President Donald Trump’s proposed bill is facing significant challenges within the House Republican conference, particularly regarding the overhaul of Medicaid. Speaker Mike Johnson is at the center of tensions as he pushes for a House vote before Memorial Day. The divide is evident between Republicans in swing districts opposing cuts to social safety net benefits and hardliners demanding trillions in spending reductions. A recent meeting highlighted the clash, with centrists refusing to back Medicaid changes that could harm eligible Americans.

Johnson’s attempt to push through Medicaid payment reductions for states that expanded under Obamacare met resistance from centrists, who viewed the idea as off the table. The rift between centrist and hardline factions has long existed, exacerbated by the pressure to deliver Trump’s tax plan while meeting conflicting demands. Key issues include the level of spending cuts, with hardliners pushing for over $1.5 trillion, and the debate over Medicaid and food stamp reductions.

Progress was made in the form of agreed work requirements for Medicaid beneficiaries, but challenges remain in aligning with Trump’s and Senate GOP’s positions. Amidst the internal strife, the need for Trump’s public endorsement to secure bill passage is emphasized. With hardliners like Rep. Eric Burlison staunchly opposing any bill adding to the deficit, the path to consensus on spending cuts and tax policy remains uncertain.

The House Republican conference is navigating a complex landscape of ideological differences and competing priorities, with the outcome of Trump’s bill hanging in the balance.