美国国家公共电台 NPR U.S. Health Care Wrestles With The 'Pre-Existing Condition'

 

LINDA WERTHEIMER, HOST:

Tuesday is Tax Day, and we're going to zero in on those tax questions dealing¹ with health insurance. Health care reporter Julie Rovner will help us out with that in a few minutes. First, this reminder² of why health care factors into our tax returns in the first place. It has to do with the Affordable³ Care Act and the law's effort to protect people with pre-existing conditions. Reporter Elana Gordon from Philadelphia member station WHYY has more.

ELANA GORDON, BYLINE⁴: For most of his life, Carl Goulden had near-perfect health. He and his wife Wanda say that changed 10 years ago.

What were the symptoms?

CARL GOULDEN: A lot of pain in the back, tired, fatigue⁵.

WANDA GOULDEN: The yellow eyes, gray-like skin.

GORDON: He was diagnosed with hepatitis B. Goulden had a flower shop in Littlestown, Pa., so he was buying insurance for his family on the market for small businesses and the self-employed. Good thing he had it. The meds he needed just to manage Hepatitis B cost more than $10,000 a year - never mind what the costs would be if he ever needed a liver transplant. But then something unexpected started happening.

C. GOULDEN: Insurance renewals⁶ went way up.

GORDON: He says after a few years, he could no longer afford the coverage⁷ - more than a thousand a month - and maintain his business. He dropped the insurance.

C. GOULDEN: I was devastated⁸ because I didn't know when my liver might fail.

W. GOULDEN: You know, it's not fair. Because you have a pre-existing condition, you cannot be covered now. Come on. You know, all this isn't right.

GORDON: But it was completely legal, says Pennsylvania insurance commissioner⁹ Teresa Miller¹⁰.

TERESA MILLER: You may just have been out of luck.

GORDON: Miller says before the ACA mandated¹² that insurers treat sick and healthy people equally, this small individual insurance market was the wild, wild West. Insurers could not overtly¹³ kick people off a plan if they got sick, but they could find ways to charge them a lot more, even people with conditions like acne or high blood pressure. Plus, if you were uninsured...

MILLER: ...An insurance company could simply decline to offer you insurance at all because of your pre-existing condition.

GORDON: Miller says companies who did offer insurance might have a catch. The plans could exclude treatment for that pre-existing condition.

MILLER: So let's say you had diabetes¹⁴, for example. You might have been able to get coverage for maybe an unexpected health care need that arose, but you would still be on your own for any treatment and management of your diabetes.

GORDON: Pennsylvania did try to create a plan for people with lower incomes who were uninsured, but the plan didn't include mental health care, prescription¹⁵ drugs or more than two nights in a hospital. And even that proved too expensive for the state.

MILLER: And so that program was spending 13 to 14 million per month when it was shut down.

GORDON: Across the Delaware River, New Jersey¹⁶ tried something else.

JOEL CANTOR: Insurers could not take health status into account.

GORDON: Joel Cantor is a health researcher at Rutgers and says before the ACA, New Jersey was one of a handful of states that prohibited insurers from denying people with pre-existing conditions coverage. And the state required that insurers provide good insurance for about the same price as covering a healthy person, but...

CANTOR: ...Of course, there were consequences to doing this.

GORDON: The cost. Cantor says the whole individual market in New Jersey became expensive for everyone. There was no mandate¹¹ that people had to have insurance, so only those who really needed coverage signed but then...

CANTOR: ...Prices went up and up and up - the premiums¹⁷ - and enrollment¹⁸ went down, down, down.

GORDON: The state ended up offering a much more bare-bone plan. People bought it, but it didn't cover much. With the ACA came the rule that insurance plans had to cover more and be available to everybody. In exchange, insurers got the mandate and subsidies¹⁹ so everyone would buy in. Cantor says these experiences point to the ongoing²⁰ dilemma²¹ in health care. A small portion of people consume a big chunk²² of health care costs, and it's hard to predict who among us that will be. So the question becomes what kind of care insurance plans should cover and who should shoulder that cost. For NPR News, I'm Elana Gordon.

