Funding cuts, premium increases and the future of Obamacare
2018-07-11 00:00:00


JUDY WOODRUFF: Now: the Trump administration'sefforts to undercut the law often referred(1)
JUDY WOODRUFF:现在:特朗普政府为削弱法律所做的努力经常提到

to as Obamacare.(2)
作为奥巴马医改。

Yesterday, administration officials said theywill cut funding to an outreach program that(3)
昨天,政府官员表示他们将削减资金用于外展计划

helps individuals sign up for coverage.(4)
帮助个人注册报道。

They say that outreach is no longer necessary.(5)
他们说不再需要外展。

As William Brangham explains, it's latestin a series of moves to strike back against(6)
正如William Brangham所解释的那样,这是一系列反击的最新举措

a program the president remains vehementlyopposed to.(7)
总统仍坚决反对的一项计划。

WILLIAM BRANGHAM: Mr. Trump was frustratedwhen the Republican-led Congress was unable(8)
WILLIAM BRANGHAM:当共和党领导的国会无法解决时,特朗普先生感到沮丧

to squash the Affordable Care Act outright.(9)
彻底击败平价医疗法案。

But the president, who says he's against thelaw philosophically, hasn't stopped trying(10)
但总统说,他在哲学上反对法律,并没有停止尝试

to knock it down.(11)
把它击倒

Funding for these so-called enrollment navigatorshas been cut by 85 percent to just $10 million.(12)
这些所谓的登记导航员的资金减少了85%,仅为1000万美元。

The administration has also suspended paymentsto insurance companies to compensate them(13)
政府还暂停向保险公司付款以补偿他们

for caring for sicker patients.(14)
照顾病情加重的病人。

That move came after a pair of court rulingsabout these payments.(15)
此举是在两项法庭裁决涉及这些付款之后发生的。

And the Justice Department has sided withthe state of Texas in a separate lawsuit arguing(16)
司法部在另一起诉讼辩称中支持德克萨斯州

that protections for people with preexistingconditions should be eliminated.(17)
应该消除对已有条件的人的保护。

Margot Sanger-Katz writes about this for TheNew York Times Web site.(18)
Margot Sanger-Katz为纽约时报网站撰写了这篇文章。

And she joins me now.(19)
她现在加入了我。

Thanks for being here.(20)
谢谢你在这里。

MARGOT SANGER-KATZ, The New York Times: Mypleasure.(21)
MARGOT SANGER-KATZ,纽约时报:我很高兴。

WILLIAM BRANGHAM: So, let's talk about thefirst of these changes.(22)
WILLIAM BRANGHAM:那么,让我们谈谈这些变化中的第一个。

These are the cuts to the so-called enrollmentnavigators.(23)
这些是对所谓的招生导航员的削减。

Who are these people, and what do these cutsmean?(24)
这些人是谁,这些削减意味着什么?

MARGOT SANGER-KATZ: So, this was a programthat was set up under Obamacare because there(25)
MARGOT SANGER-KATZ:所以,这是一个由奥巴马医改组建的计划,因为那里

are all these people who hadn't had healthinsurance before.(26)
这些人以前都没有健康保险。

Many of them didn't really have experiencebuying it.(27)
他们中的许多人并没有真正购买它的经验。

And so the law wanted to set up people whocould give them advice, who could walk them(28)
所以法律希望建立能够给他们建议的人,他们可以走路

through the process, help them understandwhat's a deductible, what is a premium, can(29)
通过这个过程,帮助他们了解什么是免赔额,什么是溢价,可以

I get a subsidy to help me buy insurance?(30)
我得到补贴来帮我买保险?

