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

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RICH RENNER: If the ACA is repealed and whatever replaces it does not include a pre-existing conditions provision, are there any programs in place at the state level that would step in to help?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

INSKEEP: Wait a minute. So the mandate 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 offset the costs of the sick people that insurers are now required to cover because of the ban on pre-existing condition exclusions.

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 premium for a year. But what analysts 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 entirely 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.