The megabill includes significant Medicaid cuts, changes to eligibility like work requirements and frequent eligibility checks, as well as substantial tax breaks. These elements, especially the Medicaid reductions which aim to save over $700 billion, have drawn criticism from both moderates and hardliners within the GOP, threatening the bill's passage.

The Medicaid provisions in the bill target roughly $625 billion in federal deficit reduction over ten years, with total health-related savings about $715 billion. However, this would result in at least 7.6 million to 8.6 million more Americans becoming uninsured by 2034.

Opposition stems from concerns about cutting Medicaid benefits for poor, elderly, and disabled Americans despite prior promises by Trump not to reduce Medicaid. The bill also imposes work requirements, more frequent eligibility checks, and penalties for states offering Medicaid to illegal immigrants, which some Republicans view as too harsh or politically risky.

Mike Johnson has remained confident about the process, stating there will be additional committee markups and expressing no doubts about advancing the bill. He is targeting an ambitious timeline to pass the bill by Memorial Day despite the ongoing debates and delays in committee scheduling.

The outcome remains uncertain as internal GOP conflicts over Medicaid cuts and tax breaks, combined with Senate criticism about budget cuts and healthcare losses, complicate the bill's path. The divisions risk derailing the bill's momentum ahead of a critical House vote.