The House Republican working behind the scenes to rein in his party's ambitions to cut Medicaid spending is a California dairy farmer who represents more Medicaid beneficiaries than any of his GOP colleagues.

Rep. David Valadao, who runs the centrist-oriented Republican Governance Group, has spent the last several weeks in near-constant communication with his leadership, including in weekly meetings with the chairs of key ideological caucuses across the GOP conference.

He led a letter signed by a dozen vulnerable Republican members urging House leadership not to make steep cuts to Medicaid earlier this month. He also has an active text chat running throughout the day with a dozen or so other lawmakers who are also concerned about cuts to Medicaid to pay for the Republican megabill of taxes, border investments, energy policy and more.

“We've got our little group chats and try to make sure that we're keeping each other abreast of what we're seeing, what we're hearing, and trying to at least do our best to stick together,” Valadao said in an interview.

Many of those members on the text chain are, like him, at-risk Republican incumbents who fear the political blowback of financing the party-line package with reductions to a safety-net program relied upon by nearly 70 million Americans. They are relying on Valadao for leadership and advice.

“He’s got a very good sense of what Americans need out of their health care. I appreciate his leadership,” said Rep. Nick LaLota (R-N.Y.), in an interview, adding that the two are in constant touch. “He’s been clear in his communications: We shouldn’t be throwing people off Medicaid who are designed to be on the program.”

Rep. Rob Bresnahan (R-Pa.), who also has a large percentage of Medicaid recipients in his district, said in an interview that Valadao was a “total pillar … He’s someone I immediately gravitated to. Just a great sounding board.”

The outcome of the Medicaid debate carries high stakes not just for the Americans who use it for coverage, but for Valadao and his colleagues’ political futures, too. Valadao knows firsthand the consequences of making the wrong move in the health care debate. In 2018, he was part of the wave of House Republicans ousted after their votes to repeal the Affordable Care Act, which would have kicked millions of people off their insurance plans.

Valadao clawed his way back to the House two years later, and now he’s determined not to make the same mistake twice — and he’s telling others they ought to follow his lead.

“Am I concerned with the way this plays? Yeah, every vote we take can be spun,” he said. “I imagine whatever decision we make, even if it cuts $1, it'll be the most dramatic dollar ever, and the most important dollar ever to this program.”

House Energy and Commerce Committee Republicans have been tasked with cutting $880 billion from programs under the committee's purview, and to meet that target they’re likely going to have to slash Medicaid, unless they can find palatable alternatives. So far, few have materialized.

In the meantime, Valadao and other vulnerable moderates are already facing a slew of television ads, billboards and town halls in their district pushing against Medicaid cuts — an onslaught that is likely to only increase in the coming weeks as Republicans get closer to taking a floor vote on their party-line megabill.

“We're going through this partisan exercise to do what is supposed to be a tax bill, and it's becoming a health care bill, which is what we’re trying to avoid, on an issue that desperately needs reform to make it better,” Valadao said.

This is a perception President Donald Trump wants to avoid, especially after the political firestorm Republicans unleashed on themselves over trying to repeal the Democrats’ health law back in 2017. House GOP leaders have also been aware of that tension for months. Still, Republicans continue to debate proposals behind closed doors that could lead to coverage losses for millions of low-income Americans in states that have expanded Medicaid.

Speaker Mike Johnson and other key House Republicans attended a meeting with Trump at the White House Thursday, where they planned to push for adding even more health care policies to the megabill. That included pitching a controversial proposal to cap federal Medicaid allotments for states — a move that would score significant savings but risk millions of low-income Americans losing their health care.

What Valadao wants to know is whether some of the House GOP’s most politically explosive health care overhauls will actually pass muster with Senate Republicans and ultimately Trump.

“One of the most common questions I think is important to ask is, ‘Where's the president on these issues?’ Because the president has made comments like he would veto anything that cut Medicaid,” Valadao said. “He said … he would support cutting waste, fraud and abuse. That's such a broad term. And what is any one of those? So, it is a dangerous situation.“

Leaders ultimately left that meeting with Trump and decided they needed to push back for another week an expected Energy and Commerce markup of its portion of the legislation, still lacking consensus on how to proceed over Medicaid.

Valadao’s drumbeat of warnings and back-channel maneuvering have at times privately irked senior Republicans who want the space to negotiate. Valadao is also not considered a close friend of the Trump administration, being one of the few Republicans left on Capitol Hill who voted to impeach Trump after the Jan. 6, 2021, attack on the U.S. Capitol.

“Obviously, I don't have a direct line with him,” Valadao said — though despite not being on close terms with the president, he believes they could be on the same page on Medicaid. Regarding one controversial House Republican proposal to cap federal allotments for some Medicaid states, Valadao said he has “gotten some feedback that [Trump is] concerned with that as well.”

The White House did not respond to a request for comment, but Trump has privately indicated in recent days he does, in fact, share some of Valadao’s anxieties about changing the so-called federal medical assistance percentage.

GOP leaders also acknowledge Valadao is possibly the only Republican who can hang onto his competitive, blue-state district that helped the House GOP narrowly retain its majority the last two election cycles.

“David Valadao is the biggest team player I’ve interacted with in my time in Congress,” Rep. Blake Moore (R-Utah), a member of GOP leadership, said in a brief interview.

“He’s been through this before. He knows the ground truth,” Moore said. “Everything we're doing right now is a balancing act.”