美国国家公共电台 NPR How Will People Who Are Already Sick Be Treated Under A New Health Law?

 

STEVE INSKEEP, HOST:

Let's ask Julie Rovner about the federal health law. Proposed changes to that law will be even more up for the public debate this week, as we learn just how much a Republican plan to replace Obamacare may cost. Julie's a longtime NPR correspondent, now with Kaiser Health News, who's covered health care roughly forever. So she's the perfect person to ask. Hi, Julie.

JULIE ROVNER: Hey, Steve.

INSKEEP: And we take this one question at a time. This week's question comes from Rich Renner of Collingswood, N.J. Here's his question.

RICH RENNER: If the ACA is repealed¹ and whatever replaces it does not include a pre-existing conditions provision, are there any programs in place at the state level that would step in to help?

INSKEEP: Julie.

ROVNER: Well, not right now. This is something that actually was overtaken by the federal Affordable² Care Act. So there's nothing at the moment.

INSKEEP: Isn't it a promise of the Republicans now, who say they want to replace the ACA, that they would keep the pre-existing conditions rule?

ROVNER: Yes, it is. And they've been saying that all along. But it's not going to be easy for them to do. First of all, a lot of people have pre-existing conditions, about 1 in 4 adults. And prior to the ACA, people could be excluded from individual insurance for things as minor³ as hay fever or having been treated for a bad back. So it's not just the serious diseases.

Now, this hasn't been a problem in the group market for 20 years. That was taken care of. But in the individual market, it was harder because insurers didn't want to sell to all the sick people. They were afraid that prices would go up, and healthy people wouldn't want to join.

INSKEEP: OK, President Trump⁴ says he wants to keep this very popular provision of the Affordable Care Act. Republicans in Congress say they want to keep it. Why do you say it's going to be hard?

ROVNER: Well, at the moment, they actually haven't touched it in the bill that they're proposing. And that's not because they didn't want to but because they can't. The budget rules they're operating under to let them avoid a filibuster⁵ in the Senate mean that they...

INSKEEP: Oh, they can't change the entire law anyway, OK.

ROVNER: That's right. This is one of the things they can't change. But they did change a different piece of it. There are eliminating the penalties for people who don't buy insurance. And those were, of course, to get more healthy people to buy insurance so insurers wouldn't go broke covering the sick people. So what could happen now is if people don't have to join, only the sick people will sign up. And the insurers might not be there to offer coverage⁶.

INSKEEP: Wait a minute. So the mandate⁷ to buy health insurance, which Republicans want to get rid of, is connected to this guarantee for people with pre-existing conditions?

ROVNER: That is exactly correct. That mandate was to help ensure that enough healthy people bought insurance to help offset⁸ the costs of the sick people that insurers are now required to cover because of the ban on pre-existing condition exclusions⁹.

INSKEEP: What are Republicans trying to do instead?

ROVNER: So instead, Republicans have said that if you have a break in coverage, if you want to buy coverage again, you'll have to pay a 30 percent higher premium¹⁰ for a year. But what analysts¹¹ say, the problem with that is that then healthy people really won't come in because now they're looking at...

INSKEEP: Really steep prices.

ROVNER: Right. And so they'll wait until they get sick to buy in.

INSKEEP: Is it entirely¹² clear to people in the industry that this is going to work?

ROVNER: It is not entirely clear to people in the industry that it's going to work. And this is one of the reasons I think Republicans keep calling this bill a work in progress.

INSKEEP: Julie, thanks very much.

ROVNER: Thank you.

INSKEEP: She's with Kaiser Health News. And she will be back next week to take another of your questions about the health law and the effort to change it. You can tweet us @MorningEdition using the hash tag, #ACAchat.

1 repealed   

撤销，废除( repeal的过去式和过去分词 )

参考例句：

• The Labour Party repealed the Act. 工党废除了那项法令。
• The legislature repealed the unpopular Rent Act. 立法机关废除了不得人心的租借法案。

2 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。

3 minor   

adj.较小(少)的，较次要的；n.辅修学科；vi.辅修

参考例句：

• The young actor was given a minor part in the new play.年轻的男演员在这出新戏里被分派担任一个小角色。
• I gave him a minor share of my wealth.我把小部分财产给了他。

4 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。

5 filibuster   

n.妨碍议事，阻挠；v.阻挠

参考例句：

• A senator dragged the subject in as a filibuster.一个参议员硬把这个题目拉扯进来，作为一种阻碍议事的手法。
• The democrats organized a filibuster in the senate.民主党党员在参议院上组织了阻挠议事。

6 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。

7 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。

8 offset   

n.分支，补偿；v.抵消，补偿

参考例句：

• Their wage increases would be offset by higher prices.他们增加的工资会被物价上涨所抵消。
• He put up his prices to offset the increased cost of materials.他提高了售价以补偿材料成本的增加。

9 exclusions   

n.不包括的项目：如接受服务项目是由投保以前已患有的疾病或伤害引致的，保险公司有权拒绝支付。；拒绝( exclusion的名词复数 )；排除；被排斥在外的人（或事物）；排外主义

参考例句：

• This is a trifle compared with the important exclusions. 比之其它重要的排除，这只是一件小事。 来自辞典例句
• For detailed exclusions, please refer to each policy's terms and conditions. 具体的免赔责任请详见条款。 来自互联网

10 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。

11 analysts   

分析家，化验员( analyst的名词复数 )

参考例句：

• City analysts forecast huge profits this year. 伦敦金融分析家预测今年的利润非常丰厚。
• I was impressed by the high calibre of the researchers and analysts. 研究人员和分析人员的高素质给我留下了深刻印象。

12 entirely   

ad.全部地，完整地；完全地，彻底地

参考例句：

• The fire was entirely caused by their neglect of duty. 那场火灾完全是由于他们失职而引起的。
• His life was entirely given up to the educational work. 他的一生统统献给了教育工作。