Major Medicaid cuts in Trump’s tax bill could hit rural voters especially hard -- giving organizers hope the party can make improvements in these areas in the midterms.

The tax and spending legislation the House voted to send to President Donald Trump’s desk on Thursday, enacting much of his domestic agenda, cuts federal health spending by about $1 trillion over a decade in ways that will jeopardize the physical and financial health of tens of millions of Americans.

Covered California, the state's Affordable Care Act health insurance marketplace, estimates that up to 660,000 of the 2 million in the program will be stripped of coverage or drop out.

For 37-year-old Kyle Garvey, a typical day includes writing film reviews and doing some tutoring. To do those things, the Columbus resident first needs to get out of bed. Having had cerebral palsy since birth,

There’s 35 million people under the poverty line inside the United States, and there’s 70 million people that are signed up for Medicaid,” Sen. Markwayne Mullin (R-Okla.)

Republicans also argue they’re protecting the “most vulnerable” Medicaid recipients by removing undocumented immigrants and others they say shouldn’t have access to the program anyway.

States and rural health advocacy groups are sounding the alarm that Congress’ slashing of Medicaid will devastate already financially fragile rural hospitals.

The bill, ushered through Congress by Republican leadership and signed by Trump Friday, includes $4.5 trillion in tax cuts, slashes spending on Medicaid, and creates temporary tax deductions for overtime and tipped income. It includes $170 billion for immigrant detention and for new personnel for Immigration and Customs Enforcement.

The Democratic Party thinks it has an opportunity to win back seats in the 2026 election from House Republicans who voted for the "big beautiful bill."

Senate Republicans have yet to finalize their version of President Donald Trump’s sweeping domestic policy proposal, but GOP lawmakers up for reelection in 2026 are bracing for the political impact of the bill’s Medicaid cuts.