JUANA SUMMERS, HOST:
House Republicans are filling in the details this week for the major components of the so-called big, beautiful bill that contains President Trump's tax, immigration and energy agenda. The president spoke about the bill earlier today.
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PRESIDENT DONALD TRUMP: I was just telling the leader and the speaker that - how do - it's going to be very hard for the Democrats to vote against the one big, beautiful deal, the greatest tax cuts in history, greatest everything.
SUMMERS: But splits among Republicans on things like changes to Medicaid and tax cuts could be the real hurdle to getting this bill through the House this month. NPR congressional correspondent Deirdre Walsh joins us now from the Capitol. Hey there.
DEIRDRE WALSH, BYLINE: Hey, Juana.
SUMMERS: So Deirdre, Republicans proposed some changes to Medicaid - which is the health care program for low-income, elderly and disabled people - in order to get a big chunk of savings. Help us understand what they want to do.
WALSH: Right. Republicans are relying on these changes to Medicaid to help reach their target in this bill of cutting $1 1/2 trillion to pay for their tax cuts. The Congressional Budget Office estimated that the changes in the draft now would cut $715 billion over 10 years from Medicaid and the Affordable Care Act and at least 8.6 million people would lose their health care coverage in the next decade.
In terms of the proposals, the Republican plan adds work requirements for able-bodied adults enrolled in Medicaid who don't have any dependents. It also adds some new copayments for some people. It freezes taxes that states impose on Medicaid providers. Those taxes help states boost how much federal money they get for Medicaid.
Republicans also say their plan will cut waste, fraud and abuse. They do this by verifying income and residency for people in the program, changing how people enroll. But under pressure from swing-district Republicans, leaders did not include major Medicaid reforms that would have shifted big cost to the states.
SUMMERS: Interesting. So Republicans, are they all on the same page about this?
WALSH: They're not. I mean, not all Republicans think that they should be doing these major changes to Medicaid. One of them, Missouri Republican Senator Josh Hawley, wrote an editorial in The New York Times today criticizing some in his party who he says want to slash health care for the working poor. He called that move, quote, "both morally wrong and politically suicidal."
SUMMERS: Now, a centerpiece of this package is renewing the tax cuts that President Trump enacted in his first term in 2017. Is that still the plan?
WALSH: It is. Those 2017 tax cuts expire at the end of this year, and the Republican bill would permanently extend them. Those - that would cost $5 trillion over the next decade, according to CBO. The Republican plan also increases the standard tax deduction for individuals and married couples for the next four years. It also increases the size of the child tax credit. That's something that both parties support. This bill also creates something new called MAGA accounts - essentially, government savings accounts for young people to use for school or businesses in the future, providing that people can contribute up to $5,000 into those accounts a year.
SUMMERS: I understand, though, some tax issues still have not been finalized. Tell us what they are.
WALSH: Right. There's still a big fight inside the Republican Party over a tax deduction for state and local taxes. Republicans who represent districts with high property taxes in places like New York, New Jersey, California, say that cap needs to be lifted. That's really expensive to do, and conservatives push to reduce the deficit - they don't want to do that. So this draft bill does increase the amount people can deduct, but it's unclear what's going to end up in the final version of this bill.
SUMMERS: So walk us through the plan for moving this bill through Congress.
WALSH: House Speaker Mike Johnson still wants to get the House to vote on a final bill that they come up with before Memorial Day recess. Remember, really slim margin in the House, and he can only afford to lose three votes to get this through. Conservatives are still pushing for larger spending cuts, as much as $2 trillion. But the real deadline for the House and Senate to get a final bill to the president's desk is mid-July. That's when Treasury Secretary Scott Bessent says the country is going to run out of revenue to pay its bills. And in this bill, Republicans plan to increase the country's borrowing authority for the next five years.
SUMMERS: NPR's Deirdre Walsh, thank you.
WALSH: Thanks, Juana. Transcript provided by NPR, Copyright NPR.
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