Trump puts Mike Johnson in a bind on health care

House Speaker Mike Johnson is starting off the new year in a familiar, uncomfortable predicament:The Louisiana Republican faces a shrinking majority, a loss of control over the legislative agenda, and pressure from President Trump to embrace an issue many in the GOP want to avoid. Why it matters: Trump is urging Republicans to make health care their issue and to be "flexible" on long-standing red lines. But many Republicans see health care as a losing issue for the party, especially in the 2026 midterms. Driving the news: Trump told House Republicans at their policy retreat Tuesday that health care has "never been our issue, it should be our issue," urging them to soften demands for expanded Hyde Amendment protections.The vast majority of House Republicans oppose extending Affordable Care Act tax credits without Hyde protections, which bar the use of federal funds for abortions. It's become a major sticking point in ACA negotiations. "This is a well settled principle of ours," Johnson said in a press conference in early December. "We do believe in the sanctity of human life and think it's important that tax payer dollars not fund abortion." But Trump's push to back off the Hyde fight could pressure some Republicans to relent.State of play: The House is expected to pass an extension of the ACA tax credits Thursday, with no additional Hyde protections, after four swing district Republicans in December joined Democrats in signing a discharge petition.It has no clear path to becoming law right now, but a group of senators hopes it can be used as a vehicle for a bipartisan bill to send back to the House.The big picture: A growing strain of Republicans are pointing to jarring internal polling indicating that health care is unfriendly turf for the party. The GOP polling firm GrayHouse has shared polling with Senate Republicans that shows:Just 31% said Republicans do a better job than Democrats in handling health care.Only 38% said they approve of how Trump deals with the issue.36% said Republicans are to blame for rising health care costs, compared to 26% for Democrats.What they're saying: "Our polling shows that if healthcare is the main focus of 2026, Republicans are likely to fare poorly in the midterms," GrayHouse founder Landon Wall told Axios in December.Another plugged-in Republican involved in midterm strategy told Axios that if "2026 becomes a 'healthcare election'...we will deserve the midterm catastrophe that follows."The other side: Republicans facing tough reelection bids say health care can't just be ignored. They are facing an avalanche of attacks from Democrats who are accusing them of doing nothing to lower costs."Healthcare is not going away, even if people wish it away." Rep. Mike Lawler (R-N.Y.), one of the four Republicans to sign the Democratic discharge petition to extend the ACA subsidies, told Axios.Behind the scenes, GOP members and aides say there is widespread doubt that leadership could assemble a second reconciliation bill on health care — let alone push it across the finish line — when members will be increasingly preoccupied with re-election.Between the lines: Johnson can now only lose two votes on party-line legislation, assuming full attendance. Rep. Marjorie Taylor Greene (R-Ga.) officially resigned from Congress on Monday night.Rep. Doug LaMalfa (R-Calif.), 65, died unexpectedly on Monday.And Rep. James Baird (R-Ind.) will be out of commission for several weeks after being in a car accident.The bottom line: Health care as an issue has dogged Republicans for more than a decade.Republicans capitalized on voter unease over the Affordable Care Act to capture the House majority in the 2010 midterms.But perceptions that the party wasn't doing enough to address rising costs has hampered them electorally ever since — including in 2018, when the GOP lost the speaker's gavel.