WASHINGTON (AP) — House Republicans have revealed the cornerstone of President Donald Trump's ambitious legislative agenda, proposing cuts exceeding $880 billion, primarily targeting Medicaid, to offset the substantial cost of $4.5 trillion in tax reductions.

The legislation, which is hundreds of pages long and was shown late Sunday, is causing the biggest political fight about healthcare 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.

While Republicans maintain their efforts are solely aimed at eradicating "waste, fraud, and abuse" to yield fiscal savings through revised work and eligibility criteria, Democrats caution that millions of Americans face the prospect of losing their healthcare coverage.

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

Democrats, however, decried the cuts as egregious and fundamentally a further endeavour to dismantle the Affordable Care Act.

"Millions of Americans stand to lose their health care coverage unequivocally," stated Representative Frank Pallone of New Jersey, the ranking Democrat on the committee. He asserted that "should this bill be enacted, hospitals will face closure, seniors will find it difficult to access essential care, and millions will experience an increase in their insurance premiums."

As Republicans aim to pass Trump's large bill of tax cuts and spending reductions by Speaker Mike Johnson's Memorial Day deadline, they plan to have many public hearings this week, happening all the time, about different parts before they are combined into a big package.

The political landscape ahead appears unpredictable.

In an article on Monday, Republican Senator Josh Hawley from Missouri told his colleagues that reducing healthcare to pay for tax cuts would be "morally wrong and politically very bad."

Overall, eleven House committees have been drafting their portions of the package as Republicans aim for at least $1.5 trillion in fiscal reductions to help offset the expense of maintaining the 2017 tax cuts, which were enacted during Trump’s initial term and are set to expire by year-end.

However, the important Energy and Commerce Committee has been watched closely. The committee was told to find $880 billion in savings and they did, mostly by cutting healthcare costs, but also by stopping green energy programs started by Biden. The first analysis by the CBO said the committee's ideas would lower the deficit by $912 billion over ten years, with at least $715 billion coming from healthcare.

Key to the savings are modifications to Medicaid, which furnishes nearly free health care to over 70 million Americans, and the Affordable Care Act, which has broadened its coverage to millions more in the fifteen years since its initial endorsement.

To qualify for Medicaid, able-bodied adults without dependents would be subject to novel "community engagement requirements," mandating a minimum of 80 hours per month dedicated to employment, education, or service. Furthermore, individuals would be compelled to re-verify their program eligibility semi-annually, as opposed to the current annual requirement. The legislation additionally institutes a more stringent income verification process for those enrolling in the Affordable Care Act's healthcare coverage.

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 office to prove their income in person. But Republicans argue that this will make sure the program only goes to people who are eligible.

Additionally, some individuals receiving Medicaid whose income surpasses 100% of the federal poverty line – approximately $32,000 annually for a household of four – would face mandatory out-of-pocket expenses for certain healthcare services. These charges, excluded for emergency room visits, prenatal and paediatric care, and routine primary care appointments, would have a ceiling of $35 per appointment.

Furthermore, candidates with residences appraised above one million dollars would be ineligible for Medicaid.

Also, the planned law is aimed at immigrants living in the country illegally or without documents. It will cut by 10% the money the government gives to states, like New York or California, that let these immigrants join Medicaid. To get ACA coverage, people would need to show they are legally in the country.

Other actions would transfer financial burdens onto all states.

Numerous states have augmented their Medicaid enrolment due to federal inducements, 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 means the federal government pays more money, which people who disagree say is a way for states to unfairly increase their budgets.

While the energy sections of the bill are much briefer, they propose repealing climate policies enacted by President Biden through the Inflation Reduction Act.

It suggests withdrawing financial support for various energy loans and investment initiatives, simultaneously offering faster approval for the development of natural gas and oil pipelines.