共和党考虑削减医疗补助计划并增加工作要求，危及数百万人的医疗服务

【中美创新时报2025 年 2 月 19日编译讯】（记者温友平编译）共和党正在考虑削减数十亿美元的医疗补助计划，威胁到参加该安全网计划的 8000 万美国成人和儿童中的部分人的医疗保险。对此，美联社记者 AMANDA SEITZ、ANDREW DEMILLO 和 KEVIN FREKING 进行了如下报道。

在拜登政府执政期间，数百万美国人注册了由纳税人资助的医疗保险，如医疗补助计划和平价医疗法案市场，民主党称赞这一转变是成功的。

但共和党人希望削减联邦支出，并为企业和富裕的美国人提供丰厚的减税，现在他们看到了一个需要削减的大目标。8800 亿美元的医疗补助计划主要由联邦纳税人资助，在某些州，他们承担了高达 80% 的费用。各州也表示，他们难以为多年的增长和参加医疗补助的病情较重的患者提供资金。

为了削减预算，共和党控制的国会正在考虑医疗补助的工作要求。它还考虑向各州支付缩减的固定费率。总而言之，在未来十年，共和党立法者可能会试图从为最贫穷的美国人提供的几乎免费的医疗保险中抽走数十亿美元。

在国会开始讨论这些变化的几周前，阿肯色州、俄亥俄州和南达科他州的共和党州长正在采取行动实施他们自己的医疗补助工作规则，这些规则很可能会得到唐纳德·特朗普总统政府的批准。

还有其他削减措施可能即将出台。共和党政府周五就宣布，将把《平价医疗法案》导航员计划年度预算缩减 90%，至 1000 万美元。导航员驻扎在全国各地，帮助人们加入平价医疗法案和医疗补助计划，近年来，他们因提高计划的加入人数而受到赞誉。

共和党人提出的建议

路易斯安那州议长迈克·约翰逊提出了将工作与医疗补助计划挂钩的想法。

“这是常识，”约翰逊说。“这样的小事不仅对预算过程有重大影响，而且对人们的士气也有重大影响。你知道，工作对你有好处。你在工作中找到尊严。”

但根据健康政策研究公司 KFF 的分析，大约 92% 的医疗补助计划参与者已经在工作、上学或照顾他人。

共和党人提出了类似于补充营养援助计划（通常称为食品券）条件的工作要求。 16 至 59 岁的人如果不上学、照顾 6 岁以下儿童、残疾、怀孕或无家可归，则必须每月工作或志愿服务至少 80 小时。平均而言，SNAP 登记者的每月家庭收入为 852 美元，登记者通常可获得 239 美元的福利。

上个月，在佛罗里达州多拉尔特朗普的高尔夫度假村举行的共和党众议院务虚会上，共和党人表示，这项要求可以激励人们寻找工作——甚至可能是一份附带医疗保险的工作。

加利福尼亚州共和党众议员达雷尔·伊萨表示，削减开支不应“落在穷人和有需要的人的身上”，而应针对那些不应该获得福利的人。

“为什么有人真的坐在沙滩上冲浪，用食品券从餐车上买三明治，然后找廉价住房等等，同时还要写一本书，”伊萨说，并指出他描述的是十多年前的一位选民。

正在讨论的其他削减措施包括一项将联邦政府的报销改为按人头计算的提案。

乔治城儿童和家庭中心执行主任琼·阿尔克说，这将把成本转嫁到各州，各州可能被迫做出艰难的选择，决定谁来承保或承保哪些项目。

“即使削减了人们的保险，他们仍然有医疗保健需求，”阿尔克说。“他们的医疗保健需求不会消失。”

削减该计划也可能引发不满，超过一半的美国成年人表示政府在医疗补助上花费“太少”。根据美联社-NORC 公共事务研究中心 1 月份的一项民意调查，只有 15% 的人认为政府花费“太多”。

一些州已经开始采取行动

拜登总统的政府在很大程度上阻止了各州制定自己的工作规则，并要求 10 个州取消医疗补助覆盖要求。

随着特朗普重新掌权，一些共和党领导的州正在国会之前再次增加工作规则。阿肯色州、爱荷华州和俄亥俄州的州长宣布，他们将寻求联邦医疗保险和医疗补助服务中心的批准，再次引入工作要求。去年秋天，南达科他州选民签署了一项增加工作规则的计划。

当阿肯色州在特朗普执政期间颁布了一项工作要求时，约有 18,000 人失去了保险。这项规定后来被一名联邦法官和拜登的民主党政府阻止。

阿肯色州法律援助的律师特雷弗·霍金斯 (Trevor Hawkins) 表示，有些人因为无法访问州政府网站记录工作时间或遇到其他程序问题而失去保险。该组织代表被取消保险的医疗补助受益人提起诉讼。

