Speaker Mike Johnson (R-LA) is inching closer to getting a handful of centrist Republicans on board with the GOP effort to overhaul Medicaid in its budget megabill, but promises not to cut federal shares to states are already angering fiscal hawks, who say their support is on thin ice.

Johnson and leadership met with the centrist holdouts for nearly two hours Tuesday evening to discuss pathways forward on reconciliation, the process Republicans are using to pass one bill to codify President Donald Trump’s agenda. Republicans supportive of Medicaid have expressed concerns that the proposed $1.5 trillion in spending cuts would run right through the beneficiary program, particularly as fiscal hawks claim that significant reforms to Medicaid are needed to earn their vote on the bill.

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But emerging from the Tuesday meeting, several key centrist GOP lawmakers said they are leaning closer to a “yes.” Now, the proposed plan includes additional work requirements for able-bodied beneficiaries, cracking down on benefits for noncitizens, and increasing the frequency of eligibility checks.

This is a deviation from the latest plan that centrist lawmakers overwhelmingly opposed: cutting the federal cost share for states that expanded Medicaid under the Affordable Care Act, or FMAPs, and capping federal payments to said expansion states.

Johnson told reporters “no” when asked if Republicans were pursuing changes to FMAP. When asked about per capita caps on the funding, the speaker said, “I think we’re ruling that out as well, but stay tuned.”

Changes to Medicaid that enjoy broad GOP support include implementing work requirements, more frequent eligibility checks, and ensuring illegal immigrants do not have access to the healthcare benefits designed for lower-income citizens. Johnson’s office did not respond to a request for comment on what other reforms are on the table.

The speaker’s decision to side with centrist Republicans on their Medicaid red lines, for now, could spell disaster for leadership, as its reconciliation passage deadline of Memorial Day is only 19 days away.

But, surprisingly, it puts Johnson in a position to hand a win to strong Trump loyalists such as Laura Loomer and Steve Bannon, who have been making the “MAGA” case for Medicaid. Loomer, a right-wing conspiracy theorist and influencer who has been somewhat successful in exerting her will in the White House, defended Medicaid in a lengthy post Monday night.

She wrote that the program is “critical to the heartland voters who propelled Donald Trump to his election victories,” warning that cuts could hit “Americans the hardest in rural red states like Texas, Florida, and Louisiana, where Trump’s base depends on the Medicaid program for survival.”

Bannon, a former Trump strategist, has been sounding alarms on the GOP’s approach to Medicaid since February, when he told a Fox interviewer that “a lot of MAGAs” are on Medicaid.

“If you don’t think so, you’re dead wrong. … You can’t just take a meat axe to it,” he said.

The speaker can only afford to lose three votes to still pass the legislation along party lines, with that number fluctuating depending on Democratic absences. Though Johnson may be able to get centrists from New York and California on board, he now must wrestle with fiscal hawks who have already expressed their displeasure over Tuesday’s results.

Rep. Chip Roy (R-TX), policy chairman of the Freedom Caucus and one of the most vocal hard-line conservatives involved in reconciliation, said he has not ruled FMAP out.

“It’s necessary to stop robbing from the vulnerable to fund the able-bodied,” Roy said, adding in another post that the GOP leadership’s position is to “defend OBAMACARE policies.”

The $1.5 trillion in spending cuts includes $880 billion from the Energy and Commerce Committee, and the plan proposed by centrists on Tuesday would only amount to $400 billion or $500 billion, per Punchbowl News. But GOP leaders are signaling to centrist members that some committees may go above their designated savings instructions, giving the Energy and Commerce Committee some breathing room as they try to reach $880 billion in savings.

Fiscal hawks, particularly in the Freedom Caucus, have warned leadership that their votes are contingent on strong reform to programs such as Medicaid and Social Security.

“Not tackling substantive reforms to save Medicaid doesn’t just mean defending Obamacare policies discriminating against the vulnerable in favor of able-bodied adults with no children and no jobs. … Under the House budget resolution, it also means scaling back the President’s campaign promises on tax relief,” a statement from the Freedom Caucus reads.

“Reconciliation has to help solve the budget deficit and debt, not make it worse. Which means you need savings to pay for tax relief. Medicaid is where you get it. Without it, the math doesn’t math.”

Placing Medicaid on the chopping block is a surefire way to lose centrists such as Reps. Don Bacon (R-NE) and Mike Lawler (R-NY), both of whom have said they would not support cuts to the program. But Bacon told the Wall Street Journal that some GOP leaders have encouraged him and other centrist members to get on board with reconciliation by promising that any steep cuts made by the House will not make it past the Senate.

“Here’s the tactic they’ve been using: ‘Don’t worry about the Senate. They’ll fix it,’” Bacon said. “And now we’re getting ready to take our third vote on this. We feel like we’re being pushed up to the edge of the cliff here.”

Things may be getting more difficult for centrist lawmakers to avoid a politically damaging vote. The Congressional Budget Office released a new analysis, requested by Democrats, on Wednesday, advising that several policies the GOP is considering for Medicaid reform could lead to health insurance coverage losses for millions of people. In a letter to Senate Finance Committee ranking member Ron Wyden (D-OR) and House Energy and Commerce ranking member Frank Pallone (D-NJ), CBO personnel said the per capita caps would save $225 billion in federal spending and may result in 1.5 million more uninsured people by 2034.

This will put more fire behind Democrats’ narrative that Republicans are looking to gut Medicaid and Medicare, a worry that has inflamed constituents in blue and red districts, leading to fiery town halls over the last few months.

THE FOUR FACTIONS SPEAKER JOHNSON MUST PLEASE TO PASS TRUMP’S BUDGET MEGABILL

In their first legislative pushback to the GOP reconciliation plan, House Democrats filed a discharge petition on Tuesday to force a vote on a bill to protect Medicaid and the Supplemental Nutrition Assistance Program. House Majority PAC, the leading campaign PAC for House Democrats, released a statement on the CBO analysis stating it hands Democrats the tools to regain the majority in the midterm elections.

“It’s clear as day: House Republicans are ripping health care away from millions of Americans to hand tax breaks to billionaires—and in the process, they’re writing the playbook for Democrats to take back the House in 2026,” HMP spokeswoman Katarina Flicker said.