Indiana Medicaid work requirements fuel worries for the poor
2018-02-13 00:00:00


JUDY WOODRUFF: Republicans in Washington andaround the nation are poised to achieve a(1)
朱迪·伍德拉夫:共和党在华盛顿和全国各地都有望实现

long-sought goal: reshaping Medicaid.(2)
长期追求的目标:重塑医疗补助。

That's medical assistance mainly for thosewith low incomes.(3)
这主要是针对低收入者的医疗援助。

The Trump administration has given the go-aheadto Indiana and other states to require many(4)
特朗普政府已经给出了反超印第安纳州和其他州需要许多

adult Medicaid recipients to do work or communityservice in order to qualify.(5)
成人医疗补助做,才能有资格工作或社区服务。

The idea is popular in Indiana, but some exemptionswill be granted for groups like caregivers,(6)
我们的想法是流行在印第安纳州,但一些豁免将被授予像照顾者群体,

students, those in addiction recovery programs.(7)
学生,那些网瘾恢复计划。

Still, as special correspondent Sarah Varneyreports, advocates for the poor say they are(8)
尽管如此,作为特约记者萨拉·瓦尼报告,主张对穷人说,他们是

worried that the requirements will jeopardizemedical care for more than 30,000 people there.(9)
担心需求将危及医疗保健超过30,000人在那里。

This story was produced in collaboration withour partner Kaiser Health News.(10)
这个故事与我们的合作伙伴凯撒健康新闻合作制作。

SARAH VARNEY: Katie Josway is a songwriterand the front woman for the Indianapolis band(11)
SARAH瓦尼:凯蒂Josway是词曲作者和前女子的印第安纳波利斯带

Gypsy Moonshine.(12)
吉普赛月光。

Over the past few years, she's been coveredby Medicaid.(13)
在过去的几年里,她一直覆盖医疗补助。

The public insurance program is largely freeto patients in other states.(14)
公共保险计划主要是免费为患者在其他国家。

But, in Indiana, Josway pays about $25 a month.(15)
但是,在印第安纳州,Josway支付每月约$ 25。

If she misses too many payments, the statewill drop her insurance.(16)
如果她错过太多支付,国家将下降自己的保险。

KATIE JOSWAY, Musician: I think that it'sfair to expect people to contribute based(17)
KATIE JOSWAY,音乐家:我认为这是公平的期望人们要根据贡献

on their level of income and their abilityto do so.(18)
他们的收入水平和他们这样做的能力。

So, I think that's kind of what we do in asociety.(19)
所以,我认为这是什么样的,我们在社会中做。

Right?(20)
对?

SARAH VARNEY: But Josway, who also works asa massage therapist, worries about changes(21)
SARAH瓦尼:但是Josway,谁也作为一个按摩师,关于变化的担忧

coming to Medicaid in Indiana.(22)
未来医疗补助在印第安纳州。

And even though she earns about $16,000 ayear, near the federal poverty level, she(23)
而且即使她的收入每年约$ 16,000,临近联邦贫困水平,她

will have to prove that she's working at least20 hours a week to stay insured, a tough bet(24)
将必须证明她每周工作至少20小时留保险,一个艰难的选择

when her hours fluctuate each week.(25)
当她小时,每星期波动。

KATIE JOSWAY: I'm trying to get people tobook with me, but if they don't, then I don't(26)
KATIE JOSWAY:我试图让人们预订了我,但如果他们不这样做,那么我不

want to be penalized and potentially losemy insurance as well.(27)
要被处罚,并可能失去我的保险。

Like, that seems really harsh.(28)
像,这似乎确实苛刻。

And I am concerned about that growing trendof assuming that anyone who is on an assistance(29)
而我关心的假设是不断增长的趋势,任何人谁是在一个援助

program somehow is mooching off the governmentor doesn't try hard enough.(30)
节目以某种方式被mooching关闭政府或不会努力不够。

