The House voted Thursday to pass President Trump's "big, beautiful bill" after weeks of Republican infighting that repeatedly threatened to tank the GOP-only legislation.

Why it matters: It's a major step toward getting the hulking fiscal package signed into law, though the Senate is likely to make substantial changes that could be difficult for House GOP hardliners to swallow.

• The vote was 215-214.
• Two Republicans — Thomas Massie of Kentucky and Warren Davidson of Ohio — joined Democrats in voting "no," while Andy Harris of Maryland voted present.

The big picture: The bill would extend the 2017 Trump tax cuts and aims to cut $1.5 trillion in federal spending, including through Medicaid work requirements and the repeal of the Inflation Reduction Act tax credits.

• It took considerable wrangling by House Republican leadership to get to this point, with members of the right-wing House Freedom Caucus threatening to oppose it as recently as Wednesday.

State of play: The vote came after a marathon congressional session in which some lawmakers stayed up for days.

• The House Rules Committee met early Wednesday morning to markup the bill only ending late Wednesday night.
• House Democrats gummed up the works with several procedural votes, pushing the vote time back to around 6:30 am ET on Thursday.

Editor's note: This story has been updated with additional reporting.

The White House is withdrawing the nomination of Janette Nesheiwat to be surgeon general and instead nominating wellness influencer Casey Means, President Trump wrote on social media Wednesday.

Why it matters: The move is the second time the Trump administration has pulled a health nominee, following the withdrawal of Centers for Disease Control director-designate Dave Weldon in March.

• The move also elevates Means, a physician whose brother Calley Means is a White House adviser. Both Means siblings are seen as allies of Health Secretary Robert F. Kennedy Jr.

Driving the news: Nesheiwat was a Fox News contributor. She had faced questions about her credentials.

• CBS reported in April that she graduated from a medical school in the Caribbean, not the University of Arkansas, as she had claimed.
• Far-right activist Laura Loomer, who has had influence on Trump administration personnel moves before, had also attacked Nesheiwat, calling her "pro-COVID vaccine" and pointing to the credential questions.

What they're saying: "Casey has impeccable 'MAHA' credentials, and will work closely with our wonderful Secretary of Health and Human Services, Robert F. Kennedy, Jr., to ensure a successful implementation of our agenda in order to reverse the Chronic Disease Epidemic, and ensure Great Health, in the future, for ALL Americans," Trump wrote on Truth Social.

• He said Nesheiwat would work "in another capacity at HHS."

Nesheiwat was due to have a confirmation hearing before the Senate health committee on Thursday.

• The White House did not respond to a request for comment.

Editor's note: A previous image in this story misidentified an influencer who appeared on Casey Means' Instagram page as Means herself.

House Speaker Mike Johnson (R-La.) is staring down a growing rebellion from his centrist wing over cuts to Medicaid in the GOP's "big, beautiful bill."

Why it matters: Moderate and swing-district House Republicans are trying to balance their loyalty to Trump with their increasingly imperiled reelection prospects.

• Many centrists are worried that cutting programs like Medicaid too harshly could inflame the already intense backlash they are facing from constituents over DOGE cuts.

Driving the news: Rep. Don Bacon (R-Neb.) confirmed to Axios that he communicated to the White House he won't support more than $500 billion in cuts to Medicaid.

• "Those are the cuts that don't impact quality of care nor hurt hospitals. A bunch of us will have to be convinced that any other cuts won't hurt patients or hospitals," he said.
• Bacon cited a letter he and 11 other Republicans wrote to Johnson warning against "any reduction in Medicaid coverage for vulnerable populations."
• "I will not vote for any bill that cuts eligible legal people," said Rep. Jeff Van Drew (R-N.J.). "That means our working poor."

The other side: Some members of the right-wing Freedom Caucus pushed back swiftly on Bacon's proposed ceiling, arguing there needs to be sufficient spending reductions to offset tax cuts.

• "These same individuals want to keep all these green energy tax credits and ... raise the SALT cap deduction," said Rep. Eric Burlison (R-Mo.). "You can't have your cake and eat it too."
• "You're not going to get the tax cuts that the American people want ... if you're talking about those kind of low numbers, on actual reform to Medicaid," said Rep. Chip Roy (R-Texas).

Between the lines: The dynamic puts Johnson between a rock and a hard place as he tries to cobble together the roughly 218 votes he needs to pass the massive package.

• President Trump and Republicans are desperate to secure roughly $4 trillion in tax cuts, which they hope will stimulate the economy and boost their sagging poll numbers.
• The measure would also raise the debt ceiling, a key priority for Trump in order to deny Democrats potential political leverage.

State of play: House Energy and Commerce Chairperson Brett Guthrie (R-Ky.) told Axios on Monday that the GOP is looking at ways to reduce the federal contribution toward states' Medicaid expansions through the Affordable Care Act.

• "It takes away the open-ended checkbook," Guthrie said of one idea, the "per capita cap," which would place a limit on federal funding per enrollee in the Medicaid expansion.
• But the proposals would likely kick many lower-income enrollees off the Medicaid rolls, leading some moderates to oppose them.
• Rep. Mike Lawler (R-N.Y.), asked about another proposal, to lower the federal share of costs for the Medicaid expansion, replied: "I've been very clear about this. You guys keep asking the same stupid f--king question: No."
• Rep. Nick LaLota (R-N.Y.) said of the per capita cap: "My sense is that would be a cut, and I'm not in favor of that."

What's next: If the reconciliation bill passes the House, it could face an even tougher path in the Senate.

• Members like Sen. Josh Hawley (R-Mo.) have staked out a position that they oppose anything that would cut Medicaid benefits.