2026-03-02T10:00:34.998Z / CNN
在佐治亚州东北部，一家医院关闭了产科病房。在新罕布什尔州农村地区，一家社区健康中心停业。在爱荷华州，得梅因一家医院系统解雇了数十名员工并关闭了一家诊所。
所有这些医疗服务提供者都表示，唐纳德·特朗普总统庞大的国内政策议程一揽子计划削减了超过1万亿美元的联邦医疗保健支持，是他们做出这些决定的一个因素。
这项被称为“一揽子美好法案”（One, Big, Beautiful Bill Act）的立法预计将使数百万更多美国人失去医保覆盖，并削减对医院的重要财政支持——这种组合可能迫使本已资金紧张的医疗机构缩减服务和人员配置，导致患者就医地点减少、等待时间延长，尤其是在急诊室。
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在该法案签署仪式上，唐纳德·特朗普总统吹捧其税收和边境安全条款，淡化了医疗保健削减的影响。政府和共和党议员常称该一揽子计划为“工薪家庭减税法案”（Working Families Tax Cut Act）。
但希望在11月的选举中以此法案为竞选优势的共和党人，正面临对这些削减措施所产生后果的政治反弹升级，因为支持该法案的议员正受到指责。
许多医院，特别是农村地区的医院或治疗大量服务不足患者的医院，多年来一直面临财务困难，他们面临医疗费用上涨、劳动力短缺、人口老龄化以及联邦报销率不足以覆盖医疗成本等问题。根据谢普斯卫生服务研究中心的数据，自2005年以来，近200家农村医院已关闭或停止提供住院服务。
专家表示，“一揽子美好法案”将加剧这种财政压力。国会预算办公室（CBO）称，该法案对医疗补助（Medicaid）的历史性削减（包括首次为该安全网项目增设工作要求）预计将在未来十年内使750万人失去医保。其他条款则使这一数字增加到1000万。
但当这些人中的许多人生病时，他们仍会出现在医院，而医院即使无法获得报销也必须提供紧急护理。
雪上加霜的是，《平价医疗法案》（Affordable Care Act）的增强版保费补贴到期，尽管民主党施加了巨大压力，国会共和党人仍选择不延长该补贴。国会预算办公室预计，今年将有大约200万人失去医保覆盖。
此外，“一揽子美好法案”限制了各州对医疗服务提供者征税的能力，而这些税收原本用于各州支付其医疗补助份额，并为医院和其他服务提供者提高报销率提供特别款项等用途。这些提供者税收和州定向支付也增加了各州获得的联邦医疗补助资金。
“我们的医疗保健系统本已脆弱不堪，现在史上最大规模的医疗保健削减将进一步摧毁它，”左倾倡导组织“保护我们的医疗”（Protect Our Care）政策项目主任瓦舒·贾瓦哈尔（Vaishu Jawahar）表示。
保守派美国行动论坛（American Action Forum）主席道格拉斯·霍尔茨-埃金（Douglas Holtz-Eakin）则认为“没有规定医疗补助必须永远保持原有的形式”，并表示共和党希望减少对它的系统性依赖。
“共和党一直将医疗补助视为针对低收入人群的安全网项目，为那些无法自行获得医保的人提供保险，”他说。“民主党则认为医疗补助只是另一个项目，另一种实现全民医保的途径。能扩展就扩展，不惜一切代价。这只是两种观点的碰撞。”
该法案还设立了500亿美元的“农村医疗转型计划”（Rural Health Transformation Program），旨在促使各州及其农村医疗服务提供者进行持久改革，使其走上更可持续的财务道路。尽管一些医疗服务提供者表示该计划将带来益处，但另一些人则认为这对解决法案将造成的重大资金缺口帮助甚微。
而农村基金对城市医院毫无帮助。哈佛大学陈曾熙公共卫生学院11月的分析显示，近100家财务困境医院（其中大多数服务于医疗补助受益人）最有可能因该法案而倒闭或限制服务。
尽管该法案的主要医疗补助条款要到明年或后年才开始实施，但一些医院和其他医疗服务提供者已开始采取措施减轻即将到来的削减影响。
佐治亚州拉沃尼亚的圣玛丽圣母医院去年秋天关闭了产科病房和妇产科中心。准妈妈们现在必须开车约30分钟到最近的有产科服务的医院，或约一个小时到雅典的圣玛丽医院（该院仍设有产科病房）。
圣玛丽医院在一份声明中表示，尽管面临人口老龄化和出生人数下降的挑战，他们花了18个月时间试图招募更多医生、建立合作关系并寻求其他资金来源，但该法案起到了推波助澜的作用。
