Democrats think they’ve finally got something real to work with ahead of the 2026 midterms. According to reporting from Politico, they’re aiming straight at the massive Medicaid cuts buried deep in Donald Trump’s new legislative prize, the so-called One Big Beautiful Bill Act.

But here’s the catch, those cuts haven’t actually kicked in yet. Republicans set the timelines way into the future: work requirements aren’t due until 2027, and changes to how Medicaid is paid for won’t happen until 2028.

Meanwhile, voters are already seeing tax breaks from the bill, including new deductions for tipped workers, and that’s giving the right something shiny to campaign on, while Democrats are stuck talking about damage that hasn’t even arrived yet.

They’re reviving the same playbook that worked for them in 2018, when they ran hard against Republican efforts to dismantle the Affordable Care Act and scored a wave of House seats. This time, they’re targeting Republican-held ground in Kentucky, Virginia, and Florida, hoping to flip seats before the clock runs out.

Democrats warn of hospital fallout in rural states

The problem? Many voters aren’t feeling anything yet. Some even think it won’t touch them. “I think that there are some people who are like, ‘Well, I’m not on Medicaid, so it’s not going to affect me,’” said Cherlynn Stevenson, a former Kentucky state representative now running to replace outgoing Republican Congressman Andy Barr. Her district is home to six rural hospitals that together serve nearly 200,000 people on Medicaid. If Medicaid funding drops, those hospitals might not make it.

The cuts Republicans voted for include reductions to a thing called the provider tax, which many states rely on to fund their Medicaid programs. There are also new work requirements that analysts say could push millions off their current plans.

But again, none of that is happening before Election Day. It all comes later, conveniently after voters hit the polls. Republicans say they’re planning to stay on offense. Mike Marinella, a spokesperson for the National Republican Congressional Committee, accused Democrats of “desperate and disgusting fear-mongering tactics” and promised the GOP would promote “widely popular” parts of the bill to win support.

Voters confused, Republicans stall, Democrats dig in

It’s not just that the pain is delayed. Even when it hits, it might not be clear who’s responsible. Medicaid goes by different names depending on where you live. It’s called Medi-Cal in California, SoonerCare in Oklahoma, Health First Colorado in Colorado.

That branding gap could blur the link between what voters feel and who they blame. And there’s polling showing mixed reactions. A tracking survey from health policy nonprofit KFF found that 63% of independents believe the bill will take health coverage from people who need it.

But at the same time, many of those same voters also said they support adding work requirements to the program. Ashley Kirzinger, associate director at KFF’s Public Opinion and Survey Research Program, explained the risk: if Republicans frame the changes as getting rid of fraud and waste, the political blowback might not be as strong.

Some of this strategy will get tested early. The Democrats are putting their Medicaid messaging on trial in this year’s gubernatorial races in New Jersey and Virginia. In New Jersey, Rep. Mikie Sherrill is running to replace Governor Phil Murphy.

She’s slammed her opponent for being “fully on board” with the Trump cuts and told voters the state is “the first chance to hold them accountable at the ballot box.” But Democratic strategist Laura Matos warned not to lean too hard on Washington talking points. “You can talk about national issues, but what she really needs to do is pivot to the things she’s going to do here to improve affordability and quality of life,” she said.

Still, not every Democrat is worried. Rebecca Cooke, running again in a swing district in Wisconsin, told Politico she’s betting that the message will come “from voters themselves as these cuts hit.” She called the bill “the same cynical backdoor bullshit that we always see in Washington.”

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