Illustration: Natalie Peeples / Axios
House Republicans released their long-awaited health care provisions Sunday night, but the challenge around selling the package is just beginning.
Why it matters: Republicans will have to figure out how to keep moderates and conservatives happy as the measure moves forward in the House and gets to the Senate.
Between the lines: Provisions in the draft released over the weekend could draw fire from both the right and the center.
- Conservative hardliner Rep. Chip Roy quickly called for deeper cuts to Medicaid.
- "I sure hope House & Senate leadership are coming up with a backup plan… because I'm not here to rack up an additional $20 trillion in debt over 10 years or to subsidize healthy, able-bodied adults, corrupt blue states, and monopoly hospital ceos," he wrote on X.
- On the other side, Sen. Josh Hawley was out Monday morning with an op-ed in The New York Times warning against Medicaid cuts.
- "Republicans need to open their eyes: Our voters support social insurance programs," he wrote. "More than that, our voters depend on those programs."
The big picture: The measure omits two of the biggest cuts that were discussed: lowering the federal share of costs, or FMAP, across all states, and per capita caps on funding.
- But plenty still remains that could make this vote tough for more moderate members.
- For one, the CBO projects the measure will lead to 8.6 million more uninsured people.
- Although there is no overall change in the FMAP, 12 states plus the District of Columbia would have their federal share lowered from 90% to 80% to penalize them for covering undocumented immigrants.
- Those states include California and New York, home to plenty of moderate House Republicans.
- There are also provisions restricting Medicaid funding for larger abortion providers, which are sure to be politically controversial.
What's next: President Trump, who is famously unpredictable in Hill negotiations, will have enormous sway over what happens.
- On Monday he announced executive actions to begin the process of implementing his "most favored nation" plan to tie drug prices to those paid in other countries.
- But it's possible he could again complicate the congressional GOP's plans by demanding its inclusion in the reconciliation package. The House GOP left the measure out of the bill released Sunday night.
