潜在的医疗补助削减给各州敲响警钟：“特朗普和共和党人认为这些人会怎样？”

【中美创新时报2025 年 2 月 28 日编译讯】（记者温友平编译）马萨诸塞州州长莫拉·希利（ Maura Healey ）本周警告称，数百万马萨诸塞州居民可能会失去医疗保健。在罗德岛，一些医疗机构正准备迎接“致命打击”。《波士顿环球报》记者Matt Stout 和 Jason Laughlin对此作了下述报道。

马萨诸塞州州长莫拉·希利本周警告称，数百万马萨诸塞州居民可能会失去医疗保健。在罗德岛，一些医疗机构正准备迎接“致命打击”。官员警告称，不仅人们的福利可能受到影响，当地经济也会受到影响。

如果国会共和党人削减、甚至削减联邦对医疗补助的支出，这将是噩梦般的情景——有些人担心，这是真正的可能性——医疗补助是美国最大的健康保险计划，也是马萨诸塞州和其他地方预算中最大的一块。

医疗补助计划由联邦政府和各州共同出资，为大约五分之一的美国人提供医疗保险，从贫困儿童和低收入成年人到老年人和依赖家庭护理的残疾人。

现在，它成了众议院共和党人的目标，他们正在考虑削减联邦政府向各州提供的报销金额，以帮助承保他们延长特朗普总统 2017 年减税计划的计划，该减税计划将于今年年底到期。

医疗补助计划。该决议没有具体说明可以削减多少资金，众议院议长迈克·约翰逊表示，立法者不会采取一些最激进的选择，例如重新制定所谓的联邦医疗援助百分比，这是联邦政府向每个州提供的医疗补助费用份额的正式名称。

但鉴于其在联邦医疗保健支出中占据了过大的地位，对医疗补助计划的任何削减都必须是重大的，共和党人才能实现他们所追求的节省类型，这可能会危及数百万美国人的医疗保健福利。

官员们表示，仅在马萨诸塞州，就有超过 200 万人依赖所谓的 MassHealth，其中包括该州 45% 的儿童。马萨诸塞州目前每为该计划中的大多数人花费一美元，联邦政府就会给他们 50 美分，但根据联邦《平价医疗法案》扩大医疗补助计划，大约 40 万人可以获得高达 90 美分的补助。

长期护理中的老年人更加依赖医疗补助资金。参议员伊丽莎白·沃伦 (Elizabeth Warren) 表示，马萨诸塞州养老院中大约有三分之二的人得到了医疗补助的支持。（联邦医疗保险是针对老年退休人员和残疾人士的联邦健康保险计划，不涵盖长期养老院护理。）

“特朗普和共和党人认为这些人会怎么样？”沃伦问道。“是不是把他们放在街角，和明天的垃圾一起运走？”

希利的警告似乎暗示了最坏的情况。她周三告诉商界领袖，如果众议院的预算决议照原样通过，“200 万居民，包括 70 万儿童和 20 万老年人，将失去医疗保健”——显然是指目前所有依赖 MassHealth 的人。

“你认为谁会为此买单？医疗保险费会怎样？当联邦资金消失时，我们的医疗保健系统、健康计划以及所有依赖这些系统的工人和企业会怎样？”她在大波士顿商会的一次活动中说道。“没有人能免受这些影响。”

该州获得近 140 亿美元的联邦 MassHealth 补偿，如果这笔钱被大幅削减，可能会迫使州官员在削减福利、从其他预算中削减资金或动用紧急资金之间做出选择。

马萨诸塞州的紧急储蓄账户中有超过 80 亿美元，但目前尚不清楚官员们有多愿意用这笔钱来抵消医疗补助资金的削减。财政部长黛布·戈德堡（Deb Goldberg ）表示，MassHealth 或其他医疗资金的大幅削减可能会对整个州产生连锁反应，尤其是在医疗保健行业。

“我们没有很多农田。我们没有油井。我们没有很多其他行业，”Goldberg 周四表示。“我们需要国会明白，他们所关注的事情正在破坏我们的经济。”

在许多州，仅仅减少医疗补助扩展计划的资金就会造成巨大的痛苦。

例如，新罕布什尔州根据《平价医疗法案》扩大了医疗补助计划的资格，但与其他新英格兰州不同，该州的立法机构通过了一项法律，制定了所谓的触发条款，如果联邦份额低于 90%，则该扩展计划将自动终止。

