美国国家公共电台 NPR Trump Is Trying Hard To Thwart Obamacare. How's That Going?

 

AUDIE CORNISH, HOST:

Despite President Trump¹'s pledges to dismantle² the Affordable³ Care Act piece by piece, those insurance marketplaces are still up and running, and open enrollment⁴ is just a few weeks away. Here to talk us through the changes to the law under the Trump administration is NPR's health policy reporter Selena Simmons-Duffin.

Welcome back to the studio.

SELENA SIMMONS-DUFFIN, BYLINE⁵: Hi.

CORNISH: The big one is definitely the individual mandate⁶, right?

SIMMONS-DUFFIN: Yes.

CORNISH: That's where the focus has been. And the penalty for not having insurance right now is zero. Here's what the president said earlier this month at an event in Florida.

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PRESIDENT DONALD TRUMP: We eliminated Obamacare's horrible, horrible, very expensive and very unfair, unpopular individual mandate - a total disaster.

CORNISH: Selena, what's the impact of that, then?

SIMMONS-DUFFIN: Well, the reason for the mandate was to get healthy people into the market. So with it gone, do healthy people get their coverage⁷ elsewhere? This is the first year the penalty is actually zero, but insurers have anticipated the Trump administration wasn't going to enforce this. So premiums⁸ have risen a bit, but it hasn't been so astronomical⁹ that a lot of people have fled from the market.

But the big impact has been in the courts. Because the penalty is now zero, there's a new avenue for people attacking the ACA to attack it again. And there's a ruling expected from the 5th Circuit Court of Appeals any day now, and it's probably headed to the Supreme¹⁰ Court. So that would be the third case on the Affordable Care Act before the Supreme Court.

CORNISH: Another way the president has tried to weaken the ACA is with cheaper so-called skinny health plans. Here he is again at that event in Florida.

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TRUMP: We vastly expanded affordable insurance options, including association health plans, short-term plans and health reimbursement¹¹ arrangements, which are incredible. And many of these options are up to 60% less expensive than Obamacare.

CORNISH: Tell us more about these options.

SIMMONS-DUFFIN: So these are plans that you can buy that have really low premiums, like maybe $70 a month. But they might have really high deductibles, so if you get into an accident or you get really sick, you could be on the hook for maybe $12,000 before your insurance company is going to pay for anything. So he has made these skinny plans much more available than they were in the past. But it's not yet clear if there's going to be, like, a huge number - we're talking maybe a couple hundred thousand people - who choose these plans over ACA plans.

CORNISH: What are some of the other rule changes or regulations that have affected¹² the ACA?

SIMMONS-DUFFIN: So a big one has been allowing states that chose to expand Medicaid under the ACA to institute work requirements. So they say if you want to have Medicaid and you're eligible¹³ for a work requirement that you have to work or go to school and document that to the state in order to continue to get this benefit. So this is all tied up in the courts right now, and so it's unclear if it's going to go into effect in the 18 states that have applied¹⁴ for something like this. But based on Arkansas' experience when it actually had this in effect for several months, a lot of people lost coverage because they just couldn't keep up with the requirements.

And another thing that I'll mention is that the administration stopped payments to insurers to help keep premiums down. That was really early on. And there was a workaround insurance commissioners¹⁵ found, so a lot of people didn't feel the effect on premiums that some people feared.

CORNISH: So no penalty for the individual mandate. You've got this cost-sharing rule that's changed. Big picture, is Obamacare actually dismantled¹⁶ the way the president pledged that he wanted it to be?

SIMMONS-DUFFIN: So it turns out these marketplaces are much more resilient than people expected. There has been some impact. It's probably all of these things have depressed¹⁷ enrollment. The uninsured rate has gone up for the first time since the ACA was passed. Premiums have gone up, probably in part because of all of these changes. But the marketplaces are still there. They're still running. People are still buying these plans.

I think the thing that he's really succeeded in is sowing uncertainty¹⁸. Is this coverage still going to be there? Are these marketplaces going away? And in this event that he held earlier this month in Florida, the way that he talks about Obamacare - how it's going to implode¹⁹ - that has really contributed to the sense of uncertainty about the future of this law.

CORNISH: That's NPR's health policy reporter Selena Simmons-Duffin. Thanks so much.

SIMMONS-DUFFIN: Thank you.

