美国国家公共电台 NPR Senate Republicans Alter Health Care Bill To Avoid 'Death Spiral'

 

ROBERT SIEGEL, HOST:

Congressional forecasters say a Senate bill that aims to repeal¹ and replace Obamacare would leave 22 million more people uninsured by 2026. That's only slightly fewer than a House version that passed last month. That forecast comes as Senate Republican leaders are pressing for a vote on the bill later this week. NPR's Scott Horsley joins us now to talk about this. Hiya, Scott.

SCOTT HORSLEY, BYLINE²: Good to be with you, Robert.

SIEGEL: These numbers come from the Congressional Budget Office. This is the nonpartisan office of bean counters on Capitol Hill. Where do they think these coverage³ reductions are going to come from?

HORSLEY: The biggest change, Robert, would be in Medicaid. Remember; Obamacare expanded the eligible⁴ population for that safety net program. This bill would shrink it. CBO forecasters think within a decade, you would have about 15 million fewer people getting coverage from the Medicaid program. They're also anticipating about 7 million fewer people who would be getting coverage on the individual insurance market. And those who'd be losing coverage would be disproportionately older people at the lower end of the income ladder, especially people between 50 and 64 years old for whom health insurance is a really serious thing.

SIEGEL: Sixty-five - of course Medicare takes over.

HORSLEY: Right. Once you get to be 65, you get kicked into Medicare.

SIEGEL: The CBO puts a big headline number on a bill, in this case the number of people who would lose insurance. Senate Republican Leader Mitch McConnell has been hoping to get a vote on this bill by the end of the week because lawmakers go out of town for the July Fourth recess⁵ after that. How does this forecast, this big number affect the chance of that happening?

HORSLEY: Well, it probably doesn't help. Remember; the Senate Republicans have very little margin⁶ for error. They can only afford to lose two members of their own caucus⁷ if they hope to pass this bill. We already have one Republican, Dean Heller of Nevada, who is up for re-election next year, who has expressed some reservations about the number of people losing coverage under this plan. This number, 22 million, could scare off a few other moderate Republicans.

We've also of course had some conservative Republicans who say this bill doesn't go far enough in unwinding Obamacare. A caveat⁸, though - the CBO says this bill saves a whole lot more money off the federal bill. It reduces the deficit⁹ by a whole lot more than the House bill, about $200 billion over a decade. Presumably Mitch McConnell could plow¹⁰ some of that money back into this bill over the next week or so, sweetening the pot and perhaps bringing some of those reluctant lawmakers along.

SIEGEL: Of course that wouldn't sweeten the pot for people who think more deficit reduction is a vital part of the...

HORSLEY: That would be a way to win over some of the moderates...

SIEGEL: Moderates.

HORSLEY: ...Not the conservatives.

SIEGEL: The senators made some last-minute changes to this bill to address a potential problem that critics said could have led to further erosion in the individual insurance market. What'd they do?

HORSLEY: Yeah. The original version that came out last week was potentially destabilizing for that individual market because it required insurance companies to provide coverage for everyone, but it didn't include any kind of requirement for people to buy coverage. And that could create a perverse¹¹ incentive¹² for people to wait till they get sick to buy coverage, thus driving up prices for everyone. The last-minute fix that they put in would penalize¹³ people who don't get coverage. Say, if you don't - if you let your coverage lapse¹⁴ for two months in any given year, you can be locked out of the market for six months the following year.

SIEGEL: This bill would not only roll back Obamacare. It would also change Medicaid very seriously. What does the CBO say about that?

HORSLEY: Yeah. This goes after the traditional Medicaid program for the poor and disabled. And it would squeeze those costs - the federal cost of that - potentially forcing states to either kick people off or offer a stingier version. But the big effects of that don't come until the later decades, and so they're not really reflected in the CBO forecast.

SIEGEL: NPR's Scott Horsley. Scott, thanks.

HORSLEY: You're welcome.

1 repeal   

n.废止，撤消；v.废止，撤消

参考例句：

• He plans to repeal a number of current policies.他计划废除一些当前的政策。
• He has made out a strong case for the repeal of the law.他提出强有力的理由，赞成废除该法令。

2 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

3 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

4 eligible   

adj.有条件被选中的；(尤指婚姻等)合适(意)的

参考例句：

• He is an eligible young man.他是一个合格的年轻人。
• Helen married an eligible bachelor.海伦嫁给了一个中意的单身汉。

5 recess   

n.短期休息，壁凹（墙上装架子，柜子等凹处）

参考例句：

• The chairman of the meeting announced a ten-minute recess.会议主席宣布休会10分钟。
• Parliament was hastily recalled from recess.休会的议员被匆匆召回开会。

6 margin   

n.页边空白；差额；余地，余裕；边，边缘

参考例句：

• We allowed a margin of 20 minutes in catching the train.我们有20分钟的余地赶火车。
• The village is situated at the margin of a forest.村子位于森林的边缘。

7 caucus   

n.秘密会议；干部会议；v.（参加）干部开会议

参考例句：

• This multi-staged caucus takes several months.这个多级会议常常历时好几个月。
• It kept the Democratic caucus from fragmenting.它也使得民主党的核心小组避免了土崩瓦解的危险。

8 caveat   

n.警告； 防止误解的说明

参考例句：

• I would offer a caveat for those who want to join me in the dual calling.为防止发生误解，我想对那些想要步我后尘的人提出警告。
• As I have written before,that's quite a caveat.正如我以前所写，那确实是个警告。

9 deficit   

n.亏空，亏损；赤字，逆差

参考例句：

• The directors have reported a deficit of 2.5 million dollars.董事们报告赤字为250万美元。
• We have a great deficit this year.我们今年有很大亏损。

10 plow   

n.犁，耕地，犁过的地；v.犁，费力地前进[英]plough

参考例句：

• At this time of the year farmers plow their fields.每年这个时候农民们都在耕地。
• We will plow the field soon after the last frost.最后一场霜过后，我们将马上耕田。

11 perverse   

adj.刚愎的；坚持错误的，行为反常的

参考例句：

• It would be perverse to stop this healthy trend.阻止这种健康发展的趋势是没有道理的。
• She gets a perverse satisfaction from making other people embarrassed.她有一种不正常的心态，以使别人难堪来取乐。

12 incentive   

n.刺激；动力；鼓励；诱因；动机

参考例句：

• Money is still a major incentive in most occupations.在许多职业中，钱仍是主要的鼓励因素。
• He hasn't much incentive to work hard.他没有努力工作的动机。

13 penalize   

vt.对…处以刑罚，宣告…有罪；处罚

参考例句：

• It would be unfair to penalize those without a job.失业人员待遇低下是不公平的。
• The association decided not to penalize you for the race.赛马协会决定对你不予处罚。

14 lapse   

n.过失，流逝，失效，抛弃信仰，间隔；vi.堕落，停止，失效，流逝；vt.使失效

参考例句：

• The incident was being seen as a serious security lapse.这一事故被看作是一次严重的安全疏忽。
• I had a lapse of memory.我记错了。