“国会近期对医疗补助的削减巩固了这一决定，”医院表示。
佐治亚州健康未来组织（Georgians for a Healthy Future）健康政策主任惠特尼·格里格斯（Whitney Griggs）表示，佐治亚州的产妇护理本已紧张。该州的母婴死亡率远高于全国平均水平，2022年只有36%的县设有产科病房。
她称，关闭产科病房对当地女性来说是“巨大损失”。
今年寻求连任的民主党参议员乔恩·奥索夫（Jon Ossoff）在竞选活动中提到了圣玛丽医院的这一决定。奥索夫在2024年大选中输掉的佐治亚州，他说：“在拉沃尼亚，圣玛丽医院宣布将不再为产妇提供产科服务，这是政客们做出的决定。”
2024年8月，副总统JD·万斯在佐治亚州宣传“一揽子美好法案”时抨击奥索夫反对该立法，称他“据称担心人们失去医保”。
“嗯，你知道吗？美国总统承诺过，只有非法移民才会失去医保，他们本就不该在这里，”万斯说。
该共和党一揽子计划还导致爱荷华州的MercyOne医疗系统（拥有21家医疗中心和多个诊所）决定关闭其在奥特姆瓦的诊所，并解雇数十名员工。
MercyOne是Trinity Health的一部分，该公司在给CNN的声明中表示，“近期和未来的政府资金政策变化”预计将使其年收入减少15亿美元。
这迫使该公司进行改革，以“确保长期可持续性和未来增长”，包括在整个Trinity Health削减10.5%的账单和收款部门岗位。
在奥特姆瓦服务了40年的退休医生彼得·赖特（Peter Reiter）对诊所关闭表示不满：“这对患者和医护人员都不是最好的办法。”
“以前的病人或熟人都说，‘我去MercyOne看病，现在该怎么办？去哪里？怎么找医生？’而我给不出答案，”他说。
爱荷华州奥特姆瓦居民朱莉·劳伦斯（Julie Lawrence）是受MercyOne关闭影响的患者之一，她分享了对这种混乱的不满：“我68岁，属于老年人群体，只想留在老家。如果身体不适，不想再开半小时车，虽然能开，但我真的不想。”
与佐治亚州的圣玛丽医院类似，爱荷华州的MercyOne关闭事件正在中期选举竞争激烈的第3选区上演。
共和党众议员扎克·努恩（Zach Nunn）在2024年以不到4个百分点的优势获胜后寻求连任，其主要民主党挑战者莎拉·特隆·加里奥特（Sarah Trone Garriott）则重点批评他投票支持“一揽子美好法案”及其对医疗补助的修改。
“爱荷华州第3选区现在的医疗状况很糟糕，这是扎克·努恩的错，”特隆·加里奥特在社交媒体视频中说。“先是MercyOne宣布因联邦医疗补助削减关闭奥特姆瓦诊所，现在得梅因的MercyOne又宣布今年3月裁员，还是因为联邦医疗补助削减。”
本月，努恩在众议院博客上表示，他会见了奥特姆瓦地区医疗中心的患者和医疗服务提供者，“直接听取一线人员的意见”，并吹嘘通过“一揽子美好法案”500亿美元的“农村医疗转型基金”，他所在州获得了2.09亿美元拨款。
“信息很明确且一致：劳动力短缺使员工不堪重负，运营成本持续攀升，农村医院无法独自承担负担，”他说。
在对投票支持“一揽子美好法案”的批评声中，努恩上月在一项延长《平价医疗法案》补贴的投票中与共和党立场决裂，尽管他一直批评该项目。
新罕布什尔州阿蒙努苏克社区健康服务中心（Ammonoosuc Community Health Services）首席执行官埃德·尚沙拉（Ed Shanshala）不得不做出痛苦决定，去年秋天关闭了其在弗兰科尼亚的服务点，该中心曾为白山农村地区近1600名患者提供服务。
阿蒙努苏克目前仍有四个中心，为26个城镇提供初级保健、行为健康和其他医疗服务，但每年因该法案减少50万美元收入，主要是因为新的工作要求导致患者医保覆盖减少。作为联邦合格健康中心，它仍将提供护理，但无法确定患者能支付多少费用。
关闭弗兰科尼亚服务点是应对该法案影响的第一步。此举通过将8名员工转移到其他地点，节省了约25万美元一次性开支。
“这为我们争取了时间，寻找符合我们使命的其他收入来源，但这远远不足以解决法案对我们亲友邻居的医疗补助投入削减的影响，”尚沙拉说。
曼尼特健康公司（Manatt Health）合伙人、前奥巴马政府官员辛迪·曼恩（Cindy Mann）表示，2014年各州开始根据《平价医疗法案》扩大对低收入成年人的医疗补助覆盖后， uninsured率下降，导致这些州医院的无补偿医疗成本减少。
