Republicans campaigning in swing districts are running ads about healthcare after facing criticism of the cuts in the One Big Beautiful Bill Act. Many of these ads target voters over 35 years old and focus on three topics: Medicaid fraud, rural hospitals and affordability.

An NPR analysis looked at video ads on YouTube that ran this midterm cycle, many of which mirror ads on other digital platforms and on television. The analysis includes advertising for candidates in races that are toss-ups or leaning toward one party or the other, as rated by the Cook Political Report.

This is a shift for the Republican Party. Jonathan Oberlander, a healthcare policy expert at the University of North Carolina, said repealing the Affordable Care Act (ACA), commonly called Obamacare, was “target No. 1” for Republican lawmakers after Trump was first elected in 2016. When the Senate failed to repeal the legislation, there was still major backlash against Republicans for attempting to do so in the midterms.

“[The repeal is] probably one of the factors that led them to lose their majority in the House,” he said of the 2018 midterm election, where Democrats won a decisive majority. “It was extraordinarily unpopular, the least popular major legislation of the past 40 years.”

With the passing of the One Big Beautiful Bill Act last year, there are now stiffer requirements for insurance and reduced funding for state programs. About 10 million fewer people are expected to have health insurance in 2034, according to a report by the Congressional Budget Office.

There were about 3 million fewer people enrolled through the health insurance exchanges in early 2026 than when the bill passed, according to the Centers for Medicare & Medicaid.

Since then, Republicans have failed to recover on the issue, with only a third of total voters approving of the Trump administration’s handling of the cost of healthcare, according to KFF’s most recent poll on the issue from April.

Republican candidates are addressing the unpopular reforms early, according to Daniel Hopkins, a professor of political science at the University of Pennsylvania.

“[Congressional Republicans] know that that’s going to be a potent line of attack from their challengers and they have to get in front of it and defend it,” he said.

Reforming Medicaid as a strength 

Rep. Mike Lawler, a Republican running for reelection in a toss-up seat in New York, ran ads on reforming Medicaid, saying the law — which he voted for — reduced the number of able-bodied individuals in the program. He’s also raised the false claim that undocumented immigrants can no longer receive benefits (they are not under a “qualified status” to receive benefits), a topic that plays well with the Republican base.

Focusing on reform plays into a strength of the Republican Party. According to KFF, Republicans outperform Democrats on “addressing fraud and waste in government health care programs” when respondents rated which party they trust more in different areas of healthcare policy.

“What Republican voters want to see from their lawmakers is changes to the Medicaid program,” Ashley Kirzinger, the director of survey methodology at KFF, said.

“They don’t want the program to go away, but they want it to reduce fraud so that the program is more sustainable.”

Notably, around a third of independent voters consistently said they don’t trust either party on addressing costs of healthcare, prescription drugs, keeping corporate interests out of medical care or addressing fraud and waste.

Funds into rural hospitals

Rural hospitals have the highest risk, because they rely on funding that was part of Medicaid expansion in the ACA. Many counties in Lawler’s home state are already in a healthcare crisis, according to a report from the New York State Comptroller last year.