And so it set up a grant program to pay communitygroups, disease advocacy groups, health care(31)
因此,它设立了一个拨款计划,以支付社区团体,疾病宣传团体,医疗保健

providers, basically pay them to have personnelto just walk people through process of enrolling(32)
提供者,基本上支付他们让人员通过注册过程走人

for health insurance.(33)
为健康保险。

And the Trump administration has now twicecut back the funding for that program.(34)
特朗普政府现在已经两次削减该计划的资金。

They say that it's not very efficient, thatthe navigators haven't been very good at signing(35)
他们说这不是很有效率,导航员并不擅长签约

people up for insurance, and that it wouldbe best to just let brokers and other people(36)
人们争取保险,最好只让经纪人和其他人

whose job it is to do this.(37)
他们的工作就是这样做。

WILLIAM BRANGHAM: So, is the expected impactthat if they're cutting money to the navigators,(38)
WILLIAM BRANGHAM:那么,如果他们向导航员削减资金,预计会产生什么影响,

that less people are going to enroll?(39)
那个人会少参加?

MARGOT SANGER-KATZ: I think that is one concern.(40)
MARGOT SANGER-KATZ:我认为这是一个问题。

Certainly, the navigators themselves and someconsumer advocates feel like this is just(41)
当然,导航员本身和一些消费者拥护者觉得这只是公正的

part of a pattern of chipping away at thetools that are going to help drive enrollment(42)
削弱有助于推动招生的工具的一部分模式

in these programs.(43)
在这些计划中。

WILLIAM BRANGHAM: Another one of right changesthat was announced this past weekend was the(44)
WILLIAM BRANGHAM:上周末公布的另一个正确变化是

Trump administration is going to limit paymentsthat are made to insurance companies.(45)
特朗普政府将限制对保险公司的付款。

Can you explain what these payments are andwhat they were meant to do?(46)
你能解释这些付款是什么以及他们打算做什么吗?

MARGOT SANGER-KATZ: Yes.(47)
MARGOT SANGER-KATZ:是的。

So, under Obamacare, everyone can get insurance,regardless of whether they have preexisting(48)
因此,在奥巴马医改期间,每个人都可以获得保险,无论他们是否已经存在

conditions.(49)
条件。

And this is a program that basically transfersmoney from insurance companies that end up(50)
这是一个基本上从保险公司转移资金的计划

with a lot of healthy patients to insurancecompanies that end up with a lot of sick patients,(51)
有很多健康的病人到保险公司那里最后患了很多病人,

so that everyone can make money regardlessof who signs up for their plans.(52)
这样每个人都可以赚钱,无论谁报名参加他们的计划。

So, the results of this are actually kindof interesting, because not every health insurer(53)
所以,这个结果实际上很有意思,因为不是每个健康保险公司

is disadvantaged.(54)
处于不利地位。

The ones that were going to have to pay nowget to keep more money.(55)
现在需要支付的人可以保留更多的钱。

They're doing better.(56)
他们做得更好。

But what it does, it tends to throw a lotof uncertainty into this market, because these(57)
但它的作用是什么,它往往给这个市场带来很多不确定性,因为这些

insurers were really counting on these paymentsin order to make money and stay viable.(58)
保险公司真的指望这些付款,以赚钱和保持活力。

And I think, fundamentally, it's also bad,because the whole system depends on these(59)
我认为,从根本上说,它也很糟糕,因为整个系统都依赖于这些

insurance companies wanting to participatein these markets.(60)
希望参与这些市场的保险公司。

There is no federal fallback.(61)
没有联邦后备。

There is no public option.(62)
没有公共选择。

The only way there is going to be Obamacareinsurance is if private companies want to(63)
奥巴马医疗保险的唯一途径是私营公司是否愿意

sell insurance.(64)
卖保险。

And this is kind of a form of pulling therug out from under them.(65)
这是一种从地板下拉出地毯的形式。

WILLIAM BRANGHAM: The president, as I mentioned,was very frustrated when Congress really couldn't(66)
WILLIAM BRANGHAM:正如我所提到的那样,当国会真的做不到时,总统非常沮丧

just undo the law totally.(67)
完全撤消法律。

And they have kept trying to chip away atit.(68)
他们一直试图削减它。

And yet enrollment numbers last year werestill pretty robust.(69)
然而去年的入学人数仍然相当强劲。

