众议院共和党人公布医疗补助削减计划，民主党人警告称，这将导致数百万人得不到医疗服务
【中美创新时报2025 年 5 月 12 日编译讯】（记者温友平编译）众议院共和党人公布了唐纳德·特朗普总统“宏伟而美丽的法案”的成本节约核心内容，即削减至少 8800 亿美元，主要用于医疗补助，以帮助弥补 4.5 万亿美元减税的成本。美联社记者丽莎·马斯卡罗对此作了下述报道。
周日晚些时候公布的这项长达数百页的法案引发了自共和党在 2017 年特朗普第一任期内试图废除并取代《平价医疗法案》（即奥巴马医改）但未能成功以来，医疗保健领域最大的政治斗争。
尽管共和党坚称，他们只是在根除“浪费、欺诈和滥用”，通过新的就业和资格要求来节省开支，但民主党警告称，数百万美国人将失去医保。无党派机构国会预算办公室的初步估计显示，这些提案将导致未来十年医疗保健覆盖人数减少860万。
负责医疗支出的能源和商业委员会共和党主席、肯塔基州众议员布雷特·格思里表示：“这样的节省使我们能够利用这项法案来延续特朗普的减税政策，并兑现共和党对辛勤工作的中产阶级家庭的承诺。”
但民主党人表示，这些削减是“可耻的”，本质上是又一次试图废除奥巴马医改。
“毫无疑问，数百万美国人将失去医疗保险，”该委员会的民主党领袖、新泽西州众议员弗兰克·帕隆说道。他表示：“如果这项法案获得通过，医院将关闭，老年人将无法获得所需的医疗服务，数百万人的保费将上涨。”
共和党人正努力赶在众议院议长迈克·约翰逊设定的阵亡将士纪念日最后期限前通过特朗普提出的大规模减税和削减开支法案，他们准备在本周就各个部分举行全天候公开听证会，然后再将这些部分整合成一个庞大的一揽子计划。
未来的政治局势充满不确定性。十多位众议院共和党人已告知约翰逊和共和党领导人，他们不会支持削减美国居民赖以生存的医疗保障计划。特朗普本人也避免重蹈第一任期覆辙，誓言不会削减医疗补助计划。
总而言之，众议院的 11 个委员会一直在编制一揽子计划的各个部分，因为共和党寻求节省至少 1.5 万亿美元的资金，以帮助支付保留 2017 年税收减免的成本，这些减免是在特朗普第一任期内批准的，并将于今年年底到期。
但权力强大的能源和商务委员会一直是最受关注的机构之一。该委员会被指示提出8800亿美元的节支方案，并实现了这一目标，主要通过削减医保支出，同时也撤销了拜登时代的绿色能源项目。国会预算办公室的初步分析显示，该委员会的提案将在未来十年内减少9120亿美元的赤字，其中至少7150亿美元来自医保支出。
节省开支的核心是对医疗补助计划（Medicaid）和《平价医疗法案》（Affordable Care Act）的改革，前者为 7000 多万美国人提供几乎免费的医疗服务，后者自首次批准以来的 15 年里不断扩大，覆盖了数百万美国人。
要获得医疗补助 (Medicaid) 资格，将新增“社区参与要求”，即无受抚养人且身体健全的成年人每月至少需要工作、接受教育或服务 80 小时。此外，人们每年还必须验证两次才能获得该计划的资格，而不是一次。
这可能会导致该计划的人员流失，并给人们继续享受保障带来障碍，尤其是当他们不得不驱车前往当地福利办公室亲自核实收入时。但共和党人表示，这将确保该计划只惠及符合条件的人群。
由于联邦政府的激励措施，许多州扩大了医疗补助名额，但该法案将削减新冠疫情期间实施的5%的增幅。联邦政府将禁止向各州提供未出示公民身份证明的移民的资金。
一些州将冻结所谓的医疗服务提供者税，该税款用于支付其医疗补助计划的大部分费用。这项额外税收通常会导致联邦政府支付金额增加，批评人士称，这是一个漏洞，会导致医疗体系滥用。
该法案中有关能源部分的页数要少得多，但包括撤销总统乔·拜登在《通胀削减法案》中签署的气候变化战略。
该法案提议撤销一系列能源贷款和投资计划的资金，同时加快天然气开发和石油管道的许可。
题图：众议院议长迈克·约翰逊。罗德·兰基/美联社
附原英文报道：
House Republicans unveil Medicaid cuts that Democrats warn will leave millions without care
By LISA MASCARO The Associated Press,Updated May 12, 2025
Speaker of the House Mike Johnson.Rod Lamkey/Associated Press
WASHINGTON (AP) — House Republicans have unveiled the cost-saving centerpiece of President Donald Trump’s “big, beautiful bill,” at least $880 billion in cuts largely to Medicaid to help cover the cost of $4.5 trillion in tax breaks.
