2026-10-15T10:00:45.119Z / https://www.cnn.com/2026/10/15/politics/trump-big-beautiful-bill-midterms
当共和党呼吁选民继续让他们掌控国会多数席位时，他们经常会提及特朗普第二届政府最重大的政策成果——这项被称为“宏伟美好法案”的税收与支出削减法案。
共和党候选人列举的主要卖点包括颇受欢迎的小费税和加班费减免，这些举措带有民粹主义吸引力，尽管多数税收减免更有可能惠及富裕美国人。
但该法案通过削减美国多项社会安全网相关项目的联邦资金来抵消减税条款的成本，这意味着越来越少的美国人能够获得政府援助来支付食品费用或获取医疗保险。
本届政府还以存在欺诈（通常没有证据）为由，缩减政府项目规模。
特朗普于2025年7月签署了这项法案，但部分政府项目的调整刚刚开始生效，其他调整则要在更晚的时候才会显现影响。
在首届任期内未能废除并取代《平价医疗法案》后，特朗普与国会共和党人试图通过多种方式削弱该法案。
最沉重的打击是他们决定让奥巴马医改的强化保费补贴在去年年底到期。这项更为慷慨的援助政策是拜登政府2021年为应对新冠疫情推出的，它扩大了 eligible 援助人群范围，并为他们提供了更高额度的补贴。2021年至2025年间，参保人数几乎翻倍。
强化补贴的到期，再加上医疗成本上涨，导致2026年的保费飙升了58%。今年参保的许多人选择了价格更低的计划——但这类计划的免赔额更高。
但还有很多人发现自己根本无力承担更高的月度保费。根据最新联邦数据，截至2月，参保人数降至1920万，较去年同期减少260万，这是七年来首次出现下滑。
然而，根据运营自己医保市场的各州数据以及CNN的报道，此后退保人数进一步增加。
州医保市场网络收集的数据显示，截至5月，18个州的参保人数较去年同期下降了8.5%，而今年年初这一降幅仅为1.4%。
密西西比州保险专员告诉CNN，8月份该州仅有12.6万人参保奥巴马医改计划，较去年同期下降了63%，超过20万人因此失去医保。
佛罗里达州居民卡拉·温德勒患有健康问题，她告诉CNN，由于无力承担保费，她不得不在11月放弃《平价医疗法案》的医保覆盖。她正趁着还有医保的机会看医生、接受治疗。
特朗普政府称，参保人数下降是因为许多人是被无良经纪人和代理机构瞒着参保的，还有部分参保者根本不存在。
由于保费预计将连续第二年大幅上涨，2027年的参保人数预计将再次下滑。无党派健康政策研究机构KFF的数据显示，保险公司提议明年的保费中位数涨幅约为15%。（保险公司提议的加息不包括联邦补贴，因此参保者月度保费的实际变化可能有所不同。）
共和党这项“宏伟美好法案”实施了自66年前这项安全网项目启动以来最大规模的 Medicaid（医疗补助计划）削减。根据国会预算办公室的数据，该方案预计在十年内从Medicaid中削减超过1万亿美元，导致额外750万人失去医保。
该项目最重大的变化之一是首次引入联邦工作要求指令。19至64岁的Medicaid扩张参保人员必须每月工作、志愿服务、上学或参加就业项目，除非他们符合特定豁免条件。国会预算办公室估计，这一条款预计到2034年将导致额外530万人失去医保。
特朗普政府在医疗弱势群体豁免资格的审核上也采取了比预期更严格的立场。根据医疗保险和医疗补助服务中心6月发布的一项规则，参保者不仅必须患有癌症或行为健康问题等疾病或医疗状况，该状况还必须严重妨碍他们遵守工作要求的能力。
工作要求将于明年生效，但已有少数州提前实施。内布拉斯加州的数据显示，自5月该指令在该州生效以来，已有近1100人因工作要求失去医保或无法参保。
而且，因程序原因（通常与文书工作有关）被拒绝的新申请者和续保者比例远高于往常。这让一些专家担心，人们正遇到与新工作要求相关的障碍。
根据KFF的数据，截至6月，Medicaid和儿童健康保险计划（CHIP）的总参保人数较去年同期减少了510万，降幅达6%，降至7320万。
乔治敦大学儿童与家庭中心的数据显示，自2025年1月特朗普就职以来至8月，参保Medicaid和CHIP的儿童人数减少了250多万。
目前尚不清楚其中有多少下滑可归因于“宏伟美好法案”的调整，又有多少儿童因此失去医保。
其他可能导致人们失去医保的条款还包括收紧移民参保资格，比如避难者和难民，这也可能影响他们的美国公民子女。一项要求通过Medicaid扩张参保的成年人每六个月重新认证资格的规定，可能导致一些人因文书工作问题被取消参保资格。
