美国国家公共电台 NPR Will My High Premiums Go Down? More Q&A About The GOP Health Plan

 

ARI SHAPIRO, HOST:

Senate Republican leaders have said that today would be the day they'd have their health care bill rewritten, but most senators have already left Washington for the July Fourth recess¹. A tweet from President Trump² this morning complicated their work. He said Republicans should immediately repeal³ the Affordable⁴ Care Act and replace it at a later date. The current bill gets rid of big parts of Obamacare, eliminates most of its taxes and shrinks Medicaid dramatically.

ROBERT SIEGEL, HOST:

We asked what was on your mind about the Senate proposal, and we heard from hundreds of you. NPR health policy correspondent Alison Kodjak is with us now to sort through a few more of those comments and questions. Good to see you again, Alison.

ALISON KODJAK, BYLINE⁵: You too. Thanks, Robert.

SIEGEL: And we're going to hear first from Jordan Myers. He's 29 years old. He's in Minneapolis. And when he was no longer eligible⁶ for insurance on his parents' plan, he bought insurance for himself on the exchange.

JORDAN MYERS: I purchased my insurance through the exchange for two and a half years. And what started to concern me was the increasing premiums⁷. I went from paying maybe $120 a month to paying somewhere in the neighborhood of $300 to $400. And I was seeing the doctor once a year for a checkup and other than that would not step inside of a doctor's office.

SIEGEL: Alison, Jordan describes his monthly cost for insurance tripling during that time. First of all, was that a typical experience for a young, healthy person buying health insurance through an exchange?

KODJAK: Well, it's not that unusual to have had your premiums go up that high, especially if you're young. Across the board on average, premiums top-line have doubled. But most people - Jordan's an exception here. Eight-five percent of people who buy insurance on the exchanges get subsidies⁸ to help offset⁹ those premiums.

SIEGEL: Let's say that Jordan has to go back to the exchange. In fact, he's gotten a job that actually has health insurance that goes along with it. Let's say he goes back. How would the Senate bill change things for him?

KODJAK: For someone like him, the Senate bill actually could be good news. The bill changes how insurance companies are allowed to charge for insurance. They're allowed to charge older people up to five times more than younger people instead of three times. So the hope is that for people like Jordan known as young invincibles, the kind of people who you really want to get into these exchanges - their costs will go down. More of them will buy insurance because they'll see value in it.

SIEGEL: It's his parents whose policy may go up, is what you're telling me.

KODJAK: (Laughter) Exactly.

SIEGEL: (Laughter) OK. Our next listener is anxious about the possible removal of protections for those with pre-existing conditions.

AMY MEYER: Hi. This is Amy Meyer. I'm from Corona¹⁰, Calif. I'm the mother of two teenage boys, ages 13 and 14. My children may have a disease called left hypertrophic cardiomyopathy. It's a disease that killed my maternal¹¹ grandfather at the age of 52, killed my mother at the age of 52, and my brother had a heart transplant at the age of 51 and nine months. I've been asked by a cardiologist to have my children genetically¹² tested to see if we could indicate the disease. But I'm refusing for the only reason that if they are positive for this disease, they will then have a pre-existing condition that may exclude them from health care later on.

SIEGEL: Just a terrible decision weighing on Amy Meyer, Alison. First, are her worries well-founded? Might a diagnosis¹³ of her sons be defined as a pre-existing condition?

KODJAK: Well, they definitely could. And that's a real concern. One of the big things the Affordable Care Act did was it ended the practice of insurance companies being able to refuse to cover people who had medical conditions. The Senate bill does keep the language that says insurance companies have to offer policies to people with pre-existing conditions like these boys could have.

SIEGEL: Right.

KODJAK: But they added a really big loophole. It allows states to opt¹⁴ out of this long series of consumer protections that are included in the ACA. And one is a list of benefits insurance companies have to offer. And they include hospitalization. They include prescription¹⁵ drug coverage¹⁶, mental health care or maternity¹⁷ care. And so if a state opts¹⁸ out, you could end up with a policy that technically¹⁹, like, covers your cancer treatment but doesn't pay for your cancer medication. And so that really can change the idea of being protected for your pre-existing conditions.

SIEGEL: A lot of people wrote to us asking about the taxes that were introduced by the Affordable Care Act, most of which the - if not all of which the Republicans say they'd like to undo²⁰. How rich do you have to be to be one of those rich people who's being taxed by the Affordable Care Act?

