The funding bill House Republican leaders released on Saturday does not avert cuts for doctors who treat Medicare patients — a blow to Republicans who had pushed for the changes that also could risk alienating members whose support will be needed to pass the legislation.

Rep. Greg Murphy (R-N.C.), who co-chairs the GOP Doctors’ Caucus, said in recent months that Republican leadership was open to including the policy in the bill to keep the government funded through September, and that Trump administration officials had assured it would be addressed. Five health industry lobbyists, granted anonymity to share details of private negotiations, were also anticipating it would be a part of the funding measure to avoid a shutdown after March 14.

Murphy said in an interview its inclusion would be a “line in the sand” necessary for his support. A Murphy spokesperson did not immediately respond to a request for comment about whether the lawmaker was still adhering to that position.

Speaker Mike Johnson can only afford to lose two votes on his side of the aisle if all Democrats band together and oppose the government funding bill, a position the minority party could ultimately take.

Two lobbyists aware of the closed-door negotiations said the patch for doctors was ultimately not included amid broader concerns among Republican leadership that adding more than standard extensions of programs would open the door to more demands for other policies to be attached.

But the legislation released Saturday, which would hold most current spending levels through the end of the fiscal year, is far from “clean“: It would boost spending for illegal immigrant deportations while cutting — and in many cases completely zeroing out — money for a variety of non-defense programs. It’s not clear how leadership will justify the exclusion of one policy provision when other priorities are getting addressed.

The doctors’ pay fix would have prevented further cuts from going into effect that would slash deeply into salaries for doctors providing Medicare services based on an outdated formula. It was part of a larger health care overhaul package set to pass as part of a year-end government funding bill in December. Then-President-elect Donald Trump and Elon Musk complained that bill was overly broad, and the package got scrapped.

Members of both parties warn the stakes are high for not addressing this issue quickly: Decades of payment reductions in Medicare have put physician practices in difficult financial straits, doctors groups say — meaning they could be forced to close their practices and reduce access to care.

But while though there is no relief for doctors, the stopgap funding bill would — as expected — include an extension of eased telehealth rules until September, avoiding a potential disruption in access to care if adopted.

Those relaxed telehealth rules were first introduced by the Center for Medicaid Services during the Covid-19 pandemic when physical doctor offices were closed. Congress has extended those telehealth rules several times, but a permanent solution has remained elusive.

The stopgap bill would also extend hospital-at-home waivers that enable facilities to offer more care at home. It would, as well, extend funding for community health centers, alongside a delay in funding cuts to safety-net hospitals.

The Affordable Care Act called for such cuts, expecting such hospitals wouldn’t have to offer less care without getting paid as millions more got covered through the law, but Congress has never let them go into effect.

A seven-month funding patch released by House Republicans Saturday would add billions of dollars in spending for deportations, veterans’ health care and the military while cutting an even greater amount of funding for non-defense programs.

The measure, crafted by Speaker Mike Johnson in coordination with the White House, reflects President Donald Trump’s top policy priorities and heightens a confrontation with Democrats ahead of a Friday midnight shutdown deadline.

House Democratic leaders have already declared themselves firmly opposed to the GOP-written stopgap. They spent weeks trading offers with Republicans to clinch a bipartisan government funding deal before House GOP leaders decided to pivot to the patch through September, which would give Trump substantially more leeway to shift federal cash.

Senate Democrats, meanwhile, have been more cautious. If Johnson can get the bill through the House, at least seven of them will need to support it in order to avert a shutdown. The Republican-friendly provisions embedded in the newly released bill could fuel Democratic opposition.

GOP leaders said that the bill would increase defense spending by about $6 billion over current budgets, while non-defense funding would fall by a total of about $13 billion. It fulfills a Trump administration request for additional ICE funding to help carry out deportations. The stopgap also maintains a freeze on more than $20 billion in special IRS funding.

Even before the bill’s release, Democrats called the stopgap a “blank check” for the president, since it does not contain earmarks ensuring federal funding goes to certain projects in their districts or the hundreds of pages in guidance Congress includes alongside regular funding bills. It also gives the Trump administration “new start” power to begin military programs Congress hasn’t approved.

GOP leaders briefed House Republicans on the funding plan Saturday morning. Earmarks would not be in the package, leaders confirmed on the call. Some fiscal hawks also raised concerns that the plan did not reduce spending enough, according to two people granted anonymity to describe the private call.

Johnson and Trump have spent weeks already trying to convince hard-right holdouts to vote for the spending patch — something hard-liners generally never support. They have argued they need the rest of the fiscal year to formulate a plan to codify sweeping cuts being undertaken by the Department of Government Efficiency initiative.

