美国国家公共电台 NPR The Future Of Medicaid May Be Found In Indiana, Where The Poor Pay

 

DAVID GREENE, HOST: 

OK, let's hear now how a Trump¹ presidency² could remake one federal program. Medicaid provides health insurance for the poor and disabled. To run the agency that oversees³ Medicaid and also Medicare, Donald Trump has nominated the architect of Medicaid in Indiana. As NPR's Alison Kodjak reports, the poor in Indiana have to pay for their Medicaid benefits or they face consequences.

ALISON KODJAK, BYLINE⁴: Seema Verma is a private consultant⁵. She was hired by Indiana Governor and Vice⁶ President-elect Mike Pence to design a Republican-friendly expansion of Medicaid. Now she'll be in a position to determine whether other states can remake their health programs for the poor in the same mold. In congressional testimony⁷ in 2013, she said Medicaid is a mess.

(SOUNDBITE OF ARCHIVED RECORDING)

SEEMA VERMA: Its rigid⁸, complex rules designed to protect enrollees have also created an intractable program that does not foster efficiency, quality or personal responsibility.

KODJAK: Personal responsibility is a theme in a lot of Verma's work. She's advised several states - Ohio, Kentucky, Iowa and many others - on ways to revamp their health care systems for the poor. Many include cost-sharing features like premiums¹⁰ or health savings¹¹ accounts or incentives¹² for healthy behavior.

(SOUNDBITE OF ARCHIVED RECORDING)

VERMA: The cost-sharing policies is not to burden the individual. I think it's to incentivize them and to empower them to be a part of the equation.

KODJAK: First off, it's important to note that Indiana's expansion under Obamacare did bring Medicaid coverage¹³ to about 246,000 people who weren't eligible¹⁴ before. It has a complex system of carrots and sticks. People make monthly payments into individual health savings accounts, and the state also contributes money. That money can be used for doctor visits and prescriptions¹⁵, and beneficiaries get premium⁹ discounts if they get vaccines¹⁶ or other preventive care. But they can also be penalized¹⁷. If their incomes are just above the poverty line, they can be cut off for months if they miss a payment. Those below poverty are knocked down to a plan with fewer benefits. Cindy Mann is an attorney with the law firm Manatt.

CINDY MANN: There are many ways to try and effectuate personal responsibility. The Indiana philosophy was to set up a health savings account and to require everybody to contribute to the account.

KODJAK: Mann was an official in the Obama administration who negotiated the deal with Indiana to expand Medicaid.

MANN: And so the responsibility was really translated into payment requirements and - with pretty strong consequences if somebody wasn't able to pay.

KODJAK: Mann says Indiana wanted the consequences to be even harsher - a full year with no coverage for people who missed payments. But the Obama administration said no. So how does Indiana's program work in practice? For Amber¹⁸ Thayer - a mom of three who lives in a homeless shelter in Indianapolis - it's been a bit of a nightmare.

AMBER THAYER: Well, unfortunately, I am a recovering addict¹⁹.

KODJAK: She's been clean for six months with the help of the medication Suboxone, and she's training to be a nursing assistant.

THAYER: It's been quite the struggle, but we've gotten there, and we're doing great, and we're getting ready to get into our own home.

KODJAK: Thayer pays a dollar a month for her Medicaid insurance. But in October, someone lost track of her dollar - her insurance company or the state - and her coverage was cut off. She had a bank statement and a receipt that showed she paid, but she still spent six weeks trying to get her coverage back. All the while, she scraped together enough money to buy Suboxone one dose at a time so she could get through her nursing assistant exams.

THAYER: I'm fearing, you know, the withdrawals²⁰, but I'm fearing, you know, I'm getting ready to go into clinicals, you know? If I miss a day of clinicals, I'm not going to get my stipend²¹. If I don't get my stipend, we're not going to have our money to, you know, help us get into our home.

KODJAK: It's these types of complications that have some advocates worried. Joe Thompson is CEO of the Arkansas Center for Health Improvement where he helped develop a Medicaid program with many of the same personal responsibility features as Indiana, including premium payments and health savings accounts. In the end, he says, it just wasn't worth it.

JOE THOMPSON: We had about a year and a half of experience there, and, candidly²², the administrative²³ cost and the operating aspects exceeded what the legislature subsequently perceived the benefit of that program was, and so they stopped the health independence accounts, the health savings accounts.

KODJAK: He says the ideas about personal responsibility are politically popular, but...

THOMPSON: When it comes to operationally having low-income Americans have to participate through that in addition to the complexities²⁴ in our health care system, we lose too many folks along the way, and we may be causing more challenges than we're solving.

KODJAK: But if Seema Verma is confirmed as administrator²⁵ of the Center for Medicare and Medicaid Services, there could be many more states moving to Medicaid systems that put a stronger emphasis on personal responsibility. Alison Kodjak, NPR News.

