Hermer Laura D
University of Texas Medical Branch, USA.
Ann Health Law. 2012 Summer;21(3):615-37, ii.
Medicaid has been subject to reconsiderations of the proper role of government in providing for the health and welfare of populations over recent decades. Over the last decade in particular, a number of states have transferred many functions that they once performed to private entities, including, in a number of cases, express policymaking functions. The Patient Protection and Affordable Care Act (ACA) takes some crucial steps towards readjusting the equilibrium of Medicaid. Rather than further prioritizing the market in its reforms, it gives the federal government stronger charge of Medicaid policy, refocusing the program more directly on expanding eligibility and providing secure care for beneficiaries in the process. I argue that this reprioritization is in better keeping with the purpose of Medicaid, in contradistinction to the market-driven reforms undertaken during the Bush administration and sought by some states today. It does, however, shift more power from the states to the federal government. This has raised concerns not only from states that oppose the new health reform law, but also from a number that support it. These two groups of states share a desire for greater flexibility in their Medicaid programs than the ACA permits. Yet only one of these groups should be permitted to use federal Medicaid funds to make the reforms they seek. Federal administrations need to be particularly careful, when considering whether to grant state Medicaid waiver requests, to uphold Medicaid's purpose of giving lower-income Americans genuine access to the same health care that other Americans receive.
近几十年来，医疗补助计划一直面临着对政府在为民众提供健康和福利方面适当角色的重新审视。特别是在过去十年中，一些州已将许多曾经由它们履行的职能转移给了私人实体，在一些情况下，甚至包括明确的政策制定职能。《患者保护与平价医疗法案》（ACA）朝着重新调整医疗补助计划的平衡迈出了一些关键步骤。该法案在改革中并非进一步优先考虑市场，而是赋予联邦政府对医疗补助政策更强的掌控权，在此过程中将该计划更直接地重新聚焦于扩大资格范围并为受益人提供可靠的医疗服务。我认为，这种重新排序更符合医疗补助计划的宗旨，这与布什政府时期进行的、且如今一些州仍在寻求的市场驱动型改革形成对比。然而，这确实将更多权力从州转移到了联邦政府。这不仅引发了反对新医疗改革法的州的担忧，也引发了一些支持该法的州的担忧。这两类州都希望在其医疗补助计划中拥有比《平价医疗法案》所允许的更大灵活性。然而，这些州中只有一类应被允许使用联邦医疗补助资金来进行它们所寻求的改革。联邦政府在考虑是否批准州医疗补助豁免请求时需要格外谨慎，以维护医疗补助计划让低收入美国人真正能够获得与其他美国人相同医疗服务的宗旨。
