2026-05-15T09:00:52.639Z / 美国有线电视新闻网（CNN）
作者：阿里特·约翰
2026年5月15日美国东部时间上午5:00发布
2024年9月21日，众议员大卫·瓦拉达奥在加利福尼亚州汉福德的家族奶牛场走过一片小片玉米地，该区域属于加利福尼亚州第22国会选区。
迈克·布莱克/路透社/档案照片
加利福尼亚州贝克斯菲尔德——
即便在孩童时代，医疗保健就一直是温贝托·里科最关心的问题。
和许多在中央谷长大的孩子一样——该地区以全国最差的空气质量之一闻名——他患有哮喘，有时会卧床数日。他至今仍在帮助移民父母预约医生。他的一些家人则依靠医疗补助计划（Medicaid）获得医疗保险。
“在中央谷，我们没有资格忽视这个问题，”26岁的里科说，他是土生土长的贝克斯菲尔德人，作为组织者为农场工人提供服务。
温贝托·里科，26岁的贝克斯菲尔德本地人，作为工会组织者为农场工人提供服务，正在为加利福尼亚州第22国会选区候选人兰迪·维列加斯开展挨家挨户游说活动。
阿里特·约翰/CNN
医疗保健也是影响他在加利福尼亚州第22国会选区投票意向的关键议题。最近一个周六下午，里科正在为兰迪·维列加斯挨家挨户拉票，维列加斯是支持“全民医保”的进步派人士，也是试图推翻共和党众议员大卫·瓦拉达奥的两名民主党候选人之一。最近获得众议院民主党竞选机构支持的州众议员贾斯米特·贝恩斯也参与了竞选。
自2012年瓦拉达奥首次当选以来，民主党仅在2018年击败过他一次——当时他投票支持本党废除《平价医疗法案》的失败提案。
今年，民主党押注该选区的选民——该选区去年经重新划分后略微有利于民主党——会同样对瓦拉达奥2025年投票支持唐纳德·特朗普总统的全面税收和支出削减法案感到不满，该法案也被称为“宏伟美好法案”（One Big Beautiful Bill Act）。从明年开始，该法律将增加医疗补助资格审核的频率，并实施新的工作要求。这些变化将影响加利福尼亚州第22选区，该选区是全国医疗补助参保人数最集中的地区之一。
根据纽约大学格罗斯曼医学院和罗伯特·伍德·约翰逊基金会基于该选区2025年边界收集的数据，该选区59%的居民通过该计划获得保险。根据联合经济委员会民主党人对国会预算办公室数据的分析，一旦新的资格要求生效，该选区近5.7万人可能会失去医疗补助覆盖。
共和党人辩称，批评者歪曲了医疗补助改革的影响，他们表示这些改革旨在推动健全人士重返职场。该法律为有药物滥用、严重精神疾病或其他重大医疗问题的人群以及孕妇提供工作要求豁免。各州还可以为失业率达到8%或全国平均水平1.5倍的县的参保者申请临时豁免。该选区大部分地区目前都符合这一门槛——占该选区最大比例的克恩县3月份的失业率为9.5%。
瓦拉达奥在给CNN的一份声明中表示，该立法旨在长期保留医疗补助计划。
“我代表中央谷的目标之一，就是为那些最需要医疗补助的人提供保障：老年人、弱势儿童和残疾美国人，”声明中写道。“这就是为什么我投票支持为面临严重医疗问题、经济困难或高失业率的加州人提供合理豁免。”
但在该地区工作的医疗保健提供者警告称，随着医院和医疗中心开始调整预算，他们已经感受到特朗普议程法案的影响。
“现在的情况是，他们面临着资源减少、药物选择减少、医生和项目选择减少，”蒂娜·克罗克斯顿说，她是行为健康护士，也是服务雇员国际工会加州分会成员，该分会支持贝恩斯。
蒂娜·克罗克斯顿，行为健康护士，服务雇员国际工会加州分会成员。
阿里特·约翰/CNN
29岁的医疗口译员戴安娜·阿尔瓦拉多接受了维列加斯竞选团队的拜访，她说自己已经在工作中看到了变化。她还担心无证移民。加州为符合收入条件的无证移民全额支付医疗补助覆盖费用，但今年暂停了19岁及以上无证患者的新参保登记。
虽然她计划在6月2日的非党派初选中投票给民主党人，但尚未决定支持哪位候选人。
两种相互竞争的民主党愿景
民主党人在挑战瓦拉达奥之前，必须在两位拥有不同支持者基础的候选人之间做出选择。
维列加斯发起了一场民粹主义竞选活动，得到佛蒙特州独立参议员伯尼·桑德斯的支持。他谈到了自己依靠社会安全网项目的个人经历，而这些项目正是去年税收和支出削减法案所影响的。在竞选活动中，他将这场竞争描述为一场斗争——不是左翼与右翼之间的斗争，而是顶层与底层之间的斗争。
兰迪·维列加斯正在竞选。
阿里特·约翰/CNN
“从第一天起我就告诉人们——癌症、谷热、糖尿病根本不在乎你上次选举投给谁，”维列加斯告诉CNN。“它不在乎你的党派身份，但我们都知道每个人都会生病，这就是为什么我们需要全民医保。”
