As has been explained in detail since the election, the principal legislative goal of the Trump administration and the Republican majority in Congress is to extend the tax cuts – which are overwhelmingly tilted towards the wealthy – that expire this year. To do so, they are looking for massive spending cuts in order to ‘offset’ this tax agenda.

The largest cuts are likely to hit Medicaid.

The House budget blueprint that passed on February 25 calls on the Energy and Commerce committee to come up with $880 billion in cuts over the next decade, which would primarily have to come from Medicaid. Donald Trump has sent mixed messages about this approach – on one hand stating that he would not touch Medicare and Medicaid, but then also endorsing the House budget resolution, and even making phone calls to round up Republican votes.

Whatever the White House might support, there has been some pushback from within the party. It most notably started with MAGA guru and former Trump adviser Steve Bannon, who said on his podcast: “Medicaid, you’ve got to be careful with, because a lot of MAGA is on Medicaid. If you don’t think so, you are dead wrong. Medicaid is going to be a complicated one.”

Senator Josh Hawley (R-MO) followed up on the same theme, telling one reporter, “I don’t like the idea of massive Medicaid cuts.” Hawley also backed an amendment that would have blocked tax cuts for the wealthy if there were any cuts to Medicaid.

Freshman Pennsylvania Republican Rep. Rob Bresnahan also weighed in, saying that “If a bill is put in front of me that guts the benefits my neighbors rely on, I will not vote for it.” Other moderate Republicans voiced similar concerns. Nonetheless, on the House side they voted in favor of the budget blueprint that lays the groundwork for these cuts they say they are concerned about.

Given that there are 72 million people enrolled in Medicaid, it is obvious that many millions of these people are either registered Republicans or Trump voters. According to the exit polls from last year’s election, about 50 percent of voters with incomes under $50,000 voted for Trump – it’s safe to assume that many of them are enrolled in Medicaid.

Of the ten states with the largest share of their populations covered by Medicaid, five of them voted for Trump (Louisiana, Kentucky, Mississippi, West Virginia and Arkansas). And given that the federal funding formula for the program is geared towards delivering more assistance to states with lower household incomes, many Trump-leaning states are currently receiving more generous levels of federal funding (see Figure 3 here).

The political difficulties this creates for Republican lawmakers are clear. Rep. David Valadao (R-CA) represents a district where almost half of residents under the age of 65 are on Medicaid. And as Politico recently reported:

“A POLITICO review of enrollment in Medicaid by congressional district found that 11 Republicans in competitive seats represent larger-than-average Medicaid populations — collectively nearly 2.7 million recipients.”

So there are clear political calculations that lawmakers will have to consider. But if the question is “Would Republican politicians actually support policies that harm their constituents?,” the answer is not so clear. Take the Medicaid expansion under the Affordable Care Act, which extended coverage to millions who previously did not qualify, with the federal government picking up the majority of the costs. All of the ten states that chose not to participate in that program voted for Trump in the last election – depriving health coverage to hundreds of thousands of people in those states.

Like Medicaid overall, the expansion is very popular with the public; in fact, one poll found that about two-thirds of people living in states that chose not to expand Medicaid eligibility would like to see their states join. And cutting Medicaid is decidedly unpopular: One recent poll found that 71 percent of Trump voters oppose such policies.

Given these circumstances, one might expect lawmakers to reject any budget plan that includes major Medicaid cuts. Whether that happens still remains to be seen.