美国国家公共电台 NPR Obamacare Is First Item On Congress' Chopping Block

 

RACHEL MARTIN, HOST: 

Today in Your Health, the future of the Affordable¹ Care Act. On Wednesday, President Obama will meet with congressional Democrats² about how to protect the health care reform plan that bears his name. Republican leaders have said they'll repeal³ Obamacare as soon as they take the reins⁴ in Washington. My co-host David Greene spoke⁵ with NPR health policy correspondent Alison Kodjak about the longstanding tension over this legislation.

ALISON KODJAK, BYLINE⁶: In 2010, the Democrats kind of ran through this law without any Republican support. It was huge, it was complicated, thousands of pages long and ever since, Republicans have been pretty mad about how it passed. And they've refused to help fix it, and, instead, they've just promised over and over again to repeal. And in fact, the House has already voted more than 60 times to do just that over the years.

DAVID GREENE, BYLINE: And now they have - they'll have a Republican president, both houses in Republican control. Looks like it can happen. What exactly does it mean to repeal?

KODJAK: Well, they can't really repeal it outright⁷ because the Democrats in the Senate can filibuster⁸ that and block it, but Democrats can't filibuster anything that has to do with the budget. So what the Republicans probably will do is eliminate the financial parts of the law, the tax and budget items.

But that means they'll eliminate the penalty for people who don't buy health insurance, and they'll eliminate the subsidies⁹ that help people pay for insurance under the law. That's really the core of the Affordable Care Act. So what's not clear is how quickly they're going to cut off the money. They're trying to come up with a replacement¹⁰ plan, and so they may delay that for months or even years.

GREENE: So lack of clarity, delays could mean a lot of people left in limbo¹¹, I imagine.

KODJAK: Millions. Right now, the estimate's about 20 million people get their insurance through Obamacare one way or another. You've got about 10 million people who buy plans through the exchanges that have been set up by the federal and state governments and then there are millions more who have insurance because of the expansion of Medicaid under the law. About 31 states and D.C. have expanded Medicaid to people who have a little bit more money just over the poverty line. And a lot of that is in the Affordable Care Act and could be reversed as well.

GREENE: Democrats have made the charge that people could be cut off if Republicans act very boldly and very quickly. Is that possible? Could Republicans literally¹² cut people off who would get insurance under this?

KODJAK: Well, I don't think that they want to. They have said over and over again - Republican leaders - that they have no intention of just throwing people off their insurance policies. But there's a lot that they have to consider. Before the Affordable Care Act, people with existing medical conditions - they often couldn't get any insurance or they were very much priced out of the market. And there are also a whole group of people who had lifetime limits like a million dollars. And when you have a severe illness, you can reach that limit. So there's this whole slew¹³ of people who did not have insurance, and they're pretty happy with Obamacare, that they can get coverage¹⁴ now. But then there are other people like Will Denecke. I talked to him last October just before he was going to start shopping for insurance for this year, and he was pretty mad because his costs were rising.

WILL DENECKE: Incredibly, we got a notice from our health care company, Moda, which has had financial problems saying that my premium¹⁵ was going up to $930.

KODJAK: So Denecke's self-employed and unlike most people on Obamacare, he makes too much money to qualify for government subsidies. So before the ACA, he paid about $340 a month for insurance, but that's all changed.

DENECKE: I've had health insurance my whole life, but it's just offensive, you know, in principle to think about spending a thousand dollars a month for health care insurance. I just don't make enough to, you know - to pay that kind of percent of my income on health insurance.

KODJAK: But on the other side of the equation, you have people like Leigh Kvetko. She lives in Texas, and she takes about 10 medications every day because she's had two organ transplants. And after Obamacare passed, she was able to quit her job at a big company, start her own business because she could finally get her own insurance.

LEIGH KVETKO: This particular plan - the fact that they cannot discriminate¹⁶ against me because of how I was born was a lifesaver, literally.

GREENE: OK. So Alison Kodjak, that voice right there is someone who really relied on this law because she had preexisting conditions, she could make a big change, start her own company and she would still get insurance. She wouldn't lose it.

KODJAK: Exactly. And that's who the law was really directed at in the first place, people like her.

GREENE: OK. So some of the things you've talked about - Congress could come in, they could defund a lot of parts of this law, the president - you know, President Trump¹⁷ once he comes in will probably sign that. What happens next?

KODJAK: Well, if they vote to defund, all the money could go away to implement¹⁸ and support the law. But some elements stay in place, including the requirement that insurance companies cover people who have ongoing¹⁹ medical conditions, people like Leigh Kvetko. And Trump has said over and over again that he wants to keep that provision because it's very popular. Here he is with Lesley Stahl on "60 Minutes" just after the election.

(SOUNDBITE OF TV SHOW, "60 MINUTES")

LESLEY STAHL: When you replace it, are you going to make sure that people with pre-conditions are still covered?

DONALD TRUMP: Yes. Because it happens to be one of the strongest assets.

STAHL: You're going to keep that?

TRUMP: Also with the children living with their parents for an extended period, we're...

STAHL: You're going to keep that?

TRUMP: ...Very much try and keep that in.

KODJAK: The problem with that is that some experts warn that the individual insurance market could collapse²⁰ altogether if that part of the law is preserved, but young, healthy people stop paying for insurance 'cause it gets too expensive.

