PBS高端访谈:共和党的税改法案严重影响了平价医疗法案

Judy Woodruff: We return to the tax bill that Congress voted to pass along party lines today. The reach of the measure extends beyond what you file with the IRS to health care. John Yang has more on that.

John Yang: Judy, the bill repeals² the penalties levied³ on individuals if they do not have health insurance coverage⁴, the so-called individual mandate⁵. That takes effect in 2019. President Trump⁶ says that repeals the Affordable⁷ Care Act.

President Donald Trump: So, in this bill, not only do we have massive tax cuts and tax reform. We have essentially⁸ repealed⁹ Obamacare, and we will come up with something that will be much better, whether it's block grants or whether it's taking what we have and doing something terrific, but Obamacare has been repealed in this bill.

John Yang: Here to discuss this and other health care issues facing Congress is Julie Rovner. She's chief Washington correspondent for Kaiser Health News, which, we should note, is not affiliated¹⁰ with Kaiser Permanente. Julie, you heard what the president said. Is he right? Is this effectively repealing¹¹ the Affordable Care Act?

Julie Rovner: Not really. I think, you know, he's been saying this. He's been saying that it's dead. And most of my colleagues have been describing it as bruised¹², battered¹³, beaten up, but not dead yet. The individual mandate was important, but is not the only piece of the law, nor I think these days people are saying it's not even the most important piece of the law. That may well be the requirement for insurers to cover people with preexisting conditions or the expansion of Medicaid. That's where most of the enrollment¹⁴ growth has come from.

John Yang: Well, we have got a graphic¹⁵. The Congressional Budget Office estimates that 13 million more people will be without insurance over the next 10 years because of this, what Congress did, and that premiums¹⁶ will go up 10 percent or more in most years. Now, what's the connection between those two things?

Julie Rovner: Well, the concern has been from the insurance companies that if people aren't — healthy people aren't required, have some sort of requirement to have coverage, that they will wait until they get sick to sign up, so that only sick people will have insurance. We're talking now about the individual market, the market where people buy their own coverage. It's somewhere around 17 million people total. And the insurers said that that's why they needed this individual mandate. So, without the individual mandate, they say, we will have only sick people. They will be required basically to raise their premiums, or else lose money, and that's where that comes in. So what the CBO says is there will be a combination of people who will no longer have coverage. Some of them will be the ones that the Republicans talk about, the people who were only buying coverage because they were required to, or else face a fine. Some of them, says the CBO, will be people who will now be priced out of coverage because the insurers are going to raise their premiums. And, finally, some of them will be people who live in areas where there won't be any more insurers. Those will likely be rural areas, where there are more Republicans than Democrats¹⁷.

John Yang: You seem to be describing a body blow to the Affordable Care Act.

Julie Rovner: Oh, yes, it's something that's serious. It's just — it's not necessarily a complete repeal¹ or even a fully¹⁸ taking apart of the law. What the CBO has said is that they expect, in most parts of the country, even without the requirement, most individual insurers' markets would remain what they call stable.

John Yang: Now, there have been two bills moving through really the Senate to try to stabilize¹⁹ the individual market under the Affordable Care Act. One would fund the plan's cost-sharing reduction payments. The other would create a pool of money to help insurance companies pay claims to the sickest policy holders²⁰. Just this afternoon, they said these are not going to go — not going to be acted on before they go home for Christmas. What's the future for these two bills?

Julie Rovner: Well, it's still pretty unclear. Senator Susan Collins rather famously said that she would vote for the tax bill only if they did these two bills, which it now looks like they're not going to do, at least not this year. One of them, actually the second one, what's called the reinsurance bill that would give insurers more money to help pay for their sickest patients, that one, most analysts²¹ think, would be fairly significant, although there's not a whole lot of money in that bill. But if they actually did it right, that could contain premiums from going up. The other bill is a little more complicated. This will restore these subsidies²² that the president cut off in October. But, really, since then, a combination of state regulators and the insurance companies have figured out ways most that people are being held harmless. Insurance companies are being paid back. The only people who are really being hit by this are people who don't get help for paying for their subsidies. Those people are paying higher premiums. But even then, some of them have been protected if they buy the right kind of plan.

John Yang: The Senate majority leader has promised a vote on these, but the speaker of the House has not. Is this — are they trying to have this collapse²³ of its own weight, the Affordable Care Act?

Julie Rovner: Well, the House — the Republicans in the House have said all along they don't want to do anything that stabilizes²⁴ this. They want the Affordable Care Act to fall apart, so why would they want to vote for something that could make this less of a body blow? They wanted to do this because they wanted it to be a body blow.

John Yang: Quickly to the Children's Health Insurance Program, CHIP, very popular program, bipartisan support. Funding ran out at the end of September, and they still have not reauthorized it. There's a study out today from the Georgetown University Health Policy Initiative saying that about two million children are at risk of losing coverage by the end of January, another one million by the end of February. Why is Congress having such a hard time keeping this going?

Julie Rovner: They agree that it should be renewed for five years. They disagree on how to fund it. The Republicans say this needs to be paid for. They want to take the money out of the Affordable Care Act and out of Medicare. Democrats don't want to do that. This is purely²⁵, how are we going to fund this? They have not resolved it. They said it was OK to wait until December. But now, as you point out, if they end up waiting until January, kids are going to start being taken off the program.

