特朗普盟友考虑在税收立法中改革医疗补助、食品券

【中美创新时报2024 年 11 月 19 日编译讯】（记者温友平编译）当选总统唐纳德·特朗普的经济顾问和国会共和党人已经开始初步讨论对医疗补助、食品券和其他联邦安全网计划进行重大修改，以抵消明年延长特朗普 2017 年减税政策的巨额成本。《华盛顿邮报》记者Jacob Bogage、Jeff Stein 和 Dan Diamond 对此作了下述报道。

据七位知情人士透露，共和党议员和助手正在讨论的选项包括新的工作要求和计划的支出上限，其中许多人不愿透露姓名，因为他们无权公开发言。这些人士说，这些对话包括特朗普过渡团队的一些经济官员。

然而，一些共和党人非常担心此类减税政策的政治负面影响，因为这将影响至少 7000 万低收入美国人的支持计划，一些熟悉谈判情况的人士强调，谈判还处于初步阶段。

“我认为，仅仅通过一项在纸面上显示赤字增加的减税延期法案，并不难，”一位共和党税务顾问表示。“但另一方面，你开始增加一些措施来减少赤字，这在政治上就更具挑战性。”

讨论的焦点是特朗普 2017 年的税收法案，该法案降低了绝大多数美国人的税收。根据国会簿记员的说法，该法案的大部分内容将于明年年底到期，而特朗普提议延长这些条款，将在未来十年内使本已飙升的国家债务增加 4 万亿美元以上。现在的债务超过 36 万亿美元。特朗普还在竞选中提出了一系列新的减税措施，例如取消小费和加班税，这些措施将使总成本增加数万亿美元。

虽然共和党领导人支持延长减税措施，但许多人担心由此造成的收入损失将进一步增加借贷，因此他们开始寻找节省资金的方法：除了社会安全网计划外，许多共和党人还希望重新利用民主党批准的清洁能源资金。特朗普的关税计划也可能增加额外收入。但这些想法可能行不通，或不足以完全说明一项全面的新税收方案的成本。

共和党人警告说，随着《平价医疗法案》的扩大，医疗补助支出激增，称该计划的结构给联邦预算带来了巨大压力。虽然各州管理该计划，但联邦政府提供配套付款，对其进行大量补贴。

众议院预算委员会主席、德克萨斯州共和党人乔迪·阿灵顿周三告诉记者，对医疗补助福利实行“负责任和合理的工作要求”，类似于食品券现有的要求，可以节省约 1000 亿美元。他还表示，每年多次检查医疗补助资格，可以再减少 1600 亿美元的成本。

“我觉得有些常识性、合理的事情，几乎 90% 的美国人会说，‘这必须改变’，”阿灵顿说。

一家有影响力的保守派智库 Paragon Health Institute 在 7 月份发表了一份论文，概述了一些额外的医疗补助变化，该研究所表示，这些变化将在十年内减少 5000 多亿美元的联邦赤字。

立法者表示，共和党人还在讨论剥夺总统重新计算补充营养援助计划（即所谓的 SNAP 食品券计划）福利的权力。2017 年的农业法案允许白宫增加福利，即使这样做会增加国家债务。共和党人认为，如果他们取消这一权力并限制 SNAP 福利（这些福利会随着通货膨胀而自动增加），根据一些估计，这应该算作减少了数百亿美元的赤字。

限制 SNAP 受助人可以用福利购买的食品也会降低成本。众议院共和党人在最近的支出法案中提出了类似的提议。

一位共和党税务顾问表示，立法者正在考虑扩大 SNAP 资格的工作要求，这是保守派传统基金会 2025 项目剧本所建议的。

共和党长期以来一直否认他们试图减少低收入美国人享受的医疗补助或食品券福利。他们将自己的努力描述为减少浪费和不必要的支出，认为精简计划将保留政府福利，而不是惩罚使用这些福利的人。

