A man who grew up on Medicaid found himself in a healthcare gap after a raise at work made him ineligible for the program. When he looked at Covered California marketplace plans, the prices were still too high.
"It was a panic at first," said Carlos A., a warehouse worker in his late 20s who now has employer-based coverage through his job at Amazon. KVPR and KFF Health News agreed to withhold his diagnosis and last name to protect him from repercussions related to his health.
Carlos has a chronic immune condition that requires regular medication. After gaining employer coverage, he encountered a new obstacle. His insurer required prior authorization for a medication he had taken for a decade, and without it, he could only receive a generic version he was nervous to try.
"I felt that this was a slap in the face because I'm paying for my premiums," he said. "It's a contract. I'm going to pay my premiums, you cover my insurance, and if there's a copay to my medicine, I'll pay it. So why are you playing funny business with my medication?"
Carlos attended a rally in Bakersfield this month in support of Democratic challenger Randy Villegas, and he said healthcare costs will be among the deciding factors when he votes this fall.
"I do expect them to campaign on healthcare," he said. "They'd be very foolish not to."
According to KFF Health News, California's 22nd Congressional District stretches from Bakersfield into parts of western Fresno County. The district has been redrawn to improve Democratic chances, but it remains one of the most competitive in the country this cycle and could influence which party controls the U.S. House. Republican Rep. David Valadao has held the seat in nearly every election since 2012.
Democrats have targeted Valadao over his vote for HR 1, the GOP tax-and-spending measure known as the One Big Beautiful Bill Act, which cut billions in healthcare funding for low-income Americans. Healthcare was central to Valadao's 2018 loss as well, when he lost his seat after voting to repeal the Affordable Care Act. He returned in 2020 by just 1,522 votes.
Valadao has defended his HR 1 vote, saying it protected Medicaid for the most vulnerable populations, including children, pregnant women, disabled people, and seniors.
The district's demographics make healthcare a particularly sharp issue. The Central Valley has high rates of Medi-Cal enrollment, agricultural workers with limited employer coverage, and communities where medical debt and prescription costs are regular concerns. Voters there have direct experience with the gaps in the American insurance system, from Medicaid income cliffs to prior authorization delays to premium sticker shock on the marketplace.
Carlos represents a profile that appears throughout the district: workers who earn too much for Medicaid but still struggle with the costs and complications of private insurance. His experience with prior authorization, a process that requires insurer approval before covering certain treatments or medications, reflects a frustration that crosses party lines and affects people at multiple income levels.
The November election will test whether healthcare concerns translate into votes in a district that has swung between parties based on those exact issues before.