“当 uninsured率上升，无补偿医疗服务将增加，这一点很快就会显现，”她说。“如果患者群体主要是医疗补助、医疗保险和 uninsured人群——这正是安全网医院的情况——他们别无选择，没有缓冲，也无法通过成本转移弥补损失。”
缅因州北方之光健康系统（Northern Light Health）高管知道，必须在多年计划中考虑“一揽子美好法案”带来的日益增加的财务压力。该系统在该州运营着9家医院、一个医疗集团、养老院和数十个初级保健点。首席财务官詹姆斯·罗尔巴赫（James Rohrbaugh）表示，该法案预计将使该系统年收入减少2700万美元，主要因为今年和明年将有3.4万缅因州人失去医疗补助覆盖。
这种迫在眉睫的收入下降迫使北方之光健康系统去年采取重大措施，包括大幅削减员工、改善收款流程和合并医生办公室，还关闭了一家亏损医院（罗尔巴赫称这一决定早于法案生效）。
目前，该系统正寻求其他方法实现财务健康——希望利用缅因州今年从“农村医疗转型基金”获得的1.9亿美元中的一部分。罗尔巴赫称，他们计划增加远程医疗使用，扩大农村居民服务能力，并雇佣更多财务顾问，主动帮助患者申请医保覆盖（包括应对医疗补助新工作要求）或寻找替代支付援助。
“我认为这是一个大机会，”他说。“农村转型基金的计划是帮助确定如何确保农村地区医疗服务的可持续性。”
随着“一揽子美好法案”条款逐步生效，更多医院和医疗机构将不得不应对报销减少和无补偿医疗成本增加的问题。
天主教健康协会（Catholic Health Association）代表天主教医院、长期护理机构和其他服务提供者，其公共政策副总裁卢卡斯·斯瓦内普尔（Lucas Swanepoel）表示：“他们将不得不决定是否继续提供所有现有服务，或不得不关闭部分服务，或转移给其他医疗机构。”
“未来一两年将至关重要，”他说。
TMC健康公司（TMC Health）首席执行官詹妮弗·门德里茨基（Jennifer Mendrzycki）负责亚利桑那州南部四所医院及数十个小型医疗点，她表示：“这是我们从未见过的医疗保健时期，压力交织。我们一直面临压力，但这次比我职业生涯中任何时候都更严峻。”
门德里茨基强调，同时应对医疗补助削减和医疗服务提供者税收减少的难度：“这完全不可持续，而且——至少在我从医期间——我们从未经历过这样的时刻。这就像完美风暴。”
这一问题在这些州的一系列高风险竞选中至关重要，可能决定今年秋季国会控制权归属。
新罕布什尔州，两党正争夺即将退休的参议员珍妮·沙欣（Jeanne Shaheen）留下的席位，该州2024年民主党总统候选人卡玛拉·哈里斯仅以不到3个百分点优势获胜。缅因州，共和党参议员苏珊·柯林斯（Susan Collins）寻求第六个任期，预计这将是2026年最激烈的竞选之一，已吸引数千万美元广告投放。
这两个州都有老年农村人口，受医疗补助改革和地方医疗服务压力影响更大。霍尔茨-埃金表示，共和党人（尤其是柯林斯）应强调“农村医疗转型基金”，尽管他承认其局限性。
“农村医疗转型基金的设立正是因为柯林斯的努力，”他说。“所以她肯定会以此为竞选资本。”
“（联邦医疗保险和医疗补助服务中心管理员梅赫梅特·奥兹）在分配100亿美元（从500亿美元中）时有很大自由裁量权，约50亿美元直接由CMS管理员控制，”他补充道，“人们希望这笔资金能流向缅因州，柯林斯可以借此强调‘这是我为你们做的’。”
Hospitals are making cuts after ‘big beautiful bill,’ fueling Democrats’ midterm attacks
2026-03-02T10:00:34.998Z / CNN
In northeast Georgia, a hospital closed its maternity ward. In rural New Hampshire, a community health center shuttered. And in Iowa, a Des Moines hospital system laid off dozens of employees and closed a clinic.