John Yang: So, this is all part of the funding problems that they face with the government funding running out on Friday, and they look like they are going to do a short-term until January.

Julie Rovner: That's what it sounds like. But that could have serious ramifications²⁶ for CHIP, which they have been saying, oh, nobody's going to lose coverage, states have plenty of money left over. Well, they're quickly spending up all the money that was left over.

John Yang: Julie Rovner of Kaiser Health News, thanks for being with us.

Julie Rovner: My pleasure.

1 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。

2 repeals   

撤销，废除( repeal的名词复数 )

参考例句：

• The measure repeals a previous law that prevented local governments from targeting specific breeds for sterilization. 这项法令的出台将废止之前一项限制地方政府针对某种犬类采用绝育措施的法律。

3 levied   

征（兵）( levy的过去式和过去分词 )； 索取； 发动（战争）； 征税

参考例句：

• Taxes should be levied more on the rich than on the poor. 向富人征收的税应该比穷人的多。
• Heavy fines were levied on motoring offenders. 违规驾车者会遭到重罚。

4 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。

5 mandate   

n.托管地；命令，指示

参考例句：

• The President had a clear mandate to end the war.总统得到明确的授权结束那场战争。
• The General Election gave him no such mandate.大选并未授予他这种权力。

6 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。

7 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。

8 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

9 repealed   

撤销，废除( repeal的过去式和过去分词 )

参考例句：

• The Labour Party repealed the Act. 工党废除了那项法令。
• The legislature repealed the unpopular Rent Act. 立法机关废除了不得人心的租借法案。

10 affiliated   

adj. 附属的, 有关连的

参考例句：

• The hospital is affiliated with the local university. 这家医院附属于当地大学。
• All affiliated members can vote. 所有隶属成员都有投票权。

11 repealing   

撤销，废除( repeal的现在分词 )

参考例句：

• In addition, repealing the alternative minimum tax would also help. 此外，废除替代性最低税也会有所帮助。
• Repealing the investment tax credit. 取消投资税款扣除。

12 bruised   

[医]青肿的，瘀紫的

参考例句：

• his bruised and bloodied nose 他沾满血的青肿的鼻子
• She had slipped and badly bruised her face. 她滑了一跤，摔得鼻青脸肿。

13 battered   

adj.磨损的；v.连续猛击；磨损

参考例句：

• He drove up in a battered old car.他开着一辆又老又破的旧车。
• The world was brutally battered but it survived.这个世界遭受了惨重的创伤,但它还是生存下来了。

14 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。

15 graphic   

adj.生动的，形象的，绘画的，文字的，图表的

参考例句：

• The book gave a graphic description of the war.这本书生动地描述了战争的情况。
• Distinguish important text items in lists with graphic icons.用图标来区分重要的文本项。

16 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》

17 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》

18 fully   

adv.完全地，全部地，彻底地；充分地

参考例句：

• The doctor asked me to breathe in,then to breathe out fully.医生让我先吸气，然后全部呼出。
• They soon became fully integrated into the local community.他们很快就完全融入了当地人的圈子。

19 stabilize   

vt.（使）稳定，使稳固，使稳定平衡；vi.稳定

参考例句：

• They are eager to stabilize currencies.他们急于稳定货币。
• His blood pressure tended to stabilize.他的血压趋向稳定。

20 holders   

支持物( holder的名词复数 )； 持有者； （支票等）持有人； 支托（或握持）…之物

参考例句：

• Slaves were mercilessly ground down by slave holders. 奴隶受奴隶主的残酷压迫。
• It is recognition of compassion's part that leads the up-holders of capital punishment to accuse the abolitionists of sentimentality in being more sorry for the murderer than for his victim. 正是对怜悯的作用有了认识，才使得死刑的提倡者指控主张废除死刑的人感情用事，同情谋杀犯胜过同情受害者。

21 analysts   

分析家，化验员( analyst的名词复数 )

参考例句：

• City analysts forecast huge profits this year. 伦敦金融分析家预测今年的利润非常丰厚。
• I was impressed by the high calibre of the researchers and analysts. 研究人员和分析人员的高素质给我留下了深刻印象。

22 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》

23 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。

24 stabilizes   

n.（使）稳定， （使）稳固( stabilize的名词复数 )v.（使）稳定， （使）稳固( stabilize的第三人称单数 )

参考例句：

• The broadbased attachment of the mesenteric root stabilizes the small bowel. 肠系膜根部基底宽阔的附着面使小肠得以稳定。 来自辞典例句
• The available supply of industrial product and produce stabilizes growth. 工业品与农产品的有效供给稳定增长。 来自互联网

25 purely   

adv.纯粹地，完全地

参考例句：

• I helped him purely and simply out of friendship.我帮他纯粹是出于友情。
• This disproves the theory that children are purely imitative.这证明认为儿童只会单纯地模仿的理论是站不住脚的。

26 ramifications   

n.结果，后果( ramification的名词复数 )

参考例句：

• These changes are bound to have widespread social ramifications. 这些变化注定会造成许多难以预料的社会后果。
• What are the ramifications of our decision to join the union? 我们决定加入工会会引起哪些后果呢？ 来自《简明英汉词典》