阅读每日头条新闻，直接发送到您的收件箱。点击此处。缅因州波特兰——对于试图在美国失灵的医疗体系中生存的缅因州居民来说，局势十分严峻。
Read the top story of the day in your inbox. here. PORTLAND, MAINE – The state of play is dire for Mainers trying to survive America’s failing health care system.
10月1日，近1000人失去了缅因州医疗补助计划（MaineCare，该州的医疗补助项目）的全额覆盖。没有医疗保险意味着只能依赖急诊室服务，并增加了医院提供的无偿医疗金额，这可能是一场慢动作的财务灾难，也可能是通向倒闭的快车道。
On October 1, nearly 1,000 people lost full coverage under MaineCare, the state’s Medicaid program. No health insurance means relying on emergency room services and increases the amount of uncompensated care that hospitals provide, which can be a slow-motion financial catastrophe or a fast track to closure.
如果医疗服务获取还不够让人焦虑，根据缅因州倡导组织“消费者负担得起医疗保健”（Consumers for Affordable Health Care）的数据，近一半的缅因州家庭背负着医疗债务。这种财务压力已经损害了家庭支付基本生活用品的能力。
If access wasn’t enough of a stressor, nearly half of Maine households carry medical debt, according to Consumers for Affordable Health Care, a Maine advocacy group. This financial pressure has compromised families’ ability to pay for basic goods.
而最糟糕的情况尚未到来。超过1万亿美元的削减——这是历史上最大规模的医疗项目回撤——计划在中期选举后生效。根据特朗普总统2025年大型法案H.R. 1，缅因州医疗补助计划面临27亿美元的削减，这意味着约3万名缅因州居民将不再拥有医疗保险。参议员苏珊·柯林斯（共和党）通过声称她个人争取到了500亿美元用于“农村医疗转型计划”以支持农村医院，来转移对这些削减的攻击。但至少在缅因州，该计划本年度的大部分资金流向了州外的远程医疗服务，或用于账单处理和其他官僚职能。
And the worst is yet to come. More than $1 trillion in cuts, the largest rollback of health programs in history, are scheduled to go into effect after the midterms. A $2.7 billion cut in MaineCare, courtesy of H.R. 1, President Trump’s 2025 mega-bill, means that about 30,000 Mainers will no longer have health care coverage. Sen. Susan Collins (R) has deflected attacks over these cuts by saying that she personally secured $50 billion for a Rural Health Transformation Program to shore up rural hospitals. But at least in Maine, most of the current year’s funding from that program goes to telehealth services outside the state, or to billing and other bureaucratic functions.
那些仍符合医疗补助资格的居民将面临工作要求，并必须每六个月重新申请福利。缅因州立法机构去年通过的一项法案将允许更多人获得免费医疗，但这很可能会打乱医院的预算，并导致更多服务削减。
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Those residents who remain eligible for Medicaid will be subject to work requirements and must reapply for benefits every six months.
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A bill that the Maine legislature passed last year will allow more people to access no-cost care but may well scramble hospitals’ budgets and lead to more service cuts.
柯林斯的民主党挑战者特洛伊·杰克逊会告诉你，所有这些杀戮表明，这个体系正在“崩溃”——而且是实时发生的。
All of this carnage, Troy Jackson, Collins’s Democratic challenger, would tell you, shows that the system is “crashing”—in real time.
最近在波特兰市中心的一场活动上，杰克逊在新闻媒体面前填写了缺席选票，随后接受《展望》杂志采访，谈到他计划如何推动医疗改革，以减轻美国人的经济压力。
After filling out his absentee ballot in front of the news media at a recent downtown Portland event, Jackson spoke with the Prospect and commented on how he planned to champion health care reforms that take financial pressures off Americans.
