唐纳德·特朗普总统和国会共和党人巨额税收和支出法案将影响数百万美国人，尤其是弱势群体，但其中一些影响在一段时间内不会被感受到。

　　该法案目前的措辞将税收变化和联邦预算的开始日期错开至2026年11月选举之后。一些在特朗普任期结束时到期。

　　该法案对年龄在19岁至64岁之间、没有家属的健全的医疗补助领取者提出了每月工作80小时的新要求。这些要求包括工作或其他经批准的活动，如志愿服务。

　　14岁以下儿童和残疾儿童的父母或监护人享有豁免。

　　这些工作要求要到2026年才会生效。

　　卫生政策专家表示，享受医疗补助的美国健全人中不工作的人口相当少，但更多的人可能会失去他们的保险，因为定期证明工作状态会带来繁重的文书工作要求。

　　另一项医疗补助资金削减将来自供应商税或医疗保健组织税的变化，各州利用这些税收为其医疗补助项目提供资金。卫生保健雇主表示，关闭农村地区的医疗中心将会带来最大的影响，因为许多医疗中心已经在长期努力保持开放。

　　卫生政策专家和卫生保健工作者表示，最大的影响将是全国各地卫生中心的关闭，特别是在医疗补助大量资助的农村地区。其他人将失去保险，因为法案要求的工作要求和额外的文书工作。

　　众议院通过的最初措施削减了约6000亿美元的医疗补助，但随着参议院的法案增加:无党派国会预算办公室的新估计显示，到2034年，联邦医疗补助支出将减少1万亿美元，未参保人数将增加近1200万。

　　参议院在一揽子计划中增加了500亿美元的农村医院基金，以安抚那些担心医疗补助削减对其选民影响的参议员，但目前尚不清楚这笔资金将如何分配，也不清楚它是否足以弥补医疗补助提供者税收变化带来的预期缺口。

　　平价医疗法案

　　根据该法案，自动续保程序将被取消，公开市场保险申请人也将面临更多的文书工作。

　　食品援助计划

　　该法案改变了补充营养援助计划(SNAP)中成年人的工作要求，这将大大减少符合条件的美国人的数量。

　　该法案将工作要求年龄从54岁提高到64岁，并增加了子女年龄超过6岁的父母。家中有受抚养子女的父母，无论年龄大小，目前都免于这些要求。

　　这些变化最早将于今年生效。

　　共和党的支出法案还迫使各州从2028年开始承担至少5%的SNAP福利成本。目前，该计划100%由联邦政府资助。

　　据估计，10年间的削减总额将达到2300亿美元。

　　税收变化

　　一些税收变化将于今年生效，并在2026年美国人申报税收时得到反映。

　　该法案允许扣除小费和加班费的税款。小费的扣减上限为每年25，000美元，加班的扣减上限为每年12，500美元。

　　单个申报者的标准扣除额将增加750美元，联合申报者将增加1500美元。

　　特朗普2017年的税收法案将扣除额上限定为1万美元。2025年支出法案将收入低于50万美元的家庭的上限提高到4万美元，并将每年上涨1%，直到2029年。

　　2030年上限重置为1万美元。

　　该法案将从9月30日开始取消购买电动汽车的税收抵免，并在年底取消太阳能等绿色家居升级的税收抵免。

　　对实施绿色项目的企业的税收减免将于明年结束。

　　How soon will you feel the effects of Trump's megabill?

　　President Donald Trump and congressional Republicans'massive tax and spending billwill affect millions of Americans, particularly vulnerable populations, but some of those impacts won't be felt for some time.

　　The bill's current language staggers the start date for tax changes and the federal budget until after the November 2026 elections. Some expire at the end of Trump's term in office.

　　The bill imposes new 80-hour per month work requirements on able-bodied Medicaid recipients aged 19 to 64 who don't have dependents. These requirements include working or other approved activities, such as volunteering.

　　There are exemptions for parents or guardians of children under age 14 and those with disabilities.

　　These work requirements won't kick in until 2026.

　　Health policy experts say the population of able bodied Americans on Medicaid who don’t work is fairly small — but that many more might lose their coverage because of the burdensome paperwork requirements that will come with regularly proving work status.

　　Another Medicaid funding cut will come from a change to provider taxes, or taxes on health care organizations, which states use to fund their Medicaid programs. The biggest impacts will felt through the closing of health centers in rural areas, health care employers say, because there are already longstanding struggles to stay open for many of them.

　　Health policy experts and health care workers say the biggest impacts will felt through the closing of health centers throughout the country, especially in rural areas that were heavily funded by Medicaid. Others will lose coverage because of the work requirements and the additional paperwork required under the bill.

　　The original measure passed by the House made around $600 billion in cuts to Medicaid, but that grew with the Senate bill: new estimates from the non partisan Congressional Budget Office project federal spending on Medicaid will be reduced by $1 trillion and the number of uninsured people will increase by nearly 12 million by 2034.

　　The Senate added a $50 billion rural hospital fund to the package to placate senators who had concerns about the impact of Medicaid cuts on their constituents, but it's unclear how the funding will be distributed or whether it will be sufficient to make up the anticipated shortfall from changes to the Medicaid provider tax.

　　MORE: What will Trump's 'big, beautiful bill' do to Medicaid and SNAP?

　　Affordable Care Act

　　Under the bill, automatic renewal processes would be eliminated and open market insurance applicants would also be subjected to more paperwork.

　　Food assistance programs

　　The bill changes work requirements for adults who are part of the Supplemental Nutrition Assistance Program, SNAP, which would greatly reduce the number of eligible Americans.

　　The bill raises the work requirement age from 54 to 64 and adds parents with children older than 6. Parents with dependent children at home, regardless of age, are currently exempt from these requirements.

　　Those changes will go into effect as early as this year.

　　The Republican spending bill also forces states to shoulder at least 5% of SNAP benefit costs starting in 2028. Currently, the program is 100% federally funded.

　　The SNAP cuts total an estimated $230 billion over 10 years.

　　Tax changes

　　Some of the tax changes will go into effect this year and be reflected when Americans file their taxes in 2026.

　　The bill allows tax deductions on tips and overtime pay. Deductions on tips is capped at $25,000 per year while deductions on overtime is capped at $12,500 per year.

　　The standard deduction would rise by $750 for single filers and $1,500 for those filing jointly.

　　Trump's 2017 tax bill capped the deduction at $10,000. The 2025 spending bill increases the cap to $40,000 for households making under $500,000 and will rise 1% every year until 2029.

　　The cap resets to $10,000 in 2030.

　　The bill will remove tax credits for buying electric vehicles starting on Sept. 30 and tax credits for green home upgrades, such as solar power, at the end of the year.

　　Tax breaks for businesses enacting green projects will end next year.