A moderate House Republican today pushed back strongly on Medicaid changes floated by a key House chair, highlighting the rocky road ahead for GOP consensus on how much to cut the program in reconciliation, Peter reports.

Why it matters: Reducing federal funding for Medicaid expansion enrollees puts moderates in a politically difficult spot, though not all are pushing back as Rep. Mike Lawler is.

What they're saying: Asked by Peter if he was open to lowering the 90% share of federal costs, known as the FMAP, Lawler replied: "I've been very clear about this. You guys keep asking the same stupid f--king question: No."

• "I've said from the very beginning: I'm against per capita caps, I'm against changing the FMAP floor," he added.
• Asked to clarify that he is opposed to lowering "any and all FMAP," meaning the 90% expansion FMAP, not just the FMAP for traditional Medicaid, Lawler replied, "Yeah, period."

Between the lines: We reported yesterday that House Energy and Commerce Chair Brett Guthrie said the House GOP is considering a per capita cap for Medicaid expansion enrollees.

• Guthrie has also long backed lowering the 90% expansion FMAP.
• Lawler's comments put him at odds with both those ideas, with extremely tight margins in the House.

Yes, but: Some moderates are leaving more room for funding cuts than Lawler is.

• Asked about lowering the FMAP for the expansion, Rep. Don Bacon said today that he needed to study the issue more. "I'm willing to consider and debate," he said.
• Rep. Jeff Van Drew, asked about per capita caps, said he is open to "guardrails" on the growth of Medicaid and that he would have to "think about" lowering the 90% expansion FMAP. He stressed that he does oppose lowering the 50% FMAP floor for traditional Medicaid.
• Senate Republicans have potentially even greater concerns with Medicaid cuts.

The big picture: The array of views highlights the difficulty Republicans have in settling on a reconciliation plan to generate savings for extending tax cuts.

• There is not much time before a planned May 7 Energy and Commerce markup of the committee's portion of the package.
• The committee's GOP members, who met for hours behind closed doors last night, were relatively tight-lipped upon leaving the room and said no Medicaid decisions had been made.
• "We're still having discussions on FMAP and per capita allotments," Guthrie told reporters this morning. "Those are the biggest discussions right now."
• He acknowledged that lowering the FMAP would be "difficult" and said he does not know "if there's 218 votes for that or not, but it's not off the table."

A House Energy and Commerce markup today of bipartisan legislation to address the opioid crisis turned into a referendum on the Trump administration's first 100 days on health care, Victoria reports.

Why it matters: The reauthorization of SUPPORT Act programs gave the panel's Democrats a forum to test messaging against GOP efforts to cut Medicaid and DOGE-directed cuts to federal health agencies.

• But the markup also showed how easily noncontroversial issues that in the past served as rallying points can be sidetracked by partisanship, even with a GOP trifecta in charge.

Context: The SUPPORT Act reauthorization would continue substance abuse treatment and recovery programs.

• The law was signed during the first Trump administration in 2018 but wasn't reauthorized in 2023.
• A reauthorization was jettisoned along with other health provisions from the year-end government funding deal after President Trump and Elon Musk sank the agreement over its size.

What they're saying: Energy and Commerce Ranking Member Frank Pallone said he wouldn't back the SUPPORT Act while the Trump administration is making steep cuts to the Substance Abuse and Mental Health Services Administration.

• Pallone enumerated a lengthy list of HHS cuts that Secretary Robert F. Kennedy Jr. has made since he was confirmed and referred to the leaked draft health budget document and potential Medicaid cuts.
• In response, Energy and Commerce Chair Brett Guthrie said: "These [health bills] are bipartisan priorities, these are priorities of all of us.… What I will tell you, we are going to use our oversight. We are talking about proposals that aren't out yet. But we want to make sure that we pass the legislation we need to pass."
• "Is that a commitment to holding a hearing and having the secretary testify?" Pallone responded.
• Guthrie said the panel expects Kennedy to appear to discuss the Trump administration's fiscal 2026 budget request. "My commitment is … we will conduct oversight."

Several other Democrats questioned why Republicans won't agree to revive the entire December health care package in committee, noting its bipartisan support during the last Congress.

• Energy and Commerce was due to mark up other noncontroversial health bills, including reauthorizations of organ transplant and cancer research programs.

1. Hospital decision: The Supreme Court today sided with HHS in a case that challenged the bounds of eligibility for enhanced hospital reimbursements under Medicare. More from Bloomberg Law.
2. Breast cancer tests: Sens. Jeanne Shaheen and Katie Britt introduced legislation that would eliminate copays and other out-of-pocket expenses for breast cancer diagnostic tests.
3. MA enrollment: Elevance Health is removing Medicare Advantage plans from online platforms that insurance brokers use to sign up members, Bloomberg reported.