Republicans are using advertising to defend the healthcare changes in the One Big Beautiful Bill as they prepare for the 2026 midterm elections. The political challenge is significant because the law’s reductions in Medicaid and Affordable Care Act support could affect voters directly, giving Democrats a potent line of attack.

The measure, signed into law in July 2025, makes substantial changes to Medicaid, including new work requirements and limits on how states finance the programme. Its effects are expected to emerge gradually, with many provisions taking effect in 2027 and 2028, while supporters emphasise tax cuts and tighter eligibility rules and critics warn of lost coverage and pressure on hospitals.