SARAH VARNEY: Under former Governor Mike Pence,now vice president, Indiana became the first(31)
SARAH瓦尼:根据前州长迈克·彭斯,现在的副总裁,印第安纳州成为第一个

state to enact a much more conservative approachto Medicaid.(32)
国家制定医疗补助一个更保守的方法。

But the idea of requiring most adults in theprogram to work was stopped by the Obama administration.(33)
但需要在程序中工作大多数成年人的想法是由奥巴马政府停止。

Now the Trump White House is allowing Indianato move ahead.(34)
现在特朗普白宫允许步行者前进。

SEEMA VERMA, Director, Centers for Medicareand Medicaid Services: What is going on in(35)
塞马VERMA,主任,中心的医疗保险和医疗补助服务:什么是怎么回事

the Medicaid program today is that we havea very inflexible system.(36)
今天的医疗补助计划是,我们有一个非常不灵活的系统。

SARAH VARNEY: The effort is being led by SeemaVerma, who President Trump appointed to lead(37)
SARAH瓦尼:这种努力正在被塞马维尔马,谁特朗普总统任命为主导

the Centers for Medicare and Medicaid Services.(38)
该中心的医疗保险和医疗补助服务。

Verma once worked for Governor Pence in Indiana,where she tested out her conservative policies,(39)
维尔马曾在印第安纳州,在那里她测试了她的保守政策工作了州长便士,

like coverage lockouts and monthly premiums.(40)
像覆盖停工和每月的保费。

Now she's taking her vision even further,by allowing states to impose work requirements(41)
现在,她甚至还带着她的眼光,通过允许各州征收工作要求

and making smokers pay more for public insurance.(42)
,使吸烟者支付更多的公共保险。

The administration has approved Kentucky andIndiana's plans and at least eight other states(43)
该管理局已经批准肯塔基州和印第安纳州的计划和其他至少八个州

have submitted similar requests.(44)
已经提交了类似的请求。

But advocates for the poor have protestedloudly in recent months, saying many will(45)
但主张对穷人近几个月来大声抗议,他说很多人都会

lose coverage.(46)
失去覆盖。

Nationwide, 60 percent of Medicaid recipientsalready work.(47)
从全国范围来看,医疗补助的60%已经工作。

And advocates say the ones that don't usuallyhave a good reason for not having a job, because(48)
并主张说,通常不会有很好的理由没有工作的那些,因为

they're caregivers, students or in drug recovery.(49)
他们的照顾者,学生或药品回收。

At the heart of the debate are people likeAntonio Berlanga.(50)
在辩论的心脏是人喜欢安东尼贝兰加。

He's 60 years old and lives in Clinton, Indiana,and spent most of his adult life without health(51)
他60岁了,住在克林顿,印第安纳州,花了他的大部分成年生活没有健康

insurance.(52)
保险。

Indiana first expanded Medicaid coverage toa small number of poor adults in 2008, as(53)
印第安纳州第一延展医疗覆盖少数成年人差在2008年,作为

the recession decimated the state's economy.(54)
经济衰退锐减州的经济。

Then, in 2015, Governor Pence expanded iteven further under the Affordable Care Act(55)
然后,在2015年,州长便士扩大甚至进一步下支付得起的医疗法案

to about 442,000 adults.(56)
约442000名成人。

That allowed Berlanga, a janitor at a localchurch, to enroll in coverage.(57)
这让贝兰加,在当地教堂的看门人,在覆盖报名参加。

Now he's been treated for severe shoulder,cirrhosis of the liver and hepatitis C at(58)
现在,他已经处理了严重的肩,在肝和丙肝肝硬化

the Valley Professionals Community HealthCenter.(59)
谷专业人员社区卫生服务中心。

Like a lot of Hoosiers, he's worried aboutwhat the changes could mean for him, but he's(60)
像很多印第安纳州的,他担心什么变化可能意味着他的,但他是

willing to do his part.(61)
愿意做他的一部分。

ANTONIO BERLANGA, Medicaid Recipient: Yes,I just don't want it for nothing.(62)
ANTONIO贝兰加,医疗收件人:是的,我只是不希望它没事。

If I'm still able to do something and givesomething back, then let's go.(63)
如果我仍然能够有所作为,回馈,然后让我们去。

I have still got a heart.(64)
我有仍然有一个心脏。

I might not be able to, you know, totallydo things.(65)
我可能不能,你知道的,完全做的事情。

But I will do what I can, you know?(66)
但我会尽我可以,你知道吗?