“这些麻烦、这些事情都非常重要，”霍金斯说，“很多人都过得很艰难。”

在佐治亚州，47 岁的保罗·米克尔 (Paul Mikell) 对这些麻烦再熟悉不过了。

他参加了佐治亚州的“覆盖之路”计划，该计划为一部分收入过高而无法享受传统医疗补助的贫困人口提供医疗补助。佐治亚州没有像大多数其他州一样扩大医疗补助，要求人们每月工作、做志愿者或上学 80 小时，以换取扩大的健康保险。

米克尔每月要开车 15 英里（24 公里）到政府办公室报告他的工作时间。他说，有时当他上网查看自己的工作时间是否已记录时，却发现没有记录。

他把浏览在线系统比作一场战斗——在图书馆的电脑上或从朋友那里借来的电脑上战斗。

在爱达荷州，立法者正在考虑制定州工作规则，并将医疗补助福利的期限定为三年。家庭医生彼得·克兰 (Peter Crane) 估计，他的约三分之二的患者参加了该计划。

许多人在农场、牧场或当地磷酸盐矿工作。在该州将医疗补助扩大到覆盖收入高达贫困线 138% 的人之前，他的许多没有保险的患者完全避开了医生。他说，有一位患者几个月来一直无视腹痛，以至于需要住院治疗严重的胆囊感染。

“他们不是异类，”克兰在上周的州听证会上谈到那些参加医疗补助的人时说。“他们是我们州辛勤工作的公民，有工作，经营着小企业。”

民主党警告称，疫情会对医疗机构产生副作用，包括乡村医院和疗养院。医院受益于医疗保险计划（如 Medicaid）的增加，因为它保证了患者治疗费用的支付。

“医院将关闭，包括美国农村、城市和美国中心地带的医院，”众议院民主党领袖、纽约州议员哈基姆·杰弗里斯 (Hakeem Jeffries) 在众议院最近的一次演讲中警告道。“疗养院将被关闭，普通美国人、儿童、老年人和残疾人都将受到伤害。”

德米洛在阿肯色州小石城报道。美联社民意调查编辑阿米莉亚·汤姆森-德沃克斯 (Amelia Thomson-DeVeaux) 在华盛顿报道，作家夏洛特·克拉蒙 (Charlotte Kramon) 在亚特兰大报道，丽贝卡·布恩 (Rebecca Boone) 在爱达荷州博伊西报道，杰克·杜拉 (Jack Dura) 在北达科他州俾斯麦报道。

题图：众议院议长迈克·约翰逊上周与共和党同僚举行闭门会议，就一项支出法案达成一致后，前来与记者交谈。J. Scott Applewhite/美联社

附原英文报道：

Republicans consider cuts and work requirements for Medicaid, jeopardizing care for millions

By AMANDA SEITZ, ANDREW DEMILLO and KEVIN FREKING The Associated Press,Updated February 18, 2025 

House Speaker Mike Johnson arrived to talk to reporters after a closed-door meeting with fellow Republicans to find agreement on a spending bill last week.J. Scott Applewhite/Associated Press

WASHINGTON (AP) — Republicans are weighing billions of dollars in cuts to Medicaid, threatening health care coverage for some of the 80 million U.S. adults and children enrolled in the safety net program.

Millions more Americans signed up for taxpayer-funded health care coverage like Medicaid and the Affordable Care Act’s marketplace during the Biden administration, a shift lauded by Democrats as a success.

But Republicans, who are looking to slash federal spending and offer lucrative tax cuts to corporations and wealthier Americans, now see a big target ripe for trimming. The $880 billion Medicaid program is financed mostly by federal taxpayers, who pick up as much as 80% of the tab in some states. And states, too, have said they’re having trouble financing years of growth and sicker patients who enrolled in Medicaid.

To whittle down the budget, the GOP-controlled Congress is eyeing work requirements for Medicaid. It’s also considering paying a shrunken, fixed rate to states. All told, over the next decade, Republican lawmakers could try to siphon billions of dollars from the nearly-free health care coverage offered to the poorest Americans.

Weeks before Congress began debating those changes, Republican governors in Arkansas, Ohio and South Dakota were making moves to implement Medicaid work rules of their own, likely to be approved by President Donald Trump’s administration.

And other cuts could be on the way. Already on Friday, the Republican administration announced it would shrink the Affordable Care Act’s navigator program annual budget by 90% to $10 million. Navigators are stationed throughout the country to help people enroll in ACA and Medicaid coverage and are credited with boosting the programs’ enrollment in recent years.

What Republicans are proposing

Speaker Mike Johnson of Louisiana has floated the idea of tying work to Medicaid.