上一次共和党控制国会和白宫两院时，也就是特朗普第一任期的前两年，他们在参议院以一票之差废除了《平价医疗法案》，即使在共和党控制的州，削减医疗补助支出的计划也遭到了强烈反对。超过 7000 万人通过医疗补助获得医疗福利。根据无党派的国会预算办公室的预测，参议院在 2017 年考虑的一项计划将使医疗补助的参保人数减少 1500 万人，其中大多数人不太可能找到替代医疗保险。

一些保守派人士抱怨说，民主党人开始重演那些斗争中的策略，在特朗普上任之前，他们努力通过关注共和党控制地区的参保人数来巩固对医疗补助的政治支持。选民对共和党削减医疗保健保护措施的努力感到愤怒，这推动民主党人在 2018 年中期选举中取得重大胜利。

“你必须看看他们提议的细节，但其中大部分不是通过阻止浪费来实现节约的，而是通过设置大量繁文缛节阻止符合条件的人成功报名，”左翼智库美国进步中心联邦预算政策高级主任 Bobby Kogan 表示。“我们看到，在一些尝试过这种做法的州，相当一部分符合条件的人口无法成功报名，没有医疗保健。”

如果国会拒绝降低医疗补助支出，共和党人可能还是会削减。虽然特朗普在 2016 年总统竞选期间曾誓言要保护医疗补助计划，但特朗普的第一届政府允许 13 个共和党领导的州在其医疗补助计划中增加工作要求，这一有争议的变化是法律纠纷的焦点。这些要求仅在阿肯色州一个州全面生效，为期五个月，约有 18,000 人被取消了该计划。

拜登政府撤销了对这些州工作要求的批准，自由派援引证据表明这些举措带来了新的行政负担，并认为这危及了参保者的健康。但现任和前任官员表示，新特朗普政府可能会再次发布豁免，允许各州对参保者施加工作要求。

支持这一想法的人包括前路易斯安那州州长鲍比·金达尔 (Bobby Jindal)，一些共和党人推选他为特朗普新政府的重要职位候选人，他长期以来一直批评医疗补助计划的结构臃肿且效率低下。

题图：当选总统唐纳德·特朗普。Anna Moneymaker/摄影师：Anna Moneymaker/Ge

附原英文报道：

Trump allies eye overhauling Medicaid, food stamps in tax legislation

By Jacob Bogage, Jeff Stein and Dan Diamond The Washington Post,Updated November 18, 2024 

President-elect Donald Trump.Anna Moneymaker/Photographer: Anna Moneymaker/Ge

President-elect Donald Trump’s economic advisers and congressional Republicans have begun preliminary discussions about making significant changes to Medicaid, food stamps, and other federal safety net programs to offset the enormous cost of extending Trump’s 2017 tax cuts next year.

Among the options under discussion by GOP lawmakers and aides are new work requirements and spending caps for the programs, according to seven people familiar with the talks, many of whom spoke on the condition of anonymity because they were not authorized to speak publicly. Those conversations have included some economic officials on Trump’s transition team, the people said.

However, concern is high among some Republicans about the political downsides of such cuts, which would affect programs that provide support for at least 70 million low-income Americans, and some people familiar with the talks stressed that discussions are preliminary.

“I don’t think that passing just an extension of tax cuts that shows on paper an increase in the deficit [is] going to be challenging,” said one GOP tax adviser. “But the other side of the coin is, you start to add things to reduce the deficit, and that gets politically more challenging.”

The discussions center on Trump’s 2017 tax bill, which lowered taxes for the vast majority of Americans. Major portions of that law are set to expire at the end of next year, and extending those provisions, as Trump has proposed, would add more than $4 trillion to the already soaring national debt over the next decade, according to congressional bookkeepers. The debt exceeds $36 trillion now. Trump also campaigned on a bevy of new tax cuts, such as ending taxes on tips and overtime, which tack trillions more onto the overall price tag.

While Republican leaders support extending the tax cuts, many are concerned that the resulting loss of revenue would further increase borrowing, so the hunt for savings is on: In addition to social safety net programs, many Republicans are also looking to repurpose clean-energy funds approved by Democrats. Trump’s tariff plans could also raise additional revenue. But those ideas may prove unworkable or insufficient to fully account for the cost of a sweeping new tax package.

