When Blair Isbell's food aid benefits arrive each month, the community college student and mother of two starts planning how to spend the roughly $7 per person per day she gets for groceries.
Isbell has an app on her phone for every grocery store in her area of California's Central Valley, and uses them to find the best deals. She favors pasta and rice combinations, stretching the meat and vegetables as far as she can for her sons, ages 4 and 8.
Without those food benefits, paid through the federal government's Supplementary Nutrition Assistance Program, Isbell said she would have had to drop out of the degree program she hopes will eventually lead to a good job as an occupational therapist.
"I wouldn't be able to be in school," she said. "I also, if I'm being honest, don't really know how I would make ends meet either."
SNAP, which provided food aid to 41.7 million Americans last year, and Medicaid, the federal health plan which provides coverage to 72 million low-income and disabled people, could face sweeping cuts under a budget plan taking shape in Congress.
A Republican blueprint passed by the House of Representatives in February seeks to lower taxes by $4.5 trillion over the coming decade, partially offsetting that lost revenue with $1.5 trillion in spending cuts.
Those proposed cuts - which may not be finalized for weeks or months - would likely fall heavily on this part of the Central Valley, a vast expanse of orchards, vineyards and cattle ranches that produces a significant portion of the United States’ fruits, vegetables and nuts. It also has some of the highest poverty rates in the country.
That puts Isbell's congressman, Republican David Valadao, in a tricky position in a competitive district that is among the top Democratic targets in 2026.
Republicans are struggling over how to pare back the federal budget without alienating working-class voters whose support is crucial to retaining control of Congress. Republicans are hoping to expand their narrow lead in two special elections in Florida on Tuesday.
More than half of Valadao's constituents receive Medicaid or Medi-Cal as it's known in California, which college student Isbell also uses. Some 28% get SNAP, or Cal-Fresh. Those are among the highest percentages for any congressional district in the nation, according to a Reuters review of Census data.
Valadao voted for the budget cuts in February - and then days later called on his colleagues to produce a final bill that "strengthens critical programs like Medicaid and SNAP."
Valadao's office did not respond to requests for comment from Reuters.
The son of local dairy farmers, Valadao has built a reputation as one of his party’s most moderate members since he was first elected in 2012. He backed bipartisan efforts to overhaul immigration laws – a priority for farmers who rely on immigrant labor – and focused on bread-and-butter issues like irrigation infrastructure, steering clear of the culture wars that have occupied many of his colleagues.
Valadao was one of just 10 House Republicans to vote for Trump's impeachment following the Jan. 6, 2021 attack on the U.S. Capitol, and one of only two still in office.
But he has faced protests against the Republican budget proposals at his office in Bakersfield.
"If he votes to cut Medi-Cal, it's going to affect him at the ballot box, because people are going to have a long memory if he takes away their health care," Sandy Reding, a registered nurse and a president of the California Nurses Association who joined the protests, told Reuters.
SAFETY-NET PROGRAMS IN SIGHTS
President Trump has ruled out cuts to Social Security and Medicare, the ballooning retirement and health care programs for the elderly, while calling for increased spending on defense and border security.
That puts nearly half of the $6.8 trillion budget off limits, pointing Republicans to weigh cuts to other safety-net programs.
The House plan does not explicitly call for Medicaid cuts, but it would be impossible to get to the party's goal of $880 billion in spending reductions without touching the program, according to the Congressional Budget Office.
It would also be difficult to cut $230 billion in agricultural spending, as the blueprint proposes, without affecting SNAP, the department's biggest program.
Congress is unlikely to finalize its budget plan for weeks, as the Senate must pass its own version and then the two must be reconciled.
The offices of Senate Republican Leader John Thune and House Speaker Mike Johnson declined requests for comment. But House Republicans have in the past downplayed the possibility of steep benefit cuts, saying they will find savings by cracking down on waste and fraud and narrowing the focus to single mothers and others who most need benefits.
Across Valadao's district, several hospitals and clinics are at risk of closure if those cuts are made, according to Jason Wells, president of Adventist Health's Central California Network of healthcare facilities, one of the largest health systems in the region.
Raul Ayala, who oversees outpatient and other care for Adventist, said Medicaid cuts would be "catastrophic" for a rural region that is already short on health resources and doctors.
Medicaid cuts could also affect health care delivered through the school system, including childhood immunization programs.
At Pioneer School in the farming town of Delano, school nurse Linda Hinojosa presides over a vision clinic for children operating from a room with a rack of colorful children’s glasses on one wall.
School nurses are mandated to test hearing and vision in certain grades - but without the clinic they couldn't do much beyond moving children to the front of the class, Hinojosa said.
"It was so very frustrating to send a letter home and say 'your child failed and they can't see, but there was no place for a family to go," Hinojosa said.
So in 2018 the school began to provide the service through a local nonprofit relying on Medicaid reimbursements.
"If you can't see, you can't learn," Hinojosa said. "If we lost Medicaid or the ability to provide those services, it would be devastating."
(This story has been refiled to change the headline and correct typos in paragraph 28)
