評論
打印
Stephen Noyes has heard a new worry from his patients and parishioners.
斯蒂芬·諾伊斯（Stephen Noyes）從他的病人和教區居民那里聽到了新的擔憂。
Both a therapist and the local deacon, he is counselling an increasing number who fear they will lose their health care.
他既是治療師又是當地的執事，正在為越來越多擔心失去醫保的人提供咨詢。
Mr Noyes is a social worker at an Ammonoosuc Community Health Services clinic in rural New Hampshire where people trundle over three mountain passes for a session.
諾伊斯是新罕布什爾州農村地區Ammonoosuc社區衛生服務診所的一名社會工作者，在這里，人們為了看病要翻越三座山口。
A fifth of patients at Ammonoosuc receive treatment at least partly thanks to Medicaid, which provides health cover for the poor or disabled.
Ammonoosuc五分之一的病人至少部分得益于醫療補助計劃，該計劃為窮人或殘疾人提供醫療保險。
It is not only patients who are concerned. "I don't know what we'd do without Medicaid," says Nicole Fischler, a nurse and manager at the clinic. "When you cut that, you cut a lifeline."
擔心的不僅僅是病人。診所的護士兼經理妮可·菲施勒（Nicole Fischler）說：“我不知道如果沒有醫療補助計劃我們會怎么樣。削減醫補就相當于切斷了一條生命線。”
It is not a phantom pain: an obscure state law could lead New Hampshire to chuck a third of enrollees off Medicaid within six months of a federal budget passing.
這不是幻痛：一項不明確的州法律可能會導致新罕布什爾州在聯邦預算通過后的六個月內取消三分之一的醫療補助計劃參保者。
On February 25th the House of Representatives narrowly passed a budget blueprint charging the committee which oversees Medicaid with finding savings worth at least $880 billion over ten years.
2月25日，眾議院勉強通過了一項預算藍圖，要求負責監督醫療補助計劃的委員會在十年內至少節省8800億美元。
Republicans are searching for savings to fund $4.5 trillion of tax cuts and Donald Trump has declared Social Security and Medicare, benefits programmes for the elderly, off-limits.
共和黨人正在尋找節省的資金來資助4.5萬億美元的減稅計劃，唐納德·特朗普已宣布禁止社保和醫保，即老年人福利計劃。
Elon Musk's DOGE will barely scratch the surface, leaving Medicaid set to bear the brunt of cuts sought by deficit hawks.
埃隆·馬斯克的政府效率部（DOGE）幾乎不會觸及問題的核心，而醫療補助計劃將承受赤字鷹派尋求的削減的沖擊。
Yet Mr Trump has also promised to "love and cherish" Medicaid. In recent years the programme has grown and any reductions will hit conservative states and voters.
然而，特朗普也承諾“熱愛和珍惜”醫療補助計劃。近年來，該計劃不斷發展，任何削減都會打擊保守的州和選民。
Working out whether—and how—to cut Medicaid crosses one of the fault lines in the Republican Party, between fiscal hardliners and a working-class electorate.
研究是否以及如何削減醫療補助計劃跨越了共和黨的一條斷層線，即財政強硬派和工薪階層選民之間的斷層線。
Medicaid was originally intended to cover only poor parents and disabled people, but the 2010 Affordable Care Act expanded its remit.
醫補計劃最初只打算覆蓋貧困父母和殘疾人，但2010年的《平價醫療法案》擴大了其覆蓋范圍。
Since then 40 states have chosen to extend the scheme to cover anyone earning less than around $21,000. As a result, Medicaid now covers 72 million people in America.
此后，已有40個州選擇將該計劃擴大到覆蓋收入低于21000美元的人群。因此，醫補計劃現已覆蓋美國7200萬人。
It runs from cradle to grave, paying for two-fifths of births and three-fifths of nursing-home residents. It has markedly reduced the share of uninsured Americans but it costs a lot.
該計劃為五分之二的新生兒和五分之三的養老院居民支付費用。該計劃顯著減少了沒有保險的美國人的比例，但成本很高。
Medicaid is funded by a mixture of state and federal dollars. The Treasury's share of the bill is $682 billion a year, or 2.3% of GDP.
醫補計劃由州政府和聯邦政府共同出資。財政部每年承擔6820億美元，占GDP的2.3%。
The House budget plan has no specifics on the cuts, just targets. Mike Johnson, the speaker, has pledged that cutting fraud and waste alone would save "a huge amount of money". But hunting down abuse will be a challenge.
眾議院預算計劃沒有具體削減措施，只有目標。眾議院議長邁克·約翰遜承諾，僅削減欺詐和浪費就能節省“大量資金”。但追查濫用行為將是一項挑戰。
Patients have to provide copious paperwork to qualify, listing all their assets, right down to the mileage on their car and any burial plots they own,
患者必須提供大量文件才能獲得資格，列出他們的所有資產，甚至包括汽車行駛里程和他們擁有的任何墓地，
explains Genevieve Doyle-Fox, who helps patients at Ammonoosuc sign up for coverage.
幫助Ammonoosuc的患者注冊保險的Genevieve Doyle-Fox解釋道。
Faced with this bureaucracy, some patients give up. Fraud is more likely to be found at health-care providers.
面對這種官僚作風，一些患者放棄了。欺詐行為更有可能在醫保提供者那里發現。
But it can be hard for the federal government to identify, given that states administer Medicaid.
但聯邦政府很難識別，因為各州管理醫療補助。
Each year the federal government produces a report estimating the number of payments that were wrongly sent through Medicaid.
聯邦政府每年都會發布一份報告，估計通過醫療補助錯誤發送的付款數量。
The average for the past three years was just 5%, many of which were due to missing paperwork, says Robin Rudowitz of KFF, a health-research group, adding "That is not fraud. Those are potential errors."
健康研究組織KFF的Robin Rudowitz說，過去三年的平均水平僅為5%，其中許多是由于文件缺失造成的，并補充說“這不是欺詐。那些是潛在的錯誤。”
Even if those mistakes could be entirely stopped, the total amount of such payments was $31 billion in 2024, well shy of the sums Republicans are hunting for.
即使這些錯誤可以完全阻止，到2024年，此類付款總額也將達到310億美元，遠遠低于共和黨人所追求的數額。
