BAKERSFIELD, Calif. — Rep. David Valadao’s vote for a Republican tax-and-spending law is emerging as a key issue in his fight to hold a newly redrawn Central Valley congressional district, where roughly six in 10 residents are enrolled in Medicaid. Valadao, a Republican who has won six of his seven House elections, says the law does not make “actual cuts” to Medicaid. But the measure is expected to reduce federal Medicaid spending by more than $900 billion through 2034, including through stricter eligibility requirements and reduced federal funding to states. Democratic challenger Randy Villegas argues the changes will cost Valley families their coverage. He has backed Medicare for All, a single-payer proposal, and says new work requirements and twice-yearly eligibility checks will put coverage at risk for some working-age adults. One Bakersfield resident, Ulises Hernandez, 41, says he plans to vote for Villegas. Hernandez, who has relied on Medicaid for years, described waiting eight hours in an emergency room after swallowing a dental crown during a procedure. He said he went more than two days without food while waiting for care. “I couldn’t eat, I couldn’t drink, I couldn’t do anything, and I was in pain,” Hernandez said. He fears the federal changes will make it harder to get care. Valadao says he helped negotiate provisions requiring some Medicaid recipients to work or take part in activities such as job training or volunteering. At an Oct. 6 debate, he called the requirements reasonable, saying people should make “a fair effort” to cover expenses and contribute to their communities. A Center for American Progress estimate, from a left-leaning think tank, projects that about 60,000 additional people in Valadao’s district could lose coverage by 2034 because of the law and the expiration of enhanced Affordable Care Act premium tax credits. The group estimates more than 2 million Californians could lose coverage statewide and that California could lose roughly $30 billion a year in federal funding. The district has long favored Democrats in voter registration, yet Valadao has repeatedly won by appealing to voters focused on agriculture, water and energy. Political science professor Jeffrey Cummins of California State University, Fresno, says the redrawn district is more favorable to Democrats and that voter frustration could put the incumbent at risk. The contest has drawn heavy outside spending: Republicans and Democrats have each booked more than $16 million in advertising through Election Day, according to AdImpact data. Valadao faces Villegas on Nov. 3, as voters weigh the Medicaid changes alongside the district’s longstanding concerns about jobs, water and agriculture.