Name: 醫療補助計劃的實際運作方式--以及特朗普如何削減資金 | WSJ (How Medicaid Actually Works—And How Trump Can Cut Funding | WSJ)
Uploaded: 2025-04-16T02:52:51.000Z
Duration: 6 min 33 s

This is a chart showing the growth of what is now the largest health insurance program in America.

這張圖顯示了目前美國最大的醫療保險計劃的增長情況。

程度副詞

Medicaid covered nearly 23 million people in 1990.

1990 年，醫療補助覆蓋了近 2 300 萬人。

Last year, more than 70 million depended on the program.

去年，有 7000 多萬人依靠該計劃。

The cost to fund Medicaid has also grown.

醫療補助計劃的資金成本也在增加。

In 2023, Medicaid cost taxpayers more than $870 billion, while President Trump has promised to love and cherish Social Security, Medicare, Medicaid.

2023 年，醫療補助計劃將花費納稅人超過 8700 億美元，而特朗普總統卻承諾要愛護和珍惜社會保障、醫療保險和醫療補助計劃。

His budget blueprint calls for $880 billion in cuts from the committee that oversees Medicaid over the next decade.

他的預算藍圖要求負責監督醫療補助的委員會在未來十年內削減 8,800 億美元。

Republicans have repeatedly said that those cuts would be achieved by rooting out waste, fraud, and abuse.

共和黨人一再表示，將通過根除浪費、欺詐和濫用來實現這些削減。

There's no number that we could put to fraud in the program, but it's highly unlikely to be $880 billion.

我們無法對計劃中的欺詐行為進行統計，但極有可能不是 8,800 億美元。

Here are some options Republicans are exploring to cut Medicaid spending, like reducing waste and fraud, reducing federal matching dollars, and adding work requirements.

以下是共和黨人正在探索的一些削減醫療補助支出的方案，如減少浪費和欺詐、減少聯邦配套資金以及增加工作要求等。

Before we dive into that, let's first explain what the program is.

在深入探討之前，我們先來解釋一下什麼是該計劃。

Medicaid provides health insurance coverage for low-income parents, children, and pregnant women, and is also available to people with disabilities and elderly people with long-term care needs.

醫療補助計劃為低收入父母、兒童和孕婦提供醫療保險，殘障人士和有長期護理需求的老年人也可享受該計劃。

Robin Rudowitz is the director of the program on Medicaid at KFF, a nonpartisan health policy nonprofit.

羅賓-魯道維茨（Robin Rudowitz）是無黨派健康政策非營利組織 KFF 的醫療補助項目主任。

It's a pretty complex program, and it has a lot of different roles in the health care system.

這是一個相當複雜的項目，在醫療保健系統中扮演著很多不同的角色。

She said the program is complicated because it is jointly funded by the federal government and the states, which administer it by different names.

她說，該計劃很複雜，因為它是由聯邦政府和各州共同資助的，而各州又以不同的名稱來管理它。

Each state gets federal matching dollars from about 50 to 76 percent of the costs in a funding formula tied to the state's per capita income.

根據與各州個人所得掛鉤的資助公式，各州可獲得約 50% 至 76% 的聯邦配套資金。

So that means the federal government pays a larger share of traditional Medicaid in states with a lower per capita income.

是以，在個人所得較低的州，聯邦政府支付的傳統醫療補助份額較大。

In 2023, the federal government paid for 69 percent of the program, or $606 billion, while states paid the rest.

2023 年，聯邦政府支付該計劃 69% 的費用，即 6,060 億美元，其餘部分由各州支付。

So what does Trump say they're looking to cut?

那麼，特朗普說他們要削減什麼呢？

The White House has cited the billions of dollars in improper payments made to states or providers.

白宮列舉了向各州或醫療服務提供者不當支付的數十億美元。

In 2024, the Centers for Medicare and Medicaid Services reported an improper payment rate of just over 5 percent, or $31 billion, a decrease from the 8.5 percent a year earlier.

據醫療保險和醫療補助服務中心報告，2024 年的不當支付率略高於 5%，即 310 億美元，比上一年的 8.5%有所下降。

CMS noted that 79 percent of those payments were the result of insufficient documentation, usually because a state or provider missed an administrative step.

CMS 指出，這些付款中有 79% 是由於文件不充分造成的，通常是因為州或醫療服務提供者錯過了一個行政步驟。

No one is against addressing fraud, waste, and abuse in the program.

沒有人反對解決計劃中的欺詐、浪費和濫用問題。

Fixing that problem will likely require funding.

In 2010, Obamacare came into the picture.

2010 年，奧巴馬醫改開始實施。

Everybody should have some basic security when it comes to their health care.

在醫療保健方面，每個人都應享有一些基本保障。

Because of the Affordable Care Act, known as the ACA, states have the option to expand Medicaid to adults making up to 138 percent of the federal poverty line, including single, able-bodied adults.

根據《平價醫療法案》（即 ACA），各州可以選擇將醫療補助擴大到聯邦貧困線 138% 以下的成年人，包括單身的健全成年人。

Since 2010, 40 states and D.C. have expanded Medicaid.

自 2010 年以來，已有 40 個州和華盛頓特區擴大了醫療補助計劃。

Under the ACA, federal dollars covered 100 percent, later phased down to 90 percent, of these new enrollees.

根據《聯邦醫療保險法》，聯邦資金對這些新參保者的覆蓋率為 100%，後來逐步降至 90%。

You can see that uptick in enrollment here.

您可以在這裡看到註冊人數的增加。

That's about 20 million people in this expansion group.

