Cuts to Medicaid Would Hurt All Communities, Red and Blue

Republicans in the US House of Representatives are pushing forward a plan to pass a budget that would cut Medicaid benefits, which provide free or low-cost health coverage to people across the country. Medicaid serves roughly 72 million Americans in every state and every locality, and another 7 million people enrolled in the Children’s Health Insurance Program (CHIP), which provides low-cost health coverage to eligible children in families with incomes too high for Medicaid but too low to afford private insurance.

If these benefits were cut, roughly a quarter of Americans would suddenly lose their health care coverage, and it’s likely that health insurance costs would rise for everyone. Cuts to Medicaid spending will also have adverse impacts on health care providers and they services they provide, especially for hospitals that are already financially at-risk.

Despite Republican efforts to cut Medicaid, most Americans support keeping the funding as is. A Kaiser Family Foundation poll from just last week found that fewer than one in five adults (17 percent) want to see Medicaid funding cut and most think funding should either increase (42 percent) or be kept about the same (40 percent). About half (53 percent) of adults surveyed, say they or a family member has received benefits from Medicaid at some point, including 4 in 10 Republicans (44 percent) and nearly half of those who voted for President Trump in 2024 (45 percent). Regardless of whether they have a connection to the program, nearly all (97 percent) adults say Medicaid is at least somewhat important for people in their local community, including three-quarters who say it is “very important.”

Using Medicaid participation data from Georgetown University and 2024 presidential election results from Tom McGovern, I explore which communities would see the most dramatic effects if Medicaid funding were cut. Crossing the two data sets, I examine concurrent geographic patterns in voting results and Medicaid participation to show how Medicaid cuts will affect different parts of the country, small and large, urban and rural.

What communities rely on Medicaid for health insurance coverage?

Areas in Arizona, New Mexico, New York, Louisiana, and Appalachia tend to have higher rates of Medicaid participation, with as many as 1 in 3 people receiving benefits. By comparison, most counties in North Dakota, Wyoming, Utah, and Vermont have lower-than-average participation.

Comparing participation rates with the share of people who voted for Donald Trump in the 2024 presidential election reveals a weakly negative relationship between the two metrics. In other words, the greater the Trump vote share, the lower the Medicaid participation rate. States like California and New York, two of the more Democratic-leaning states in the country, have higher Medicaid participation rates, while North Dakota and Wyoming, two of the more Republican-leaning states, have lower participation rates.

However, these data are misleading. Currently, 10 states have not expanded Medicaid coverage under the Affordable Care Act (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Texas, Wisconsin, and Wyoming), meaning some adults who would otherwise be eligible do not qualify. All 10 of these states sent their electoral votes for President Trump, which skews the participation rate data broken down by vote. According to the Kaiser Family Foundation, about 1.4 million adults in states without Medicaid expansion have incomes above their state’s Medicaid eligibility threshold but below the poverty level, meaning they would qualify in expansion states.

We can also look at the two variables geographically. This bivariate choropleth map shows the share of people who received Medicaid in 2023 and the share that voted for Trump in each county.