George Washington University.
J Health Polit Policy Law. 2010 Feb;35(1):5-28. doi: 10.1215/03616878-2009-038.
In 2006 Congress passed, and the Centers for Medicare and Medicaid Services (CMS) rapidly issued, regulations requiring states to obtain proof of citizenship from citizens who had applied for Medicaid. This policy was framed as reducing fraud by illegal aliens to preserve benefits for citizens. In fact, evidence indicates there was no significant problem of fraud by immigrants, and the major effect of the policy was to reduce coverage of eligible citizens. This article addresses the reasons why Congress developed this policy and why CMS acted with uncharacteristic haste to implement these counterproductive policies. We note the importance of the policy's symbolic framing--that is, as establishing sanctions against illegal immigration--in congressional passage during a period of rising nativism in Congress and the nation. The regulatory actions reflected the ideological preferences of political appointees and an increasingly adversarial relationship between CMS and state agencies during this period. These haphazard regulatory actions made the policies more convoluted and likely led more eligible citizens to lose coverage. In 2009, Congress amended the law to modify implementation. These issues have continued to persist in the recent debate on national health care reform.
2006 年，国会通过了一项规定，要求各州从申请医疗补助的公民那里获得公民身份证明，医疗保险和医疗补助服务中心（CMS）迅速发布了这一规定。这一政策被说成是为了防止非法移民欺诈，以保护公民的福利。事实上，有证据表明移民欺诈问题并不严重，而该政策的主要影响是减少了符合条件的公民的覆盖面。本文探讨了国会制定这项政策的原因，以及 CMS 为何以不寻常的速度采取行动实施这些适得其反的政策。我们注意到，该政策的象征性框架——即对非法移民实施制裁——在国会和整个国家移民情绪高涨的时期，对国会通过该政策起到了重要作用。在这一时期，监管行动反映了政治任命官员的意识形态偏好，以及 CMS 与州机构之间日益敌对的关系。这些随意的监管行动使政策更加复杂，可能导致更多符合条件的公民失去保障。2009 年，国会修改了法律以修改实施细则。这些问题在最近关于国家医疗改革的辩论中一直存在。