“宏伟美好法案”还对Medicaid的融资进行了重大调整，限制各州为其应承担的项目份额筹集资金以及提高对医疗服务提供者的支付标准。
医院和其他医疗服务提供者担心，这些融资条款，再加上失去Medicaid和《平价医疗法案》医保的无医保患者增加，可能会迫使他们削减服务、裁员甚至关门。一些已经不得不缩减服务的机构将这项法案的影响列为原因之一。
特朗普和国会共和党人称，所有这些调整都是为了改善Medicaid，确保该计划仍能为美国最弱势人群提供保障。他们还辩称，Medicaid应该帮助参保者通过工作实现经济独立。
“宏伟美好法案”包含多项条款，预计在未来十年内让数百万人退出补充营养援助计划（SNAP，即食品券项目的正式名称）。根据国会预算办公室的数据，该方案实施了该项目历史上最大规模的食品券削减——十年内削减近2000亿美元。
事实上，根据左翼智库预算与政策优先中心基于美国农业部数据的估算，自2025年7月该法案签署生效至今年6月，SNAP的参保人数已经减少了500多万，降幅近13%，其中至少150万是儿童。
专家表示，尽管共和党法案并非唯一原因，但它是一个主要因素。
其中最具影响力的条款之一是一项规定：如果某个州的支付错误率较高，该州将首次开始承担部分食品券福利费用。根据预算与政策优先中心的数据，各州合计可能需要承担90亿美元的费用。（历史上，联邦政府为SNAP福利提供资金，各州负责项目管理。）
尽管这项措施要到明年10月才生效，但各州已经在积极加强监督，要求参保者提供更多证明材料。专家表示，这导致许多人因文书工作问题被取消参保资格。
“宏伟美好法案”还将SNAP现有的工作要求扩大到特定成年参保者，覆盖至64岁，有14岁及以上受抚养子女的父母，以及退伍军人、无家可归的成年人和脱离寄养系统的青年。此外，该法案要求各州承担更多行政成本，并取消了难民、避难者、家庭暴力受害者和其他特定移民的参保资格。
“宏伟美好法案”和教育部的多项决定正在彻底改革联邦学生贷款项目。许多条款已于7月1日生效，其他条款将在未来几年逐步实施。
联邦学生贷款对许多美国人上大学或读研究生至关重要。根据联邦学生援助办公室的数据，目前有超过4200万借款人背负学生贷款，贷款总额超过1.7万亿美元。
美国教育部表示，该法案的改革实施了“合理的贷款限额”，简化了还款选择，并改善了联邦学生贷款体系的健康状况。但批评者担心，该项目的改革将使学生更难负担教育费用，毕业后还款的成本也更高。
其中一项重大变化涉及贷款偿还。该法案创建了新的分层标准还款计划和一项名为RAP的还款援助计划。
这些选项目前仅适用于申请新贷款的学生。目前正在偿还贷款的借款人不会因“宏伟美好法案”立即看到还款选项的变化，但大多数人必须在2028年7月前切换到其中一项新计划或收入还款计划。
研究生将不再能够按“课程就读成本”全额贷款。取而代之的是，他们将面临根据所学专业设定的贷款限额。Grad PLUS贷款也将被取消。
教育部做出了一项极具争议的决定，将护理、医师助理和物理治疗等某些医疗专业研究项目排除在职业项目之外。这意味着从事这些职业的学生在联邦学生贷款 borrowing 方面将受到更多限制。该决定引发了诉讼，目前正处于法院审理阶段。
此外，父母为本科生贷款的额度也将受到限制。
与此同时，教育部终止了“节省宝贵教育支出（SAVE）计划”——这是拜登政府时期的一项收入驱动还款计划，今年7月被联邦法院叫停。借款人有90天时间切换到其他计划，其中许多计划的月度还款额可能更高。
SAVE计划的终止让许多借款人担心自己无法承担更高的月度还款额。加州的一名言语治疗师告诉CNN，她和丈夫正在重新考虑何时——或者是否——可以组建家庭。
How Trump’s megabill may be affecting you right now
2026-10-15T10:00:45.119Z / https://www.cnn.com/2026/10/15/politics/trump-big-beautiful-bill-midterms
When Republicans ask voters to keep them in the majority, they frequently point to the most significant policy achievement of Trump 2.0 — the tax and spending cuts bill known as the One Big Beautiful Bill Act.
