WASHINGTON (AP) — House Republicans have presented the main cost-saving component of President Donald Trump’s significant healthcare legislation, comprising at least $880 billion in reductions, primarily to Medicaid, intended to offset the expense of $4.5 trillion in tax cuts.

The long document of laws, shown late on Sunday, has started the biggest political argument about health care since Republicans tried and failed to get rid of and change the Affordable Care Act, also called Obamacare, when Trump was first president in 2017.

Republicans argue their aim is to eliminate inefficiency and deceit to create savings through revised work and eligibility criteria, while Democrats caution that this could result in millions of Americans losing their health coverage; a preliminary assessment from the non-aligned Congressional Budget Office projected the proposals would decrease the number of insured individuals by 8.6 million over ten years.

These savings mean we can use this bill to continue the Trump tax cuts and keep the Republican promise to working middle-class families, said Representative Brett Guthrie of Kentucky, the Republican chairman of the Energy and Commerce Committee, which is in charge of health care spending.

However, Democrats characterised the cuts as reprehensible and fundamentally constituting another attempt to annul Obamacare.

"Millions of Americans will definitively lose their health care coverage," stated Representative Frank Pallone of New Jersey, the ranking Democrat on the committee. He predicted that "hospitals will cease operations, elderly individuals will be unable to obtain necessary care, and premiums will increase for millions of people if this bill is enacted."

Republicans are trying to pass Trump's large bill of tax cuts and spending changes by House Speaker Mike Johnson's Memorial Day deadline. This week, they plan to have many public meetings all day and night about different parts of the bill before putting them together into one big plan.

The political landscape ahead appears unpredictable.

Senator Josh Hawley, a Republican from Missouri, cautioned his fellow politicians in an opinion piece on Monday that reducing healthcare funding to finance tax reductions would be "ethically indefensible and politically disastrous."

In total, eleven committees in the House have been putting together their parts of the plan because Republicans want to save at least $1.5 trillion. This money will help pay for keeping the 2017 tax cuts, which were agreed on when Trump was president and will end at the end of this year.

However, the influential Energy and Commerce Committee has drawn particular attention. Tasked with identifying $880 billion in savings, the committee achieved this objective, largely through reductions in healthcare spending, but also by reversing environmental initiatives introduced during the Biden administration. Initial projections from the Congressional Budget Office indicated the committee's proposals would decrease the deficit by $912 billion over ten years, with at least $715 billion of this attributable to healthcare measures.

The main way they are saving 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 was first approved 15 years ago and has since grown to cover millions more people.

To get Medicaid, able-bodied adults without children would need to meet new "community engagement requirements." This means they would have to work, study, or volunteer for at least 80 hours each month. Also, people would need to prove they are still eligible for the program twice a year instead of once. The new rule also makes it harder to check income for those who sign up for health care through the Affordable Care Act.

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

Some people on Medicaid who earn more than the federal poverty level, which is about $32,000 a year for a family of four, might have to pay some costs themselves for certain services. These payments would not be for emergency room visits, care before a baby is born, doctor visits for children, or regular check-ups with a primary doctor. The most they would have to pay is $35 for each visit.

Furthermore, individuals whose residences are appraised at over $1 million were ineligible for Medicaid.

The planned law also focuses on immigrants living in the country without papers. It would cut the money the federal government gives to states like New York or California by 10% if they let these immigrants join Medicaid. To get the ACA health coverage, people would need to show they are legally allowed to be here.

Other measures would reallocate expenses to all states.

Numerous states have enlarged their Medicaid rolls due to federal inducements, but the proposed legislation would discontinue a 5% increase implemented during the COVID-19 pandemic.

They would stop using the provider tax, which some states use to help pay for a big part of their Medicaid programs. This extra tax often makes the federal government pay more, and people who don't like it say it's a way for states to unfairly increase their money.

The sections of the legislation pertaining to energy are considerably shorter, yet they incorporate the reversal of climate change policies enacted by President Joe Biden through the Inflation Reduction Act.

It suggests withdrawing funding for various energy loan and investment schemes, alongside accelerating the approval process for natural gas extraction and oil pipelines.