PBS高端访问:美国精神病患者是否享受到了充足的医保权益?

 　　STEPHEN FEE: Gail Davis is 52 years old and lives on Chicago's SouthSide. Every day she prepares lunch for her 82 year old mother who suffered a stroke.

　　Gail is her mom's primary caregiver — yet Gail herself has struggled for decades with mental illness.

　　GAIL DAVIS: "I was like that I guess before — when I come into the world I guess. I didn't match up, and I didn't um — seem to blend in with society, what society says what the world says this is what you have to be and do."

　　STEPHEN FEE: For years, anger, depression, and anxiety all kept Gail from holding a job. And she didn't have health insurance. That meant that for much of her life, except a few emergency room visits, Gail's mental conditions went untreated.

　　MARK ISHAUG: "People with serious mental illnesses generally don't show up to the doctor's office. They don't make medical appointments and psychiatric appointments."

　　STEPHEN FEE: That's Mark Ishaug — he runs Thresholds, Chicago's largest nonprofit mental health provider. He says Gail's story isn't unique among the millions of low-income, uninsured Americans with mental illness.

　　MARK ISHAUG: "So people with a serious or persistent¹ mental illness in general have been treated very badly by the health care system. Either they haven't had insurance and so they weren't able to get care, or they used emergency rooms in hospitals for their care. And it's really hard to engage people and convince them that they can get help and they can be treated well."

　　STEPHEN FEE: In 2010, a family member referred Gail to a mental health clinic in her neighborhood — run and paid for by the city of Chicago. It was the first time in her life she'd seen a therapist.

　　GAIL DAVIS: "He's been a good force. He come into my life at the right time because that's probably what I needed all along."

　　STEPHEN FEE: But during the recession, Illinois was under financial strain. From 2009 to 2012, the state cut mental health spending by $187 million dollars — a pattern that was happening nationwide. During the same period, states slashed² overall mental health budgets by $1.6 billion dollars.

　　And that meant mental health clinics like Gail's were suddenly on the chopping block.

　　By the end of 2012, Chicago had closed half of its outpatient mental health clinics — including Gail's.

　　GAIL DAVIS: "It's like we was dismissed. And that was the hardest part."

　　STEPHEN FEE: But the Chicago clinic closures — along with similar mental health facility closures around the country — weren't just about budget cuts.

　　When the Affordable³ Care Act, or Obamacare, was signed in 2010, it included a provision to expand Medicaid. Twenty-seven states, including Illinois, have opted⁴ in to the plan, which means the federal government — rather than states — will pay for treatment of newly qualified⁵ low-income people like Gail.

　　Bechara Choucair has been Chicago's public health commissioner⁶ for five years.

　　BECHARA CHOUCAIR: "Now all of a sudden they have more options. And if they choose to transition to another provider, we support them through that transition."

　　STEPHEN FEE: Just here in Illinois 120 thousand people with persistent mental illnesses are expected to enroll⁷ in Medicaid who weren't eligible⁸ before the new rules came into effect. But of course being eligible for insurance doesn't necessarily mean you're getting the coverage⁹ you need.

　　STEPHEN FEE: For Gail, signing up for Medicaid complicated her mental health care. After her clinic closed, her therapist began visiting her at home.

　　But according to her medical records, Gail's therapist in mid-2013 "was forced to inform [her] that [mental health] services…would likely have to wind down" and that she could only continue services if she dis-enrolled from her Medicaid plan.

　　A city spokesperson says there was initially¹⁰ uncertainty¹¹ over whether Medicaid recipients¹² could continue seeing city therapists — but that clinicians were never told services had to cease. Nevertheless, Gail went a year without seeing a mental health professional.

　　GAIL DAVIS: "If this is something that's working and this is somebody that I build a bond with, why break that up. You know, because I felt like that was really useless and senseless."

　　Mark Heyrman is a law professor at the University of Chicago and advocates for people with mental illness. He says they have a particularly difficult time when they move out of publicly financed facilities and must find new providers on their own using Medicaid.

　　MARK HEYRMAN: "Losing that human connection and a place that they've gone for treatment for quite a few years and being told 'Now you must go find a new person to be connected to.' That's a difficult thing. And people fall through the cracks. They fail to show up."

　　STEPHEN FEE: So far, Heyrman says figuring out just how many people like Gail have slipped through the system is nearly impossible.

　　MARK HEYRMAN: "I think the answer is we don't know yet. And unfortunately no one has the money or the time or wants to invest their money and time in sort of really figuring out what is happening to everyone who has a serious mental illness."

　　HAROLD POLLACK: "It's gonna be a wild ride I think over the next several years."

　　STEPHEN FEE: Harold Pollack is a public health researcher, also at the University of Chicago — he's an expert on the national health care reform law — and a supporter of it. He says Gail's difficulties show how important it is to help vulnerable people navigate¹³ the system.

　　HAROLD POLLACK: "Because it's not enough to just insure people. You actually have to have systems in place that are effective and economical and credible¹⁴."

　　STEPHEN FEE: Is Medicaid and the private health insurance expansion enough to get people in Chicago who have persistent mental illness the care that they need?

　　MARK ISHAUG: "Medicaid and private insurance, they're– that's just what it is. It's insurance. It doesn't mean that it's care and it doesn't mean that it's access to care. But it's a necessary precondition to what we're able to do."

　　STEPHEN FEE: Not everyone agrees though that Medicaid expansion is the necessary first step. Twenty states have decided¹⁵ not to expand their Medicaid programs mostly out of cost concerns. The federal government has agreed to pay 100 percent of expansion costs, but that figure steadily¹⁶ declines to 90 percent by 2020.