这意味着，如果国会共和党人将联邦匹配额度调整到 90% 以下，新罕布什尔州约三分之一的医疗补助受益人（约 60,000 人）将失去保障。

共和党州长凯利·阿约特正在制定州一级医疗补助福利改革计划，作为她为期两年的预算提案的一部分。她本周警告说，联邦预算程序还有很长的路要走。

“我不能做假设，”她说。

据州政府官员称，在罗德岛，311,444 名居民享受全额医疗补助福利，另有 12,000 人享受部分福利，包括接受早期干预服务的儿童。

还有一个问题：罗德岛的医疗补助报销额明显低于邻近各州，医院和医生表示，他们获得的报酬低于实际成本，有时单次手术的费用会少数千美元。

布朗大学健康中心（原名 Lifespan Corp.）发言人杰西卡·沃顿 (Jessica Wharton) 表示，这种情况意味着“任何潜在的削减都会给罗德岛的医疗界和整个州的经济带来问题”。

对于那些患者更依赖医疗补助的机构来说，打击将是巨大的。罗德岛公共卫生研究所首席执行官艾米·努恩博士表示，其旗下的 LGBTQ+ 健康诊所 Open Door Health 约有 30% 至 35% 的患者享受医疗补助。

“这很有可能对其他医疗补助患者比例更高的医疗中心造成致命打击，”Nunn 说。

即使是报销率更高的马萨诸塞州也会受到影响。

马萨诸塞州卫生与医院协会首席执行官史蒂夫·沃尔什（Steve Walsh ）表示，去年马萨诸塞州约有三分之二的急症护理医院亏损，其中一个原因是 MassHealth 的报销率不足。

他说，进一步削减医疗补助将对那些财务困难的医院及其服务的患者造成“灾难性”的打击。

“医疗补助是整个医疗系统的基础，”·沃尔什说。“如果你削减它，那么在其他所有领域提供服务的能力就会变得困难，甚至不可能。”

在国会可能削减预算之前，MassHealth 就已经面临压力。州政府官员表示，疫情时期的联邦资金已经用完，而该计划因不断增长的医疗成本而捉襟见肘。

去年，残疾人为保护主要由医疗补助计划资助的家庭护理计划免受希利政府提出的削减计划的影响而斗争。现在，由于国会可能会大幅削减，他们担心他们所依赖的个人护理助理计划的护理可能会面临更大的威胁。

“每当政府想要削减时，他们总是想要削减为残疾人和社会最需要帮助的人提供的服务，”西罗克斯伯里的 55 岁的杰瑞·博伊德说。

博伊德患有脑瘫，依靠电动轮椅，每周需要 38 小时的个人护理助理的帮助，他们的服务包括帮助他准备上班和晚上睡觉、购物和准备饭菜。

“如果我的工作时间被削减，我就必须认真思考如何最好地利用我拥有的时间，”博伊德说。

《环球报》的乔恩·切斯托、亚历克萨·加戈斯、史蒂文·波特和罗布·韦斯曼对本报告做出了贡献。

题图：众议院议长迈克·约翰逊在众议院于周二通过预算决议后离开了国会大厦。Kayla Bartkowski/Getty

附原英文报道：

Potential Medicaid cuts raise alarm for states: ‘What do Trump and the Republicans think will happen to these people?’

By Matt Stout and Jason Laughlin Globe Staff,Updated February 27, 2025 

House Speaker Mike Johnson left the Capitol after the House passed his budget resolution on Tuesday.Kayla Bartkowski/Getty

Millions of Massachusetts residents could lose their health care, Governor Maura Healey warned this week. In Rhode Island, some health care facilities are bracing for a “death blow.”

And it’s not just people’s benefits that could suffer, officials warn, but local economies, too.

Such are the nightmare scenarios — and, some worry, real possibilities — if congressional Republicans trim, cut, or even gut federal spending on Medicaid, the country’s largest health insurance program and the single biggest piece of the budget in Massachusetts and elsewhere.

Funded jointly by the federal government and states, Medicaid provides health insurance for roughly one in five Americans, from impoverished children and low-income adults to seniors and those with disabilities reliant on care at home.

Now it’s a target of House Republicans, who have weighed cutting the reimbursement the federal government provides to states to help underwrite their plans to extend President Trump’s 2017 tax cuts, which are due to expire by year’s end.

Medicaid. The resolution doesn’t specify how much could be slashed for the program, and House Speaker Mike Johnson has said lawmakers would not pursue some of the most dramatic options, such as reworking the so-called Federal Medical Assistance Percentage, the formal name for the share of Medicaid costs the federal government provides to each state.

But given its outsized place in federal health care spending, any cuts to Medicaid would have to be significant for Republicans to realize the type of savings they’re pursuing, potentially putting health care benefits at risk for millions of Americans.

In Massachusetts alone, more than 2 million people rely on what’s known as MassHealth, including 45 percent of all children in the state, officials said. Massachusetts currently gets 50 cents from the federal government for every dollar it spends on most people in the program, but up to 90 cents for roughly 400,000 who receive coverage under an expansion of Medicaid through the federal Affordable Care Act.

