With costs up, healthcare a defining issue in South Texas’ battleground House races
This article first appeared on The Texas Tribune. The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
With costs up, healthcare a defining issue in South Texas’ battleground House races
One of the most expensive ads in a South Texas congressional race this cycle opens with a simple pitch: “When it comes to your healthcare, Bobby Pulido believes you should be in charge — not politicians.”
Pulido, a Tejano musician and Democratic candidate for Congress, is putting healthcare at the forefront of his campaign to defeat U.S. Rep. Monica De La Cruz this fall, blasting the Edinburg Republican over her vote for the GOP’s 2025 megabill that cut billions in Medicaid spending. De La Cruz has countered with a spot that fashions her as a boxer punching and weaving in the ring, fighting for “affordable healthcare.”
It is no accident that both candidates are selling their healthcare bona fides in a district centered in the Rio Grande Valley, a predominantly Hispanic and historically underserved corner of the state where more than a quarter of adults lack health coverage, according to the U.S. Census Bureau. Uninsured rates are expected to swell after the expiration of enhanced premium tax credits, which had lowered out-of-pocket costs for Affordable Care Act enrollees. The federal subsidies lapsed in January after Republicans balked at preserving a policy they saw as a giveaway to insurers.
Without anything to replace them, experts say, the lost subsidies are a hard blow to the Valley, where roughly one in five residents rely on the marketplace for coverage.
This all means healthcare is again top of mind for voters in the Valley, where the uninsured rate is more than double the national average and chronic diseases are a disproportionate problem. A decade-long study found more than two in five adults in the region suffer from diabetes and one in four from obesity. These are conditions that, like other chronic diseases, require the level of continual care that cash-strapped or uninsured patients often avoid, said Rashmi Chandran, a clinician and hospital administrator in the Valley.
“Most of these patients get one annual visit, or they go when they get sick,” said Chandran, noting that those who skip follow-ups tend to put off refilling prescriptions, a dangerous limbo for the chronically ill.
These health woes are not new to residents in the Valley and surrounding communities. But what’s different this year is that the GOP’s cuts to Medicaid and ACA subsidies have armed Democrats with a potent campaign tool as they campaign on making everyday life more affordable. And South Texas, a region where pocketbook issues drive voters, is blanketed by five competitive U.S. House races, making it a key arbiter of which party will control the narrowly divided chamber.
Despite suffering catastrophic losses in the region two years ago, Democrats are optimistic that campaigning on the GOP’s healthcare record — and their own plans to reverse course — will resonate with the majority-Hispanic, working-class electorates that make up all five districts.
“I'm old enough to remember when the president said in two weeks he would have a healthcare plan in 2016,” Pulido said in an interview with The Texas Tribune. “Nine years have passed since then, and we still don't have a plan.”
Healthcare-related political ads have become a fixture during commercial breaks across these districts, which include a pair of Democratic seats in the Valley that the GOP is trying to flip and a vacant red-leaning district that spans most of Texas’ southwest border. Across those three races, plus the Pulido-De La Cruz contest, candidates and outside groups have spent more than $3 million on TV, radio and digital ads that mention Medicare, Social Security or other issues tied to healthcare, according to the media tracking firm AdImpact.
The spending is outpacing every other pocketbook issue, from inflation to jobs, and Democrats are steering much of the conversation. The party has more than doubled the GOP’s healthcare ad spending across the four districts, with a playbook that seeks to tie voters’ affordability worries to Republican-backed Medicaid cuts and the healthcare subsidies that expired under the GOP’s watch.
Democrats had teased this very messaging for months, inspired by polling that found far more Texas voters thought President Donald Trump’s megabill would raise healthcare costs than those who expected savings. In a Texas Politics Project poll earlier this month, 31% of Texas voters said they approved of how Trump was handling healthcare, while 52% voiced disapproval.
Republicans, meanwhile, have leaned more on border security and tax cuts in their South Texas ads. Those who have engaged on healthcare, such as De La Cruz, have promised to protect Medicare and Social Security, focusing on the two biggest entitlement programs that matter especially for older voters.
What stands out to Pulido, though, are findings like what came out of a poll conducted earlier this year across the five South Texas congressional battlegrounds, in which voters ranked healthcare as their third most important issue. It was preceded by the related topics of cost of living and “the economy and jobs/wages."
“When you make things more expensive, which includes healthcare, what do you think is going to happen?” Pulido said. “People are going to revolt because the people over here have already been trying to figure out life with less money.”
The South Texas landscape
Pulido, a first-time political candidate, won his primary in March with help from Blue Dog Action PAC, the campaign arm of the centrist Blue Dog Coalition, which spent more than $560,000 on the ad touting his support for giving people autonomy over their healthcare.
