WASHINGTON ― Some of Republicans’ top ideas for reducing Medicaid spending would cut enrollment by millions, according to a new report by the Congressional Budget Office. The analysis comes as no surprise but nevertheless could make it harder for House Speaker Mike Johnson (R-La.

The Congressional Budget Office expects states will replace about half of the reduced federal support with their own resources, and then reduce spending by cutting provider payment rates, optional benefits and enrollment.

House Republicans appear to be backing off some, but not all, of the steep reductions to the Medicaid program as part of their big tax breaks bill, as they run into resistance from more centrist GOP lawmakers opposed to ending nearly-free health care coverage for their constituents back home.