Seniors in long-term care rely even more heavily on Medicaid funding. Senator Elizabeth Warren said about two out of every three people in a nursing home in Massachusetts get support from Medicaid. (Medicare, the federal health insurance program for older retirees and those with disabilities, doesn’t cover long-term nursing home care.)

“What do Trump and the Republicans think will happen to these people?” Warren said. “Is the idea to set them out on the street corner and have them carted away with tomorrow’s trash?”

Healey’s warnings appear to nod to the worst-case scenario. She told business leaders on Wednesday that if the House’s budget resolution is passed as is, “2 million residents, including 700,000 children and 200,000 seniors, would lose health care” — an apparent reference to all of those who currently rely on MassHealth.

“Who do you think is going to pay for that? What’s going to happen to health care premiums? What’s going to happen to our health care system, health plans, and all the workers and businesses who depend on that when that federal funding goes away?” she said a Greater Boston Chamber of Commerce event. “No one is immune or unaffected by these impacts.”

The state gets nearly $14 billion in federal reimbursements for MassHealth, which, if slashed, could force state officials to choose among cutting benefits, slicing elsewhere from the budget, or tapping emergency funds.

Massachusetts is sitting on more than $8 billion in its emergency savings account, but it’s unclear how willing officials would be to use it to offset Medicaid funding cuts. And significant cuts to MassHealth or other health funding could have a cascading effect across the state, especially within the health care industry, said Treasurer Deb Goldberg.

“We don’t have a lot of farmland. We don’t have oil wells. We don’t have a lot of other industries,” Goldberg said Thursday. “We need Congress to understand that what they are looking at is undermining our economy.”

Just reducing funding for the Medicaid expansion would, in many states, cause significant pain.

New Hampshire, for example, expanded Medicaid eligibility under the Affordable Care Act, but unlike other New England states, its legislature passed a law creating a so-called trigger clause to automatically sunset that expansion if the federal portion falls below 90 percent.

That means if congressional Republicans adjust the federal match below that 90 percent threshold, about one-third of Medicaid beneficiaries in New Hampshire — roughly 60,000 people — would lose coverage.

Kelly Ayotte, the Republican governor, is crafting changes to Medicaid benefits at the state level as part of her two-year budget proposal. She cautioned this week that the federal budget process has a long way to go.

“I can’t deal in hypotheticals,” she said.

In Rhode Island, 311,444 residents get full Medicaid benefits, and another 12,000 receive partial benefits, including children receiving early intervention services, according to state officials.

There’s another wrinkle: Medicaid reimbursements in Rhode Island are significantly lower than those in neighboring states, and hospitals and physicians say they are paid less than their actual costs, sometimes thousands of dollars less for a single procedure.

The situation means that “any potential cuts would be problematic for Rhode Island’s medical community and the entire state’s economy,” said Jessica Wharton, a spokesperson for Brown University Health, formerly known as Lifespan Corp.

For facilities with patients who rely more heavily on Medicaid, the hit would be dramatic. Dr. Amy Nunn, chief executive of the Rhode Island Public Health Institute, said about 30 to 35 percent of its patients at Open Door Health, a LGBTQ+ health clinic it owns, are on Medicaid.

“There’s a good chance that this would be a death blow to other health centers with much higher rates of Medicaid patients,” Nunn said.

Even Massachusetts, with its higher reimbursement rates, would suffer.

About two-thirds of acute care hospitals in Massachusetts lost money last year, citing inadequate reimbursement rates from MassHealth as one factor, said Steve Walsh, chief executive of the Massachusetts Health & Hospital Association.

Further cuts to Medicaid would be “catastrophic” for those financially ailing hospitals and the patients they serve, he said.

“Medicaid is the chassis that the entire health system is built upon,” Walsh said. “If you chip away at that, the ability to provide services in every other area becomes difficult, if not impossible.”

MassHealth was already under pressure before Congress’s potential budget slashing emerged. Pandemic-era federal funds have run out, while the program is strained by growing health care costs, state officials have said.

Last year, people with disabilities fought to protect a home care program largely funded by Medicaid from trims proposed by the Healey administration. Now, with the possibility Congress could make significant cuts, they fear the care they rely on through the Personal Care Assistant program could face an even greater threat.

“Whenever government looks to cut, they always look to cut services for the disabled and the most needy of our society,” said Jerry Boyd, 55, of West Roxbury.

Boyd has cerebral palsy, relies on a power wheelchair, and uses 38 hours a week of assistance from personal care assistants, whose services include helping him get ready for work and to bed at night, shopping, and preparing meals.

“If I get cut in hours, I’d have to really, really think about how best to use the hours that I have,” Boyd said.

Jon Chesto, Alexa Gagosz, Steven Porter, and Rob Weisman of the Globe staff contributed to this report.