BAKERSFIELD, Calif. \u2014 Carlos A. grew up in a family on Medicaid, which made healthcare an afterthought since the public insurance is free for low-income enrollees. But when he received a raise two years ago, he found himself earning too much to qualify for the safety net program. And when he browsed Covered California plans, he found that marketplace prices were still too steep for his comfort.<\/p>\n
\u201cIt was a panic at first,\u201d Carlos said.<\/p>\n
He has a chronic immune condition that needs to be managed by regular medication. KVPR and KFF Health News agreed to withhold his diagnosis and last name to protect him from repercussions related to his health.<\/p>\n
\u201cI have to be able to afford my health insurance to go to the doctor, because if not, then there\u2019s no peace of mind,\u201d he added.<\/p>\n
Now in his late 20s, he receives employer-based coverage through his job at an Amazon warehouse. In addition to adjusting to monthly premiums and copays for medical visits and prescriptions, he also learned he needs prior authorization<\/a> for that medication he had been on for a decade. Without it, he could get only the generic version, which he\u2019s nervous to try. He felt his insurer failed to justify the switch.<\/p>\n \u201cI felt that this was a slap in the face because I\u2019m paying for my premiums,\u201d he said. \u201cIt\u2019s a contract. I\u2019m going to pay my premiums, you cover my insurance, and if there\u2019s a copay to my medicine, I\u2019ll pay it. So why are you playing funny business with my medication?\u201d<\/p>\n Carlos is one of many voters weighing healthcare costs in California\u2019s 22nd Congressional District, which stretches from Bakersfield up to parts of western Fresno County. It\u2019s newly redrawn<\/a> to improve Democrats\u2019 chances, but it remains among the nation\u2019s most competitive<\/a> this cycle and could determine control of the U.S. House. It\u2019s long been held by Republican Rep. David Valadao, who\u2019s been voted into the seat in almost every election since 2012.<\/p>\n Rep. David Valadao (R-Calif.) at the U.S. Capitol on March 25, 2025. (Bill Clark\/CQ-Roll Call, Inc via Getty Images)<\/p>\n Carlos was among dozens of people who attended a rally in Bakersfield this month in support of Democratic challenger Randy Villegas. Carlos said healthcare costs will be among the key considerations in his vote in this fall\u2019s midterm election, calling it an issue that both candidates need to address.<\/p>\n \u201cI do expect them to campaign on healthcare,\u201d Carlos said. \u201cThey\u2019d be very foolish not to.\u201d<\/p>\n Democrats are calling out Valadao\u2019s vote for HR 1<\/a>, the GOP tax-and-spending law known as the One Big Beautiful Bill Act, which cut billions in healthcare for poor people. The last time healthcare was on the ballot to this extent, Valadao lost his Central Valley seat in 2018<\/a> during a \u201cblue wave\u201d after the Republican lawmaker voted to repeal the Affordable Care Act. He retook his seat in 2020 by just 1,522 votes.<\/p>\n Valadao has said he voted for HR 1<\/a> because it protected Medicaid, known as Medi-Cal in California, for the most vulnerable, including children, pregnant women, disabled people, and seniors. He supported a rural health fund<\/a> for hospitals in underserved areas. At the same time, he said the legislation\u2019s work requirements for nondisabled adults were reasonable<\/a> and would help maintain the program.<\/p>\n \u201cPolling shows that the majority of Americans want us to have our programs to be sustainable,\u201d Valadao told TV channel KERO<\/a> in Bakersfield before the vote. \u201cSustainable means taking care of those who need it most, and those who should be working in part of society and being productive should be. And it\u2019s not an unfair ask.\u201d<\/p>\n The work requirement<\/a>\u2019s documentation mandate will take effect in 2027 for Medi-Cal enrollees. According to the California Health Care Foundation, an estimated 1.1 million<\/a> people are expected to lose coverage by 2030 due to the eligibility and administrative changes.<\/p>\n Villegas, a populist who favors universal healthcare<\/a> and is backed by Sen. Bernie Sanders (I-Vt.), has highlighted how Valadao\u2019s HR 1 vote will be felt by low-income residents across the district. The Visalia school board member said he grew up as a Medi-Cal recipient. As of 2024, the current 22nd District, which has some overlap with its redistricted replacement, had the highest Medicaid enrollment rate<\/a> \u2014 64% \u2014 of any Republican-held seat in the nation, according to KFF, a health information nonprofit that includes KFF Health News.