Among the main selling points Republican candidates cite are popular cuts to taxes on tips and overtime, things that have a populist appeal, although many of the tax savings are more likely to benefit wealthier Americans.
But the law offsets tax cut provisions by slashing federal funding for many programs that help make up the social safety net in the US, which means fewer Americans are getting aid from the government to afford food or obtain health insurance.
The administration has also cited fraud, frequently without evidence, to cut down on government programs.
Trump signed the law in July 2025, but some of the changes to government programs are just now coming into effect, while others won’t be felt until further down the road.
After failing to repeal and replace the Affordable Care Act during his first term, Trump and congressional Republicans have sought to weaken it in a variety of ways.
The biggest blow was their decision to let Obamacare’s enhanced premium subsidies lapse at the end of last year. The more generous assistance, which was approved in 2021 during the Biden administration as part of its response to the Covid-19 pandemic, broadened the number of people eligible for help and provided them larger subsidies. Enrollment nearly doubled between 2021 and 2025.
The enhanced subsidies’ expiration, along with rising healthcare costs, sent premium payments soaring 58% for 2026. Many of those who signed up for coverage this year bought less expensive plans — though those come with higher deductibles.
But many others found they simply could not afford the heftier monthly payments. As of February, enrollment fell to 19.2 million, a drop of 2.6 million from the same period a year prior, according to the latest federal data. It was the first decline in seven years.
However, more people have dropped their coverage since then, according to states that run their own marketplace and CNN reporting.
Enrollment in 18 states fell 8.5% as of May compared with a year prior, according to data collected by the State Marketplace Network. It had dipped only 1.4% at the start of the year.
In Mississippi, only 126,000 people were enrolled in Obamacare plans in August, a decline of 63%, the state insurance commissioner told CNN. More than 200,000 people have become uninsured.
Kara Windeler,a Florida resident who has health conditions, told CNN that she must give up her Affordable Care Act coverage in November because she cannot afford the premiums. She is trying to see doctors and receive treatment before she becomes uninsured.
The Trump administration has said that enrollment has fallen because many people were unknowingly signed up by unscrupulous brokers and agents and other enrollees did not exist at all.
Signups are expected to drop again for 2027 since premiums are forecasted to soar for the second year in a row. Insurers have proposed a median increase of about 15% for next year, according to KFF, a nonpartisan health policy research group. (Insurers’ proposed rate hikes don’t include federal subsidies, so the change in enrollees’ monthly premium payments may be different.)
The Republicans’ “big beautiful bill” enacted the largest cuts to Medicaid since the safety net program began 66 years ago. The package is expected to slash more than $1 trillion from Medicaid and leave 7.5 million more people uninsured over a decade, according to CBO.
Among the biggest changes to the program is the first-ever federal work requirement mandate. Medicaid expansion enrollees ages 19 through 64 will be required to work, volunteer, attend school or participate in a job program at least 80 hours a month, unless they are eligible for certain exemptions. Some 5.3 million more people are expected to be uninsured in 2034 because of this provision, CBO estimates.
The Trump administration is also taking a harder-than-expected line on who qualifies for an exemption for the medically frail. Not only must enrollees have an illness or medical condition, such as cancer or a behavioral health issue, but that condition must also significantly impair their ability to comply with the work mandate, according to a rule issued by the Centers for Medicare and Medicaid Services in June.
The work mandate kicks in next year, but a few states opted to implement it early. In Nebraska, nearly 1,100 people lost coverage or were not able to enroll because of the work requirement since the mandate began there in May, according to state data through August.
And a much higher than usual share of new applicants and those seeking to renew coverage were denied for procedural reasons, often relating to paperwork. This has led some experts to worry that people are running into hurdles that could involve the new work requirement.
Overall, enrollment in Medicaid and the Children’s Health Insurance Plan (CHIP) has declined by 5.1 million, or 6% — to 73.2 million — as of June compared with the year before, according to KFF.
