PBS高端访谈:随着公共医疗补助制度的深化,失足者拥有了医疗保险

 　　GWEN IFILL: Now: bringing health care to an often-forgotten population.

　　One out of three of those newly eligible¹ for Medicaid under the Affordable² Care Act are expected to be former inmates⁴ after their release from prison or jail. It's a story that hasn't gotten a lot of attention, but it represents a big change.

　　Sarah Varney of the Kaiser Health News collaborated⁵ with the NewsHour on this report.

　　SARAH VARNEY, Kaiser Health News: The Santa Rita Jail outside Oakland, California, is one of the largest detention⁶ facilities in the U.S. Some 3,000 inmates are currently housed here and many require medical treatment.

　　WOMAN: Hi, Jackson.

　　SARAH VARNEY: It costs the jail $28 million a year to provide medical and mental health services to the inmates. The pharmacy⁷ dispenses⁸ with 350,000 pills a month for conditions like depression, diabetes⁹, high blood pressure, all common ailments¹⁰ among offenders¹¹, who tend to be sicker than the general population.

　　RICHARD LUCIA, Undersheriff, Alameda County, California: So, we have all of the medications that are required by doctor's prescription¹².

　　SARAH VARNEY: Richard Lucia is the undersheriff for Alameda County.

　　RICHARD LUCIA: We get a lot of sick people coming and physically¹³ ill people who come into our custody¹⁴. We get them medicated and sort of stabilized¹⁵. Once they leave our facility, there is no way to know what was going happen to them in terms of their medical care.

　　SARAH VARNEY: When inmates in California and around the country are released, most leave prison or jail with no health insurance and little access to medical care, but that's beginning to change.

　　The federal health care law encourages states to expand Medicaid to include all poor single adults, not just those who are disabled or who have children. Although Medicaid won't cover medical care for prisoners, except for longer hospital stays, public health experts say the change in the law represents an unprecedented¹⁶ opportunity for ex-offenders when they get out.

　　ALEX BRISCOE, Health Director, Alameda County, California: Historically, 10, 11 percent have been eligible for Medicaid. That number is well over 90 percent as of January 2.

　　SARAH VARNEY: Alex Briscoe is health director for Alameda County. He says enrolling¹⁸ men and women who have been incarcerated¹⁹ into Medicaid will save the county money and help former inmates.

　　ALEX BRISCOE: When they do need care, they come to our emergency department. They cost us between $600 and $800 a visit. So the cost drivers on our system are intense. We now have a chance to treat and reconnect communities to care and support.

　　SARAH VARNEY: The county is now making a big push to get men and women into Medicaid when they leave jail.

　　DONALD WILLIAMS, Healthy Oakland: Cone²⁰ on. Let's roll.

　　SARAH VARNEY: Donald Williams is one of those on the front lines of the enrollment²¹ effort. A former inmate³, Williams now works for a nonprofit called Healthy Oakland patrolling the city's neighborhoods for those who might be eligible.

　　DONALD WILLIAMS: We pick up three or four guys within a week, and sometimes I just get one. But it's basically all over — all over Oakland.

　　SARAH VARNEY: On the day we caught up with Williams, he was picking up three young men who were recently paroled, giving them a ride back to the Healthy Oakland clinic so they could do something they have never done before, apply for health insurance.

　　Twenty-five-year-old Rodrigo Salido spent two years in the maximum security wing at Santa Rita Jail. He was convicted of burglary, assault and gang involvement. While inside, he was diagnosed with bipolar disorder²² and prescribed an anti-psychotic drug.

　　MAN: Planning on staying out this time?

　　RODRIGO SALIDO: Definitely.

　　MAN: Good. Good.

　　RODRIGO SALIDO: I'm three strikes. I can't go back.

　　MAN: Oh, yes. No, you can't.

　　RODRIGO SALIDO: Everybody kind of told me like, dude, you got anger problems and you need to get some help. I started getting Risperdal. It's been helping²³ me be more relaxed, you know, like not so much on the edge.

　　WOMAN: Mr. Salido, is there any medication that you are supposed to be taking today.

　　RODRIGO SALIDO: Just Risperdal.

　　WOMAN: OK. And the milligram bar?

　　RODRIGO SALIDO: Three.

　　SARAH VARNEY: Salido got out of jail in February and soon ran out of his medication. He's getting a preliminary checkup at Healthy Oakland, but once he gets his Medicaid card, he can regularly visit a primary care doctor, refill his meds and see specialists like a psychiatrist²⁴.