维列加斯得到了全国护士联合会的支持，这是一个倡导单一支付者政府医疗体系的进步工会。在最近的一次游说启动活动和母亲节庆祝活动上，维列加斯身边有大约六名工会成员和其他几位支持者，包括附近阿尔文市市长奥利维亚·卡尔德隆。
“现在我们没有资格袖手旁观，”她说。“我们必须走出去，明确表明我们的立场和宗旨，因为我们的家庭和社区正面临着真正的痛苦、恐惧和焦虑。”
维列加斯批评贝恩斯拒绝与他进行辩论，并指责她作为州议员时接受油气和制药行业的竞选捐款。上周末，他的竞选团队的游说者告诉选民，亲以色列资金正流入这场竞选以支持贝恩斯。根据最近提交给联邦选举委员会的文件，以色列民主党多数派计划斥资50万美元攻击维列加斯。
贝恩斯是一名医生，目前仍在其家乡德尔ano的一家诊所为医疗补助患者提供治疗，她指出自己多年来作为医生、医疗政策专家和立法者的经历，证明她是最有资格实现真正变革的人选。
加利福尼亚州众议员贾斯米特·贝恩斯医生于2024年6月8日在加利福尼亚州阿蒂西亚出席一场午餐会。
迈克·布莱克/路透社
“她了解这里患者的需求，而这些需求非常迫切，”克罗克斯顿说。
贝恩斯抨击维列加斯不住在选区内——他担任校董会成员的维塞利亚市就在第22选区之外，并为自己的捐款辩护，称她的选票不会被收买。她还对这样一种观点表示更广泛的不满：一位缺乏与她同等立法经验和专业背景的候选人声称自己更适合这份工作。
“我可以拥有医学学位，我可以在州议会担任职务，但总会有一个男人说他能做得更好，”贝恩斯告诉CNN。“对不起，我受够了。我厌倦了。我已经精疲力竭了。”
瓦拉达奥面临的挑战
无论哪位挑战者脱颖而出，民主党在这场竞选活动中的信息都很明确。两位候选人都将瓦拉达奥投票支持特朗普的议程法案作为其竞选活动的激励因素。
“我们之前见过他为中央谷挺身而出，所以我完全相信——其他人也完全相信——他会做正确的事情，”贝恩斯告诉CNN。“直到我看到他在我40岁生日那天投票……那是我人生中最糟糕的一个生日，我才决定参选。”
虽然医疗保健问题在2018年让瓦拉达奥失去了席位，但他的盟友表示，这次情况不同了。加州共和党政治主任、瓦拉达奥前助手布兰登·赫雷曼表示，这位从奶农转型为议员的人士在该选区已经更加家喻户晓。
赫雷曼说，为了反击民主党的攻击，这位国会议员和他的盟友需要强调特朗普议程法案的豁免条款，特别是针对该选区高失业率县的豁免。
“他们会说瓦拉达奥削减了医疗补助，他不为中央谷的家庭着想，”赫雷曼说。“但关于这个问题的信息传递至关重要。”
在特朗普的第二任期内，瓦拉达奥一直试图将自己塑造成该地区医疗保健的保护者。2025年4月，他是签署一封信反对削减医疗补助的12名共和党议员之一，警告削减可能会伤害弱势群体和医院，特别是在农村地区。
“平衡联邦预算绝不能以依赖这些福利保障健康和经济安全的人们为代价，”他们写道。
众议员大卫·瓦拉达奥于1月22日在华盛顿特区国会山的新闻发布会上发表讲话。
亚伦·施瓦茨/路透社
投票结束后，瓦拉达奥在一份声明中表示，这不是一个容易做出的决定，但他曾努力阻止对其选区造成更大伤害的条款。他还称赞了拨付给农村医疗转型基金的500亿美元资金，这是一项为期五年的赠款计划，用于各州改善农村医疗保健。美国医疗保险和医疗补助服务中心去年年底宣布，加州将在2026年获得2.33亿美元资金。瓦拉达奥今年早些时候与该机构负责人穆罕默德·奥兹一同宣传了这笔资金。
但其中一半资金将在各州之间平均分配，这让加州等大州处于不利地位。专家指出，这500亿美元基金无法完全弥补各州预计损失的收入。
对于该选区的一些人来说，限制特朗普议程法案影响的努力还不够。纳塔利·圣玛丽亚是该选区的社区领袖——也就是所谓的“ promotora”——帮助人们获得医疗保健，她说瓦拉达奥没有足够解释未来的发展方向。
“作为一名选民，因为我是他的选民，我觉得他背叛了我们，”她说。
How a vote for Trump’s ‘big, beautiful bill’ put Republican David Valadao in danger of losing his seat
2026-05-15T09:00:52.639Z / CNN
By Arit John
PUBLISHED May 15, 2026, 5:00 AM ET
Rep. David Valadao walks past a small field of corn at his family’s dairy farm in California’s 22nd congressional district in Hanford, California, on September 21, 2024.
