After President Trump’s budget bill passed, Democrats and health care groups launched ads against U.S. Rep. Ryan Mackenzie in the 7th Congressional District, saying his yes vote has set up rural hospitals for closures and for seniors, veterans and disabled children to lose health care.
Mackenzie, in turn, has touted the bill as helping working families – highlighting the permanent extension of Trump’s 2017 tax cuts, bigger standard deductions, more money for border walls and defense, and temporarily ending taxes on tips, overtime and Social Security.
“This budget delivers on those priorities — bringing tax relief to every American, protecting our communities, enacting commonsense government reforms, and investing in our future,” Mackenzie said in a statement to Armchair Lehigh Valley.
The 2026 midterms may be 15 months away, but Trump’s One Big Beautiful Bill Act has emerged as a wedge issue in the race for control of Congress.
“[T]here may be many events that will intervene in the midterm outcome between now and then. But historically major legislative efforts such as the [One] Big Beautiful Bill have played major roles in the election that follow the passage, and I think this will be the case in this cycle,” Christopher Borick, director of the Muhlenberg College Institute of Public Opinion, said in an email.
One such piece of legislation was the Affordable Care Act, better known as Obamacare, which led Republicans to gain 63 seats and control of the House in the midterms that took place months after its 2010 passage.
Messaging will play a key role in whichever party comes out on top on the issue, said Berwood Yost, the director of the Institute for Public Policy at Franklin & Marshall College.
“These kinds of low-level information cues will go a long way in shaping how voters think about the legislation that just passed,” Yost said in an email.
7th a toss up
Mackenzie is seeking his second, two-year term in the 7th District, which covers all of Carbon, Lehigh and Northampton counties and a tiny portion of Monroe County,
Running in the Democratic primary next spring are Lamont McClure, who is Northampton County’s executive, former federal prosecutor Ryan Crosswell and Carol Obando-Derstine, a former aide to Sen. Bob Casey and PPL Electric Utilities supervisor.
In November, Mackenzie ousted three-term incumbent Democrat Susan Wild by 1% in an election year that also saw Donald Trump take Pennsylvania and Casey lose to Republican David McCormick.
Sabato’s Crystal Ball, which is run by the University of Virginia Center for Politics, has placed the 7th in the toss-up category for 2026.
Details of the bill
The tax and spending plan passed the Senate with Vice President J.D. Vance’s tie-breaking vote. It squeaked through the House 218 to 214 on July 3.
It makes Trump’s 2017 tax cuts for individuals and businesses permanent, offers new tax write-offs for small businesses, raises the child tax credit by $200 to $2,200 and deductions for single and joint filers by $1,150 to $15,750 and $2,300 to $31,300, respectively.
The bill also includes temporary breaks for taxes paid on Social Security, tips and overtime that have income limits. Local and state deductions would quadruple to $40,000 for five years. New vehicle buyers will be able to write off up to $10,000 worth of interest on loans until 2028.
On the spending front, the bill sets aside about $350 billion for national security, including $46 billion for the border wall with Mexico and $45 billion for 100,000 migrant detention facility beds. Defense spending would exceed $1 trillion for the first time.
“All Americans will benefit from safer communities and more secure borders through new investments in national security. Vulnerable populations will have their vital benefits safeguarded by prioritizing American citizens who meet commonsense criteria,” Mackenzie said.
To help pay for the bill, Medicaid, a health care program for the low-income, would see a $863 billion cut over the next decade. Republicans said the cuts will help sustain the program for the truly vulnerable by reducing fraud and waste.
Under a new rule that won’t fully go into effect until after the midterms, able-bodied recipients would have to document they are working, attending school, in a job-training program and/or volunteering 80 hours a month. In addition, the age of able-bodied recipients would be expanded from 19 to 54 to age 64.
All Medicaid recipients will have to verify eligibility every six months, instead of once a year.
