共和党推行的HR 1法案由特朗普于2025年7月4日签署1，将于2027年1月1日生效1。该法案对联邦医疗支出进行约1万亿美元的削减1。
根据新规，约2000万医疗补助受益人（仅限44个扩展州的扩展人口）需要证明每月工作80小时或每月收入580美元，才能保持保险资格1。此外，追溯性医疗补助覆盖期限将从三个月缩减至两个月或一个月1。
这些变化预计将带来广泛影响。研究显示，到2034年前，约1700万人将因此新增无保险1，同时产生2780亿美元的医疗未偿债务1。美国儿科学会主席Andrew Racine医生表示，"家庭和整个社会的成本无法高估"1。医学债务专家Luke Messac医生则指出，"最简单的方式就是把人们从医疗补助中赶出去，让他们无保险和无保护"1。
A Republican-backed bill signed by President Trump on July 4, 2025, will impose sweeping changes to Medicaid beginning January 1, 2027, affecting approximately 20 million beneficiaries 1. The HR 1 legislation will cut roughly $1 trillion from federal healthcare spending and introduce strict work requirements, mandating that recipients in the 44 states that have expanded Medicaid demonstrate either 80 hours of monthly work or $580 in monthly income 1.
The changes will also reduce retroactive Medicaid coverage from three months to either two months or one month 1. According to projections, these measures could leave an estimated 17 million additional Americans uninsured by 2034 and generate approximately $278 billion in unpaid medical debt over the same period 1.
Dr. Andrew Racine, president of the American Academy of Pediatrics, warned that "the costs to families and society as a whole cannot be overstated" 1. Medical debt expert Dr. Luke Messac characterized the approach more bluntly, stating that "the simplest way is to just kick people off Medicaid, leave them uninsured and unprotected" 1.
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