The speaker aims to pass the bill as soon as Tuesday with Republican votes only, and then jam the Senate by adjourning the House and putting the onus on Democrats across the Capitol to back a plan they loathe. Referring to the Senate minority leader, Johnson argued on Friday that any lapse in government funding would be “a Chuck Schumer shutdown” if Democrats don’t help Republicans clear the Senate’s 60-vote threshold.

“Democrats are not the ones interested in finding a reasonable solution to fund the government,” a House Republican leadership aide told reporters on a call Saturday, accusing Democrats of using “government funding as a weapon” to stop the Trump administration’s agenda.

“It’s going to be a tough choice now for Democrats to decide if they want to be the ones to shut down the government, something that they’ve long opposed,” added the aide, who was granted anonymity to describe GOP leaders’ thinking.

As expected, the bill doesn’t include any additional disaster aid to address the recent California wildfires or hurricane victims. Nor does it address a looming debt ceiling deadline.

Senate Democrats have a fast-approaching dilemma: Vote for a spending bill unilaterally drafted by House Republicans or engage in the kind of shutdown brinkmanship they’ve long opposed.

It isn’t a decision they’ll be able to put off for much longer. House GOP leaders are poised early next week to send a bill to the floor that would largely hold current spending levels in place through the end of September. Democrats don’t like this approach, arguing it would only further empower President Donald Trump and Elon Musk to continue to act beyond their authority in clawing back congressionally approved dollars.

In the House, Democrats are vowing to hold back support, arguing that Republicans are responsible for finding the votes for a continuing resolution, or CR, after walking away from negotiations with the minority party.

“If Republicans decide to take that approach, as Speaker [Mike] Johnson indicated it’s his expectation, then Republicans are going it alone,” House Minority Leader Hakeem Jeffries told reporters Thursday.

It’s not so simple in the Senate, where Democratic leaders are being more careful to avoid promising blanket opposition to a relatively “clean” stopgap bill ahead of the March 14 shutdown deadline. Privately, leaders have urged their members to stay silent and force Republicans to come up with a palatable plan.

Sen. Dick Durbin, the No. 2 Senate Democrat, said in a brief interview Thursday he didn’t sense there were enough Democratic senators yet willing to clear a seven-month stopgap — Republicans need at least eight, assuming more GOP lawmakers don’t join Sen. Rand Paul of Kentucky, who has pledged to vote no.

Still, when pressed if he would oppose that bill if it was the only option on the table just hours before the shutdown deadline, Durbin hedged, saying that it was premature until he saw what gets through the House.

“Ask me after that,” he added.

While a handful of Democrats indicated in interviews that they are a no, so far Republicans have at least one Democrat on their side: Sen. John Fetterman of Pennsylvania, who said in a brief interview Thursday that “I’m never going to be a part of any vote that shuts the government down.”

“The fact that anyone on our side would even rattle those sabers, that’s bullshit,” Fetterman said. “To think I’m going to burn the village down to save it, that’s bonkers.”

Roughly a dozen other Senate Democrats declined in interviews this week to say explicitly they would vote against a shutdown-averting bill. Several lawmakers said they want to know for sure that this bill would be the only way to avoid a lapse in federal funding before committing to supporting it. They also said they want to see proof that Speaker Mike Johnson can actually get it through the House.

“There’s enough Senate Republicans who have told us that they support the idea of a short-term CR and completing all the bills,” said Sen. Chris Van Hollen (D-Md.), adding that before he makes a decision on a House bill, “I want to make sure that play is not available.”

Sen. Tim Kaine (D-Va.) described himself as “anti-shutdown” and that Musk’s ascension “makes it even more perilous to shut down” because it would only further embolden him. But Kaine — who, like Van Hollen, has a large share of federal workers in his state — also declined to say how he would vote on a September funding patch if one comes to the Senate floor.

A group of Democrats and Republicans in the Senate have been quietly talking about a back-up option if the House isn’t able to pass its stopgap bill — not an unthinkable scenario, given the GOP’s razor-thin majority. Several of those Democrats emphasized their preference is to pursue a government funding path that gives space to senior appropriators who still insist they’re close to an agreement on updated agency funding levels.

“We’re real close to a deal,” said Sen. Gary Peters (D-Mich.), an Appropriations Committee member. “We should get that done.”

One option being floated by Democrats is a four- to five-week stopgap to give appropriators more time to land that deal. But Republicans involved in the bicameral negotiations warned that they don’t believe their House counterparts are ready to accept anything other than an extension of current funding levels through the end of the fiscal year.

“My best guess right now is that the House will pass or attempt to pass a full-year CR,” Senate Appropriations Chair Susan Collins (R-Maine) told reporters. Asked about the possibility of a shorter stopgap, she added, “I do not think the House is interested in that.”

Mia McCarthy, Lisa Kashinsky, Nicholas Wu and Jennifer Scholtes contributed to this report.