　　So far, the A-C-A has survived court challenges and repeal¹⁷ efforts – and analyst¹⁸ Harold Pollack says the emerging consensus¹⁹ among states may be more about fixing implementation²¹ problems than eliminating the law altogether.

　　HAROLD POLLACK: "I do think that governors, both Democrats²² and Republicans are– you know, they do raise a number of very valid²³ points with the Obama Administration that say, 'You know, health reform has to be tweaked so that it actually works well.' And as we start to really implement²⁰ the Affordable Care Act, we will discover various things that have to be fixed²⁴ along the way."

　　STEPHEN FEE: President Obama has said he welcome ideas to modify health care reform as problems arise.

　　PRESIDENT BARACK OBAMA: "I will always work with anyone who is willing to make this law work even better."

　　STEPHEN FEE: Meanwhile, back on the South Side of Chicago, Gail Davis is seeing her city-funded therapist again.

　　Are you getting the help and the assistance that you need to keep yourself healthy?

　　GAIL DAVIS: "Not like it should be, you know. But that as I speak will change because I do have an appointment by the way next Friday."

　　STEPHEN FEE: Though the city mental health clinics aren't taking Gail's Medicaid plan, they are keeping patients like her on board at least for now.

1 persistent   

adj.坚持不懈的，执意的；持续的

参考例句：

• Albert had a persistent headache that lasted for three days.艾伯特连续头痛了三天。
• She felt embarrassed by his persistent attentions.他不时地向她大献殷勤，使她很难为情。

2 slashed   

v.挥砍( slash的过去式和过去分词 )；鞭打；割破；削减

参考例句：

• Someone had slashed the tyres on my car. 有人把我的汽车轮胎割破了。
• He slashed the bark off the tree with his knife. 他用刀把树皮从树上砍下。 来自《简明英汉词典》

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 opted   

v.选择，挑选( opt的过去式和过去分词 )

参考例句：

• She was co-opted onto the board. 她获增选为董事会成员。
• After graduating she opted for a career in music. 毕业后她选择了从事音乐工作。

5 qualified   

adj.合格的，有资格的，胜任的，有限制的

参考例句：

• He is qualified as a complete man of letters.他有资格当真正的文学家。
• We must note that we still lack qualified specialists.我们必须看到我们还缺乏有资质的专家。

6 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。

7 enroll   

v.招收；登记；入学；参军；成为会员（英)enrol

参考例句：

• I should like to enroll all my children in the swimming class.我愿意让我的孩子们都参加游泳班。
• They enroll him as a member of the club.他们吸收他为俱乐部会员。

8 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。

9 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。

10 initially   

adv.最初，开始

参考例句：

• The ban was initially opposed by the US.这一禁令首先遭到美国的反对。
• Feathers initially developed from insect scales.羽毛最初由昆虫的翅瓣演化而来。

11 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。

12 recipients   

adj.接受的；受领的；容纳的；愿意接受的n.收件人；接受者；受领者；接受器

参考例句：

• The recipients of the prizes had their names printed in the paper. 获奖者的姓名登在报上。 来自《简明英汉词典》
• The recipients of prizes had their names printed in the paper. 获奖者名单登在报上。 来自《现代英汉综合大词典》

13 navigate   

v.航行，飞行；导航，领航

参考例句：

• He was the first man to navigate the Atlantic by air.他是第一个飞越大西洋的人。
• Such boats can navigate on the Nile.这种船可以在尼罗河上航行。

14 credible   

adj.可信任的，可靠的

参考例句：

• The news report is hardly credible.这则新闻报道令人难以置信。
• Is there a credible alternative to the nuclear deterrent?是否有可以取代核威慑力量的可靠办法？

15 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

16 steadily   

adv.稳定地；不变地；持续地

参考例句：

• The scope of man's use of natural resources will steadily grow.人类利用自然资源的广度将日益扩大。
• Our educational reform was steadily led onto the correct path.我们的教学改革慢慢上轨道了。

17 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。

18 analyst   

n.分析家，化验员；心理分析学家

参考例句：

• What can you contribute to the position of a market analyst?你有什么技能可有助于市场分析员的职务？
• The analyst is required to interpolate values between standards.分析人员需要在这些标准中插入一些值。

19 consensus   

n.(意见等的)一致，一致同意，共识

参考例句：

• Can we reach a consensus on this issue?我们能在这个问题上取得一致意见吗？
• What is the consensus of opinion at the afternoon meeting?下午会议上一致的意见是什么？

20 implement   

n.(pl.)工具，器具；vt.实行，实施，执行

参考例句：

• Don't undertake a project unless you can implement it.不要承担一项计划，除非你能完成这项计划。
• The best implement for digging a garden is a spade.在花园里挖土的最好工具是铁锹。

21 implementation   

n.实施，贯彻

参考例句：

• Implementation of the program is now well underway.这一项目的实施现在行情看好。

22 democrats   

n.民主主义者，民主人士( democrat的名词复数 )

参考例句：

• The Democrats held a pep rally on Capitol Hill yesterday. 民主党昨天在国会山召开了竞选誓师大会。
• The democrats organize a filibuster in the senate. 民主党党员组织了阻挠议事。 来自《简明英汉词典》

23 valid   

adj.有确实根据的；有效的；正当的，合法的

参考例句：

• His claim to own the house is valid.他主张对此屋的所有权有效。
• Do you have valid reasons for your absence?你的缺席有正当理由吗？

24 fixed   

adj.固定的，不变的，准备好的；(计算机)固定的

参考例句：

• Have you two fixed on a date for the wedding yet?你们俩选定婚期了吗？
• Once the aim is fixed,we should not change it arbitrarily.目标一旦确定，我们就不应该随意改变。