As lawmakers return from a two-week recess, those plans will have to come together quickly.
House Energy and Commerce Committee leaders are eyeing a May 7 markup for their portion of the bill, which calls for $880 billion in cuts to offset the cost of other priorities — cuts many moderates worry could threaten Medicaid coverage their constituents rely on.
Analysts say that number is impossible to meet without making changes to Medicaid.
Twelve House Republicans in competitive districts — more than enough in the House GOP's razor-thin majority to keep the bill from passing — sent a letter to GOP leaders last week saying they will not support the legislation if it includes cuts to Medicaid benefits.
Republican leaders say they only want to root out waste, fraud and abuse in Medicaid, and to implement work requirements for nondisabled adults.
But there's some disagreement about what that "waste, fraud and abuse" looks like.
Some Republicans have floated the idea of rolling back the extra federal money going to states to pay for Medicaid expansion. They argue it would be governors who would have to make hard decisions about cutting benefits, not lawmakers in Congress.
"The federal government is paying 90 percent of the Medicaid expansion. What we have talked about is moving that 90 percent level of the expansion back toward the more traditional level," Rep. Austin Scott (R-Ga.) said in an interview Monday on Fox Business. "Nobody would be kicked off Medicaid as long as governors decided they wanted to continue to fund the program."
Scott doesn't sit on the Energy and Commerce panel, but his comments didn't come in a vacuum.
"When you have people on the program that are draining the resources, it takes it away from the people that are actually needing it the most and are intended to receive it," Speaker Mike Johnson (R-La.) said on Fox News last week.
"You're talking about young, single mothers, down on their fortunes at a moment — the people with real disabilities, the elderly," he continued. "And we've got to protect and preserve that program. So we're going to preserve the integrity of it."
The letter from swing district Republicans did not specifically rule out rolling back the enhanced federal match. But it's a politically risky move regardless, and at least one Senate Republican — Sen. Josh Hawley (Mo.) — has said he would oppose such an effort.
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