House Speaker Mike Johnson said Tuesday that major cuts to the Affordable Care Act’s Medicaid expansion were off the table. Now, the largest cut left among their whittled-down options would disproportionately hurt states that supported Mr. Trump in the 2024 election.

Republicans worried about losing their slim House majority next year are struggling with how to achieve Medicaid savings as even more Americans rely on the program.

President Donald Trump's fellow Republicans in the U.S. Congress are weighing steep cuts to the Medicaid health program as part of a wide-ranging budget package that also would cut taxes and raise spending on defense and border security.