1 dealing   

n.经商方法，待人态度

参考例句：

• This store has an excellent reputation for fair dealing.该商店因买卖公道而享有极高的声誉。
• His fair dealing earned our confidence.他的诚实的行为获得我们的信任。

2 reminder   

n.提醒物，纪念品；暗示，提示

参考例句：

• I have had another reminder from the library.我又收到图书馆的催还单。
• It always took a final reminder to get her to pay her share of the rent.总是得发给她一份最后催缴通知，她才付应该交的房租。

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 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 fatigue   

n.疲劳，劳累

参考例句：

• The old lady can't bear the fatigue of a long journey.这位老妇人不能忍受长途旅行的疲劳。
• I have got over my weakness and fatigue.我已从虚弱和疲劳中恢复过来了。

6 renewals   

重建( renewal的名词复数 )； 更新； 重生； 合同的续订

参考例句：

• Number of circulations excluding renewals. 7th out of 10 libraries. 借阅数目（不包括续借）。在10间图书馆中排行第七。
• Certification Renewals shall be due on July 1 of the renewal year. 资格认证更新在更新年的7月1日生效。

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 devastated   

v.彻底破坏( devastate的过去式和过去分词)；摧毁；毁灭；在感情上（精神上、财务上等）压垮adj.毁坏的；极为震惊的

参考例句：

• The bomb devastated much of the old part of the city. 这颗炸弹炸毁了旧城的一大片地方。
• His family is absolutely devastated. 他的一家感到极为震惊。

9 commissioner   

n.（政府厅、局、处等部门）专员，长官，委员

参考例句：

• The commissioner has issued a warrant for her arrest.专员发出了对她的逮捕令。
• He was tapped for police commissioner.他被任命为警务处长。

10 miller   

n.磨坊主

参考例句：

• Every miller draws water to his own mill.磨坊主都往自己磨里注水。
• The skilful miller killed millions of lions with his ski.技术娴熟的磨坊主用雪橇杀死了上百万头狮子。

11 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。

12 mandated   

adj. 委托统治的

参考例句：

• Mandated desegregation of public schools. 命令解除公立学校中的种族隔离
• Britain was mandated to govern the former colony of German East Africa. 英国受权代管德国在东非的前殖民地。

13 overtly   

ad.公开地

参考例句：

• There were some overtly erotic scenes in the film. 影片中有一些公开色情场面。
• Nietzsche rejected God's law and wrote some overtly blasphemous things. 尼采拒绝上帝的律法，并且写了一些渎神的作品。

14 diabetes   

n.糖尿病

参考例句：

• In case of diabetes, physicians advise against the use of sugar.对于糖尿病患者，医生告诫他们不要吃糖。
• Diabetes is caused by a fault in the insulin production of the body.糖尿病是由体內胰岛素分泌失调引起的。

15 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

16 jersey   

n.运动衫

参考例句：

• He wears a cotton jersey when he plays football.他穿运动衫踢足球。
• They were dressed alike in blue jersey and knickers.他们穿着一致，都是蓝色的运动衫和灯笼短裤。

17 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》

18 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。

19 subsidies   

n.补贴，津贴，补助金( subsidy的名词复数 )

参考例句：

• European agriculture ministers failed to break the deadlock over farm subsidies. 欧洲各国农业部长在农业补贴问题上未能打破僵局。
• Agricultural subsidies absorb about half the EU's income. 农业补贴占去了欧盟收入的大约一半。 来自《简明英汉词典》

20 ongoing   

adj.进行中的，前进的

参考例句：

• The problem is ongoing.这个问题尚未解决。
• The issues raised in the report relate directly to Age Concern's ongoing work in this area.报告中提出的问题与“关心老人”组织在这方面正在做的工作有直接的关系。

21 dilemma   

n.困境，进退两难的局面

参考例句：

• I am on the horns of a dilemma about the matter.这件事使我进退两难。
• He was thrown into a dilemma.他陷入困境。

22 chunk   

n.厚片，大块，相当大的部分（数量）

参考例句：

• They had to be careful of floating chunks of ice.他们必须当心大块浮冰。
• The company owns a chunk of farmland near Gatwick Airport.该公司拥有盖特威克机场周边的大片农田。