PBS高端访谈:今年的平价医疗法案报名情况（在线收听）

WILLIAM BRANGHAM: For most Americans, the enrollment period to sign up for insurance plans under the Affordable Care Act ends tomorrow. John Yang has a look at the numbers so far.

JOHN YANG: William, the latest government figures show that, as of last Saturday, more than 4.1 million people had signed up for ACA coverage. That's down nearly 12 percent from last year, and the number of new enrollments is down almost 20 percent, this despite stable premiums and more plans available. Now, millions more are expected to sign up or be reenrolled by tomorrow's deadline. To discuss what's going on, we're joined by Julie Rovner, chief Washington correspondent for Kaiser Health News. Julie, thanks and welcome. Why is enrollment down from last year?

JULIE ROVNER, Kaiser Health News: Well, there are a lot of reasons. A big one, of course, is that Congress last year repealed what's called the mandate penalty, so if you don't have health insurance, you will no longer have to pay a tax penalty for not having it, although a lot of people actually don't even know that. The economy is better. More people have jobs. They don't need their own health insurance. There are some smaller things. In Virginia, they're expanding Medicaid, so you have got tens of thousands, more than 100,000 people who were getting ACA coverage who will now be able to get Medicaid. And the Trump administration allowed these short-term plans, these alternative kinds of plans, that might be cheaper if you're healthy. And there are some number of people who are probably going to sign up for those plans instead, so there are a lot of things that are contributing to this.

JOHN YANG: So, even though enrollment is down, that doesn't mean necessarily that people, that coverage is down?

JULIE ROVNER: We don't know yet. We won't find that out for several more months. But, yes, enrollment is down, but some people could be getting alternate coverage.

JOHN YANG: What does this tell us about the health of the ACA?

JULIE ROVNER: Well, actually, that it's really more resilient than a lot of people thought. It was predicted that, when Congress got rid of the penalty for not having insurance, that the bottom would fall out of the market. And while enrollment is down, the bottom is not really falling out of the market, which is coming as a bit of a surprise to people, that they, it seems to be more the subsidies that can help people buy insurance that are keeping people there, rather than the prospect of a tax penalty if they don't buy it.

JOHN YANG: The bottom not falling out, does that also mean that the market is, the marketplace is stabilizing?

JULIE ROVNER: The marketplace is stabilizing. Insurers are starting to make money. And, in fact, this year, most of them didn't raise premiums anymore, in fact. And some are coming, more insurers are coming into the market. So there's more choices at sort of less rapidly rising prices. So, yes, the market is in better shape certainly than it was last year.

JOHN YANG: And the deadline tomorrow is for the federal marketplace.

JULIE ROVNER: That's right, for the states that use the federal marketplace. It is most of the states. But there's some very large states, including California and New York and Massachusetts, where the deadline is in January. So, they're, so, in most states, tomorrow is a deadline, but in about a half-a-dozen states and Washington, D.C., it is later. So you will still have a chance to sign up.

JOHN YANG: And, also, we won't know final numbers for a while.

JULIE ROVNER: No, we will not know final numbers for a while. Some millions of people will be reenrolled at some point. If they don't come to the marketplace and choose a new plan, they will just be renewed into their old plan.

JOHN YANG: So, people who want to enroll in the federal marketplace before tomorrow's deadline, they go to?

JULIE ROVNER: Healthcare.gov. At this point, it's pretty crowded. They may put you in what they call a waiting room and they will call you back. But if you get in that line, then you will be able to enroll even after the deadline.

JOHN YANG: Julie Rovner of Kaiser Health News, thank you very much.

JULIE ROVNER: You're very welcome.

威廉·布兰汉姆：对于大多数美国人来说，根据平价医疗法案参加保险计划的报名期将于明天截止。约翰·杨了解了一下目前的报名情况。

约翰·杨：威廉好。最新的政府数据显示，截至上周六为止，已经有410多万人报名参加了平价医疗法案。同比下降了12%，而新加入的用户也同比下降了近20%，虽然目前保险费日趋稳定，也有更多的保险项目可供选择。目前，预计还会有上百人在明天截止日期来临之前报名参加医疗法案。为了讨论这个话题，我们邀请了朱莉·瑞福纳，她是凯撒健康新闻驻华盛顿的首席记者。朱莉，感谢并欢迎您来到现场。想请教您，为什么参加比率会较去年下降呢？

朱莉·瑞福纳，凯撒健康新闻：有很多原因。当然了，其中一个重要原因就是：去年国会废止了所谓的授权处罚，所以如果你没有健康保险，也不必再为没交健康保险而付税务罚款了。不过很多人还不知道这件事。美国经济好转了，更多人找到工作了。他们不再需要健康保险了，但还有一些小问题。弗吉尼亚州正在扩张医疗补助计划，所以现在有很多人，至少是10万多已经参加了平价医疗法案的人现在可以享受医疗补助计划的福利。而特朗普政府是允许这些短期计划存在的，这些都是替代性的计划。身体健康的人支出的成本会更低。不过，还是会有一些人报名参加这些计划。这其中是有很多促成因素的。

约翰·杨：所以，虽然参加率下降了，但这并不意味着平价医疗法案覆盖的人数减少了。

朱莉·瑞福纳：这一点还不确定，还需要几个月的时间才能知道。不过，您说的对，虽然参加率下降了，但一些人可以参与其他计划。

约翰·杨：这种情况是否可以说明关于平价医疗法案的一些问题呢？

朱莉·瑞福纳：实际上，平价医疗法案要比很多人想的韧性更强。此前有人预测过，一旦国会撤销不参加健康保险而要承受的处罚，市场就会失去下端的很多受众。而虽然参加率降低了，但下端受众并没有真正地退出市场，这是很多人意料之外的。所以，如果有补贴，就可以促进人们购买保险，并保持保有量。这要比因为没买保险而受到税务罚款要好。

约翰·杨：下端受众并未退出市场，这是否意味着市场正在趋于稳定呢？

朱莉·瑞福纳：市场确实在趋于稳定，保险公司也开始盈利了。而且，实际上，今年，大多数保险公司都没有提高保费。市场上的保险公司越来越多了。所以现在的情况是：选择更多了，价格上涨的也没那么快了。所以说，没错，市场情况肯定比去年更好了。

约翰·杨：明天就是联邦保险市场参保的截止日期了。

朱莉·瑞福纳：是的，对参与联邦市场的州而言，明天是截止日期。大多数州都是如此。但有一些大州，比如加州、纽约、马萨诸塞州，它们的截止日期是1月。确实如此，大多数州明天就是截止日期了，但个别州以及华盛顿哥伦比亚特区的截止日期就要稍晚一些。所以，现在还是有机会参保的。

约翰·杨：我们一时半会还不会知道最终的参保人数。

朱莉·瑞福纳：没错。可能还会有几百人参保。如果这些人不去参加市场上的新计划，就会在旧计划里续费。

约翰·杨：所以，如果要在明天的截止日期之前参保联邦政府计划的话，应该去哪里呢？

朱莉·瑞福纳：可以登录Healthcare.gov。目前网络十分拥挤。他们可能会将准备参保的人员放在等候室里，然后到时候了会叫你。一旦排上了队，那么即便过了截止日期也能报上名。

约翰·杨：非常感谢凯撒健康新闻的朱莉·瑞福纳。

朱莉·瑞福纳：您客气了。