The number of children enrolled in Medicaid and CHIP fell by more than 2.5 million between January 2025, when Trump took office, and August, according to the Georgetown University Center for Children and Families.
It’s unclear how much of the declines can be attributed to the “big beautiful bill” changes and how many children are winding up uninsured.
Other provisions that are expected to strip people of coverage include a narrowing of eligibility for immigrants, such as asylees and refugees, which could also affect their US citizen children. A requirement that adults enrolled through Medicaid expansion recertify their eligibility every six months could lead some to fall off because of paperwork issues.
The “big beautiful bill” also made significant changes to the financing of Medicaid, limiting how states raise money for their share of programs and enhance payments to providers.
Hospitals and other healthcare providers are concerned that these financing provisions — along with an increase in uninsured patients who have lost Medicaid and Affordable Care Act coverage — could force them to curtail services, lay off staff or even shut their doors. Some that have already had to pull back care have cited the impact of the package as one of the reasons.
Trump and congressional Republicans say all these changes are meant to improve Medicaid and make sure it remains available for the most vulnerable Americans. They also argue that Medicaid should help enrollees become financially independent through work.
The “big beautiful bill” contained several provisions that are expected to reduce enrollment in the Supplemental Nutrition Assistance Program, or SNAP, the formal name for food stamps, by millions of people over the next decade. The package enacted the largest cuts to food stamps in the program’s history — nearly $200 billion over a decade, according to CBO.
In fact, enrollment has already fallen by more than 5 million people, or nearly 13%, between the law’s enactment in July 2025 and June, according to estimates from the left-leaning Center on Budget and Policy Priorities that are based on US Department of Agriculture data. At least 1.5 million of them are children.
While the GOP package is not the sole cause, it is a major factor, experts say.
Among the most consequential provisions is a requirement that states start shouldering a portion of the food stamp benefit for the first time if they have a high rate of payment errors. They could be on the hook for $9 billion collectively, according to CBPP. (Historically, the federal government funded SNAP benefits, while states administered the program.)
Though this measure doesn’t kick in until next October, states are being proactive in tightening their oversight and requiring more documentation from enrollees. This is leading to many people being dropped because of paperwork issues, experts say.
The “big beautiful bill” also broadened SNAP’s existing work requirements to certain adult enrollees through age 64, to parents with dependent children ages 14 and older and to veterans, homeless adults and youth who aged out of foster care. Plus, the package requires states pay more of the administrative costs and ended the eligibility of refugees, asylees, victims of domestic violence and certain other immigrants.
Both the “big beautiful bill” and Department of Education decisions are leading to a major overhaul of the federal student loan program. Many of the provisions kicked in on July 1, but others take effect in coming years.
Federal student loans are critical to many Americans’ ability to go to college or grad school. More than 42 million borrowers have student loans, totaling more than $1.7 trillion, according to the Federal Student Aid office.
The US Department of Education says the law’s reforms implement “commonsense loan limits,” simplify repayment options and improve the health of the federal student lending system. But critics worry that the program’s revamp will make it harder and more expensive for students to finance their education and to repay their loans afterwards.
One of the major changes involves paying back one’s loans. The law created a new tiered standard repayment plan and a new Repayment Assistance Plan, known as RAP.
These options only apply to students taking out new loans at the moment. Borrowers who are currently repaying loans won’t see any immediate changes in their options as a result of the “big beautiful bill,” but most will have to switch to one of the new plans or the Income-Based Repayment plan by July 2028.
Graduate school students will no longer be able to borrow up to the “cost of attendance” for their programs. Instead, they will face borrowing limits that depend on what they are studying. And the Grad PLUS loan is being eliminated.
In a very controversial move, the Education Department decided that certain healthcare studies — such as nursing, physician assistants and physical therapy — were not considered professional programs. That means students pursuing these careers will be more limited in their federal student loan borrowing. The decision spurred lawsuits, which are now working their way through the courts.
Also, parents will be limited in how much they can borrow to help their undergraduate students.
Meanwhile, the Department of Education ended the Saving on Valuable Education (SAVE) plan — a Biden administration-era income-driven repayment plan that was blocked by federal courts in July. Borrowers are being given 90 days to switch into alternate plans, many of which may leave them with higher monthly payments.
SAVE’s demise has left many borrowers worried about how they’ll afford the higher monthly payments. One speech-language pathologist in California told CNN that she and her husband are reconsidering when — or whether — they can grow their family.