All these providers cited President Donald Trump’s sweeping domestic policy agenda package, which slashed more than $1 trillion in federal support for health care, as a factor in their decisions.
The legislation, known as the “One, Big, Beautiful Bill Act,” is expected to leave millions more Americans without coverage and to cut vital financial support for hospitals – a combination that could force already cash-strapped providers to pull back on services and staffing, leaving patients with fewer places and longer waits for care, particularly in emergency rooms.
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At the legislation’s signing, President Donald Trump touted its tax and border security provisions, downplaying the impact of the health care cuts. The administration and GOP lawmakers often refer to the package as the “Working Families Tax Cut Act.”
But Republicans hoping to tout the legislation as a point in their favor in November are confronting an escalating political backlash to the emerging consequences of those cuts, as lawmakers who supported it take the blame.
Many hospitals, particularly those in rural areas or who treat a lot of underserved patients, have been struggling financially for years, contending with rising expenses, workforce shortages, an aging population and federal reimbursement rates that don’t cover the cost of care. Nearly 200 rural hospitals have closed or stopped providing inpatient care since 2005, according to the Sheps Center for Health Services Research.
The “big, beautiful bill” will increase that fiscal strain, experts say. Its historic cuts to Medicaid, which include adding the first-ever work requirement to the safety net program, are expected to leave 7.5 million more people uninsured over the next decade, according to the Congressional Budget Office. Other provisions push up that figure to a total of 10 million.
But when many of those folks get sick, they will still show up at hospitals, who must provide emergency care even if they won’t get reimbursed.
Compounding the problem is the expiration of the Affordable Care Act’s enhanced premium subsidies, which Republicans in Congress opted not to extend despite heavy pressure from Democrats. Some 2 million fewer people are expected to be insured this year, according to the CBO.
In addition, the “big, beautiful bill” curtailed states’ ability to levy taxes on health care providers, which help states fund their share of Medicaid, and to offer special payments to beef up the reimbursement rates for hospitals and other providers, among other uses. These provider taxes and state-directed payments also boost federal Medicaid funding that states receive.
“Our health care system was already fragile and now the largest cuts in health care history are going to disintegrate it further,” said Vaishu Jawahar, director of policy programs at Protect Our Care, a left-leaning advocacy group.
Douglas Holtz-Eakin, president of the conservative-leaning American Action Forum, argued that “there’s nothing that says Medicaid always has to look like the original program,” and said Republicans want less systemic dependence on it.
“Republicans have always viewed Medicaid as a targeted, low-income safety net program for health insurance for those who cannot get it on their own,” he said. “Democrats have taken the view that Medicaid is just another program, another way to get to universal coverage. Expand wherever you can, do what you have to. And so this just represents the collision of those views.”
The package also created a $50 billion Rural Health Transformation Program, which is intended to prompt states and their rural providers to enact lasting changes that will put them on a more sustainable financial path. While some providers say the program will be beneficial, others say it won’t do much to help them contend with the major funding holes the bill will create.
And the rural fund doesn’t do anything to help urban hospitals. Nearly 100 of these hospitals that are financially distressed and disproportionately provide care to Medicaid enrollees are most at risk of shutting down or limiting services because of the bill, according to a November analysis by Harvard’s TH Chan School of Public Health.
Although many of the bill’s main Medicaid provisions don’t start kicking in until the next year or two, some hospitals and other providers are beginning to take steps now to blunt the impact of the coming cuts.
St. Mary’s Sacred Heart Hospital in rural Lavonia, Georgia, closed its labor and delivery unit, as well as its obstetrics and gynecology center, last fall. Expectant mothers now must drive about 30 minutes to the nearest hospital with labor and delivery services or about an hour to St. Mary’s hospital in Athens, which still operates a maternity ward.