<\/p>\n Randy Villegas, a Democrat running for California\u2019s 22nd Congressional District, campaigns in Bakersfield on May 23. (Myung J. Chun\/Los Angeles Times via Getty Images)<\/p>\n \u201cDavid Valadao voted to cut healthcare for nearly 70,000 people in the Valley to give tax breaks to billionaires and his wealthy donors,\u201d Villegas said in a statement. \u201cIn Congress, I\u2019ll fight to reverse those cuts and lower healthcare costs.\u201d<\/p>\n Valadao\u2019s office didn\u2019t return requests for comment. His campaign<\/a> touts his support for quality, affordable health coverage and maintaining access for the most vulnerable. Polling also finds that the Trump administration\u2019s recent withholding of Medicaid funds<\/a> from states is resonating with Republicans, with 55% saying it\u2019s important<\/a> for candidates to discuss fraud in government health programs. Republicans in swing districts, including Valadao, have begun airing ads<\/a> emphasizing reform.<\/p>\n But many in the electorate remain undecided in this district where nearly a quarter of voter registrations are nonpartisan. Some said they haven\u2019t heard enough from candidates about affordability solutions, which they hope will change because healthcare costs top the list<\/a> of their economic anxieties.<\/p>\n Matthew Depue, who lives in Hanford and has private health insurance through his employer, said he has been fortunate to have reliable coverage. His healthcare premiums affect his monthly budget, but he said he hasn\u2019t had to delay care or choose between paying medical bills and other necessities.<\/p>\n Still, Depue said, rising healthcare costs are quickly becoming harder to ignore. Last year, federal lawmakers declined to extend enhanced tax credits, which state officials say contributed to an average 10% premium increase<\/a> for Covered California plans.<\/p>\n He also sees how affordability is pushing people across borders to find cheaper treatments and medications.<\/p>\n \u201cPeople go from here to Mexico to get stuff done because it\u2019s so much cheaper,\u201d Depue said.<\/p>\n Even though healthcare is important to him, it isn\u2019t the only issue driving his vote. Depue, who doesn\u2019t know whom he\u2019ll vote for, said he would evaluate candidates based on everything they stand for, including their positions on things like taxes and the difficult job market. District 22\u2019s voter registration is 42% Democratic, 26% Republican, and 24% no party preference, according to the California secretary of state\u2019s May report<\/a>, the latest available.<\/p>\n Hanford, with a population of roughly 62,000, is the seat of Kings County. (Cresencio Rodriguez-Delgado\/KVPR)<\/p>\n For Hanford resident Patreza Newton, affording healthcare has become deeply cumbersome. She hopes that whoever wins the election will work to prioritize healthcare, saying the current health system is unaffordable.<\/p>\n She used to purchase her own plan under Obamacare and is now covered by her church\u2019s insurance. But to keep monthly premiums affordable, she chose a high-deductible plan, which means she has to pay out-of-pocket for some prescriptions and specialist visits.<\/p>\n Newton said she falls into what she calls \u201cthe in-between,\u201d people who earn too much to qualify for Medicaid but still struggle to afford coverage.<\/p>\n Years ago, Newton was hit with a hospital bill of roughly $65,000 after surgery and had to apply for financial hardship assistance because she couldn\u2019t afford to pay the bill.<\/p>\n As she considers how to vote this fall, she said she isn\u2019t looking for overwhelming promises but rather a leader who understands what families are experiencing. She\u2019s undecided on a candidate, saying none has shown the initiative she is looking for.<\/p>\n \u201cI do think there should be a way that people can afford it,\u201d she said, \u201cno matter who they are.\u201d<\/p>\n This article is from a partnership that includes KVPR<\/a>, an NPR affiliate in central California, and KFF Health News.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" BAKERSFIELD, Calif. \u2014 Carlos A. grew up in a family on Medicaid, which made healthcare an afterthought since the public insurance is free for low-income enrollees. But when he received a raise two years ago, he found himself earning too much to qualify for the safety net program. And when he browsed Covered California plans,…<\/p>\n","protected":false},"author":0,"featured_media":15254,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-15253","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15253"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15253"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15253\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/15254"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15253"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15253"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15253"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}