WASHINGTON (AP) — House Republicans have presented a key cost-cutting proposal of President Donald Trump’s significant healthcare bill, involving reductions of at least $880 billion, primarily to Medicaid, aimed at partially offsetting the cost of $4.5 trillion in tax cuts.

The long law, which came out late Sunday and is hundreds of pages long, has started the biggest political argument about health care since Republicans tried but could not get rid of and replace the Affordable Care Act, also called Obamacare, when Trump was first president in 2017.

Republicans say they are just getting rid of "waste, fraud, and abuse" to save money with new rules about working and who can get benefits. But Democrats warn that millions of Americans could lose their health insurance. A first report from the nonpartisan Congressional Budget Office estimated that these plans would mean 8.6 million fewer people have health care over the next ten years.

These savings mean we can use this bill to continue the Trump tax cuts and keep the promise Republicans made to working middle-class families," said Rep. Brett Guthrie of Kentucky, the Republican chairman of the Energy and Commerce Committee, which deals with health care spending.

However, Democrats characterized the proposed reductions as "disgraceful" and asserted they fundamentally constitute a further effort to dismantle the Affordable Care Act.

"Millions of Americans stand to lose their health care coverage unequivocally," stated Rep. Frank Pallone of New Jersey, the leading Democrat on the panel. He contended that "hospitals would face closure, seniors would struggle to access necessary care, and premiums for millions would escalate should this bill be enacted."

Republicans are trying to meet House Speaker Mike Johnson’s deadline by Memorial Day to pass Trump’s important bill about tax cuts and spending reductions. This week, they plan to have many public hearings all the time about different parts of the bill before they combine them into one large package.

The impending political landscape remains ambiguous.

In a Monday op-ed, Republican Senator Josh Hawley of Missouri cautioned his peers that reducing healthcare access to fund tax cuts would be "morally reprehensible and politically ruinous."

Overall, eleven committees in the House have been writing their parts of the plan because Republicans want to save at least $1.5 trillion to help pay for keeping the 2017 tax cuts, which were approved when Trump first started and will end at the end of the year.

The influential Energy and Commerce Committee has attracted significant attention, having been tasked with identifying $880 billion in fiscal improvements. It met this objective largely through reductions in healthcare expenditure, but also by rescinding environmental initiatives implemented during the Biden administration. According to an initial assessment by the Congressional Budget Office, the committee's recommendations are projected to decrease the deficit by $912 billion over ten years, with a minimum of $715 billion stemming from healthcare provisions.

The main way to save money is by changing Medicaid, which gives almost free health care to over 70 million Americans, and the Affordable Care Act. The Affordable Care Act has grown in the 15 years since it was first agreed upon and now covers millions more people.

The proposed legislation for Medicaid eligibility introduces stricter criteria, including a mandate for able-bodied adults without dependents to engage in community activities like work, education, or service for a minimum of 80 hours monthly. Furthermore, participants would be required to reconfirm their program eligibility biannually instead of annually, and the bill incorporates a more stringent process for verifying income for individuals enrolling in healthcare coverage through the Affordable Care Act.

This could mean more people leave the program and it will be harder for them to keep their coverage, especially if they have to travel a long way to a local office to show proof of their income in person. However, Republicans say this will make sure the program is only for those who are eligible.

Some Medicaid beneficiaries whose income exceeds the federal poverty level threshold – around $32,000 annually for a family of four – would also be required to contribute financially for certain services, with these out-of-pocket expenses capped at $35 per visit and excluding emergency room visits, prenatal care, paediatric consultations, and primary care check-ups.

Furthermore, applicants would be ineligible for Medicaid should their home be valued in excess of $1 million.

The planned law also affects immigrants living in the country without permission. It lowers the amount the government pays to states like New York or California by 10% if they let these immigrants join Medicaid. To get ACA coverage, people would need to show they are allowed to be in the country legally.

Other measures would redistribute the financial burden across all states.

Numerous states have enlarged their Medicaid enrollment owing to federal inducements, yet the proposed law would eliminate a 5% enhancement that was implemented during the COVID-19 pandemic.

There would be a temporary halt on the provider tax that some states use to help pay for their Medicaid programs. This extra tax often leads to more money from the federal government. Some people say this is a loophole that lets states make their budgets bigger.

The sections of the legislation concerning energy are considerably shorter, yet they contain provisions that reverse climate-change policies previously enacted by President Joe Biden in the Inflation Reduction Act.

The proposal advocates for the annulment of funding for various energy loans and investment schemes, concurrently offering accelerated permission processes for natural gas development and oil pipelines.