SARAH VARNEY: Dr. John Wernert, one of thearchitects of Indiana's Medicaid plan, says(67)
SARAH瓦尼:约翰Wernert博士,印第安纳州的医疗补助计划的建筑师之一,他表示

that's what he's heard in every part of thestate, that people on Medicaid want to feel(68)
这是他在该州的每一个部分的头,人们对医疗补助想要的感觉

like they're contributing in some way.(69)
像他们贡献以某种方式。

DR.(70)
DR。

JOHN WERNERT, Former Indiana Cabinet Member:It doesn't have to be a lot of money for people(71)
JOHN WERNERT,前印第安纳州内阁成员:这并不一定是人很多的钱

to feel like they have some ownership andtake some responsibility for the administration(72)
感觉到他们有一定的所有权,并采取了一些行政责任

of their program.(73)
他们的计划。

One of the things I can say with confidenceas a psychiatrist that has practiced for 30(74)
其中一件事我可以肯定的是已经练了30心理医生说

years is, stigma is real.(75)
年是耻辱是真实的。

And there's a great stigma that folks thatare living at or near the poverty level don't(76)
并有一个很大的耻辱被住在或接近贫困线人不

care about their health.(77)
关心他们的健康。

Well, that's completely wrong.(78)
嗯,这是完全错误的。

They have just not been put in a positionwhere they could take some ownership of that.(79)
他们刚才没有放在一个位置,他们可以采取的一些所有权。

SARAH VARNEY: Revenues at Indiana's hospitalshave jumped as more Hoosiers have become insured.(80)
SARAH瓦尼:在印第安纳州的医院收入已经跃升为更印第安纳州已成为保险。

The CEO of Margaret Mary Health, Tim Putnam,hired a company called ClaimAid to enroll(81)
玛格丽特玛丽生,添普特南公司的CEO雇了一个叫ClaimAid公司报名

uninsured patients into Medicaid and helpthem comply with Indiana's complicated rules.(82)
没有保险的病人到医疗补助,并帮助他们遵守印第安纳的复杂的规则。

Now they will have to add the work requirementsto their checklist.(83)
现在,他们将不得不工作需要添加到他们的清单。

Putnam says the new rules aren't designedto be punitive.(84)
普特南说,新规则没有设计为惩罚性。

TIM PUTNAM, CEO, Margaret Mary Health: Ifit was purposefully trying to get people off(85)
CEO蒂姆·普特南,玛格丽特玛丽生:如果有人故意试图让人们关

of HIP, off of Medicaid and onto no coverageat all, that would be a detrimental program(86)
HIP,关医疗和到没有覆盖可言,那将是一个有害的程序

for us.(87)
为了我们。

But as it is, it's trying to get people toget work experience or get some job training(88)
但因为它是,它试图让人们获得工作经验或获得一些就业培训

to move on and transition to full employment,full insurance.(89)
继续前进,并过渡到充分就业,全程保险。

SARAH VARNEY: But Indiana's conservative planhas added layers of bureaucracy that has ensnared(90)
SARAH瓦尼:已诱捕官僚但印第安纳州的保守计划增加了层

people like Allen Wilson.(91)
人们喜欢艾伦·威尔逊。

He and his wife paid their monthly premium,buta paperwork glitch locked him out of coverage,(92)
他和妻子缴纳了每月保费,但文书毛刺把他锁在覆盖范围外,

to the point that his wife started to panic.(93)
以他的妻子开始恐慌的地步。

ALLEN WILSON, Medicaid Recipient: And shetold them two or three times, I think you're(94)
ALLEN WILSON,医疗收件人:她告诉他们两两三次,我觉得你

just trying to kill my husband, because he'sgoing to be too much money out of your pocket.(95)
只是想杀死我的丈夫,因为他将是太多的钱从口袋里拿出来。

