Republicans once maligned Medicaid. Now some see a program too big to touch.

Every time a baby is born in Louisiana, where Republican House Speaker Mike Johnson handily won reelection last year, there’s more than a 60% chance taxpayers will finance the birth through Medicaid.

In Republican Rep. David Valadao ‘s central California district, 6 out of 10 people use Medicaid to pay for doctor visits and emergency room trips.

And one-third of the population is covered by Medicaid in GOP Sen. Lisa Murkowski’s Alaska, one of the nation’s costliest corners for health care.

Each of these Republicans—and some of their conservative colleagues—lined up last week to defend Medicaid, in a departure from long-held GOP policies. Republicans, who already have ruled out massive cuts to Social Security and Medicare, are turning their attention to siphoning as much as $880 billion from Medicaid over the next decade to help finance $4.5 trillion in tax cuts.

But as a deadline to avoid a partial government shutdown nears, hesitation is surfacing among Washington’s Republican lawmakers—once reliable critics of lofty government social welfare programs such as Medicaid—who say that deep cuts to the health care program could prove too untenable for people back home.

“I’ve heard from countless constituents who tell me the only way they can afford health care is through programs like Medicaid,” Valadao said on the House floor. “And I will not support a final reconciliation bill that risks leaving them behind.”

And on Wednesday, President Donald Trump, too, made his position on Medicaid clear: “We’re not going to touch it.”

States and the federal government jointly pay for Medicaid, which offers nearly-free health care coverage for roughly 80 million poor and disabled Americans, including millions of children. It cost $880 billion to operate in 2023.

Johnson has ruled out two of the biggest potential cuts: paying fixed, shrunken rates to states for care and changing the calculation for the share of federal dollars that each state receives for Medicaid. Just a few years ago, Johnson spearheaded a report that lobbied for some of those changes during the first Trump administration.

Johnson insisted in a CNN interview that the focus will instead be ferreting out “fraud, waste and abuse, in Medicaid, although it’s unlikely to deliver the savings Republicans seek.

GOP pressure over Medicaid is mounting, with some state party leaders joining the calls to preserve the program. States are already struggling with the growing cost of sicker patients and could be left to cover more if the federal government pulls back. In some states, the federal government picks up over 80%.

More than a dozen Minnesota GOP lawmakers wrote the president recently warning that “too deep of a cut is unmanageable in any instance.” Gov. Joe Lombardo, R-Nev., told Congress in a letter that “proposed reductions would put lives at risk.” In Alaska, state Senate Majority Leader Cathy Giessel, a Republican and nurse, cited “huge concerns” during a floor speech.

Nationally, 55% of Americans said the government spends too little on Medicaid, according to a January poll from The Associated Press-NORC Center for Public Affairs Research.

“It’s now a very popular program that touches a very broad cross-section of American society,” said Drew Altman, president of the health care research firm KFF. “Roughly half of the American people say that they or a family member have at one time been served by the program.”

Significant changes to Medicaid are still on the table. They have to be for Republicans get the savings they need to pay for tax cuts.

Work requirements, which could save as much as $109 billion over the next decade, seem to have solid support among GOP members, with some individual Republican-led states already moving to implement them.

Republicans also could consider cuts in benefits or coverage, as well as eliminating a provider tax that states use to finance Medicaid, Altman added.

Democrats warn that reductions are inevitable and could be dire.

Starting Monday, TV ads will caution people across 20 congressional districts that hospitals are at risk of closing and millions of people could lose coverage if Republicans cut Medicaid “to fund massive tax cuts for Elon Musk and billionaires.” The Democratic super political action committee House Majority Forward has launched the seven-figure campaign.

Trump and Republicans have for years called to lower government spending on health care, but they have struggled to formulate a serious plan that gains traction. Trump, for example, has spent nearly a decade arguing for an overhaul of the Affordable Care Act. His efforts to repeal the Obama-era national health care law failed during his first term and in his most recent presidential campaign he offered only “concepts of a plan” to adapt the program.

Michael Cannon, a director of health studies at libertarian Cato Institute, believes Medicaid needs an overhaul because it is a significant part of the federal budget and a contributor to the nation’s growing debt.

But Republicans, he said, are not looking at serious ways to drive down the cost of health care.

“The only reason for the cuts right now is to pay for the tax cuts,” Cannon said. “None of them are talking about the need to do better health reform.”