KODJAK: You have to have a pretty good income - if you're an individual, $200,000 - a couple, $250,000. And then you get taxed on your income above that amount. And also there's a tax on investment income above $250,000. And those along with a lot of corporate²¹ taxes have helped to pay for the Medicaid expansion. They've helped to pay for those subsidies that help people buy insurance.

SIEGEL: You're already being taxed on that income at the marginal rate. How much more are you taxed under the Affordable Care Act, an extra percent? Or...

KODJAK: It's an extra percent for your income, an extra 3.9 for your investment income.

SIEGEL: Now, one listener wrote in and said that many people just aren't following what's happening in Congress because they're covered by their employers, and they think that they'll be unaffected. And listener David Hayes wants to know if that's true.

KODJAK: Well, not completely true. People who have employer health insurance should be paying attention. The Affordable Care Act requires employers of a certain size to offer coverage to their employees, and this bill takes away that mandate²². And in addition, some of the consumer protections that are in the Affordable Care Act that now actually apply to employers may not if states take those waivers because employers can choose which state to follow in terms of their requirements.

SIEGEL: So you might find yourself in a state where, say, your employer has been able to offer insurance that doesn't cover maternity care, doesn't cover obstetrics.

KODJAK: Exactly. Or you know, if there's one thing that we hear a lot about is this lifetime limits. People will have a limit on how much they can get in terms of medical benefits over their lifetime. Those are gone under the Affordable Care Act. They could potentially come back as well.

SIEGEL: That's NPR health policy correspondent Alison Kodjak. Thanks so much.

KODJAK: Thanks, Robert.

1 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。

2 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。

3 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。

4 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。

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 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。

7 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》

8 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》

9 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。

10 corona   

n.日冕

参考例句：

• The corona gains and loses energy continuously.日冕总是不断地获得能量和损失能量。
• The corona is a brilliant,pearly white,filmy light,about as bright as the full moon.光环带是一种灿烂的珠白色朦胧光，几乎像满月一样明亮。

11 maternal   

adj.母亲的，母亲般的，母系的，母方的

参考例句：

• He is my maternal uncle.他是我舅舅。
• The sight of the hopeless little boy aroused her maternal instincts.那个绝望的小男孩的模样唤起了她的母性。

12 genetically   

adv.遗传上

参考例句：

• All the bees in the colony are genetically related. 同一群体的蜜蜂都有亲缘关系。
• Genetically modified foods have already arrived on American dinner tables. 经基因改造加工过的食物已端上了美国人的餐桌。 来自英汉非文学 - 生命科学 - 基因与食物

13 diagnosis   

n.诊断，诊断结果，调查分析，判断

参考例句：

• His symptoms gave no obvious pointer to a possible diagnosis.他的症状无法作出明确的诊断。
• The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做一次彻底的调查分析。

14 opt   

vi.选择，决定做某事

参考例句：

• They opt for more holiday instead of more pay.他们选择了延长假期而不是增加工资。
• Will individual schools be given the right to opt out of the local school authority?各个学校可能有权选择退出地方教育局吗？

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 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。

17 maternity   

n.母性，母道，妇产科病房；adj.孕妇的，母性的

参考例句：

• Women workers are entitled to maternity leave with full pay.女工产假期间工资照发。
• Trainee nurses have to work for some weeks in maternity.受训的护士必须在产科病房工作数周。

18 opts   

v.选择，挑选( opt的第三人称单数 )

参考例句：

• One player hoping to get another chance to shine if Mourinho opts to rest Cole backBridge. 假如穆里尼奥安排阿。科尔轮休，那么同一位置上的将会得到一个上场的机会来证实自己。 来自互联网
• If he opts out this summer, he d sign a five year deal. 如果今夏跳出，他估计会签五年。 来自互联网

19 technically   

adv.专门地，技术上地

参考例句：

• Technically it is the most advanced equipment ever.从技术上说，这是最先进的设备。
• The tomato is technically a fruit,although it is eaten as a vegetable.严格地说，西红柿是一种水果，尽管它是当作蔬菜吃的。

20 undo   

vt.解开，松开；取消，撤销

参考例句：

• His pride will undo him some day.他的傲慢总有一天会毁了他。
• I managed secretly to undo a corner of the parcel.我悄悄地设法解开了包裹的一角。

21 corporate   

adj.共同的，全体的；公司的，企业的

参考例句：

• This is our corporate responsibility.这是我们共同的责任。
• His corporate's life will be as short as a rabbit's tail.他的公司的寿命是兔子尾巴长不了。

22 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。