“It’s common sense,” Johnson said. “Little things like that make a big difference not only in the budgeting process but in the morale of the people. You know, work is good for you. You find dignity in work.”

But about 92% of Medicaid enrollees are already working, attending school or caregiving, according to an analysis by KFF, a health policy research firm.

Republicans have suggested a work requirement similar to the conditions for the Supplemental Nutrition Assistance Program, commonly called food stamps. Those ages 16 to 59 must work or volunteer at least 80 hours a month if they are not in school, caring for a child under age 6, disabled, pregnant or homeless. On average, a SNAP enrollee’s monthly household income is $852, and the enrollee typically receives $239 in benefits.

During a GOP House retreat last month at Trump’s golf resort in Doral, Florida, Republicans said the requirement could motivate people to find employment — maybe even a job that comes with health insurance.

Rep. Darrell Issa, R-Calif., said the spending cuts should not be “on the back of the poor and needy” but instead target those who shouldn’t be getting the benefit.

“Why should somebody literally sit on the beach and surf, buy their sandwiches from the food truck with their food stamps and then pick up low-cost housing and so on, while writing a book,” Issa said, noting that he was describing a constituent from more than a decade ago.

Other cuts on the table include a proposal to change the federal government’s reimbursement to a per-person limit.

That would shift the costs to states, which might be forced to make tough choices about who or what they cover, said Joan Alker, executive director of the Georgetown Center for Children and Families.

“People still have health care needs even if you cut their coverage,” Alker said. “Their health care needs are not going to go away.”

Cuts to the program could also prompt upset, with just over half of U.S. adults saying the government spends “too little” on Medicaid. Only 15% say it’s spending “too much,” according to a January Associated Press-NORC Center for Public Affairs Research poll.

Some states are already making moves

President Joe Biden’s administration largely blocked states from enacting work rules of their own and required 10 states to remove the requirement for Medicaid coverage.

With Trump now back in charge, some Republican-led states are pressing ahead of Congress to add work rules again. Governors in Arkansas, Iowa and Ohio have announced they’d pursue approval from the federal Centers for Medicare and Medicaid Services to introduce work requirements again. And last fall, South Dakota voters signed off on a plan to add a work rule.

When Arkansas enacted a work requirement during the Trump years, about 18,000 people lost coverage. The rule was later blocked by a federal judge and Biden’s Democratic administration.

Some people lost coverage because they had trouble accessing the state’s website to log their hours or had other procedural problems, said Trevor Hawkins, an attorney with Legal Aid of Arkansas. The organization sued on behalf of Medicaid beneficiaries who were dropped from coverage.

“These hoops, these things are very consequential,” Hawkins said “There were a lot of people having hard times.”

In Georgia, 47-year-old Paul Mikell is all too familiar with those hoops.

He’s enrolled in Georgia’s Pathways to Coverage plan, which offers Medicaid for a slice of impoverished people who make just too much to qualify for traditional Medicaid. Georgia, which has not expanded Medicaid like most other states, requires that people work, volunteer or go to school for 80 hours a month in exchange for accessing the expanded health coverage.

Mikell makes 15-mile (24-kilometer) monthly drives to a government office where he reports his work hours. Sometimes, he said, when he goes online to check whether his hours were logged, they’re not there.

He likened navigating the online system to a battle — one fought on a computer at the library or borrowed from a friend.

In Idaho, where lawmakers are considering a state work rule and a three-year limit for Medicaid benefits, family physician Peter Crane estimates about two-thirds of his patients are enrolled in the program.

Many work on farms, on ranches or in the local phosphate mines. Before the state expanded Medicaid to cover those with incomes of up to 138% of the poverty level, many of his uninsured patients avoided the doctor entirely. One ignored abdominal pain for months, to the point of needing hospitalization for a severe gallbladder infection, he said.

“They’re not outliers,” Crane said of those enrolled in Medicaid during a state hearing last week. “They’re hardworking citizens of our state who are employed and running small businesses.”

Democrats are warning of the side effects for health care facilities, including rural hospitals and nursing homes. Hospitals have benefited from increased enrollment in health insurance programs such as Medicaid because it guarantees payment for a patient’s treatment.

“Hospitals will close, including in rural America and urban America and the heartland of America,” House Democratic leader Hakeem Jeffries of New York warned during a recent speech on the House floor. “Nursing homes will be shut down, and everyday Americans, children, seniors, those who are suffering with disabilities, will be hurt.”

DeMillo reported from Little Rock, Arkansas. Associated Press polling editor Amelia Thomson-DeVeaux in Washington and writers Charlotte Kramon in Atlanta; Rebecca Boone in Boise, Idaho; and Jack Dura in Bismarck, North Dakota, contributed.