　　In fact, several studies have shown that ex-inmates who have access to health care when they leave jail, especially mental health and substance abuse counseling, are less likely to re-offend.

　　But not everyone supports extending Medicaid benefits to those who have done time. The subject recently during debate on the FOX News program "FOX & Friends."

　　MAN: So go to jail and get an insurance policy?

　　MAN: No, yes, go to jail and get Obamacare.

　　AVIK ROY, The Manhattan Institute: I think a lot of those people who work hard and play by the rules and are paying their taxes and paying their insurance bills say, hey, I was told that this was about helping people with preexisting conditions. I wasn't told that it was supposed to be about helping ex-convicts and people coming out of prison.

　　SARAH VARNEY: Avik Roy is a senior fellow at The Manhattan Institute, a conservative research group. While Roy agrees that access to health care reduces recidivism²⁵, he says access to Medicaid hasn't been shown to stop criminals from re-offending.

　　AVIK ROY: As much as we might intuitively think that this could be a way to address this problem, thus far, it hasn't been. The way that Medicaid has evolved over the last 50 years have made it very ineffective, because a lot of physicians don't accept Medicaid and don't see Medicaid patients. And, as a result, it's very difficult for Medicaid patients to get access to needed care.

　　SARAH VARNEY: Nineteen states, many led by Republican governors, have chosen not to expand Medicaid, over concerns about cost and federal overreach. Another five states are still debating their plans. That decision affects all poor single adults in those states, not just ex-inmates.

　　States that do expand, though, stand to receive a significant infusion²⁶ of federal funds to cover all of those newly eligible. Efforts to target men and women who have been incarcerated are under way in Colorado, Oregon, Illinois, and elsewhere.

　　Here in Oakland, the county expects to enroll¹⁷ some 18,000 Medicaid-eligible inmates and detainees in the coming years, but even supporters like Alex Briscoe admit a Medicaid card is no panacea²⁷ for troubled lives.

　　ALEX BRISCOE: You can't treat away the problems that face poor communities, right? It's about a good job. It's about a sense of meaning and belonging. It's about a place to sleep. So all of those basic human needs have to be met too. But health care can be a tool for social justice if it is delivered effectively and creatively. And that is why the Medicaid expansion is such a great opportunity for us.

　　SARAH VARNEY: Still, it may be some time before ex-inmates like Rodrigo Salido receive any benefits. California, like other states, has been overwhelmed by new Medicaid applications. And it's taking months for people to receive their benefits.

　　GWEN IFILL: Our partners at Kaiser Health News have more reporting on how the numbers of mentally ill behind bars have grown substantially. You can find that online.

1 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。

2 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。

3 inmate   

n.被收容者；(房屋等的)居住人；住院人

参考例句：

• I am an inmate of that hospital.我住在那家医院。
• The prisoner is his inmate.那个囚犯和他同住一起。

4 inmates   

n.囚犯( inmate的名词复数 )

参考例句：

• One of the inmates has escaped. 被收容的人中有一个逃跑了。 来自《简明英汉词典》
• The inmates were moved to an undisclosed location. 监狱里的囚犯被转移到一个秘密处所。 来自《简明英汉词典》

5 collaborated   

合作( collaborate的过去式和过去分词 )； 勾结叛国

参考例句：

• We have collaborated on many projects over the years. 这些年来我们合作搞了许多项目。
• We have collaborated closely with the university on this project. 我们与大学在这个专案上紧密合作。

6 detention   

n.滞留，停留；拘留，扣留；(教育)留下

参考例句：

• He was kept in detention by the police.他被警察扣留了。
• He was in detention in connection with the bribery affair.他因与贿赂事件有牵连而被拘留了。

7 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

8 dispenses   

v.分配，分与；分配( dispense的第三人称单数 )；施与；配（药）

参考例句：

• The machine dispenses a range of drinks and snacks. 这台机器发售各种饮料和小吃。
• This machine dispenses coffee. 这台机器发售咖啡。 来自《简明英汉词典》

9 diabetes   

n.糖尿病

参考例句：

• In case of diabetes, physicians advise against the use of sugar.对于糖尿病患者，医生告诫他们不要吃糖。
• Diabetes is caused by a fault in the insulin production of the body.糖尿病是由体內胰岛素分泌失调引起的。

10 ailments   

疾病（尤指慢性病），不适( ailment的名词复数 )

参考例句：

• His ailments include a mild heart attack and arthritis. 他患有轻度心脏病和关节炎。
• He hospitalizes patients for minor ailments. 他把只有小病的患者也送进医院。