SARAH VARNEY: And you got stuck with thousandsof dollars of bills.(96)
SARAH瓦尼:你卡住了数以千计的账单美元。

ALLEN WILSON: Yes, I did.(97)
ALLEN WILSON:是的,我做到了。

Yes, I did.(98)
是的,我做到了。

SARAH VARNEY: Some 25,000 Hoosiers were disenrolledfrom Medicaid from 2015 to 2017 because they(99)
SARAH瓦尼:大约2.5万名印第安纳从医疗disenrolled 2015至17年,因为他们

didn't pay their premiums.(100)
没有支付保费。

But it's unclear why.(101)
但目前还不清楚这是为什么。

Some may have moved out of state, found jobswith insurance, or even died.(102)
有些人可能已经搬出了状态,找到工作保险,甚至死亡。

Advocates like Alan Witchey say, now thatIndiana is adding a work requirement, bureaucratic(103)
像艾伦Witchey提倡者说,现在印第安纳添加工作要求,官僚主义

mistakes become much more common, especiallyfor vulnerable populations like the homeless.(104)
错误变得更为常见,尤其是对于弱势群体,如无家可归。

ALAN WITCHEY, Coalition for Homelessness Interventionand Prevention: Even though we have been told(105)
ALAN WITCHEY,联合为无家可归干预和预防:尽管我们已被告知

there's an exemption for homelessness, wehaven't heard, how is that going to work?(106)
有一个为无家可归的豁免,我们还没有听说过,怎么是去上班?

What does that look like?(107)
那是什么样子的?

How are we going to get it?(108)
我们如何去得到它?

What proof do you have to provide?(109)
你有什么证据来提供?

SARAH VARNEY: Those living in isolated ruralareas, where jobs are few, have many of the(110)
SARAH瓦尼:那些生活在偏远农村地区,就业机会少,有很多的

same questions.(111)
同样的问题。

Niki Carty moved into her brother's rentedfarmhouse here in the town of Dana after getting(112)
尼基·卡蒂达纳镇搬进了她弟弟的租农舍及彼后

out of prison in 2015.(113)
出狱的2015年。

She was convicted of selling meth, opioidsand other drugs.(114)
她被判犯销售甲基,阿片类药物和其他药物。

Before prison, she became addicted to fentanylprescribed by a doctor, and soon her two daughters(115)
入狱前,她开始沉迷芬太尼遵医嘱,很快她的两个女儿

were hooked on opioids as well.(116)
阿片类药物大呼过瘾也是如此。

Now the family is in recovery, and Carty istaking online classes to become an addiction(117)
现在,家庭是恢复和卡蒂正在网上班会上瘾的

counselor.(118)
顾问。

But even though most students are exempt fromthe work requirement, Carty worries her courses(119)
但是,即使大多数学生是从工作要求的限制,卡蒂担心她的课程

won't qualify, and she will be forced to dropout of school and get a dead end job.(120)
将没有资格,她将被迫辍学,并得到了死胡同工作。

NIKI CARTY, Medicaid Recipient: I am concerned,because I got screwed once before.(121)
NIKI卡蒂,医疗收件人:我很担心,因为我也有过一次拧紧。

