Facing pushback from moderates and a sobering CBO report, House GOP leaders are retreating from their most aggressive Medicaid reduction proposals.

The report projected that up to 10 million people could lose coverage under some plans, including efforts to reduce federal matching rates for Medicaid expansion enrollees and impose per-capita spending caps on states. Those provisions would have left states with multibillion-dollar budget shortfalls, likely forcing cuts to services, eligibility, or provider payments.

Speaker Mike Johnson confirmed this week that such structural changes are no longer under consideration, a move aimed at holding together his slim House majority amid concerns from Republicans in swing districts. The Congressional Budget Office warned that these options would disproportionately impact states that expanded Medicaid under the Affordable Care Act, including several where Republicans face tight reelection races.

Still, other cost-cutting proposals remain on the table. Republicans are considering new work requirements for beneficiaries, more frequent eligibility verifications, and limits on how states tax hospitals and other providers to generate matching federal funds. These narrower changes could still result in millions losing coverage and are central to GOP efforts to secure up to $880 billion in Medicaid savings.