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The Senate-passed reconciliation bill puts the House on the spot over whether to accept a much tougher Medicaid provider tax crackdown that would bring deeper cuts to the program than the lower chamber had envisioned.
Why it matters: The House represents the last chance to make changes to arguably the most sweeping piece of health care legislation since the Affordable Care Act.
The big picture: Although there's angst from both moderates and conservative House Republicans over what comes next, there's also tremendous pressure to get the legislative package containing a big chunk of President Trump's domestic agenda to his desk.
What they're saying: House GOP leadership said in a statement immediately after the Senate passage that it would "work quickly to pass the one big beautiful bill" and meet Trump's July 4 deadline.
- But moderate Rep. David Valadao has already said he would vote against the Senate's reconciliation bill "that makes harmful cuts to Medicaid."
- Others, including Reps. Young Kim and Don Bacon, have also expressed concerns. GOP leaders can afford only three defections.
The Senate's stricter limits on the provider taxes that states levy to cover a portion of their Medicaid costs have been House moderates' main concern.
The other side: Freedom Caucus members insist the measure does not cut spending enough.
- "We've got a lot of wins in the one big beautiful bill," Rep. Ralph Norman wrote on X on Tuesday. "But let's be honest: the spending provisions in this thing are massive and will blow up the deficit. We can't keep mortgaging our future."
Between the lines: Even the Senate seems a bit uncertain on how the House will handle the bill.
- Majority Leader John Thune told reporters immediately after passage that "we'll see" if the House can pass the bill, adding that "you know how hard it was to pass it here."
- Sen. Lisa Murkowski, who wound up casting a pivotal vote for the package, signaled openness to renegotiating the bill again, telling reporters after the vote that she "struggled mightily with the impact on the most vulnerable," including on Medicaid.
- She added that she hoped the "House is going to look at this and recognize that we're not there yet."
What's next: House Rules started meeting at 1:30pm ET and is expected to take until late evening to suss out rules for debating the Senate-passed package.
- House Freedom Caucus member Chip Roy could vote against the rule, and fellow member Norman has said he will. But the bill would still get to the floor if all other Republicans on the Rules Committee back the bill.
- That would mean the package would hit the floor Wednesday, which is when House members were instructed to be back in town.
