The congressional districts hit hardest by healthcare cuts

Modern Healthcare – Thursday, August 7, 2025
By Michael McAuliff

It will take years for the full impacts of the healthcare cuts in President Donald Trump’s sweeping new tax law to manifest, but independent analyses make clear some congressional districts will be hard hit.

The types and locations of the districts are highly diverse, ranging from urban areas to agricultural regions. What they have in common is millions of people who will lose health coverage and providers who will lose paying customers.

“You are just going to see the uninsured rate increase in these areas,” said Natasha Murphy, director of health policy at the left-leaning Center for American Progress.

There are two main ways Trump’s “One Big Beautiful Bill” will affect healthcare. The first is by spending $960 billion less on Medicaid over 10 years through new rules on states and tougher eligibility requirements for enrollees. Other provisions will reduce health insurance exchange enrollment, as well.

Altogether, the law will cause 10 million people to become uninsured, according to the nonpartisan Congressional Budget Office.

Further coverage losses are on the horizon if Trump and the Republican majority in Congress allow enhanced exchange subsidies to lapse at the end of the year.

The combined effects of the premium tax credits becoming smaller and a recent regulation imposing stricter exchange enrollment processes next year would be another 5.1 million uninsured, according to a separate CBO report.

There isn’t much geographic overlap between the locations that will be most affected by the Medicaid and exchange cuts from the tax law and those that would be affected by smaller subsidies.

The Medicaid cuts will be felt most acutely in low-income areas, primarily in cities represented by Democrats, such as New York’s 15th Congressional District in the Bronx, the poorest in the country. According to data compiled by nonpartisan health researchers at KFF, 71% of the district is enrolled in Medicaid or the Children’s Health Insurance Program. Los Angeles’ 43rd Congressional district isn’t far behind at 66%.

But struggling rural areas with Republican lawmakers who voted for the tax law will also suffer. California’s 22nd District, represented by Rep. David Valadao, has the third-highest Medicaid and CHIP enrollment at 64%, per KFF. Rep. Hal Rogers has 54% of his constituents in Kentucky’s 5th District on Medicaid or CHIP, landing it in the top 10.

Nationally, average exchange premiums are projected to rise 20% if the larger subsidies disappear, while the enrollee share will be 75% higher because they would receive less financial assistance, according to an analysis of preliminary rate filings from health insurance companies that KFF and the Peterson Center on Healthcare published Wednesday.

Districts in conservative states are likely to see the greatest impact of diminished subsidies, especially in states that chose not to broaden Medicaid eligibility for adults under the Affordable Care Act of 2010.

The 10 congressional districts with the largest exchange enrollment are in Florida, which didn’t expand Medicaid. Net premiums for these customers are projected to rise 76%-119% in those markets.

“Residents of these states are really going to struggle with seeing their costs of care increase, and likely having to forego insurance altogether as it gets increasingly expensive,” Murphy said.

According to KFF, 56% of exchange enrollees are represented by Republicans in the House and 76% live in districts Trump won in the 2024 presidential election.

More than 20 “red” and “purple” congressional districts are expected to see net premium hikes that could exceed 140%.

Mississippi’s 2nd District faces an enormous 218% average net spike, followed by Texas’ 34th District and Wyoming’s at-large district, which could see 194% net increases.

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