
民主党人在各个关键选区正紧咬共和党人不放,指责他们支持的标志性法案“一个宏伟美丽的法案”削减医疗补助。在市政厅会议和辩论舞台上,民主党人猛烈抨击对手支持一项将削减近1万亿美元医疗补助资金、主要用于给富人和企业减税的法律。距离中期选举不足两周,共和党人陷入守势。特朗普政府聚焦欺诈问题,暂停向各州拨付数十亿美元医疗补助资金,并让数十万人退出“奥巴马医改”参保。
Democrats across battleground districts are holding Republicans’ feet to the fire over the Medicaid cuts in their signature One Big Beautiful Bill law. In s and on debate stages, the Democrats are hammering their opponents over their support for a law that will reduce Medicaid funding by nearly $1 trillion to pay for tax cuts primarily for wealthy individuals and corporations. With less than two weeks before the midterm elections, Republicans are playing defense. The Trump administration is focusing on fraud, suspending billions of dollars in Medicaid money to states and disenrolling hundreds of thousands of people from ObamaCare.
一些议员谈论该法案500亿美元农村医疗基金中的较小额投入。另一些人则回避这一问题。加利福尼亚州众议员大卫·瓦拉达奥(共和党)正在一个全美医疗补助人口比例最高的选区之一竞选连任,他为自己投赞成票进行了辩护。“医疗补助没有实际削减,”他在最近一场辩论中表示。瓦拉达奥称,该法律为合格群体保留了医疗补助,并为农村医疗提供了额外资金。
Some lawmakers are talking about smaller investments made as part of the law’s $50 billion rural health fund. Others are avoiding the issue. California Rep. David Valadao (R), who is running for reelection in a district with one of the highest Medicaid populations nationwide, defended his vote for the law. “There are no actual cuts” to Medicaid, he said during a recent debate. Valadao said the law preserved Medicaid for eligible groups and included additional funding for rural healthcare.
上周,缅因州参议员苏珊·柯林斯(共和党)播放了一则广告,宣传她为该州农村医院争取到了1.9亿美元——“20多年来联邦在农村医疗方面最大的一笔投资。”柯林斯投票推动该立法进入议程,并在争取法案中500亿美元农村医疗转型基金的谈判中发挥了关键作用。但她最终投反对票,与共和党参议员汤姆·蒂利斯(北卡罗来纳州)和兰德·保罗(肯塔基州)站在了一起。
Last week, Maine Sen. Susan Collins (R) aired an about how she secured $190 million for her state’s rural hospitals — “the biggest federal investment in rural healthcare in more than 20 years.”Collins voted to advance the legislation to the floor and was a key negotiator in securing $50 billion for the law’s rural health transformation fund. She ultimately voted against final passage, joining fellow Republican Sens. Thom Tillis (N.C.) and Rand Paul (Ky.).
在与民主党挑战者特洛伊·杰克逊的激烈辩论中,柯林斯指出,她在法案中为缅因州农村医疗争取到了资金,如果她在委员会阶段否决法案,这根本不可能实现。杰克逊说,与法案中的总体削减相比,柯林斯争取到的只是“九牛一毛”。“参议员“柯林斯就像个纵火犯,帮着点火,然后又想邀功,说自己端来一杯水去灭火,”杰克逊说。这笔农村医疗基金最终将给缅因州拨付9.5亿美元,其中只有一小部分可用于直接支付给医疗服务提供者。据KFF的一项分析,“一项宏伟美好法案”将从该州削减超过25亿美元。
During a heated debate against Democratic challenger Troy Jackson, Collins noted she had been able to secure funding for Maine’s rural healthcare in the law, which wouldn’t have been possible if she killed it in committee. Jackson said Collins secured a “pittance” compared to the overall cuts in the law. “Sen. Collins is like an arsonist who helped set the fire, and then she wants credit for bringing a cup of water to put it out,” Jackson said. The rural health fund will ultimately give Maine $950 million, and only a small percentage can be used to directly pay providers. The One Big Beautiful Bill will cut more than $2.5 billion from the state, according to an analysis from KFF.
上个月,在亚利桑那州一个势均力敌的选区举行的一场辩论中,民主党人乔安娜·门多萨用类似的措辞攻击现任共和党众议员胡安·西斯科马尼投赞成票支持该法案。“这就像你自己放了一把火,又端来一杯水去浇,”门多萨说。西斯科马尼表示,要不是他施加压力,削减幅度会更大。西斯科马尼是15名众议院共和党温和派议员之一,他们曾告诉领导层,无法支持包含大幅削减医疗补助、威胁医院生存的立法。
During a debate last month in a toss-up district in Arizona, Democrat JoAnna Mendoza used similar language to attack incumbent Rep. Juan Ciscomani (R) for his vote in favor of the bill. “It's like bringing a glass of water to a fire that you started,” Mendoza said. Ciscomani said the cuts would have been larger had he not pushed back. Ciscomani was among 15 House GOP moderates who told leadership they couldn’t support legislation with deep cuts to Medicaid that would threaten hospitals.