The ad also touched on fighting for affordable healthcare for South Texas families — a message Pulido is now carrying into the general election against De La Cruz in the 15th Congressional District, which Trump carried by 18 points in 2024.
But Pulido and other Democratic candidates appear to be scrambling Republican gains that reshaped South Texas in recent elections. On Wednesday, the nonpartisan elections forecaster Sabato’s Crystal Ball shifted the race from “lean Republican” to “toss-up.” That makes it the second district in the Valley rated by the site as a jump ball, joining the neighboring seat of U.S. Rep. Vicente Gonzalez, D-McAllen.
Gonzalez and U.S. Rep. Henry Cuellar, D-Laredo, are running for reelection in districts that Texas Republicans reconfigured last summer to add more GOP voters. But while Trump won both Cuellar and Gonzalez’s new seats by 10 points, recent polling of the districts found the Democratic incumbents ahead of their GOP challengers, with Cuellar up by a whopping 11 points over Webb County Judge Tano Tijerina, the Republican nominee. Gonzalez had a narrower 3-point lead over his GOP foe, Eric Flores.
Rounding out the South Texas map are a pair of seats that wrap around San Antonio, including the 23rd Congressional District, left vacant since the resignation of former GOP Congressman Tony Gonzales. There, voters are choosing between Republican Brandon Herrera, a prominent gun-rights activist and YouTuber, and Democrat Katy Padilla Stout, an attorney and former teacher. Although Trump won this district by 17 points in 2024, national Democrats added it to their target list earlier this month, in part citing the GOP’s record on healthcare.
Next door, the 35th Congressional District was also drawn by the GOP-controlled Legislature last year to favor a Republican. Trump carried the newly configured district by 10 points in 2024.
De La Cruz is the only incumbent Republican among the five districts, making Pulido the only Democrat who can run ads attacking his opponent’s record on Capitol Hill. He and his allied Democratic groups have aired four separate ads criticizing De La Cruz for backing Republicans' sweeping tax-and-spending law, known as the One Big Beautiful Bill Act. Every Texas House Republican voted for the law in July 2025.
Among its provisions are an estimated $911 billion in federal Medicaid spending cuts over the next decade, which translates to a loss of $23 billion to $39 billion for Texas over the next decade, according to a projection by the nonpartisan health policy organization KFF. The law also created a $50 billion, five-year federal grant program intended for rural healthcare. Yet many of the state's rural healthcare facilities rely on Medicaid payments, and a majority of them could lose services, according to Kiplinger.
In South Texas, which is dotted with sparsely populated towns and ranchlands, Chandran said those who are insured — typically seniors — depend on federally funded community clinics that serve under-resourced areas. Chandran, who runs a nonprofit that provides health access to rural areas, said these centers are "functioning beyond their saturation level," leaving little room for ongoing, coordinated care.
On the campaign trail in these sorts of areas, Democrats are pointing to the Medicaid cuts, and the loss of ACA subsidies, in what they see as an opening to tie Republicans to rising healthcare costs. These attacks are also being echoed in districts across the country and are a subset of the party’s broader affordability message.
Particularly in the Valley, healthcare is often intertwined with other economic factors. Chandran recalled how she once treated a construction worker who arrived unconscious and septic after a nail wound in his leg had gone untreated for weeks. Surgeons amputated his leg to save his life. When she asked whether he had realized his leg was rotting, he told her, “If I don't go to work one day, I get replaced.”
Pulido argued that healthcare “hasn’t appeared to be a priority” for De La Cruz, accusing her of touting the other parts of Trump’s megabill to distract from the Medicaid and ACA changes.
“She's saying that she voted for no tax on tips and that this big beautiful bill was awesome, and the people are not stupid,” Pulido said. “They're like, ‘Hold on, my healthcare is more expensive.’”
A spokesperson for De La Cruz’s campaign pushed back against Pulido’s critiques, noting that she voted to extend the ACA tax credits — the only Texas Republican to do so. The bill died in the Senate, failing to garner enough Republican support.
“As a working mom, Monica knows what one hospital bill can do to a family,” James Shook, De La Cruz’s campaign manager, said in a statement. “She has taken on DC special interests to protect Medicare and Social Security for our abuelitos and brought home funding for our hospitals.”
The campaign cited the One Big Beautiful Bill Act as evidence of De La Cruz’s work on hospital funding. The law created a $50 billion, five-year federal grant program for rural healthcare, a large sum of which was allotted for Texas in late 2025. Many of the state's rural healthcare facilities rely on Medicaid payments, however, and a majority of them could lose services amid the law’s reductions, according to Kiplinger.
Additionally, Shook said, De La Cruz’s “bill to expand telemedicine for underserved communities is now the law of the land.” He was referring to the provisions of a 2025 bill De La Cruz sponsored — called the Supporting Patient Education and Knowledge, or SPEAK Act — that became law as part of a broader spending package. The measure requires the Department of Health and Human Services to develop guidance on best practices for improving telehealth access for people with limited English language skills, including through the use of interpreters, multilingual materials and patient portals.