The new bill also penalizes states that offer Medicaid to immigrants, caps state reimbursements for direct costs and places a moratorium on new or increased state provider taxes, which are used to calculate federal funding. Recipients also would have to pay up to $35 for doctor visits.
More than 71 million people get health care through Medicaid, which became available to able-bodied adults under the 2014 expansion of Obamacare. Forty-one states, including Pennsylvania, did so.
In Pennsylvania, 310,000 people are on Medicaid, including 17,510 living in the 7th District.
With the changes to Medicaid and new, tighter rules for Obamacare, the Congressional Budget Office estimates that 11.8 million more Americans will become uninsured by 2034.
KFF, a nonpartisan group that analyzes health policies, projects the reduction in enrollees will extend beyond the weeding out ineligible recipients.
People will also lose coverage because they failed to timely complete or incorrectly filled out documentation. While many able-bodied recipients already have jobs, many may have trouble meeting or documenting the required hours, KFF said.
Other groups, such as disabled children, could lose support services if states reduce spending in the face of lost Medicaid funding, KFF projected.
Further, hospital groups said the bill could impact financially struggling rural hospitals, which typically see a higher proportion of Medicaid patients. Mackenzie pointed out that $50 billion was set aside to help rural hospitals cope with lower Medicaid reimbursements. Health care advocates, however, say that amount is insufficient.
Dueling messaging
Against this backdrop, the Democratic Congressional Campaign Committee is targeting Mackenzie and 35 other Republicans in competitive races with digital ads running on Meta. Other groups such as Protect Our Health are running ads on YouTube.
In the 7th, Obando-Derstine, Crosswell and McClure have seized on the issue as well, saying Mackenzie voted for a bill that will cause people in the 7th to lose their health care so billionaires can keep their tax breaks.
Mackenzie said the messaging against him is being organized by “special interests and radical groups to spread lies and sow panic.”
“Opponents of this bill advocated for the largest tax increase in American history, defended government waste and taxpayer-funded benefits for illegal immigrants, sought to block efforts to secure the border and crack down on drug trafficking, and fought to continue taxing tips, overtime, and Social Security. That is their record, and we’re going to make sure the people of our region know it,” he said.
Political analysts said both parties will have to play their strengths if they want to control the narrative.
Borick said Democrats have struggled for a clear direction winning back voters. He said juxtaposing the cuts against the continued tax breaks for higher-income Americans gives them “an easy frame for voters to grasp.”
He said Mackenzie is countering with messaging highlighting more popular elements of the bill such as the tax breaks and more border wall money. But he noted it could be an uphill battle for Republicans next year.
“For the GOP, [which] has increasingly relied on voters from lower socio-economic groups, the image of a law that seems slanted against that group will likely follow them through the next year and a half,” Borick said.
Yost said the bill could have an impact if voters view it through an economic lens. The bill also cuts the Supplemental Nutrition Assistance Program by $295 billion over 10 years. Gov. Shapiro estimates that 144,000 people in Pennsylvania could see their benefits reduced or ended, including 6,096 in the 7th District.
“Donald Trump was elected in 2024 primarily because voters were dissatisfied with their economic circumstances. Surveys show voters aren't any happier now than they were last November about the economy and President Trump's overall ratings on the economy have sunk and are now a liability for him,” Yost said.
“If people lose benefits, or know people who are losing benefits like Medicaid and SNAP, or see hospital closures in their areas, then it is likely to harm Republicans running in competitive races.”
Sam Chen, a consultant who managed Kevin Dellicker’s unsuccessful run against Mackenzie in last year’s primary, said Republicans will have to meet the Democratic messaging head on, trumpeting the positives in the legislation and how they will benefit their constituents.
“The smart play for each Republican congressman or senator is to speak clearly about how he or she voted and why he or she voted for the legislation,” he said.
“Then they should give an opportunity for voters to voice their opinions and concerns regarding the legislation. These members of Congress are elected to represent their respective districts or states and, come November 2026, they will face only those voters in their district or state, not the entire nation,” Chen said.