As Congress deliberates on significant cuts to Medicaid, tensions rise among Republican lawmakers regarding the potential impact on millions already reliant on the safety net. Conservative factions are pushing for controversial changes, which critics warn could devastate healthcare systems, particularly for older adults and vulnerable populations in states like New York and D.C. Mayor Bowser and health officials are urging action to prevent the cuts, emphasizing the real threat to public health. Meanwhile, moderate Republicans express deep concern over the proposed reductions, fearing they may lead to widespread coverage losses and negative health outcomes. The debate is further complicated by ties to GOP think tanks and the ongoing push to reform key components of the Affordable Care Act.