Overview
- Speaker Mike Johnson has ruled out Medicaid cuts to federal match rates and per-capita caps, responding to moderate Republicans' concerns over coverage losses.
- The Congressional Budget Office's analysis estimates proposed Medicaid changes could leave millions uninsured, complicating GOP efforts to meet $2 trillion in savings targets.
- Hardline conservatives, including the House Freedom Caucus, insist on at least $2 trillion in spending cuts, threatening to withhold support for the reconciliation package.
- Moderates have signaled support for narrower Medicaid reforms, such as work requirements and stricter eligibility checks, which yield limited savings compared to original proposals.
- With a Memorial Day deadline approaching, divisions within the GOP threaten the passage of President Trump’s fiscal 2026 budget agenda, which includes defense boosts and tax cuts.