That clash — with the White House on one side and GOP hard-liners in Congress on the other — is now playing out in closed-door meetings and in the hallways of Capitol Hill as the party rushes to write the megabill and potentially cut more than a half-trillion dollars from the safety-net health program over the coming decade.

At least one Republican is thinking about the millions of Americans that depend on Medicaid. Representative David Valadao, a California dairy farmer, represents more Medicaid recipients in his district than anyone else in his party.