(SOUNDBITE OF JOSHUA REDMAN & THE BAD PLUS' "FRIEND OR FOE")

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 presidency   

n.总统(校长，总经理)的职位(任期)

参考例句：

• Roosevelt was elected four times to the presidency of the United States.罗斯福连续当选四届美国总统。
• Two candidates are emerging as contestants for the presidency.两位候选人最终成为总统职位竞争者。

3 oversees   

v.监督，监视( oversee的第三人称单数 )

参考例句：

• She oversees both the research and the manufacturing departments. 她既监督研究部门又监督生产部门。 来自《简明英汉词典》
• The Department of Education oversees the federal programs dealing with education. 教育部监管处理教育的联邦程序。 来自互联网

4 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。

5 consultant   

n.顾问；会诊医师，专科医生

参考例句：

• He is a consultant on law affairs to the mayor.他是市长的一个法律顾问。
• Originally,Gar had agreed to come up as a consultant.原来，加尔只答应来充当我们的顾问。

6 vice   

n.坏事；恶习；[pl.]台钳，老虎钳；adj.副的

参考例句：

• He guarded himself against vice.他避免染上坏习惯。
• They are sunk in the depth of vice.他们堕入了罪恶的深渊。

7 testimony   

n.证词；见证，证明

参考例句：

• The testimony given by him is dubious.他所作的证据是可疑的。
• He was called in to bear testimony to what the police officer said.他被传入为警官所说的话作证。

8 rigid   

adj.严格的，死板的；刚硬的，僵硬的

参考例句：

• She became as rigid as adamant.她变得如顽石般的固执。
• The examination was so rigid that nearly all aspirants were ruled out.考试很严，几乎所有的考生都被淘汰了。

9 premium   

n.加付款；赠品；adj.高级的；售价高的

参考例句：

• You have to pay a premium for express delivery.寄快递你得付额外费用。
• Fresh water was at a premium after the reservoir was contaminated.在水库被污染之后，清水便因稀而贵了。

10 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》

11 savings   

n.存款，储蓄

参考例句：

• I can't afford the vacation,for it would eat up my savings.我度不起假，那样会把我的积蓄用光的。
• By this time he had used up all his savings.到这时，他的存款已全部用完。

12 incentives   

激励某人做某事的事物( incentive的名词复数 )； 刺激； 诱因； 动机

参考例句：

• tax incentives to encourage savings 鼓励储蓄的税收措施
• Furthermore, subsidies provide incentives only for investments in equipment. 更有甚者，提供津贴仅是为鼓励增添设备的投资。 来自英汉非文学 - 环境法 - 环境法

13 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。

14 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。

15 prescriptions   

药( prescription的名词复数 )； 处方； 开处方； 计划

参考例句：

• The hospital of traditional Chinese medicine installed a computer to fill prescriptions. 中医医院装上了电子计算机来抓药。
• Her main job was filling the doctor's prescriptions. 她的主要工作就是给大夫开的药方配药。

16 vaccines   

疫苗，痘苗( vaccine的名词复数 )

参考例句：

• His team are at the forefront of scientific research into vaccines. 他的小组处于疫苗科研的最前沿。
• The vaccines were kept cool in refrigerators. 疫苗放在冰箱中冷藏。

17 penalized   

对…予以惩罚( penalize的过去式和过去分词 )； 使处于不利地位

参考例句：

• You will be penalized for poor spelling. 你拼写不好将会受到处罚。
• Team members will be penalized for lateness. 队员迟到要受处罚。

18 amber   

n.琥珀；琥珀色；adj.琥珀制的

参考例句：

• Would you like an amber necklace for your birthday?你过生日想要一条琥珀项链吗？
• This is a piece of little amber stones.这是一块小小的琥珀化石。

19 addict   

v.使沉溺；使上瘾；n.沉溺于不良嗜好的人

参考例句：

• He became gambling addict,and lost all his possessions.他习染上了赌博，最终输掉了全部家产。
• He assisted a drug addict to escape from drug but failed firstly.一开始他帮助一个吸毒者戒毒但失败了。

20 withdrawals   

n.收回，取回，撤回( withdrawal的名词复数 )；撤退，撤走；收回[取回，撤回，撤退，撤走]的实例；推出（组织），提走（存款），戒除毒瘾，对说过的话收回，孤僻

参考例句：

• He has made several withdrawals from his bank account. 他从银行账户上提了几次款。 来自《简明英汉词典》
• It is not the bank's policy to deduct interest on withdrawals. 提款需扣除利息这并非是本银行的政策。 来自辞典例句

21 stipend   

n.薪贴；奖学金；养老金

参考例句：

• The company is going to ajust my stipend from this month onwards.从这一个月开始公司将对我的薪金作调整。
• This sum was nearly a third of his total stipend.这笔钱几乎是他全部津贴的三分之一。

22 candidly   

adv.坦率地，直率而诚恳地

参考例句：

• He has stopped taking heroin now,but admits candidly that he will always be a drug addict.他眼下已经不再吸食海洛因了,不过他坦言自己永远都是个瘾君子。
• Candidly,David,I think you're being unreasonable.大卫，说实话我认为你不讲道理。

23 administrative   

adj.行政的，管理的

参考例句：

• The administrative burden must be lifted from local government.必须解除地方政府的行政负担。
• He regarded all these administrative details as beneath his notice.他认为行政管理上的这些琐事都不值一顾。

24 complexities   

复杂性(complexity的名词复数)； 复杂的事物

参考例句：

• The complexities of life bothered him. 生活的复杂使他困惑。
• The complexities of life bothered me. 生活的杂乱事儿使我心烦。

25 administrator   

n.经营管理者，行政官员

参考例句：

• The role of administrator absorbed much of Ben's energy.行政职务耗掉本很多精力。
• He has proved himself capable as administrator.他表现出管理才能。