Congressional Republicans are feeling growing pressure to show progress on healthcare.

Modern Healthcare: Divisions sharpened last week between hard-right and more pragmatic Republicans over both policy and strategy for repealing and replacing the Affordable Care Act.

Those differences—along with the apparently slow progress in drafting actual legislation that could be scored by the Congressional Budget Office on cost and coverage impact—underscore the tough struggle Republicans face in dismantling Obamacare and establishing an alternative system.

One of their biggest disagreements is over the future of the ACA's expansion of Medicaid coverage to more than 10 million low-income adults. Conservatives want to eliminate it while a number of GOP senators and governors want to keep that coverage.

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