但他最终还是投了赞成票。“如果我们采纳了该法案最初提出的FMAP(联邦医疗援助百分比)变更,那么医疗补助扩展覆盖的全部人群都将被从账面上划掉,”西斯科马尼在辩论中说。“那对该州将是毁灭性的。”今年亚利桑那州从农村医疗基金首批拨款中获得了1.67亿美元;“一项宏伟美好法案”预计将从该州削减345亿美元。
He voted for the bill anyway. “Had we done the FMAP [Federal Medical Assistance Percentage] changes that were proposed initially on this bill, then the entire expansion population of Medicaid would have been off the books,” Ciscomani said during the debate. “That would have been devastating for the state.”Arizona received $167 million from the first tranche of the rural health fund this year; the One Big Beautiful Bill is projected to cut $34.5 billion from the state.
过去一年的民调一致显示,选民担心医疗费用,并更信任民主党来解决这一问题。KFF本月早些时候的一项调查显示,总体而言,选民信任民主党处理医疗费用的比例以近2比1的优势领先共和党。盖洛普3月的一项调查发现,比起其他任何国内政策问题,更多美国人担心“医疗服务的可获得性和可负担性”,三分之一的受访者为了负担医疗费用,至少在日常生活开支上做出了一项取舍。
Polling over the past year has consistently shown that voters are worried about the cost of healthcare and trust Democrats more to fix it. A survey from KFF earlier this month showed voters overall trust Democrats to handle healthcare costs by a nearly 2-to-1 margin over Republicans. A Gallup survey from March found more Americans were concerned about the “availability and affordability of healthcare” more than any other domestic policy issue, and one-third made at least one tradeoff of daily living expenses to afford care.
根据库克政治报告和AdImpact分析的数据,民主党在医疗保健主题广告上的支出也超过了共和党;在竞争激烈的众议院选区投入了7000万美元,在竞争激烈的参议院选区投入了9650万美元。共和党在参议院选区的医疗保健广告支出刚刚低于6800万美元,在众议院选区则低于4300万美元。
According to data analyzed by the Cook Political Report and AdImpact, Democrats are also outspending Republicans on healthcare-focused ads; $70 million spent in House competitive races, and $96.5 million spent on competitive Senate races. Republicans have spent just under $68 million on healthcare in Senate races, and under $43 million in House races.
《一个宏伟美好的法案》预计将到2034年削减医疗补助开支超过9000亿美元,其中大部分削减来自对低收入无子女成年人实施严格的全国性工作要求,以及对各州向医疗服务提供者征收的税收实施新限制。共和党策略师承认,如果民主党的攻击引起共鸣,共和党候选人缺乏有力的辩护。
The One Big Beautiful Bill law is expected to reduce Medicaid spending by more than $900 billion through 2034, with the bulk of the cuts coming from a strict national work requirement on low-income childless adults, as well as new restrictions on state-levied taxes on health providers. GOP strategists admit there isn’t a strong defense for Republican candidates if the Democratic attacks resonate.
总部位于密歇根州、正在为众议员汤姆·巴雷特(共和党-密歇根州)竞选工作的共和党策略师杰森·卡贝尔·罗说,民主党成功地扭曲了关于医疗补助的信息。“这被描绘成我们共和党在削减医疗补助,而不是根除浪费、欺诈和滥用。让有劳动能力的人承担一些最低工作要求,”罗说。罗说,几十年来民主党一直在医疗保健问题上宣扬“末日景象”。“我认为对许多选民来说,他们只是对此置若罔闻,”罗说。“现在,如果你切身感受到削减,那就不一样了。”
Jason Cabel Roe, a Michigan-based Republican strategist working on Rep. Tom Barrett’s (R-Mich.) campaign, said Democrats are successfully warping the message about Medicaid. “It is being portrayed as us, Republicans, cutting Medicaid as opposed to rooting out waste, fraud, abuse. Getting able-bodied people to have some minimum work requirements,” Roe said. Roe said Democrats have been campaigning on “doom and gloom” about healthcare for decades. “I think for a lot of voters, they just kind of tune it out,” Roe said. “Now, if you're feeling the cuts, then that's different.”
亚利桑那州的共和党转独立策略师查克·考夫林说,无论共和党怎么说,都在遭受猛烈抨击。医疗保健和医疗补助是原因之一,但选民愤怒的问题还有很多——比如汽油和食品价格、关税以及伊朗战争。马洛里·威尔逊对此文有贡献。
Chuck Coughlin, a Republican-turned-independent strategist in Arizona, said Republicans are being hammered no matter what they say. Healthcare and Medicaid are part of the reason, but there are so many issues voters are angry about — like gas and food prices, tariffs and the war in Iran. Mallory Wilson contributed.