Republicans warn that Medicaid spending has ballooned in the wake of the Affordable Care Act’s expansion, saying that the program’s structure puts outsize pressure on the federal budget. While states administer the program, the federal government provides matching payments that heavily subsidize it.

House Budget Committee chairperson Jodey Arrington, a Texas Republican, told reporters Wednesday that a “responsible and reasonable work requirement” for Medicaid benefits resembling the one that already exists for food stamps could yield about $100 billion in savings. He also said another $160 billion in reduced costs could come from checking Medicaid eligibility more than once per year.

“I feel like there are some common sense, reasonable things, that almost 90 percent of the American people would say, ‘That’s got to change,’ ” Arrington said.

One influential conservative think tank, the Paragon Health Institute, published a July paper outlining some additional Medicaid changes that it said would cut federal deficits by more than $500 billion over a decade.

Republicans are also discussing stripping presidential authority to recalculate benefits for the Supplemental Nutrition Assistance Program, the food stamp program known as SNAP, lawmakers say. The 2017 farm bill allowed the White House to increase benefits even if doing so raised the national debt. Republicans argue that if they eliminate that authority and hemmed in SNAP benefits, which increase automatically with inflation, that should count as reducing the deficit by tens of billions of dollars, according to some estimates.

Limiting what food items that SNAP recipients can purchase with benefits would also reduce costs. House Republicans have pushed a similar proposal in recent spending bills.

One GOP tax adviser said lawmakers were looking at broadening work requirements for SNAP eligibility, something the conservative Heritage Foundation’s Project 2025 playbook recommends.

Republicans have long denied that they are trying to reduce benefits for low-income Americans on either Medicaid or food stamps. They have framed their efforts as an attempt to reduce wasteful and unnecessary spending, arguing that streamlining the programs would preserve government benefits, not penalize people who use them.

The last time Republicans controlled both branches of Congress and the White House, in the first two years of Trump’s first term, they came within one Senate vote of repealing the Affordable Care Act, amid a significant backlash even in GOP-controlled states to plans to cut Medicaid spending. More than 70 million people receive health benefits through Medicaid. One plan considered by the Senate in 2017 would have lowered Medicaid enrollment by 15 million people, with most of them unlikely to find alternate health coverage, according to projections by the nonpartisan Congressional Budget Office.

Some conservatives are grumbling that Democrats are beginning to rerun their strategies from those battles, working to shore up political support for Medicaid before Trump can take office by calling attention to the number of enrollees in GOP-controlled districts. Voter anger at GOP efforts to roll back health-care protections helped propel Democrats to major victories in the 2018 midterm elections.

“You’ll have to see the details of what they’re proposing, but most of these achieve their savings not by stopping waste but instead by preventing eligible people from successfully signing up by creating so much red tape,” said Bobby Kogan, senior director of federal budget policy at the Center for American Progress, a left-leaning think tank. “What we’ve seen in some states that have tried this is a significant portion of the eligible population unable to successfully enroll, without health care.”

If Congress balks at lowering Medicaid spending, Republicans may be able to reduce it anyway. While Trump vowed to protect Medicaid as a candidate during his 2016 presidential bid, the first Trump administration allowed 13 GOP-led states to add work requirements to their Medicaid programs, a controversial change that was the focus of legal battles. The requirements only took full effect in one state, Arkansas, for a five-month period when about 18,000 people were dropped from the program.

The Biden administration rescinded approval for those states’ work requirements, with liberals citing evidence that the initiatives created new administrative burdens and arguing that it jeopardized enrollees’ health. But the new Trump administration could again issue waivers that allow states to impose work requirements on enrollees, say current and former officials.

Supporters of the idea include Bobby Jindal, a former Louisiana governor whom some Republicans have pushed as a candidate for a major role in Trump’s new administration and who has long criticized Medicaid’s structure as bloated and inefficient.