I really did get screwed.(122)
我真的就会上当受骗。

SARAH VARNEY: In the 1990s, when Indiana forcedpeople on welfare to work, Carty says the(123)
SARAH瓦尼:在20世纪90年代,当印第安纳迫使人们对福利工作,卡蒂说,

state didn't recognize the classes she wastaking then.(124)
国家不承认她正在然后的类。

She quit school and ended up getting injuredon the job.(125)
她退学,最终在工作伤病。

NIKI CARTY: I look at this way: If I had nothad to go to a full-time job where I was being(126)
NIKI卡蒂:我看是这样的:如果我还没有去一个全职工作,在那里我被

a full-time student then back in the '90s,I would have never been in that factory to(127)
一个全职学生再回到在90年代,我就从来没有在工厂

get hit by two forklifts.(128)
得到两个叉车击中。

I mean, 20-some years later, I'm having thissurgery, and this is pretty much the results.(129)
我的意思是,20几年后,我有这种手术,这是相当多的结果。

SARAH VARNEY: State Representative Ed Clere,a Republican from New Albany, is one of the(130)
SARAH瓦尼:国家代表埃德Clere,来自New Albany的共和党,是的一个

few lawmakers raising these kinds of issuesat the Statehouse.(131)
一些国会议员在州议会大厦提高这类问题。

I know one of your big concerns is creatingmore bureaucracy here in Indiana.(132)
我知道你的大问题之一是在印第安纳这里创造更多的官僚主义。

ED CLERE (R), Indiana State Representative:Right.(133)
ED CLERE(R),印第安纳州立代表:对。

I think we have to be concerned about thatand we need to be realistic.(134)
我认为,我们必须要关注的是,我们需要面对现实。

What it's going to cost to administer this?(135)
什么它要花费来管理呢?

SARAH VARNEY: Clere says those added administrativecosts will pull money away from medical care.(136)
SARAH瓦尼:Clere说,这些增加的管理成本将撤出资金从医疗路程。

And although he supports the work requirementsin theory, he says the new rules are unlikely(137)
虽然他支持在理论工作提出了要求,他说,新的规则是不可能的

to improve health outcomes.(138)
以改善健康状况。

ED CLERE: And, in fact, it may over time takeus in the other direction.(139)
ED CLERE:而且,事实上,它可能会随着时间带我们向另一个方向。

SARAH VARNEY: But many here say people whowork live healthier lives and the changes(140)
SARAH瓦尼:但是很多在这里说,人谁的工作更健康的生活和变化

will benefit the entire state.(141)
将有利于整个国家。

DR.(142)
DR。

JOHN WERNERT: We're now starting to move thebig battleship in a different direction, more(143)
JOHN WERNERT:我们现在开始移动的大战舰在不同的方向,更

towards what's needed in our economy and what'sneeded in our society now.(144)
对什么是需要在我们的经济,什么是现在需要在我们的社会。

SARAH VARNEY: Back in Dana, a world away fromthe booming economy in Indianapolis, Niki(145)
SARAH瓦尼:早在达纳,世界从印第安纳波利斯,尼基蓬勃发展的经济走

Carty says the message from lawmakers to peoplelike her is pretty clear.(146)
卡蒂说,从立法者到喜欢她的人的信息是很清楚的。

NIKI CARTY: They think we're trash, that we'rejust garbage to throw away.(147)
NIKI卡蒂:他们认为我们是垃圾,那我们只是垃圾扔掉。

They're all worried about the money and allthat.(148)
他们都担心钱和所有。

And I can understand that.(149)
我可以理解。

But at the same time, there's a lot of usthat are trying to pick our lives up and put(150)
但在同一时间,有很多我们正试图拿起我们的生活并把

them back together.(151)
他们重新走到一起。

SARAH VARNEY: For Carty, that means planningher weekly Narcotics Anonymous meeting with(152)
SARAH瓦尼:对于卡蒂,这意味着计划与她每周禁毒无名氏会议

a local pastor.(153)
当地的牧师。

She's determined, she says, to set her lifestraight and hopes the upcoming changes to(154)
她决定,她说,为了把她的生活笔直希望即将到来的变化,以

Medicaid won't get in her way.(155)
医疗不会在她的方式获得。

For the "PBS NewsHour" and Kaiser Health News,I'm Sarah Varney in Indiana.(156)
对于“新闻时间PBS”和凯撒健康新闻,我叫莎拉瓦尼在印第安纳州。


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