“我们可以对共和党人说，我们要为那些为员工支付高得离谱的医疗保险费的雇主卸下负担，从而争取到他们的支持。你知道这能让我们的经济、让他们的企业好上多少吗？”杰克逊对《展望》杂志说。他还补充说，这个问题也能凝聚一个新的民主党党团。
“We pick off Republicans by saying that we take the burden off of employers that are paying obscene rates for health care for their employees. You know how much better that can make our economy, make their businesses,” Jackson told the Prospect. And he added that the issue could consolidate a new Democratic caucus, too.
“这场竞选真正令人兴奋的另一点是，现在有一大群参选人都抱有同样的信念，比如乔什·图雷克、佩吉·弗拉纳根、玛丽·佩尔托拉和（詹姆斯·）塔拉里科，”他说。“如果我们能有七八位新参议员都相信这一点，我认为我们就能形成一个足以推动它的阵营。”当然，政治无法与特殊利益集团分开，比如医疗保险行业和大型制药公司。“我不怕那些人，”杰克逊坚称。
“What’s really exciting also about this race is that there’s a whole bunch of people running right now that believe the same thing, like Josh Turek, Peggy Flanagan, Mary Peltola, and [James] Talarico,” he said. “If we get seven or eight new senators that all believe in this, I think we’ll have a bloc that can push it.”Of course, the politics cannot be separated from the special interests, like the health insurance industry and Big Pharma. “I’m not afraid of those people,” Jackson insisted.
他经常公开推崇的解决方案是“全民医保”，即单一支付者方案。杰克逊支持《全民医保法案》，该法案将建立一个由卫生与公众服务部监管的全国医疗体系。“把它摆上台面，无论从财务上还是健康上，都是对美国最有利的做法，”杰克逊说。“我知道这是个大工程。”富兰克林·罗斯福和他的劳工部长弗朗西斯·珀金斯曾在大萧条时期尝试建立全国医疗保险计划，但未能成功。自那以后，全民医保体系始终没能在国会找到持久的政治立足点。
The solution he gives a regular shout-out for is Medicare for All, the single-payer solution. Jackson supports the Medicare for All Act, which would establish a national health care system overseen by the Department of Health and Human Services. “Just putting it on the line is the best thing to do for America, financially, health-wise,” Jackson said. “I know it’s a big lift.”Franklin Roosevelt and his labor secretary, Frances Perkins, tried and failed to establish a national health insurance program during the Great Depression. Since then, a universal system has never managed to find a permanent political footing in Congress.
国际油漆工及相关行业工会主席吉米·威廉姆斯在波特兰郊区韦斯特布鲁克举行的另一场杰克逊活动上告诉我，医疗保健费用已经开始上涨，因为医疗保健提供者正在为无法通过医疗补助计划或联邦医疗保险获得付款的那一天做准备。
Jimmy Williams, president of the International Union of Painters and Allied Trades, told me at another Jackson event in Westbrook, a Portland suburb, that the cost of health care has already started to go up because health care providers are preparing for that time when they won’t get paid through Medicaid or Medicare.
他的会员“在我们工会支付的医疗保健费用超过每小时20美元，他们说，‘过去15年里我们的口袋里一直没有涨过工资。’”他说，他们越来越希望看到一种单一支付方式的解决方案或补贴，以“一劳永逸地”控制成本。
His members “are paying over $20 an hour for health care in our union, and they go, ‘We haven’t had a raise in our pocket for the last 15 years.’”He said they increasingly want to see a single-payer-type solution or subsidy that will rein in costs “once and for all.”
“双方在我们的医疗保健系统上除了玩弄政治之外什么也没做，”威廉姆斯说，“特洛伊说得对，美国公众现在希望看到更好的医疗保健解决方案。如果那就是全民联邦医疗保险，那就去做吧。”柯林斯的程序性投票如何促成了对历史上对美国社会福利项目最具破坏性的攻击之一的通过，一直是缅因州参议院竞选的主要话题。她最终投票反对这项巨型法案，但此前曾投票支持通过一项程序性动议推进该法案。那一刻她本可以阻止参议院推进该计划，远在立法进入全院最终投票之前。
“Both sides have played nothing but politics for our health care system,” Williams said, “and Troy’s right in saying that where the American public is right now is wanting to see a better solution for health care. If that’s Medicare for All, let’s do it.”How Collins’s procedural votes contributed to the passage of one of the most destructive attacks on American social welfare programs in history has been a major talking point of the Maine Senate campaign. She ultimately voted against the mega-bill after voting earlier to advance it through a procedural motion. That was a moment when she could have stopped the Senate from moving forward with the plan, long before the legislation came up for a final vote on the floor.
