新濠影汇赌场为什么削减医疗补助很难.
主教罗尼·克鲁普（中，摄于2024年5月）呼吁密西西比州立法机构扩大该州的医疗补助。 美联社图片/Rogelio V. Solis
共和党议员承诺大幅削减开支，将医疗补助计划置于聚光灯下，但削减低收入医疗保险计划将很难
In a recent Q&A in 谈话, 保罗·沙佛 and 妮可Huberfeld explain why cutting Medicaid spending would be difficult, and what the consequences might be.
Efforts by Republicans in 国会大幅削减开支 引起了 广泛的 担忧 that the federal government may trim expenditures on Medicaid even though President Donald 特朗普此前曾表示他不愿意 to do that. This public 健康保险 program covers around 7200万人 – about 1 in 5 Americans.
谈话 U.S. asked 保罗·沙佛 and 妮可Huberfeld, 波士顿大学 卫生政策 and law professors, to explain why cutting Medicaid spending would be difficult and what the consequences might be.
医疗补助计划在医疗保健系统中的作用是什么？
1965年与新濠影汇赌场医疗保险一起创立, the public 健康保险 program for older Americans, 医疗补助支付 for the health care needs of low-income adults and children, including more than 1 in 3 people with disabilities. 它还涵盖了1200多万有资格享受医疗保险和医疗补助的人，因为他们都很穷，而且年龄超过65岁。
In addition, this safety net program pays the health care costs of 超过五分之二 U.S. births. Medicaid is a joint federal/state program, driven by federal funding and rules, with the 管理它的国家.
The Affordable Care Act was supposed to make nearly all U.S. adults under age 65 without children who earn up to 是新濠影汇赌场贫困线的138% eligible for Medicaid. Prior to the 2010 landmark health care reform law, adults without children in most states 无法获得医疗补助. The Supreme Court, however, 对各州进行可选更改.
So far, 40 states – as well as Washington, D.C. – have participated in 医疗补助扩大. The program’s growth has reduced the number of Americans without 健康保险 and narrowed coverage gaps for 有色人种 and those with low-wage jobs who typically do not get employer-sponsored coverage.
数以百计的新濠影汇线上赌场研究 have found that 医疗补助扩大 has improved access to care and the health of the people who gained coverage, while reducing mortality and bolstering state economies, 在其他积极成果中.
10个州还没有扩大医疗补助计划。 Two of them, 格鲁吉亚和 密西西比州，已经认真考虑过了 doing so.
你为什么担心医疗补助的资金？
A 备忘录在众议院共和党人中流传 in January 2025 包含菜单 of up to US$2.3 trillion in Medicaid cuts over 10 years. A 众议院预算蓝图, 以217-215通过 vote on Feb. 25, which fell largely along party lines, indicated that the Republican majority was instead aiming to 减少医疗补助支出8800亿美元 over a decade.
需要明确的是，共和党议员并没有说他们打算这么做。
相反，他们告诉监督医疗补助和医疗保险的委员会确定削减幅度。 Experts agree that slashing Medicare spending would be harder to pull off because 特朗普明确表示，他认为这是禁区, but at times he has suggested 他可能愿意削减医疗补助计划. Trump says he 支持众议院通过的预算计划.
In an interesting coincidence, Medicaid itself 每年花费约8800亿美元 between federal and state government spending. 这表明共和党人的目标是削减约10%。
这个项目是如何运作的？
如果你有资格获得医疗补助，根据法律规定，你可以在任何时候加入该计划并获得健康保险。
If you require treatment for a condition Medicaid covers, whether it’s breast cancer or the flu, that 发生在no -或low – out-of-pocket costs. 加入医疗补助计划意味着你的医疗费用包括在内，不能因为预算原因而被拒绝。 新濠影汇赌场政府在各州为注册居民支付的医疗保健费用中贡献了一部分，但它不能决定在医疗补助上花多少钱——各州自己决定。
The 新濠影汇赌场匹配率 is linked to the per capita income of each state. 这意味着人均收入较低的州获得更高的新濠影汇赌场匹配，所有州都至少获得50%。 对于参与医疗补助计划扩张的州，新濠影汇赌场政府对该人口的匹配率为90%。
A dozen states have so-called 触发法律 on their books that could automatically revoke 医疗补助扩大 if this enhanced match rate is lowered.