Still, Pulido said he hopes the impact of the lost tax credits and Medicaid cuts will prove a political liability for the GOP. The longtime Tejano musician noted that he does not have health coverage himself and travels across the border to Mexico to receive care.
"The Rio Grande Valley has the lowest [income] per capita in the state. Down here, small-business owners like myself don't have health insurance because it's expensive," he said. "We should not have to be going to Mexico to go see a doctor."
Rising costs
The Medicaid cuts mark a deliberate shift in federal policy, said Laura Dague, a health economist and associate professor at Texas A&M University's Bush School of Government and Public Service.
"The federal government has clearly signaled through this legislation that they are not interested in continuing to fund Medicaid infinitely, and that's going to mean that states have to make some new choices about how to cover populations," Dague said.
While the cuts are spread across a decade, some Texans are feeling the more immediate effect of the lapsed Affordable Care Act tax credits. The subsidies have been around since 2014 and were expanded during the COVID-19 pandemic, providing a temporary financial crutch that lowered monthly premiums for marketplace coverage and extended aid to households that previously earned too much to qualify. Nowhere relied on them more than the Rio Grande Valley, where 98% of the region's marketplace enrollees used the credits to afford coverage, driving enrollment up nearly fourfold from 2021 to 2025.
Because the Valley leaned on the subsidies more than almost anywhere else, Dague said, it stands to feel their loss the most. So far this year, residents in the four Valley counties are paying about double the average out-of-pocket costs for their premiums, with a more than threefold increase in Willacy County.
"With the current trends, with all the inflation, it's hard enough for people to even pay what they were paying, now that there are other things that [are] also going away," like federal food assistance, Chandran said.
Though Texas unexpectedly saw an increase in marketplace enrollment at the start of the year, that was followed by a decline in the number of people who activated their coverage by paying for their first premium.
"A lot of those folks that were still signed up, maybe they got re-enrolled, or they clicked re-enroll and didn't pay too much attention — when they got that first bill, they just didn't pay it," Dague said.
“This seat will be decided on records”
Over in the 34th Congressional District, Democrats are also spending big as they try to make healthcare a defining issue. Gonzalez and supportive outside groups have dropped about $1 million on healthcare-related ads in the race, over three times as much as Republicans, according to AdImpact.
A Gonzalez campaign spokesperson said in a statement that the incumbent “has spent his career lowering [health] costs by taking on Big Pharma to cap insulin at $35 a month, cutting prescription drug prices, and protecting earned Social Security benefits.”
Flores, the lawyer and Army veteran challenging Gonzalez, has not yet aired healthcare-focused ads. Two GOP groups have run ads attacking Gonzalez over his vote against the GOP’s tax-and-spending law, arguing that it would raise taxes on seniors and people receiving Social Security.
Flores’ campaign did not respond to requests for comment.
The gap in healthcare spending was narrowest in the 28th District, where Democrats had poured $400,000 into healthcare-related advertising compared to Republicans' roughly $270,000. Tijerina, the Republican nominee, is running on his record as the Webb County executive, where his campaign says he opened the Bruni Public Health Facility, brought South Texas its first OnMed CareStation, expanded rural telehealth and broke ground on a new Southern Public Health Facility.
"This seat will be decided on records: a proven local executive who spent more than a decade delivering health care access and lower costs, against a twenty-year incumbent who has been federally indicted and whose record is defined by scandal and self-dealing," Tijerina campaign spokesperson Nick Engstrom said in a statement, referring to Cuellar’s federal indictment on charges of bribery, conspiracy and money laundering. The Laredo Democrat denied wrongdoing and was ultimately pardoned by Trump.
The 23rd District has yet to see healthcare advertising from Herrera or Padilla Stout, but the campaigns are previewing different approaches.
A spokesperson for Herrera’s campaign said he supports changes intended to expand insurance-plan options, reduce prescription-drug and malpractice-related costs, and allow physician-owned hospitals to accept Medicare and Medicaid patients. He also said he wants to protect rural hospitals from closures.
"Rural hospitals are facing an unprecedented rate of closure, creating healthcare deserts that can leave Texans without access to healthcare at all, particularly for the most life-threatening needs," Kimme Gonzalez, Herrera's campaign manager, said in a statement.
Stout, meanwhile, is leaning into the affordability message, saying quality healthcare "should not depend on where you live, where you work, or how much money you make."
"Making health care more affordable and accessible is central to my campaign's broader focus on lowering costs for working families," she said in a statement to the Tribune.
Disclosure: Texas A&M University has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in The Texas Tribune's journalism. Find a complete list of them here.
This article first appeared on The Texas Tribune.
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