Representative Gabe Evans, Republican of Colorado, secured his ticket to Washington in November when he defeated a Democratic member of Congress by less than 1 percentage point — just 2,449 votes.
Now Mr. Evans, 39, is helping to write legislation that could cement his own ticket back home.
The first-term congressman, whose swing district just north of Denver includes 151,749 Medicaid recipients, sits on the Energy and Commerce Committee. The Republican budget resolution that lays the groundwork for sweeping legislation to enact President Trump’s domestic agenda instructs the panel, which has jurisdiction over Medicaid, to slash spending by $880 billion over the next decade to help pay for a large tax cut. That number is impossible to reach without substantially reducing the cost of Medicaid, the government program that provides health insurance for lower-income Americans.
As Republicans in Congress struggle to coalesce around the core pieces of what Mr. Trump calls his “one big, beautiful bill,” Mr. Evans and other G.O.P. lawmakers from some of the most competitive districts in the country are facing committee votes next week to approve cuts to popular programs that could come back to haunt them politically.
And Democrats are gleeful at the prospect of Republican incumbents going on the record supporting the effort.
“These members of Congress won with fewer votes than the number of people in their district on Medicaid,” said Jesse Ferguson, a veteran Democratic strategist and a former spokesman for the Democratic Congressional Campaign Committee. “Voting for this is like being the captain of the Titanic and deciding to intentionally hit the iceberg.”
The group includes Representative Mariannette Miller-Meeks, Republican of Iowa, who also sits on the Energy and Commerce Committee and is on even shakier ground than Mr. Evans, despite having warded off a challenger multiple times. Last year, Ms. Miller-Meeks, who represents 132,148 Medicaid recipients, won her seat by 0.2 percent, or 799 votes. Her local office in Davenport has been besieged by demonstrators concerned about spending cuts.
Also on the panel is Representative Thomas H. Kean Jr., a Republican from a highly competitive district in New Jersey.
On the Agriculture Committee, which must find $230 billion in cuts over a decade, Republicans are feuding over how much to slash from federal food assistance programs, with those from competitive seats wary of reductions that could hit their constituents. That panel also includes some of the most endangered Republicans in the House: Representatives Rob Bresnahan Jr., a first-term Republican from Pennsylvania; Don Bacon of Nebraska; Zach Nunn of Iowa; and Derrick Van Orden of Wisconsin.
Both committees are expected to meet next week to work on and finalize their bills, although that could change if Republicans fail to reach agreement on what cuts should be included. The panels had been slated to meet this week, but pushed off the meetings amid lingering disagreements.
“Many of them have been talking in private to their leadership, telling them that this is a really tough vote for them,” Representative Angie Craig of Minnesota, the ranking Democrat on the Agriculture Committee, said of Republicans.
Adding to their dilemma, Mr. Trump has said he does not want to “touch” Medicaid, and some far-right thought leaders are blaring alarms about cutting the program.
“Medicaid — you got to be careful, because a lot of MAGA’s on Medicaid,” Stephen K. Bannon, the former adviser to Mr. Trump, said recently on his “War Room” podcast. More than 60 percent of Trump voters said Medicaid was “very important” to their communities, according to a recent KFF poll.
As the G.O.P. struggles to cobble together legislation that can please its right flank, which is demanding deep cuts, without alienating moderates who oppose them, many vulnerable lawmakers fear that they are setting themselves up to take a tough vote on something that may never become law.
Representative Nick LaLota, a New York Republican who opposes Medicaid cuts, said he and his colleagues had no interest in going through the difficult process of writing and voting for a bill that ultimately could not pass the Senate, which has embraced a fraction of the spending cuts the House has.
“We’re not looking to float a trial balloon,” Mr. LaLota said in an interview. “We only want to vote for something that’s real, that’s passable by the Senate and that the president will sign.”
Such concerns are one reason that Speaker Mike Johnson was forced this week to drop one of the most aggressive options the G.O.P. was considering to cut Medicaid costs: lowering what the federal government pays states to care for working-age adults who became eligible for the program through the Affordable Care Act’s Medicaid expansion.
Privately, many Republicans on Capitol Hill said they expected the House to miss its self-imposed Memorial Day deadline to write and pass the bill, and eventually settle on a Senate-approved package of tax cuts that includes no major changes to Medicaid, food assistance or any other popular program. Such an outcome would enrage fiscal conservatives on the hard right, who are demanding that the package not add to the deficit and who could bring down the whole package if they refused to go along.
Some vulnerable Republicans who oppose cutting Medicaid said they were still hoping to find other ways to reduce the program’s costs, such as imposing work requirements and tightening rules to ensure that undocumented immigrants, who are barred by law from the program, cannot receive any of its services. And they note that there are other proposals to raise the federal revenue needed to offset tax cuts.
“There are ways to cut the Energy and Commerce budget which aren’t just health care,” Mr. LaLota said. “I’m not so fatalistic that it’s a tough vote.”
But cleaning up Medicaid fraud and tightening rules generate far less money than what the Republican plan requires. And the Congressional Budget Office on Wednesday wrote that after estimating the budget impact of four different options for cutting Medicaid, all of them would have the same overall result: “enrollment would decrease and the number of people without health insurance would increase.”
Democrats have for weeks been working to capitalize on the potential impact of the cuts.
They have targeted vulnerable Republicans with billboards in their districts, accusing them of voting to cut Medicaid in order to give billionaires like Elon Musk a tax cut. The National Republican Campaign Committee issued a cease-and-desist letter about the billboards, calling them defamatory.
“All national Democrats have are pathetic lies and fear-mongering tactics to distract from their failures,” a spokesman for the committee, Mike Marinella, said in a statement.
Mr. Evans, for his part, has been trying to thread the needle by criticizing the way his state administers Medicaid, charging that it has paid millions of dollars to deceased people and undocumented immigrants.
“The overall goal is to be able to protect the program by cutting out the fraud, waste and abuse,” he told a Colorado public radio station last month. He declined to comment for this article.
Ms. Craig said her hope was that some center-leaning Republicans would stand up to their leaders and simply draw a red line on any cuts to the Supplemental Nutrition Assistance Program or Medicaid.
“The real question is whether the moderates on my committee are really going to take this to the mat and fight these cuts or if they’re going to cave,” Ms. Craig said.
For newcomers to Congress like Mr. Evans and Mr. Bresnahan, the situation has echoes of the difficult position that Representative Marjorie Mezvinsky, a one-term Democratic congresswoman from Pennsylvania, faced in 1993 when she voted for President Bill Clinton’s budget after originally opposing it because it did not include enough spending cuts.
As she cast the deciding vote, Republicans knew they were witnessing a political death.
On the House floor, they chanted, “Goodbye, Marjorie!”
She was defeated the following year.
