WASHINGTON (AP) — House Republicans have revealed the crucial cost-cutting element of President Donald Trump’s ambitious legislative proposal, involving reductions of at least $880 billion, primarily targeting Medicaid, to offset the cost of $4.5 trillion in tax concessions.

The long document of laws, shown late Sunday, is starting the biggest political argument about health care since Republicans tried but could not get rid of and change the Affordable Care Act, also called Obamacare, when Trump was first president in 2017.

Republicans contend they are eradicating "waste, fraud, and abuse" to yield cost reductions through revised work and eligibility criteria, whereas Democrats caution that millions of Americans will forfeit their coverage.

According to Rep. Brett Guthrie of Kentucky, the Republican chairman of the Energy and Commerce Committee that deals with health care costs, these savings mean we can use this bill to continue the Trump tax cuts and keep the Republican promise to working middle-class families.

Democrats, however, deemed the cuts ignominious and fundamentally an additional endeavour to overturn the Affordable Care Act.

Congressman Frank Pallone of New Jersey, the leading Democrat on the committee, unequivocally stated that millions of Americans would lose their health care coverage. He further warned that the passage of this bill would result in hospital closures, seniors being unable to obtain essential care, and increased premiums for many individuals.

As Republicans try to meet House Speaker Mike Johnson’s Memorial Day deadline to pass Trump’s large bill with tax cuts and spending reductions, they are getting ready to have many public hearings all day and night this week on different parts before they are put together into a very big package.

The future political landscape remains unpredictable.

In a Monday op-ed, Republican Senator Josh Hawley of Missouri cautioned his colleagues that reducing healthcare provisions to fund tax cuts would be both morally indefensible and politically ruinous.

Eleven committees in the House have been putting together their parts of the plan. Republicans want to save at least $1.5 trillion to help pay for keeping the 2017 tax cuts, which were approved when Trump was first president and will end by the end of the year.

However, the influential Energy and Commerce Committee has drawn considerable scrutiny.

The main way they plan to save money is by changing Medicaid, which gives very low-cost healthcare to over 70 million Americans, and the Affordable Care Act. The Affordable Care Act has grown over the past 15 years to cover millions more people.

To get Medicaid, able-bodied adults without children would have new rules called "community engagement requirements." They would need to spend at least 80 hours each month working, studying, or doing service. Also, people would have to prove they qualify for the program twice a year instead of just once. The new law also makes it harder to check income for people who join the Affordable Care Act's health care plan.

This will probably cause more problems in the program and make it harder for people to keep their coverage, especially if they have to travel far to an office to show proof of their income in person. But Republicans say it will make sure the program is only for people who are eligible.

Additionally, certain Medicaid beneficiaries whose income surpasses 100% of the federal poverty threshold – roughly $32,000 annually for a family of four – would be obliged to contribute to the cost of some healthcare services. These charges, excluding those for emergency room visits, prenatal care, paediatric appointments, and routine primary care check-ups, would not exceed $35 per consultation.

Furthermore, prospective beneficiaries were ineligible for Medicaid if their residential property exceeded a valuation of one million dollars.

Also, the new law affects immigrants living in the country without permission or papers. It lowers the amount the federal 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 legally in the country.

Other measures would redistribute expenditures across all states.

Due to federal incentives, numerous states have enlarged their Medicaid programmes, yet the proposed legislation would eliminate a 5% increase implemented during the COVID-19 pandemic.

There would be a temporary stop on the provider tax that some states use to help pay for a large part of their Medicaid programs. This extra tax often results in more money from the federal government, which critics say is a way for states to make their budgets seem bigger than they are.

While significantly shorter in length, the energy sections of the bill propose the reversal of climate change policies enacted by President Biden in the Inflation Reduction Act.

It suggests withdrawing financial support for various energy loans and investment initiatives, concurrently offering a fast-tracked approval process for natural gas projects and oil pipelines.