which includes significant cuts to Medicaid.
The apparent contradiction has left members like Van Drew caught between their loyalty to Trump and the political realities of representing districts where Medicaid is deeply important. In recent days, protestors have lined up outside Van Drew’s South Jersey district office. The uncertainty surrounding Trump’s stance on Medicaid cuts has created further rifts within the GOP, as some lawmakers fear alienating the very constituents that helped Trump win crucial swing states.
“I don’t want to see him go through this,” Van Drew says.
House Speaker Mike Johnson plans to hold a vote Tuesday on the measure, which calls for $2 trillion in cuts over a decade. But it’s uncertain to pass given the fierce opposition from lawmakers representing districts with high Medicaid enrollment, many of whom are facing pressure from constituents who depend on the program for vital health care services. At recent town halls across the country, constituents have voiced their discontent over spending freezes and federal worker firings spearheaded by Elon Musk’s Department of Government Efficiency. Some fear that voting in favor of these cuts could cost Republicans re-election support in 2026 by alienating their voters—many of whom voted for Trump and have benefited from Medicaid.
The ideological divide within the GOP runs deep. On one side, budget hawks argue that Medicaid is an “open checkbook” contributing to the nation’s $34 trillion debt, and they view this moment as a crucial opportunity to curb the nation’s ballooning deficit. The proposed solution includes capping Medicaid spending, imposing work requirements, and targeting fraud—all of which would save an estimated $880 billion over the next decade, House Republicans estimate. Critics say that if the Medicaid cuts are approved by the House and Senate, millions of Americans will lose coverage, including children, new moms, seniors, veterans, and people with disabilities. Medicaid pays for 6 out of 10 of residents in nursing homes, with 5.6 million Americans counting on Medicaid for their long-term care bills.
Rep. Nick Begich, a Republican who represents Alaska’s only congressional district, where a third of residents are enrolled in Medicaid, tells TIME that he wants “to make sure that our nation’s most vulnerable populations continue to be supported by programs like Medicaid.” While he didn’t share how he would vote, he said he plans to “ensure that Medicaid is preserved.”
Rep. Tony Gonzales, a Texas Republican who also has a large constituency enrolled in the program, co-authored a letter with seven other House Republicans representing large Hispanic populations urging Speaker Johnson to rethink the GOP’s potential cuts on Medicaid. Gonzales met with Speaker Johnson on Monday and told TIME afterwards that he plans to continue their dialogue. “We will cut waste and fraud while investing in our national security without pulling the rug out from under millions of Americans,” he says.
But the uncertainty leaves Speaker Johnson and his leadership team in a tight spot. With the House’s razor-thin 218-215 majority, the GOP can afford only a handful of defections—making it increasingly unlikely that the party will be able to unite behind a budget that includes Medicaid cuts.
“I think we look good,” Johnson told reporters as he was leaving the Capitol Monday night. “I mean we’re having very productive conversations. As you all know, this is all part of the process and I think we’re on track.”
Still, the internal strife could have dire consequences: without a budget, the government faces the very real possibility of a shutdown in mid-March.
From a political standpoint, that may present a prime opportunity for Democrats to sharpen their messaging heading into the midterms. Democrats plan to seize on any potential disarray to rally opposition to the Medicaid cuts, according to a source familiar with Democratic leadership’s thinking, and could push hard to mobilize voters in Medicaid-heavy districts. Protect Our Care, a Democratic health care advocacy group formed to defend the Affordable Care Act during that last Republican trifecta in 2017, already launched a $10 million campaign titled “Hands Off Medicaid” and is running ads on Fox News urging constituents to call their representatives.
House Minority Leader Hakeem Jeffries told reporters Monday that if Republicans vote for the budget, “they’re going to be held accountable for raising expectations that they were going to solve the affordability crisis in America and doing the exact opposite.”
Sen. John Fetterman, a Democrat from Pennsylvania, tells TIME that cuts to Medicaid are “unacceptable” and that if Republicans “want to further damage their brand … that’s their prerogative.”
For House Republicans, the stakes are high. They must navigate the competing pressures from their own party’s hard-line budget conservatives, the promises they and Trump made to constituents, and the threat of a government shutdown that could play into the Democrats’ hands.
“It’s not like I’m being soft or don’t think we need to change a whole lot of stuff,” Van Drew says. “I’m one of these people that was caught in the middle that wants to do the right thing by real people.”
“There’s being conservative, and there’s being extreme,” he adds. “Those are two different things.”