在這個擴大的群體中，大約有 2000 萬人。

Congressman Chip Roy, who favors big spending cuts, says the enhanced federal matching rate for Medicaid expansion should be reduced.

支持大幅削減開支的眾議員奇普-羅伊說，應降低擴大醫療補助計劃的聯邦配套率。

Why are we paying more for the expansion population, which tend to be more of the able-bodied, particularly single population, than it is the most vulnerable?

為什麼我們為擴張人口支付的費用比為最脆弱人口支付的費用多？

Why would we pay more federal match for that?

我們為什麼要為此支付更多的聯邦配額？

Because they wanted to goose the Obamacare expansion and to show that this is working.

因為他們想讓 "奧巴馬醫改 "的擴張起死回生，並證明它是有效的。

Reducing the matching rate for expansion enrollees is estimated to save the federal government $561 billion over 10 years. 21 states that expanded Medicaid also voted for President Trump in the 2024 election, making this option difficult for Republican leaders of those states.

據估計，降低擴展計劃參保者的對等費率將在 10 年內為聯邦政府節省 5610 億美元。擴大醫療補助的 21 個州在 2024 年大選中也投票支持特朗普總統，這使得這些州的共和黨領導人很難做出這一選擇。

Kristi Putnam, who oversees the Medicaid program in Arkansas, wants enrollees to have a job, attend school, or be working towards both.

負責阿肯色州醫療補助計劃的克里斯蒂-普特南（Kristi Putnam）希望參保者有工作、有學業，或者正在為這兩方面努力。

This is not intended to be a punitive measure.

It is intended to be a compassionate approach to working community engagement.

它旨在以富有同情心的方式促進工作社區的參與。

Arkansas was the first state in the U.S. to have work requirements for Medicaid in 2018.

阿肯色州是美國第一個在 2018 年對醫療補助計劃提出工作要求的州。

You may need to report 80 hours of activity each month to keep your health insurance. 18,000 people in Arkansas lost coverage in the first five months.

您可能需要每月報告 80 個小時的活動時間，以保留您的健康保險。阿肯色州有 1.8 萬人在前五個月失去了保險。

A federal judge shut down Arkansas' work requirement program in 2019, citing the number of recipients who lost coverage.

聯邦法官於 2019 年關閉了阿肯色州的工作要求計劃，理由是失去保險的受助人數太多。

In January, Arkansas' Republican Governor Sarah Huckabee Sanders announced she is submitting a new and different work requirements program, which still needs approval from the Trump administration.

今年 1 月，阿肯色州共和黨州長薩拉-赫卡比-桑德斯（Sarah Huckabee Sanders）宣佈，她將提交一份新的、與以往不同的工作要求計劃，該計劃仍需得到特朗普政府的準許。

The state estimates that nearly 90,000 people will be affected.

該州估計將有近 9 萬人受到影響。

The new program will require Medicaid enrollees aged 19 to 64 to be on track with a personal development plan in order to keep their benefits.

新計劃要求 19 至 64 歲的醫療補助參保者必須按計劃完成個人發展計劃，才能繼續享受補助。

And we're going to use some new state technology that we've just implemented to be able to do some data matching so that people won't have to do the reporting that was done in 2018.

我們將利用剛剛實施的一些新的國家技術來進行一些數據匹配，這樣人們就不必像 2018 年那樣進行報告了。

It's meant to apply broadly to the expansion population, to have them get on a pathway through education or skills training or employment with an opportunity to advance in that employment.

它的目的是廣泛適用於擴展人口，讓他們通過教育、技能培訓或就業走上發展道路，並有機會在就業中獲得晉升。

A KFF analysis of census data found that about 64% of Medicaid expansion enrollees were already working.

KFF 對人口普查數據的分析發現，約 64% 的醫療補助擴展計劃參保者已經工作。

Many individuals who are not working say that they're not working because they either have an illness or a disability.

許多不工作的人說，他們不工作是因為他們要麼有病，要麼有殘疾。

They have caretaking responsibilities or they might be in school.

他們有照顧他人的責任，也可能在上學。

Under the Arkansas proposal, if the enrollee does not participate and gets what they call not on track, their Medicaid insurance could be suspended.

根據阿肯色州的提議，如果參保人不參加，並出現他們所說的不在正軌上的情況，他們的醫療補助保險可能會被暫停。

Secretary Putnam says she wants Arkansas to be a model for the future of Medicaid.

普特南部長說，她希望阿肯色州成為未來醫療補助的典範。

We're hopeful that actually at the federal level that this working community engagement becomes part of what we do in the Medicaid program.

我們希望，在聯邦層面上，這種工作社區參與能成為醫療補助計劃的一部分。

An analysis of a bill that passed the House in 2023 that would mandate work requirements for all states estimated it would reduce federal spending by $109 billion over a decade.

對 2023 年眾議院通過的一項法案進行的分析估計，該法案將規定所有州的工作要求，十年間聯邦支出將減少 1090 億美元。

And about 1.5 million adults would lose coverage.

Medicaid has become a key piece of the American health care system.

醫療補助計劃已成為美國醫療體系的重要組成部分。

Even if Congress passes cuts to Medicaid, it's the states that have to decide how to implement them.

即使國會通過削減醫療補助，也必須由各州決定如何實施。

States really have to have these hard decisions about what to do in the face of less federal dollars.

在聯邦資金減少的情況下，各州必須做出艱難的決定。

You can either cut coverage, cut access and benefits, or cut provider reimbursement.

你可以削減覆蓋範圍、減少使用機會和福利，或者削減醫療服務提供者的報帳額度。