Mike Blake/Reuters/File
Bakersfield, California—
Even when he was a child, healthcare was top of mind for Humberto Rico.
Like many children who grew up in the Central Valley — known for having some of the worst air quality in the country — he had asthma that would sometimes leave him bedridden for days. He still helps his immigrant parents schedule their doctors’ appointments. And he has family members who depend on Medicaid for health insurance.
“In the Central Valley, it’s not really something we have the privilege to ignore,” said Rico, a 26-year-old Bakersfield native who works with farm workers as an organizer.
Humberto Rico, a 26-year-old Bakersfield native who works with farm workers as a union organizer, goes canvassing for California’s 22nd Congressional District candidate Randy Villegas.
Arit John/CNN
Healthcare is also a key issue shaping his support in California’s 22nd Congressional District. Rico spent a recent Saturday afternoon canvassing for Randy Villegas, a pro-Medicare for All progressive and one of two Democrats seeking to unseat GOP Rep. David Valadao. State Assemblywoman Jasmeet Bains, who recently won the support of House Democrats’ campaign arm, is also running.
Since Valadao was first elected in 2012, Democrats have only been able to beat him once: in 2018, after he voted for his party’s failed effort to repeal the Affordable Care Act.
This year, Democrats are betting voters in the district — which was redrawn last year to slightly favor their party — will be equally frustrated with his vote in 2025 for President Donald Trump’s sweeping tax and spending cuts legislation, also known as the “One Big Beautiful Bill Act.” Starting next year, the law increases the frequency of Medicaid eligibility verifications and imposes a new work requirement. Those changes will impact California’s 22nd District, which has one of the highest concentrations of Medicaid enrollees in the country.
Fifty-nine percent of residents in the district are insured by the program, according to data collected by the New York University Grossman School of Medicine and the Robert Wood Johnson Foundation based on the seat’s 2025 boundaries. Nearly 57,000 people in the district could lose their Medicaid coverage once the new eligibility requirements go into effect, according to an analysis of Congressional Budget Office data by Democrats on the Joint Economic Committee.
Republicans argue that critics are misrepresenting the impact of the changes to Medicaid, which they say are meant to push able-bodied people into the workforce. The law provides exemptions from work requirements, including for people with substance abuse, severe mental health or other significant medical issues, and pregnant people. States may also request a temporary exemption for enrollees in counties where the unemployment rate is either 8% or 1.5 times the national average. Much of the district currently meets that threshold — Kern County, which makes up the largest part of it, had an unemployment rate of 9.5% in March.
Valadao said in a statement to CNN that the legislation was designed to preserve Medicaid long-term.
“One of my goals representing the Central Valley is to protect Medicaid for those who truly need it the most: seniors, vulnerable children, and disabled Americans,” the statement reads. “That’s why I voted to include commonsense exemptions for Californians facing serious medical issues, economic hardship, or high unemployment.”
But healthcare providers who work in the district warn that they’re already feeling the impact of Trump’s agenda bill, as hospitals and healthcare centers begin making changes to their budgets.
“What’s happening now is that they’re facing reductions in resources, reductions in options in medications, reductions in options in physicians and programs,” said Tina Croxton, a behavioral health nurse and member of the Service Employees International Union California, which has backed Bains.
Tina Croxton, a behavioral health nurse and member of the Service Employees International Union California.
Arit John/CNN
Diana Alvarado, a 29-year-old medical interpreter and translator who was visited by the Villegas campaign, said she’s already seeing changes at her workplace. She’s also worried about undocumented migrants. California, which pays the full cost of Medicaid coverage for income-eligible undocumented people, paused new enrollment for undocumented patients ages 19 and up this year.
While she’s planning to vote for a Democrat in the June 2 non-partisan primary, she hasn’t decided on which one.
Two dueling Democratic visions
Before Democrats can take on Valadao, they have to choose between two candidates with different bases of support.
