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.

The House Republican working behind the scenes to rein in his party's ambitions to cut Medicaid spending is a California dairy farmer who represents more Medicaid beneficiaries than any of his GOP colleagues.

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.