House Republicans Struggle To Unite On Trump’s ‘One Beautiful Bill’ Amid Battle Over Medicaid Cuts & SALT Deduction

With weeks remaining before their self-imposed Memorial Day deadline, House Republicans are growing more divided over President Donald Trump’s ambitious legislative proposal. Dubbed the “one big, beautiful bill,” the package is intended to solidify Trump’s first-year policy priorities. Still, internal disagreements—particularly on Medicaid cuts and tax policy—threaten its progress.

One central area of disagreement is how to approach Medicaid. House Energy and Commerce Committee Chair Brett Guthrie (R-Kentucky) has floated the possibility of “per capita caps” on Medicaid expansion based on populations. However, this contradicts the assurances of House Speaker Mike Johnson (R-Louisiana), who said Republicans would likely steer clear of such controversial changes. 

Meanwhile, the Ways and Means Committee faces its own internal clash over the state and local tax (SALT) deduction cap. Members of the SALT Caucus, including Reps. Andrew Garbarino (R-New York) and Young Kim (R-California), are pushing to raise the cap to benefit constituents in high-tax states. However, no specific figure has been agreed upon.

Complicating matters, a recent Congressional Budget Office (CBO) analysis warned that millions could lose health insurance under the proposed Medicaid changes. A plan to cap spending for the Medicaid expansion population, for example, would save approximately $225 billion but leave an estimated 1.5 million more people uninsured by 2034. These projections have fueled resistance among moderate Republicans like Rep. Mike Lawler (R-New York), who opposes benefit reductions.

Hardline conservatives, however, are pushing for aggressive deficit cuts, arguing that significant reductions to Medicaid are necessary to meet the $1.5 trillion savings target. Over 30 Republicans, led by Rep. Lloyd Smucker (R-Pennsylvania), signed a letter urging leaders to stick to the House budget framework and resist watering down cuts in negotiations with the Senate.

Despite plans to begin committee markups next week, no dates have been officially scheduled. Lawmakers remain at odds not just over policy details, but also over the broader direction of the bill. While Trump insists Medicaid benefits will remain intact, GOP leaders face the daunting task of reconciling conflicting demands from moderates and conservatives, all under a rapidly closing window for action.