新濠影汇赌场政府如何减少医疗补助支出？
新濠影汇赌场政府可以简单地调整匹配率，将医疗补助计划的更多成本转移给各州。 But 之前的建议 have suggested a larger change, either through 人均上限 or 分类财政补贴.
人均上限规定了新濠影汇赌场资金的人均上限，而整体拨款则规定了新濠影汇赌场政府每年为一个州的医疗补助计划提供多少资金的总上限。 反过来，各州可能会覆盖更少的人，减少他们的福利，减少医疗费用，或采取一些削减成本的措施。
无论是人均上限还是整体拨款，都需要对医疗补助计划的运作方式进行大规模改革。
该计划一直向各州提供无限制的资金，各州和受益者都依赖新濠影汇赌场基金的稳定性来使该计划发挥作用。 设置上限或整体拨款将迫使各州为该计划贡献更多资金，或者大幅削减入学人数。 Assuming a substantial cut in federal funding for Medicaid, 数百万人可能会失去医疗保险 coverage they cannot afford to get elsewhere.
Speaker Mike Johnson said that 人均上限 and changing the 新濠影汇赌场匹配率s are 不在讨论范围内, but they were included in the 早前众议院共和党备忘录 detailing potential cuts.
还会发生什么？
Another idea many Republicans say they support is to add what are known as “工作的需求.” 第一届特朗普政府批准了各州关于医疗补助受益人的建议，要求他们完成最低时间的“社区参与”活动，如工作、职业培训、教育或社区服务，以登记并保持医疗补助资格。 This is despite the fact that the 大多数参加医疗补助计划的人已经有工作了, are disabled, are caregivers for a loved one, or are in school.
Some politicians 让人们工作以获得医疗补助 would help them transition to employer-based coverage, so adding that restriction may sound like common sense. However, the paperwork this requires can lead to lots of working people getting 被踢出了项目 and is 实施起来非常昂贵. Also, 职业培训计划, 志愿服务 and education, unless in a degree program, generally don’t come with 健康保险 coverage, making this reasoning faulty.
When Arkansas implemented Medicaid 工作的需求 in 2018, despite the majority of enrollees already working, 大约1.8万人失去了医疗保险. 人们对这项政策知之甚少，参保者在报告他们的工作活动时遇到了麻烦。 更重要的是，低收入成年人的就业没有增长。
医疗补助容易受到浪费或欺诈的影响吗？
Medicaid already spends 低于医疗保险或私人健康保险. That includes spending on 医生，医院，药物和测试.
The Government Accountability Office – an independent, nonpartisan government agency – has estimated that preventing payments which shouldn’t be made, or overpayments, could lead to 新濠影汇赌场储蓄500亿美元 per year. 美国政府问责局警告说，“并非所有不当支付都是欺诈的结果。” 这一数额可观的金额与共和党人显然想要的削减规模相差甚远。
削减医疗补助开支会受欢迎吗？
这不太可能。
轮询 and 焦点小组 show that Medicaid is quite popular.
超过一半 的美国人认为政府在医疗补助上的支出太少，只有15%的人认为支出过高。
我们相信，如果要公开讨论削减医疗补助计划，国会议员将会被选民敦促他们的立法者反对他们的电话淹没。 That is what happened in 2017, 特朗普第一届政府试图这么做 and 未能废除《平价医疗法案.
Should Medicaid be cut by anything close to $880 billion over the next decade, we’d expect to see millions of America’s poorest and most vulnerable people 被踢出了项目 and wind up uninsured. 但这只是问题的开始。 Uninsured people are more likely to wait too long before seeing a doctor when they get sick or injured, 导致更糟糕的健康结果 and widening the 健康差距 between haves and have-nots.