St. Mary’s said in a statement that it spent 18 months trying to recruit more doctors, create partnerships and pursue other funding as it contended with an aging population and a declining number of births. But the bill played a role.
“Recent Congressional cuts to Medicaid solidified this decision,” the hospital said.
Maternal care is already strained in Georgia, said Whitney Griggs, director of health policy at Georgians for a Healthy Future, an advocacy group. The state has maternal and infant mortality rates that are much higher than the national average, and only 36% of counties had a labor and delivery unit in 2022.
Losing a labor and delivery unit is a “huge loss” to the women in the area, she said
Sen. Jon Ossoff, the lone Democrat running for reelection this year in a state Trump won in 2024, has pointed to St. Mary’s decision on the campaign trial.
“In Lavonia, St. Mary’s Hospital, they’ve announced they will no longer provide obstetric services to delivering mothers because of decisions made by politicians,” Ossoff said in Atlanta last September.
In Georgia promoting the “One Big Beautiful Bill Act” last August, Vice President JD Vance slammed Ossoff’s opposition to the legislation, saying he was “allegedly worried about people getting kicked off their health care.”
“Well, you know what? The President of the United States made a promise, a sacred promise that the only people who are going to lose access to health care are illegal aliens who shouldn’t be in this country to begin with,” Vance said.
The GOP package also contributed to MercyOne, which has 21 medical centers and multiple clinics across urban and rural Iowa, deciding to close its clinic in Ottumwa and lay off dozens of staffers.
MercyOne is part of Trinity Health, which said in a statement to CNN that “the recent and future government funding policy changes” are expected to reduce its annual revenue by $1.5 billion.
That is forcing it to make changes “to ensure long-term sustainability and future growth,” including cutting positions in its billing and collections department by 10.5% across Trinity Health.
Retired Dr. Peter Reiter, who spent four decades serving patients in Ottumwa, reacted to the closure of the MercyOne clinic there, saying that “this is not the way that’s best for patients and not the best for providers.”
“The number of people who were former patients or just acquaintances who said, I go to MercyOne. What am I supposed to do? Where do I go? How do I get a doctor? And I don’t have an answer,” he said.
Julie Lawrence, an Ottumwa resident and a patient impacted by the MercyOne closure, shared her frustration with the disruptions.
“You know, I’m in the elderly category,” she said. “I’m 68, and I would just like to stay in my hometown. So, you know, if you don’t feel good, you don’t want to have to drive half an hour. I mean, I can, but I don’t really want to.”
Like St. Mary’s in Georgia, the MercyOne closures in Iowa are playing out in competitive midterms contests, with affected locations in the battleground 3rd district.
GOP Rep. Zach Nunn is seeking reelection there after winning in 2024 by just under 4 points, and his leading Democratic challenger, Sarah Trone Garriott, has focused her criticism on his vote for the “One, Big Beautiful Bill Act” and its changes to Medicaid.
“It’s a bad time for health care here in Iowa’s 3rd congressional district, and it’s Zach Nunn’s fault,” Trone Garriott said in a social media video. “First MercyOne announced they were closing their Ottumwa clinic because of federal Medicaid cuts. Now MercyOne Des Moines is announcing layoffs this March, because again, federal Medicaid cuts.”
This month, Nunn wrote on his House blog that he met with patients and providers at Ottumwa Regional Health Center “to hear directly from those on the front lines,” touting $209 million allocated to his state through the OBBBA’s $50 billion “Rural Health Transformation Fund.”
“The message was clear and consistent: workforce shortages are stretching staff thin, operating costs continue to climb, and rural hospitals can’t keep carrying the burden alone,” he said.
And amid the backlash to his vote for the One Big Beautiful Bill Act, Nunn broke with his party last month on a vote to extend subsidies for the Affordable Care Act despite his vocal criticism of the program.
Ed Shanshala, CEO of Ammonoosuc Community Health Services in New Hampshire, had to make the painful decision to shut down its location in Franconia, which served nearly 1,600 patients in the rural White Mountains, last fall.
Ammonoosuc, which has four remaining centers that provide primary care, behavioral health and other medical services to 26 towns, is facing a $500,000 annual loss in revenue from the bill, mainly because fewer of its patients are expected to have Medicaid coverage due to the new work requirements. As a federally qualified health center, it will continue to provide care, but it won’t know how much the patients will be able to pay.