11 offenders   

n.冒犯者( offender的名词复数 )；犯规者；罪犯；妨害…的人（或事物）

参考例句：

• Long prison sentences can be a very effective deterrent for offenders. 判处长期徒刑可对违法者起到强有力的威慑作用。
• Purposeful work is an important part of the regime for young offenders. 使从事有意义的劳动是管理少年犯的重要方法。

12 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。

13 physically   

adj.物质上，体格上，身体上，按自然规律

参考例句：

• He was out of sorts physically,as well as disordered mentally.他浑身不舒服，心绪也很乱。
• Every time I think about it I feel physically sick.一想起那件事我就感到极恶心。

14 custody   

n.监护，照看，羁押，拘留

参考例句：

• He spent a week in custody on remand awaiting sentence.等候判决期间他被还押候审一个星期。
• He was taken into custody immediately after the robbery.抢劫案发生后，他立即被押了起来。

15 stabilized   

v.（使）稳定， （使）稳固( stabilize的过去式和过去分词 )

参考例句：

• The patient's condition stabilized. 患者的病情稳定下来。
• His blood pressure has stabilized. 他的血压已经稳定下来了。 来自《现代英汉综合大词典》

16 unprecedented   

adj.无前例的，新奇的

参考例句：

• The air crash caused an unprecedented number of deaths.这次空难的死亡人数是空前的。
• A flood of this sort is really unprecedented.这样大的洪水真是十年九不遇。

17 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。

18 enrolling   

v.招收( enrol的现在分词 )；吸收；入学；加入；[亦作enrol]( enroll的现在分词 )；登记，招收，使入伍（或入会、入学等），参加，成为成员；记入名册；卷起，包起

参考例句：

• They lashed out at the university enrolling system. 他们猛烈抨击大学的招生制度。 来自辞典例句
• You're enrolling in a country club, Billy. 你是注册加入乡村俱乐部了，比利。 来自辞典例句

19 incarcerated   

钳闭的

参考例句：

• They were incarcerated for the duration of the war. 战争期间，他们被关在狱中。 来自辞典例句
• I don't want to worry them by being incarcerated. 我不想让他们知道我被拘禁的事情。 来自电影对白

20 cone   

n.圆锥体，圆锥形东西，球果

参考例句：

• Saw-dust piled up in a great cone.锯屑堆积如山。
• The police have sectioned off part of the road with traffic cone.警察用锥形路标把部分路面分隔开来。

21 enrollment   

n.注册或登记的人数；登记

参考例句：

• You will be given a reading list at enrollment.注册时你会收到一份阅读书目。
• I just got the enrollment notice from Fudan University.我刚刚接到复旦大学的入学通知书。

22 disorder   

n.紊乱，混乱；骚动，骚乱；疾病，失调

参考例句：

• When returning back,he discovered the room to be in disorder.回家后，他发现屋子里乱七八糟。
• It contained a vast number of letters in great disorder.里面七零八落地装着许多信件。

23 helping   

n.食物的一份&adj.帮助人的，辅助的

参考例句：

• The poor children regularly pony up for a second helping of my hamburger. 那些可怜的孩子们总是要求我把我的汉堡包再给他们一份。
• By doing this, they may at times be helping to restore competition. 这样一来, 他在某些时候,有助于竞争的加强。

24 psychiatrist   

n.精神病专家；精神病医师

参考例句：

• He went to a psychiatrist about his compulsive gambling.他去看精神科医生治疗不能自拔的赌瘾。
• The psychiatrist corrected him gently.精神病医师彬彬有礼地纠正他。

25 recidivism   

n.累犯，再犯

参考例句：

• Many areas and work units have experienced no recidivism at all for as long as ten or more years.不少地区和单位出现了连续几年、十几年没有发生重新犯罪的好典型。
• It needs to supplement the personality factor to confirm the ordinary recidivism.在普通累犯成立的条件中,应增加罪犯的人格因素。

26 infusion   

n.灌输

参考例句：

• Old families need an infusion of new blood from time to time.古老的家族需要不时地注入新鲜血液。
• Careful observation of the infusion site is necessary.必须仔细观察输液部位。

27 panacea   

n.万灵药；治百病的灵药

参考例句：

• Western aid may help but will not be a panacea. 西方援助可能会有所帮助，但并非灵丹妙药。
• There's no single panacea for the country's economic ills. 国家经济弊病百出,并无万灵药可以医治。