A dozen or so House Republicans are expressing concern about the likelihood of supporting their party’s budget proposal due to possible cuts to Medicaid, as reported by multiple sources familiar with the discussions. With a slim majority in the House, GOP leaders find themselves navigating a precarious situation, where the future of the budget—and the risk of a government shutdown—rests on addressing these internal disagreements.
Representative Jeff Van Drew, a former Democrat from New Jersey who has aligned himself with Trump, indicated to TIME that he is ready to oppose the expansive budget plan scheduled for a Tuesday vote, calling its proposed $880 billion cuts to Medicaid excessive—even if these cuts are intended to fund tax reductions and bolster national security initiatives.
“Working-class individuals rely on Medicaid as they work,” Van Drew comments regarding the government health insurance program that supports over 72 million Americans. “This isn’t just about people who are idle and not fulfilling their responsibilities.”
Van Drew stated that he reached out to President Donald Trump on Monday evening to voice his concerns about the budget resolution: “I informed him that I might not support this, and I’m certainly holding off until the last moment to see if any modifications can be made, because I’m quite discontented.” During their conversation, Van Drew says Trump did not pressure him to change his stance and vote for the House GOP’s budget resolution or dispute his worries regarding potential Medicaid reductions. “He listened and was receptive to my concerns,” Van Drew noted. “I believe this could reflect poorly on him since he made a commitment,” alluding to Trump’s ongoing assertions during his campaign and presidency to safeguard Medicaid, a promise that many Republicans feel he could potentially violate.
Trump has consistently presented himself as a protector of entitlement programs, including Medicaid, which offers health care for low-income Americans. Throughout his political journey, he has pledged not to enact cuts to Medicaid, even while his administration has pursued broader budget reductions. “We will love and protect Social Security, Medicare, Medicaid,” Trump asserted to journalists on January 31. Yet, just days later, he endorsed the GOP-led House budget proposal featuring substantial Medicaid cuts.
This apparent inconsistency has left figures like Van Drew torn between their allegiance to Trump and the political realities of representing districts heavily reliant on Medicaid. Recently, demonstrators have gathered outside Van Drew’s South Jersey district office. The ambiguity surrounding Trump’s stance on Medicaid reductions has deepened the divisions within the GOP, as some legislators fear estranging the very voters who helped Trump secure critical victories in swing states.
“I don’t want him to be faced with this situation,” Van Drew expresses.
House Speaker Mike Johnson has scheduled a vote on the measure for Tuesday, proposing $2 trillion in cuts over a decade. However, its passage remains uncertain due to strong opposition from lawmakers representing districts with high Medicaid enrollment, many of whom are under pressure from constituents who rely on the program for essential health care services. During recent town halls nationwide, constituents have voiced their dissatisfaction with spending freezes and federal layoffs instigated by Elon Musk’s Department of Government Efficiency. Fears are mounting that supporting these cuts could jeopardize Republicans’ re-election prospects in 2026 by alienating voters—many of whom supported Trump and have benefited from Medicaid.
The ideological schism within the GOP is pronounced. On one side, fiscal conservatives contend that Medicaid serves as an “open checkbook” contributing to the nation’s $34 trillion debt, considering this time a crucial chance to mitigate the escalating deficit. Their proposed solutions include capping Medicaid spending, introducing work requirements, and combating fraud—all anticipated to save about $880 billion over the next decade, according to House Republicans. Detractors warn that if the Medicaid cuts move forward in both the House and Senate, millions could lose coverage, including children, new mothers, seniors, veterans, and individuals with disabilities. Medicaid covers 60% of nursing home residents, with 5.6 million Americans relying on it for long-term care costs.
Representative Nick Begich, a Republican from Alaska, where one-third of residents are enrolled in Medicaid, shared with TIME his intention to “ensure that our nation’s most vulnerable populations remain supported by programs like Medicaid.” While he did not indicate how he would vote, he expressed his commitment to “preserve Medicaid.”
Representative Tony Gonzales, a Republican from Texas with a significant number of constituents enrolled in Medicaid, co-wrote a letter with seven other House Republicans representing large Hispanic populations, urging Speaker Johnson to reconsider the GOP’s proposed Medicaid cuts. After meeting with Speaker Johnson on Monday, Gonzales informed TIME that he aims to continue their discussions. “We can eliminate waste and fraud while enhancing our national security, without undermining millions of Americans,” he stated.
Nonetheless, this uncertainty places Speaker Johnson and his leadership team in a challenging position. With the House’s narrow 218-215 majority, the GOP can afford only a few defections—making it increasingly unlikely that the party will rally around a budget incorporating Medicaid reductions.
“I think we’re in a favorable position,” Johnson remarked to reporters as he exited the Capitol on Monday night. “We’re engaging in very constructive discussions. As you all understand, this is all part of the process and I believe we are on the right track.”
Despite this, internal discord could have serious repercussions: without an approved budget, the government risks a shutdown in mid-March.
From a political perspective, this situation could provide an excellent opportunity for Democrats to sharpen their messaging ahead of the midterms. Democrats intend to capitalize on any potential disarray to rally opposition against the Medicaid cuts, according to a source familiar with Democratic leadership’s strategy, and could make a concerted effort to mobilize voters in districts heavily reliant on Medicaid. Protect Our Care, a Democratic health care advocacy group formed to safeguard the Affordable Care Act during the last Republican trifecta in 2017, has already initiated a $10 million campaign titled “Hands Off Medicaid” and is running advertisements on Fox News urging constituents to contact their representatives.
House Minority Leader Hakeem Jeffries informed reporters on Monday that if Republicans support the budget, “they’re going to be held accountable for raising expectations that they were going to address the affordability crisis in America and doing the exact opposite.”
Senator John Fetterman, a Democrat from Pennsylvania, expressed to TIME that cuts to Medicaid are “unacceptable,” asserting that if Republicans “wish to further damage their reputation … that’s their choice.”
For House Republicans, the stakes are exceptionally high. They must navigate the conflicting pressures from their party’s hard-line budget conservatives, the commitments they and Trump made to their constituents, and the looming threat of a government shutdown that could benefit the Democrats.
“It’s not that I’m against change or think we need substantial reform,” Van Drew remarks. “I’m among those caught in the middle, striving to do what’s right for real individuals.”
“There’s a distinction between being conservative and being extreme,” he emphasizes. “Those are not the same.”
