Lawmakers in Washington are zeroing in on a health care agreement this week, albeit a far cry from the comprehensive overhaul President Donald Trump touted last Thursday. While Trump's vision seems increasingly unlikely to pass, a more modest proposal is gaining traction.

— The Achievable Deal: After extensive negotiations at the committee level, a bipartisan consensus has emerged among congressional leaders and top appropriators. An agreement, part of a hefty $1.2 trillion government funding package, was reached early Tuesday. This plan, less ambitious than Trump's proposal, focuses on tightening regulations on pharmacy benefit managers, extending several public health programs, and allocating $4.6 billion this fiscal year for community health centers. However, the sprawling size of the bill, now over 1,000 pages, could pose a challenge for House conservatives who have previously expressed concerns about voting on expansive legislation with little lead time.

— The Elusive Grand Plan: Trump's more extensive health care affordability proposal appears to be on shaky ground. The plan faces resistance not only from Democrats, who are weary after repeated health care battles with Republicans, but also within Trump's own party. Disagreements persist over the strategic use of the budget reconciliation process, and key components of Trump’s plan, like the “most favored nation” drug pricing policy, have been particularly divisive. Speaker Mike Johnson has voiced objections to this aspect of the plan, complicating its prospects further.

— Additional Legislative Activity: As Capitol Hill buzzes with negotiations, other significant legislative movements are underway. The House is poised to tackle a critical funding bill by Friday to avert a government shutdown, with the Senate scheduled to follow suit next week. In parallel, House Majority Leader Steve Scalise is pushing for a vote on updated voter registration legislation, which now includes a photo ID requirement. Meanwhile, the Congressional Review Act may be employed for the first time to challenge mining protections on public lands, with a House Rules Committee meeting set to discuss this on Tuesday.

— Looking Forward: The developments of this week will likely shape the health care landscape and broader legislative agenda significantly. As discussions unfold and lawmakers strive to find common ground, the outcomes of these negotiations will be crucial in determining the direction of U.S. health policy and governance in the coming months.

Contributions to this report were made by Benjamin Guggenheim, Meredith Lee Hill, Jordain Carney, Calen Razor, and James Bikales.