House Republicans are beginning to scale back some of their proposed deep Medicaid cuts as part of their sweeping tax break legislation, facing mounting resistance from centrist GOP lawmakers wary of slashing health coverage for their constituents. However, not all proposed reductions are off the table.

A new report released Wednesday by the nonpartisan Congressional Budget Office (CBO) estimated that millions of Americans would lose Medicaid coverage under various Republican proposals aimed at cutting federal spending. “Under each of those options, Medicaid enrollment would decrease and the number of people without health insurance would increase,” the CBO report said.

The findings added fresh complications for House Speaker Mike Johnson, who is struggling to rally support for what President Donald Trump has dubbed his “big, beautiful bill,” which Republicans aim to pass by Memorial Day. The package would extend the expiring 2017 Trump-era tax breaks but requires up to $1.5 trillion in cuts to programs like Medicaid and food stamps to offset the estimated $4.5 trillion in lost revenue.

The political pressure is intensifying as economic uncertainty grows, in part due to Trump’s trade policies that have led to rising prices, supply disruptions, and job losses. Speaker Johnson has been holding closed-door meetings with moderate Republicans, many from swing districts, who are urging the leadership to abandon the most controversial Medicaid cuts.

“This non-partisan Congressional Budget Office analysis confirms what we’ve been saying all along: Republicans’ Medicaid proposals result in millions of people losing their health care,” said Rep. Frank Pallone, a New Jersey Democrat, who requested the review with Democratic Sen. Ron Wyden of Oregon.

Some lawmakers say leadership is now retreating from changes to federal Medicaid matching rates. “Those Medicaid changes are dead,” said Rep. Jeff Van Drew, a Republican from New Jersey.

Republican Rep. Nick LaLota of New York noted Trump’s opposition to cutting Medicaid, saying the party is instead considering narrower changes like work requirements, more frequent eligibility checks, and restricting aid to undocumented immigrants.

Despite the pushback, hardline conservatives, including the House Freedom Caucus, continue to press for deeper cuts. Republicans are still weighing options like limiting provider taxes used by states to draw extra federal funds—measures the CBO says could cost 8 million people their coverage.

Reporting by the Associated Press contributed to this story.