Trying to win over conservatives, House Republicans are sweetening their budget proposal by putting several programs on the chopping block, including the Affordable Care Act.
But a drive to cap medical malpractice awards has faltered before a GOP-controlled committee, though cuts to Medicaid and a popular program that provides health coverage to children have advanced through a panel responsible for federal health programs.
Still, it may not be enough. And if the party's broader budget plan sinks, the effort may fade.
The strategy behind the work is to increase support for the budget, a nonbinding measure that sets a more than $1.1 trillion overall cap next fiscal year for the operating budgets of federal agencies. Beyond the appropriations cap, the measure calls for sweeping spending cuts to benefit programs like Medicaid, the healthcare law, and food stamps.
So far, the idea of the so-called "sidecar" spending cuts hasn't swayed conservatives opposing the broader budget outline over its endorsement of last year's bipartisan budget pact between Obama and the GOP-controlled Congress.
The situation amounts to a black eye for House Republicans and their new leader, Speaker Paul Ryan. Just three years ago, House Republicans lashed out at a Democratic-controlled Senate for failing to adopt a budget and forced through a temporary law that would have cut off the paychecks of lawmakers if they failed to pass a budget.
"When I grew up in Wisconsin, if you had a job and you did the work, then you got paid. If you didn't do the work you didn't get paid. It's that simple," Ryan said at the time. "All we're saying is: 'Congress, follow the law. Do your work. Budget.' "
The "No Budget, No Pay" law has lapsed, however, and for the first time since taking over the House in 2011, Republicans are at risk of failing to do a budget. If the broader but nonbinding budget plan remains stalled, the sidecar idea is likely to get scrapped, several GOP aides said.
Republicans have never sought to actually implement the most controversial cuts they've proposed, such as transforming Medicare into a voucher-like program for future retirees or sweeping cuts to Medicaid health coverage for the poor, elderly and disabled.
Instead, when proposing real, concrete spending savings. Republicans have gone after many of the same targets time after time, opting for cuts that are politically easy for GOP lawmakers. And that's the case now with the two committees that have already approved their share of the 10-year, $140 billion in cuts called for by House GOP leaders.
The tax-writing Ways and Means Committee and the Energy and Commerce panel have weighed in with cuts to a prevention fund established by the Affordable Care Act and a move to reclaim Obamacare subsidies from people whose income has unexpectedly increased. A temporary increase in the government's contribution to a popular healthcare program for children from lower-income families would be repealed.
The tax panel also would require taxpayers claiming the refundable portion of the $1,000 child tax credit to claim it by filing their taxes with a Social Security number rather than an ID number commonly used by immigrants working illegally, saving $20 billion over the coming decade.
But an effort to save $44 billion by putting restrictions on medical malpractice awards unraveled in the Judiciary Committee last month. The measure was estimated to generate savings because doctors would be less likely to perform "defensive medicine."
The Judiciary measure would have placed a $250,000 cap on noneconomic damages and established new guidelines for punitive damages. That drew opposition from some panel Republicans, even though similar legislation has passed in prior years.
"What this legislation does is goes and tells 15 states that since you do not have a limit on punitive damages, we are going to impose a limit on punitive damages in your state whether you like it or not," said Rep. Ted Poe, R-Texas, an opponent of the measure.
Meanwhile, the chairman of the Agriculture Committee is delaying cuts to food stamps until the broader budget blueprint is passed.
"I'm going to wait until there's a deal," said Agriculture Committee Chairman Mike Conaway, R-Texas. He added that there was no reason to "create a furor and have an argument with a bunch of folks" if the effort is going nowhere.
The Agriculture panel has jurisdiction over food stamps and farm subsidies and while Conaway wouldn't say, it's likely he would seek cuts to food stamps. That would draw intense opposition from Democrats whose support he'll want when writing a future farm bill.
Rep. Jeb Hensarling, R-Texas, chairman of the Financial Services Committee, has been silent about his plans, but he's likely to opt to eliminate a provision from the 2010 Dodd-Frank financial system overhaul. That provision provides the Federal Deposit Insurance Corp. with a line of credit with the Treasury that it could tap to orderly liquidate non-banks whose failure might harm the financial system. The move could save about $20 billion over 10 years.