The Republican-controlled Congress, which has so far done little to break with or limit President Trump, has plenty to do in the coming weeks. Government funding, oversight of immigration and deportation officers, potential action related to the Jeffrey Epstein files, and additional briefings on Venezuela will dominate headlines. Now, it appears health care could be the one issue that actually causes some strife within the GOP. 

Welcome to Washington, where Republicans are entering the midterm election year facing significant challenges. Mr. Trump’s approval rating has slipped into the low forties and Democrats are leading on the generic congressional ballot. The most important issues for voters by far are the state of the economy and the cost of living — something that is set to get worse before November with a significant spike in health care costs now hitting families’ wallets.

In the coming weeks, the Senate is set to consider a new proposal to deal with those increased costs, which are coming as a result of the expiration of Biden-era Affordable Care Act subsidies. While the bipartisan proposal has not yet been unveiled, the final product is certain to upset conservatives, given it is being written by Senator Susan Collins, the moderate from Maine who leads the Appropriations Committee. 

Ms. Collins’ first pass at extending the ACA tax credits, which lapsed at the beginning of this year, was a bill with Senator Bernie Moreno. That legislation would extend the subsidies for two years with new income limits placed on wealthier individuals and families who get their health care through the Affordable Care Act. 

“This bill would help prevent unaffordable increases in health insurance premium costs for many families by extending the Affordable Care Act enhanced premium tax credits for two years and putting a reasonable income cap on these subsidies to ensure they are going to the individuals who need them,” she said in a statement last month. 

Ms. Collins has spent decades being at the heart of key bipartisan negotiations around everything from infrastructure to education to pandemic responses. Whatever final product comes out of Ms. Collins’ negotiations with Democrats is sure to upset conservative lawmakers on the south side of the Capitol, where Speaker Mike Johnson has pushed back against all recent attempts to extend the ACA tax credits. 

Mr. Trump himself did not help this past week when he essentially rolled a political grenade into the middle of the House Republican Conference, urging lawmakers to be “flexible” on the issue of government funding of abortions. 

“You have to be a little flexible on Hyde,” Mr. Trump told House Republicans this week, referring to the Hyde Amendment, which is a federal law barring the use of federal dollars for abortion services. “You know that. You gotta be a little flexible. You gotta work something [out].”

Usually, Mr. Trump takes joy in the campaign-style talks he gets to give for his allies in Congress, whether it be at lawmakers’ annual retreats or just during lunches at the White House. Members of Congress love such events, as well, often clapping enthusiastically or laughing loudly at his jokes. 

When Mr. Trump mentioned the Hyde Amendment, however, the silence in the room was deafening. The president’s comments drew an incredibly rare thing — a rebuke from Mr. Johnson himself. 

“We’re not going to authorize taxpayer funding for abortion. I’m just not going to allow that to happen,” Mr. Johnson — who has stood by the president on every other issue that comes to mind — told reporters this week after Mr. Trump made his comments. 

Mr. Johnson has been holding his House majority together thanks only to Mr. Trump, who often says that he is the one who has to be making calls in the middle of the night to soothe the egos of conservatives rabblerousers. This past week, though, neither Mr. Johnson nor Mr. Trump was able to keep the GOP in line on health care. 

On Thursday, Democrats successfully forced a bill to the floor which would extend the Affordable Care Act tax credits for three years with no changes made to the program. Stunningly, 17 Republican lawmakers went along with them, most of whom are in competitive races this year. 

“[M]y affirmative vote today … is not an endorsement of a clean 3-year extension, but rather a commitment to a bipartisan solution,” Congressman Mike Lawler, one of just three Republicans representing a district won by Vice President Harris in 2024, said in a statement. The only real question about that bipartisan solution is to what degree it enrages Mr. Johnson’s conservative detractors in the House.