GREENE: Because there'd be less money in the system to actually support the people who need the insurance.

KODJAK: Exactly.

GREENE: That's the argument that Democrats are making.

KODJAK: Exactly.

GREENE: So do the Republicans have kind of a broad plan that would give us some idea of, you know, something comprehensive that would be replacing Obamacare?

KODJAK: Well, so what they have is they don't have legislative²¹ language. There's a lot of ideas out there. Various members of Congress have put out proposals, but they don't have a definitive²² plan which is where this talk of delay comes in. They may vote to repeal, but not cut off the money immediately while they come up with their replacement plan.

But included in those ideas there are some general principles. One is that instead of requiring people to buy insurance which is really unpopular, they would instead create incentives²³ for people to buy insurance by offering tax credits toward your insurance premiums²⁴. But there's not a definitive proposal out there. And Republicans are talking about perhaps waiting years before they find a replacement to the Affordable Care Act.

GREENE: All of which is to say you're going to be a very busy reporter covering all of this in this year and the coming year.

KODJAK: I'm sure I will be (laughter).

GREENE: All right. That's NPR's health policy correspondent Alison Kodjak. Thanks, Alison.

KODJAK: Thanks, David.

1 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。

2 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》

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 reins   

感情，激情； 缰( rein的名词复数 )； 控制手段； 掌管； （成人带着幼儿走路以防其走失时用的）保护带

参考例句：

• She pulled gently on the reins. 她轻轻地拉着缰绳。
• The government has imposed strict reins on the import of luxury goods. 政府对奢侈品的进口有严格的控制手段。

5 spoke   

n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说

参考例句：

• They sourced the spoke nuts from our company.他们的轮辐螺帽是从我们公司获得的。
• The spokes of a wheel are the bars that connect the outer ring to the centre.辐条是轮子上连接外圈与中心的条棒。

6 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。

7 outright   

adv.坦率地；彻底地；立即；adj.无疑的；彻底的

参考例句：

• If you have a complaint you should tell me outright.如果你有不满意的事，你应该直率地对我说。
• You should persuade her to marry you outright.你应该彻底劝服她嫁给你。

8 filibuster   

n.妨碍议事，阻挠；v.阻挠

参考例句：

• A senator dragged the subject in as a filibuster.一个参议员硬把这个题目拉扯进来，作为一种阻碍议事的手法。
• The democrats organized a filibuster in the senate.民主党党员在参议院上组织了阻挠议事。

9 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》

10 replacement   

n.取代，替换，交换；替代品，代用品

参考例句：

• We are hard put to find a replacement for our assistant.我们很难找到一个人来代替我们的助手。
• They put all the students through the replacement examination.他们让所有的学生参加分班考试。

11 limbo   

n.地狱的边缘；监狱

参考例句：

• His life seemed stuck in limbo and he could not go forward and he could not go back.他的生活好像陷入了不知所措的境地，进退两难。
• I didn't know whether my family was alive or dead.I felt as if I was in limbo.我不知道家人是生是死，感觉自己茫然无措。

12 literally   

adv.照字面意义，逐字地；确实

参考例句：

• He translated the passage literally.他逐字逐句地翻译这段文字。
• Sometimes she would not sit down till she was literally faint.有时候，她不走到真正要昏厥了，决不肯坐下来。

13 slew   

v.（使）旋转；n.大量，许多

参考例句：

• He slewed the car against the side of the building.他的车滑到了大楼的一侧，抵住了。
• They dealt with a slew of other issues.他们处理了大量的其他问题。

14 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。

15 premium   

n.加付款；赠品；adj.高级的；售价高的

参考例句：

• You have to pay a premium for express delivery.寄快递你得付额外费用。
• Fresh water was at a premium after the reservoir was contaminated.在水库被污染之后，清水便因稀而贵了。

16 discriminate   

v.区别，辨别，区分；有区别地对待

参考例句：

• You must learn to discriminate between facts and opinions.你必须学会把事实和看法区分出来。
• They can discriminate hundreds of colours.他们能分辨上百种颜色。

17 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。

18 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。

19 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。

20 collapse   

vi.累倒；昏倒；倒塌；塌陷

参考例句：

• The country's economy is on the verge of collapse.国家的经济已到了崩溃的边缘。
• The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做了一次彻底的调查分析。

21 legislative   

n.立法机构，立法权；adj.立法的，有立法权的

参考例句：

• Congress is the legislative branch of the U.S. government.国会是美国政府的立法部门。
• Today's hearing was just the first step in the legislative process.今天的听证会只是展开立法程序的第一步。

22 definitive   

adj.确切的，权威性的；最后的，决定性的

参考例句：

• This book is the definitive guide to world cuisine.这本书是世界美食的权威指南。
• No one has come up with a definitive answer as to why this should be so.至于为什么该这样，还没有人给出明确的答复。

23 incentives   

激励某人做某事的事物( incentive的名词复数 )； 刺激； 诱因； 动机

参考例句：

• tax incentives to encourage savings 鼓励储蓄的税收措施
• Furthermore, subsidies provide incentives only for investments in equipment. 更有甚者，提供津贴仅是为鼓励增添设备的投资。 来自英汉非文学 - 环境法 - 环境法

24 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》