自2006年以来，凯泽家庭基金会关于该主题的民调显示，美国成年人支持联邦政府在医疗保险覆盖方面做得更多。9月，一项民调发现，66%的美国成年人支持一项全国性医疗保健计划。
KFF polls on the subject since 2006 have indicated that American adults favor having the federal government do more on health care coverage. In September, a poll found that 66 percent of American adults supported a national health care plan.
与此同时，缅因州各地的医疗设施仍在不断关闭。过去十年间，已有12家分娩中心关闭。最新一家是位于中海岸小镇达马里斯科塔的缅因健康林肯医院，定于12月关闭。杰克逊最近迎来了他的第一个孙女，她比预产期早两周出生。杰克逊曾表示，如果他的儿子和伴侣当时身处遥远的阿鲁斯图克县北部——杰克逊自己在那里养大了家人——这次分娩的情况可能会大不相同。那里离最近的分娩中心约有90分钟车程。
Meanwhile, medical facilities continue to shut down across Maine. Twelve birthing centers have closed over the past decade. The latest, MaineHealth Lincoln Hospital in the midcoast town of Damariscotta, is scheduled to shut down in December. Jackson, who recently celebrated the arrival, two weeks early, of his first granddaughter, has remarked that the birth could have been very different for his son and his partner had they been in far northern Aroostook County, where Jackson raised his own family. The closest birthing center is about 90 minutes away.
最近，在一个阳光明媚、天空湛蓝的下午，我与班戈的阿什琳·沃德和萨科的凯莉·布伦南共度了一段时间。两人都是注册护士，也是缅因州护士协会/全国护士联合会的成员。她们正在波特兰西区社区为杰克逊拉票，那里许多宏伟的维多利亚式住宅已被分割成公寓。
I spent some time recently on a sunny, clear blue-sky afternoon with Ashlynn Ward of Bangor and Kelli Brennan of Saco, two registered nurses who are members of Maine State Nurses Association/National Nurses United. They were canvassing for Jackson in Portland’s West End neighborhood, where many grand Victorian homes have been divided into apartments.
沃德是一名产房护士。她说，分娩中心关闭不仅伤害患者和医护人员，也伤害那些因无法吸引年轻居民而无法发展壮大的小社区。沃德指出，选民们往往认同柯林斯“对缅因州有利，对国家有害”的说法。但她表示，组织者和拉票者需要说明，这场选举不仅仅关乎缅因州。
Ward, a labor and delivery nurse, said that birthing center closures hurt not only patients and health care professionals. They also harm smaller communities that won’t be able to grow because they can’t attract younger residents. Ward noted that voters tend to agree that Collins is “good for Maine; bad for the country.”But organizers and canvassers, she said, need to make the case that the election is not just about Maine.
“我们需要照顾我们在佐治亚州的兄弟姐妹，因为她投票支持[布雷特]卡瓦诺、推翻罗诉韦德案，这会影响到其他州的人，”沃德说。“她所负责的那一票点燃了整个国家，而特洛伊才是那个不得不在缅因州为我们收拾局面的人……如果她是拨款委员会主席、拥有这么大的控制权，那我们为什么还会陷入这种境地？”
“We need to take care of our brothers and sisters in Georgia, because her voting for [Brett] Kavanaugh and overturning Roe, that impacts people in other states,” Ward said. “The vote that she was responsible for that torched the whole country, Troy was the one that had to fix that in the state of Maine for us … If she’s chair of Appropriations and she has so much control, then why are we in this situation?”