As President Donald Trump and Elon Musk lay waste to scores of federal programs and the careers of thousands of government workers, Republicans on Capitol Hill have mostly kept their objections to themselves — with one big exception.

Military veterans have been disproportionately affected by the administration’s early cuts, and GOP lawmakers have unleashed a rare tide of public pushback. That reached a crescendo this week as the Trump administration raises the possibility of large-scale dismissals of Veterans Administration employees.

Mass firings at the VA began weeks ago, spurring a flurry of panicked calls from GOP lawmakers to the White House. But a new memo outlines the potential for 80,000 more firings across a roughly 480,000-person department, according to an internal memo obtained by POLITICO.

Senate Veterans’ Affairs Chair Jerry Moran (R-Kan.) said in a statement that while the massive department is “in need of reform,” efforts to downsize “must be done in a more responsible manner,” after the AP first reported the 80,000 figure Wednesday. Moran, who has been in close contact with VA Secretary Doug Collins and White House staff about personnel issues for weeks, added in an interview Thursday that lawmakers “need information” and that the numbers need to be “justifiable.”

Leaving a lunch meeting with Musk Wednesday where the VA cuts came up, Sen. Lindsey Graham (R-S.C.) voiced his irritation to reporters and suggested Trump’s veterans chief needed to get a better handle on his department.

“It’s political malpractice not to consult Congress if that’s what you intend to do,” Graham said. “Maybe you’ve got a good reason to do it. I like Doug Collins — he’s a great guy. But we don’t need to be reading memos in the paper about 20 percent cut at the VA.”

Even before the VA memo became public, there was heartburn about how the cuts undertaken by Musk’s Department of Government Efficiency initiative might impact the country’s roughly 18 million veterans.

Federal job cuts generally affect veterans more profoundly, since they are given preference in government hiring. The provision of health care and other services is directly threatened by cuts to the VA, and those impacts have been a frequent concern at the spate of town hall protests GOP lawmakers have encountered in recent weeks.

There are signs the message has gotten through. Senate Majority Leader John Thune said Thursday that senators raised the issue of VA cuts directly with Musk during the lunch meeting at the Capitol on Wednesday.

“I’m hoping there will be some clarification on that issue soon,” Thune told a small group of reporters.

Sen. John Barrasso, Thune’s No. 2, said that while they didn’t get confirmation of the VA cuts, Republicans stressed to Musk that Collins needs to be involved, with “the concern being that we want to make sure that veterans get the care that they need.”

Senate Appropriations Chair Susan Collins, who has recently been in contact with Musk, said she’s also coordinating with Moran as he tries to get answers.

“We have an obligation to our veterans, and these mass firings undermine that obligation,” Collins told reporters.

Democrats, who have been searching for a political foothold as they try to fight back against DOGE, blasted the proposed VA cuts. Senate Minority Leader Chuck Schumer called it “a betrayal of our promise to our service members” that will spark “longer wait times, fewer appointments, less health care service for our veterans.”

Across the Capitol, the more DOGE-friendly House GOP is more willing to give the administration leeway on efforts to slash the size of the federal workforce. But even GOP leaders who are normally quick to praise Musk’s slash-and-burn operation are sensitive about the VA and impacts on veterans.

“We’re going to talk to the secretary to see what their needs are,” said House Majority Leader Steve Scalise (R-La.). “You had, in a lot of these departments, a large increase during COVID, some of which may have been needed but a lot of which wasn’t justified.

“So you need to sort through what actually helps the veterans versus what actually takes money away from veterans benefits,” Scalise added.

House Foreign Affairs Chair Michael McCaul said in an interview Thursday he needed to study the VA cuts in more detail. But he had a visceral reaction when informed of the level of workforce cuts in the memo.

“Jeez,” McCaul said, his eyes widening.

“I worry because our veterans are hurting after Afghanistan; PTSD has gone way up,” McCaul added. “Suicide rates gone way up, and morale has gone way down. So I worry in the sense that I don’t want that to be a signal that we don’t care about our veterans.”

Some House Republicans, including some with a high number of veterans in their districts who get their care from the VA, offered measured support.

“I trust the president,” said Rep. Brian Babin (R-Texas), adding “there are a lot of complaints” about the VA. Rep. Austin Scott (R-Ga.) added that he had faith in Collins to make cuts that “create efficiencies and actually improve care” at VA.

But Rep. Rob Wittman (R-Va.) — a senior member of the House Armed Services Committee whose state includes large numbers of federal workers and veterans — warned the job cuts would have real impacts on his constituents.

“I think everybody looks at it and says, ‘Let’s get the federal government to the right size that’s sustainable.’ Companies do that all the time,” Wittman said. “But I also want to be mindful that these employees are really good people. They work hard, and I want to make sure we keep in mind the impact that it has on them.”

Ben Leonard, Connor O’Brien and Katherine Tully-McManus contributed to this report.