Villegas is running a populist campaign backed by Vermont independent Sen. Bernie Sanders. He’s talked about his personal experience depending on the social safety net programs hit by last year’s tax and spending cuts law. On the campaign trail, he frames the race as a fight – not between the left and the right – but between the top and the bottom.
Randy Villegas campaigning.
Arit John/CNN
“I’ve told people from day one — cancer, valley fever, diabetes doesn’t give a shit who you voted for in the last election,” Villegas told CNN. “It does not care what your party ID is, but we know that everybody gets sick, which is why we need health care for all.”
Villegas has been backed by National Nurses United, a progressive union that is also advocating for a single-payer government health care system. At a recent canvass launch and Mother’s Day celebration, Villegas was joined by about half a dozen members of the union and a few other supporters, including Olivia Calderón, the mayor of the nearby town of Arvin.
“This is a time where we don’t have the luxury of being on the sidelines,” she said. “We have to be out there and be very clear about what we stand for, what we are about, because our families and because our communities — there’s real suffering and fear and anxiety.”
Villegas has criticized Bains for not agreeing to a debate with him and for her campaign donations from the oil and gas and pharmaceutical industries as a state assembly member. Over the weekend, canvassers for his campaign told voters that pro-Israel money was flowing into the race to boost Bains. The Democratic Majority for Israel is planning to spend $500,000 attacking Villegas, according to a recent Federal Election Commission filing.
Bains, a medical doctor who still works at a clinic in her hometown of Delano treating Medicaid patients, has pointed to her years of experience as a doctor, a health policy expert and lawmaker as evidence she’s the most qualified to enact real change.
California Assemblywoman Dr. Jasmeet Bains attends a luncheon in Artesia, California, on June 8, 2024.
Mike Blake/Reuters
“She knows what the patients need here, and the needs are great,” Croxton said.
Bains has hit Villegas on not living in the district — Visalia, where he serves as a school board trustee, is just outside of the 22nd — and has defended her donations, saying her vote can’t be bought. She’s also expressed a broader frustration with the idea that a candidate who lacks the same legislative experience and professional background as her is arguing he is better suited for the job.
“I could have the medical degree. I could have the position in the assembly, yet there’s going to be a man that’s going to say he can do it better,” Bains told CNN. “I’m sorry. I’m fed up. I’m tired. I am exhausted.”
Valadao’s challenge
Regardless of which challenger advances, the Democratic Party’s messaging in the race is clear. Both candidates cited Valadao’s decision to vote for Trump’s agenda bill as a motivating factor in their campaigns.
“We’ve seen him stand up for the valley before, so I had full faith —everybody else had full faith — that he was going to do the right thing,” Bains told CNN. “And I didn’t jump in to run until after I saw him vote on my 40th birthday … it was the worst birthday in my life.”
While healthcare cost Valadao his seat in 2018, his allies say this time is different. The dairy farmer-turned-lawmaker has become even more of a household name in the district, said Brandon Herreman, the political director of the California Republican Party and a former Valadao aide.
To counter Democratic attacks, the congressman and his allies need to stress the Trump agenda law’s exemptions, particularly for counties in the district with high unemployment, Herreman said.
“They’re going to say Valadao slashed Medicaid, he’s not there for Central Valley families,” Herreman said. “But the messaging on this is crucial.”
Valadao has sought to frame himself as a protector of the district’s healthcare throughout Trump’s second term. He was one of a dozen Republicans who signed onto a letter in April 2025 opposing cuts to Medicaid, warning they could hurt vulnerable populations and hospitals, particularly in rural areas.
“Balancing the federal budget must not come at the expense of those who depend on these benefits for their health and economic security,” they wrote.
Rep. David Valadao gives remarks during a press conference on Capitol Hill in Washington, DC, on January 22.
Aaron Schwartz/Reuters
After the vote, Valadao said in a statement it wasn’t an easy decision, but that he’d worked to block provisions that would have been more harmful for his district. He also touted the $50 billion placed into the Rural Health Transformation Fund, a five-year grant program for states to modernize rural healthcare. The Centers for Medicare and Medicaid Services announced late last year that California would receive $233 million in 2026. Valadao appeared with the agency’s administrator, Mehmet Oz, to tout the funding earlier this year.
But half of the funding will be divided equally among the states, putting larger states like California at a disadvantage. And experts note that the $50 billion fund won’t fully cover the revenue states are expected to lose.
For some in the district, the efforts to limit the impact of the Trump agenda bill fall short. Nataly Santamaria, a community leader — known as a promotora — in the district who helps people access health care said Valadao hadn’t done enough to explain what the path forward looks like.
“As a constituent, because I am his constituent, I feel he betrayed us,” she said.
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