In a new effort to increase access to healthcare for poor people, the Obama administration is proposing a rule that would make it much more difficult for states to cut Medicaid payments to doctors and hospitals. The rule could also put pressure on some states to increase Medicaid payment rates, which are typically lower than what Medicare and commercial insurance pay. Federal officials said Monday that the rule was needed to fulfill the promise of federal law, which says Medicaid recipients should have access to healthcare at least to the same extent as the general population. "We have a responsibility to ensure sufficient beneficiary access to covered services," the administration said in issuing the proposal, to be published Friday in the Federal Register.