罗得岛州总检察长提出医疗体系大改革：重组监管机构并新设州营公共保险选项
罗得岛州总检察长彼得·内罗纳（Peter Neronha）10月29日在普罗维登斯县普罗维登斯市举行的记者会上公布一份医疗体系改革方案，主张重组州卫生厅、医疗补助（Medicaid）管理以及统管两者的机构。内罗纳因任期届满今年不再竞选连任，他表示，该州医疗行业以及监管它的州政府架构已不堪重负、运转不灵。
方案列举的数据显示，罗得岛州医疗体系多处承压：许多居民没有基层医生、没有保险，或即使有保险也负担不起自付费用；医院运营财务不稳，保费涨幅超过工资增长，急诊室人满为患，基层医疗预约要等很久。方案称，若不紧急改革，这些压力将加深系统性失灵，而联邦对医疗补助的预算削减与私人保险市场的不稳定更凸显全面结构改革的必要。
在机构改革方面，方案主张改组罗得岛州卫生与公共服务执行办公室（EOHHS）。该办公室成立于2005年，统管州卫生厅、健康保险专员办公室以及每年约30亿美元的医疗补助管理等。改组后，其下将设两个重构的内阁级机构：医疗管理与融资局，涵盖卫生厅、健康保险专员办公室、医疗补助、州医疗保险交易平台HealthSource RI以及行为健康、发育障碍与医院部；人类服务局，涵盖人类服务部、健康老龄办公室、儿童青年与家庭部以及退伍军人服务办公室。
方案还提议新设一个独立机构「健康政策与进步办公室」，负责加强健康数据分析与卫生政策制定，为州医疗体系设定走向可持续的长期政策。方案指出，该州卫生机构目前分散、资源不足，医院与养老院等设施易主时审查很少，导致管理不善与投入不足反复出现。
方案的另一核心是设立州营公共保险选项：由州政府运营、居民与雇主可自愿加入的健康保险计划，通过收取保费、支付医疗机构并动用州补贴降低保费负担，预计每年需要州政府投入近4亿美元，约占罗得岛州年度医疗总支出的3%。方案引述布朗大学公共卫生学院健康政策研究中心的一份报告称，公共选项可使保费降低80%，并把覆盖扩大到13.3万多名居民；内罗纳表示，联邦法律变化与平价医疗法案强化的保费税收抵免到期，预计将使约5.2万名罗得岛人失去保险。
内罗纳表示，他不指望方案立即通过，相关内容将被打包成法案，提交罗得岛州议会在2027年审议。他在八年任内大幅扩展了总检察长办公室在医疗监管中的角色：2022年否决了Lifespan与Care New England两大医疗系统的合并提议，并参与促成Centurion基金会收购法蒂玛圣母医院与罗杰·威廉姆斯医疗中心的交易，该交易已于今年3月完成。
Rhode Island Attorney General Proposes Health Care Overhaul With Public Insurance Option
Rhode Island Attorney General Peter Neronha unveiled a health care overhaul proposal at an October 29 press conference in Providence, in Providence County, calling for a reorganization of the state Department of Health, the state's administration of Medicaid and the agency that oversees both. Neronha, who is not seeking reelection this year because he has reached his term limit, characterized the industry and the state government structure that regulates it as overburdened and ineffective.
The proposal presents data painting a difficult picture of Rhode Island's health system: many residents are without primary care providers, lack insurance or cannot afford out-of-pocket costs even if covered; hospital operations are financially unstable, premium hikes are outpacing wage increases, emergency rooms are overrun and primary care appointments face long delays. Without urgent reform, the proposal reads, these pressures will deepen systemic failures, while federal budget cuts to Medicaid and instability in private insurance markets intensify the need for comprehensive structural reform.
On reorganization, the plan would restructure the Rhode Island Executive Office of Health and Human Services (EOHHS), established in 2005 as an umbrella agency overseeing the state health department, the Office of the Health Insurance Commissioner (OHIC) and the state's annual administration of roughly $3 billion in Medicaid, among other functions. Under the plan, health care regulation would be centralized under two reconstituted Cabinet-level agencies: a Health Administration and Financing Agency, encompassing the health department, OHIC, Medicaid, HealthSource RI and the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals; and a Human Services Agency, covering the Department of Human Services, the Office of Healthy Aging, the Department of Children, Youth and Families and the Office of Veteran Services.
The proposal would also create the Office of Health Policy and Progress as a new, independent agency to enhance health data analysis and health policy development, setting long-term policies to put the state's health care system on a path to sustainability. The proposal says Rhode Island's health agencies are fragmented and under-resourced, and that hospitals, nursing homes and other facilities have historically changed hands with minimal scrutiny, resulting in repeated cycles of mismanagement and underinvestment.
Another core element is a public health insurance option, a state-run plan that Rhode Islanders and employers could choose to enroll in, collecting premiums, paying providers and using state subsidies to make coverage more affordable. The proposal estimates it would require close to $400 million in annual state funding, about 3 percent of total health care expenditures per year in Rhode Island. Citing a report by the Center for Advancing Health Policy through Research at Brown University's School of Public Health, the proposal says a public option could reduce premiums by 80 percent and expand coverage to more than 133,000 Rhode Islanders. Neronha said federal changes, including the One Big Beautiful Bill Act and the expiration of enhanced Affordable Care Act premium tax credits, are expected to result in about 52,000 Rhode Islanders losing coverage.
Neronha said he does not expect the plan to pass immediately; the overhaul would be packaged into legislative bills for consideration by the Rhode Island General Assembly in 2027. In his eight-year tenure, he greatly expanded his office's role in health care regulation, denying the proposed merger between Lifespan and Care New England in 2022 and helping broker the Centurion Foundation's acquisition of Our Lady of Fatima Hospital and Roger Williams Medical Center, completed in March, which placed the two ailing hospitals into new nonprofit ownership.
来源：GSM·美国（原文链接）
图片来源：位于普罗维登斯市的罗得岛州议会大厦（资料图）。CC BY-SA 4.0，经 Wikimedia Commons。 / The Rhode Island State House in Providence (file photo). CC BY-SA 4.0, via Wikimedia Commons.