Tallying hundreds of pages, the legislation revealed late Sunday is touching off the biggest political fight over health care since Republicans tried but failed to repeal and replace the Affordable Care Act, or Obamacare, during Trump’s first term in 2017.
While Republicans insist they are simply rooting out “waste, fraud and abuse” to generate savings with new work and eligibility requirements, Democrats warn that millions of Americans will lose coverage. A preliminary estimate from the nonpartisan Congressional Budget Office said the proposals would reduce the number of people with health care by 8.6 million over the decade.
“Savings like these allow us to use this bill to renew the Trump tax cuts and keep Republicans’ promise to hardworking middle-class families,” said Rep. Brett Guthrie of Kentucky, the GOP chairman of the Energy and Commerce Committee, which handles health care spending.
But Democrats said the cuts are “shameful” and essentially amount to another attempt to repeal Obamacare.
“In no uncertain terms, millions of Americans will lose their health care coverage,” said Rep. Frank Pallone of New Jersey, the top Democrat on the panel. He said “hospitals will close, seniors will not be able to access the care they need, and premiums will rise for millions of people if this bill passes.”
As Republicans race toward House Speaker Mike Johnson’s Memorial Day deadline to pass Trump’s big bill of tax breaks and spending cuts, they are preparing to flood the zone with round-the-clock public hearings this week on various sections before they are stitched together in what will become a massive package.
The politics ahead are uncertain. More than a dozen House Republicans have told Johnson and GOP leaders they will not support cuts to the health care safety net programs that residents back home depend on. Trump himself has shied away from a repeat of his first term, vowing there will be no cuts to Medicaid.
All told, 11 committees in the House have been compiling their sections of the package as Republicans seek at least $1.5 trillion in savings to help cover the cost of preserving the 2017 tax breaks, which were approved during Trump’s first term and are expiring at the end of the year.
But the powerful Energy and Commerce Committee has been among the most watched. The committee was instructed to come up with $880 billion in savings and reached that goal, primarily with the health care cuts, but also by rolling back Biden-era green energy programs. The preliminary CBO analysis said the committee’s proposals would reduce the deficit by $912 billion over the decade — with at least $715 billion coming from the health provisions.
Central to the savings are changes to Medicaid, which provides almost free health care to more than 70 million Americans, and the Affordable Care Act, which has expanded in the 15 years since it was first approved to cover millions more.
To be eligible for Medicaid, there would be new “community engagement requirements” of at least 80 hours per month of work, education or service for able-bodied adults without dependents. People would also have to verify their eligibility to be in the program twice a year, rather than just once.
This is likely to lead to more churn in the program and present hurdles for people to stay covered, especially if they have to drive far to a local benefits office to verify their income in person. But Republicans say it’ll ensure that the program is administered to those who qualify for it.
Many states have expanded their Medicaid rosters thanks to federal incentives, but the legislation would cut a 5% boost that was put in place during the COVID-19 pandemic. Federal funding to the states for immigrants who have not shown proof of citizenship would be prohibited.
There would be a freeze on the so-called provider tax that some states use to help pay for large portions of their Medicaid programs. The extra tax often leads to higher payments from the federal government, which critics say is a loophole that creates abuse in the system.
The energy portions of the legislation run far fewer pages, but include rollbacks of climate-change strategies President Joe Biden signed into law in the Inflation Reduction Act.
It proposes rescinding funds for a range of energy loans and investment programs while providing expedited permitting for natural gas development and oil pipelines.