The closing of the Franconia site is only the first step to dealing with the effects of the legislation, Shanshala said. The move provides about $250,000 in one-time savings since Ammonoosuc shifted the eight staffers to other locations.
“It buys time for us to look at other revenue opportunities consistent with our mission, but it won’t come close to addressing the impact of the bill’s disinvestment in our friends, family and neighbors through Medicaid,” he said.
After states began expanding Medicaid to more low-income adults under the Affordable Care Act in 2014, the uninsured rate fell, which led to a decline in hospitals’ uncompensated care costs in those states, said Cindy Mann, a partner at Manatt Health and former Obama administration official.
“When the uninsured rate goes up, you’ll have more uncompensated care and you’ll see it pretty quickly,” she said. “If you have a patient base which is mostly Medicaid, Medicare and the uninsured — which is really a lot of the safety net hospitals — there’s nowhere to go to, there’s no cushion, there’s no cost shift that can make that up.”
In Maine, Northern Light Health’s executives knew they had to factor into their multi-year plan the increased financial pressures that the “big, beautiful bill” would bring. The health system, which operates nine hospitals, a medical group, nursing homes and several dozen primary care locations in the state, is projecting a $27 million annual drop in revenue from the package, said chief financial officer James Rohrbaugh. That’s largely because 34,000 Mainers are expected to lose Medicaid coverage later this year and next.
The looming revenue decline led Northern Light Health to make some major moves last year, including significantly cutting staff, improving its payment collection and consolidating doctors’ offices. It also closed one of its money-losing hospitals, though Rohrbaugh said that decision predated the legislation.
Now, the health system is looking for other ways to become more fiscally sound – and it hopes to use some of the $190 million that Maine is receiving from the Rural Transformation Health Program this year to help it do so. Among its plans are to increase its use of telehealth to expand its ability to care for rural residents and to hire more financial counselors to more proactively aid patients with applying for coverage – including navigating Medicaid’s new work requirements — or finding alternative payment assistance, Rohrbaugh said.
“I see that as a big opportunity,” he said of the program. “The plan for the rural transformation funds is to help figure out how to make sure health care is sustainable in rural areas.”
Going forward, more hospitals and providers will have to contend with shrinking reimbursements and higher uncompensated care costs as the provisions of the “big, beautiful bill” start to take effect.
“They will have to determine whether they can continue offering all their current services or have to shutter some or shift them to other providers,” said Lucas Swanepoel, vice president for public policy at the Catholic Health Association, which represents Catholic hospitals, long-term care facilities and other providers.
“The coming year or two will be really telling,” he said.
Jennifer Mendrzycki is the CEO of TMC Health, which based out of Tucson oversees four hospitals located throughout southern Arizona, in addition to dozens of other smaller locations covering the state’s large rural expanse.
“This is a time like we have not seen in health care before, where we’ve got competing pressures,” she said, discussing the impacts of the sweeping legislation. “We’ve always had competing pressures, but this is more acute than I have seen it in my career.”
Mendrzycki emphasized the difficulty of simultaneously contending with Medicaid cuts and reductions in provider taxes. “It’s totally untenable, and it’s – we’ve never, I don’t think, had a time like this, in at least the time that I have been in healthcare, where both of those things are coming. It’s like the perfect storm,” she said.
It’s an issue for a series of high-stakes races across all these states that could help decide control of Congress this fall.
In New Hampshire, the parties are vying for the open seat left by retiring Sen. Jeanne Shaheen in a state that Democratic presidential nominee Kamala Harris carried by less than 3 full points in 2024. And in Maine, Republican Sen. Susan Collins is seeking a sixth term in what’s expected to be one of the most competitive 2026 races, already drawing tens of millions of dollars in ad spending reservations.
Both states have older, rural populations disproportionately exposed to the changes to Medicaid and the pressure on local providers. Holtz-Eakin said Republicans, and Collins especially, should point to the Rural Transformation Fund, though he acknowledged its limitations.
“The Rural Health Transformation Fund is there because of her,” he said, touting her legislative efforts. “So certainly she’s going to talk about that.”
“There’s an enormous amount of discretion by (Centers for Medicare & Medicaid Services Administrator Mehmet Oz) in allocating – so there’s like $10 billion you have that goes out from the total of $50 billion. And about $5 billion of that is greatly at the discretion of the CMS administrator. One would hope that that might be showing up in Maine and she could point to it and say, this is what I did for you,” he said.