(SOUNDBITE OF DZIHAN & KAMIEN SONG, "AY, AY, AY")

1 trump   

n.王牌，法宝；v.打出王牌，吹喇叭

参考例句：

• He was never able to trump up the courage to have a showdown.他始终鼓不起勇气摊牌。
• The coach saved his star player for a trump card.教练保留他的明星选手，作为他的王牌。

2 dismantle   

vt.拆开，拆卸；废除，取消

参考例句：

• He asked for immediate help from the United States to dismantle the warheads.他请求美国立即提供援助，拆除这批弹头。
• The mower firmly refused to mow,so I decided to dismantle it.修完后割草机还是纹丝不动，于是，我决定把它拆开。

3 affordable   

adj.支付得起的，不太昂贵的

参考例句：

• The rent for the four-roomed house is affordable.四居室房屋的房租付得起。
• There are few affordable apartments in big cities.在大城市中没有几所公寓是便宜的。

4 enrollment   

n.注册或登记的人数；登记

参考例句：

• You will be given a reading list at enrollment.注册时你会收到一份阅读书目。
• I just got the enrollment notice from Fudan University.我刚刚接到复旦大学的入学通知书。

5 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。

6 mandate   

n.托管地；命令，指示

参考例句：

• The President had a clear mandate to end the war.总统得到明确的授权结束那场战争。
• The General Election gave him no such mandate.大选并未授予他这种权力。

7 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。

8 premiums   

n.费用( premium的名词复数 )；保险费；额外费用；（商品定价、贷款利息等以外的）加价

参考例句：

• He paid premiums on his life insurance last year. 他去年付了人寿保险费。 来自《现代英汉综合大词典》
• Moves are afoot to increase car insurance premiums. 现正在酝酿提高汽车的保险费。 来自《简明英汉词典》

9 astronomical   

adj.天文学的，（数字）极大的

参考例句：

• He was an expert on ancient Chinese astronomical literature.他是研究中国古代天文学文献的专家。
• Houses in the village are selling for astronomical prices.乡村的房价正在飙升。

10 supreme   

adj.极度的，最重要的；至高的，最高的

参考例句：

• It was the supreme moment in his life.那是他一生中最重要的时刻。
• He handed up the indictment to the supreme court.他把起诉书送交最高法院。

11 reimbursement   

n.偿还，退还

参考例句：

• He received reimbursement for his travel expenses.由于出差的花费他可以得到公司的补偿。
• Which forms do I need to complete for my travel reimbursement?我需要填什么表来报我的旅费？

12 affected   

adj.不自然的，假装的

参考例句：

• She showed an affected interest in our subject.她假装对我们的课题感到兴趣。
• His manners are affected.他的态度不自然。

13 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。

14 applied   

adj.应用的；v.应用，适用

参考例句：

• She plans to take a course in applied linguistics.她打算学习应用语言学课程。
• This cream is best applied to the face at night.这种乳霜最好晚上擦脸用。

15 commissioners   

n.专员( commissioner的名词复数 )；长官；委员；政府部门的长官

参考例句：

• The Commissioners of Inland Revenue control British national taxes. 国家税收委员管理英国全国的税收。 来自《简明英汉词典》
• The SEC has five commissioners who are appointed by the president. 证券交易委员会有５名委员，是由总统任命的。 来自英汉非文学 - 政府文件

16 dismantled   

拆开( dismantle的过去式和过去分词 )； 拆卸； 废除； 取消

参考例句：

• The plant was dismantled of all its equipment and furniture. 这家工厂的设备和家具全被拆除了。
• The Japanese empire was quickly dismantled. 日本帝国很快被打垮了。

17 depressed   

adj.沮丧的，抑郁的，不景气的，萧条的

参考例句：

• When he was depressed,he felt utterly divorced from reality.他心情沮丧时就感到完全脱离了现实。
• His mother was depressed by the sad news.这个坏消息使他的母亲意志消沉。

18 uncertainty   

n.易变，靠不住，不确知，不确定的事物

参考例句：

• Her comments will add to the uncertainty of the situation.她的批评将会使局势更加不稳定。
• After six weeks of uncertainty,the strain was beginning to take its toll.6个星期的忐忑不安后，压力开始产生影响了。

19 implode   

v.内爆，剧减

参考例句：

• The engine imploded.发动机内爆了。
• He has nightmares about the tanks imploding.他老是做油箱爆炸的噩梦。