As Republican leaders draft President Donald Trump’s big bill of $4.5 trillion in tax breaks and $1.5 trillion in spending cuts, dozens of more moderate Republicans from contested congressional districts have positioned themselves at the center of the negotiating table.

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.