I think it was, what, nine or 10 million people.(70)
我认为是,有九千万或一千万人。

This law still seems to be resilient, despitethe attacks against it.(71)
尽管受到攻击,这项法律似乎仍具有弹性。

MARGOT SANGER-KATZ: I do think it's been abit of a surprise how resilient these markets(72)
MARGOT SANGER-KATZ:我认为这些市场的弹性是多么令人惊讶

-- in particular where people buy their owninsurance.(73)
- 特别是人们购买自己的保险。

There just have been so many blows againstthem over the years.(74)
多年来,他们遭受了如此多的打击。

And they seem to kind of still be standing.(75)
他们似乎仍然站着。

I think in some ways they're not as good aspeople had hoped.(76)
我认为在某些方面它们并不像人们希望的那么好。

Insurance has gotten really expensive.(77)
保险已经变得非常昂贵。

We have seen two years in a row of very largepremium increases.(78)
我们已经连续两年看到了非常大的保费增长。

So, if you're someone who buys your own insurance,and you don't get a government subsidy, you're(79)
所以,如果你是购买自己保险的人,并且没有获得政府补贴,那么你就是

really facing some serious sticker shock.(80)
真的面临一些严重的贴纸震惊

There's going to be some price increases againfor next year.(81)
明年会有一些价格再次上涨。

I think there is also a less choice and competitionthan the people who wrote the law had hoped(82)
我认为,与法律所希望的人相比,选择和竞争的选择也更少

for.(83)
对于。

There was this idea it was going to be likea KAYAK for health insurance, you were going(84)
有这个想法,它会像健康保险的KAYAK,你要去

to get to pick from lots of options.(85)
从众多选项中挑选。

And there are many places in the country wherethere's only one insurer available.(86)
这个国家有很多地方只有一家保险公司。

But I think the fact that there is one insurereverywhere who at least wants to continue(87)
但我认为,到处都有一家保险公司至少想继续这样做

to participate, and that there are so manypeople signing up shows that the government(88)
参与,并有那么多人报名表明政府

subsidies are adequate to help certain peoplebuy insurance, and also that there are a lot(89)
补贴足以帮助某些人购买保险,而且还有很多

of Americans who really want to be able tobuy insurance, and they're grateful to have(90)
那些真正希望能够购买保险的美国人,他们很感激

this program available to them.(91)
这个程序可供他们使用。

WILLIAM BRANGHAM: Are there -- amongst thesupporters of the Affordable Care Act, are(92)
WILLIAM BRANGHAM:在“平价医疗法案”的支持者中,有吗?

there other ways that they're looking thatthey're worried might be coming down the road,(93)
还有其他方式,他们看起来他们担心可能会在路上,

other attempts by the administration to diminishthe law?(94)
政府还试图削弱法律?

MARGOT SANGER-KATZ: Absolutely.(95)
MARGOT SANGER-KATZ:绝对。

So, there's really one big one that I thinkwe're going to see come any day now.(96)
所以,我认为现在任何一天都会有一个很大的问题。

And this is a plan that would allow insuranceplans that don't have to cover all of the(97)
这是一个允许保险计划不必涵盖所有保险计划的计划

Obamacare benefits, that don't have to offerinsurance to people with preexisting conditions.(98)
奥巴马医改的好处,不必为有先前存在条件的人提供保险。

These are going to be much more liberalized,and they going to become much more common.(99)
这些将更加自由化,并且它们将变得更加普遍。

And I think there are two concerns about theseplans.(100)
我认为这些计划有两个问题。

One is, consumer advocates really worry thatpeople won't understand what they're buying,(101)
一个是,消费者倡导者真的担心人们不会理解他们所购买的东西,

so they might buy a plan and then find outlater, oh, it only covers $250,000 worth of(102)
所以他们可能会购买一个计划然后再找出来哦,它只能支付25万美元的价值

care this year, or it doesn't cover any kindof maternity or prescription drug benefits,(103)
今年的护理,或者它不包括任何形式的产假或处方药福利,

and that they're going to be people who arekind of left in the lurch if they buy it.(104)
并且如果他们购买它们,那么他们将成为那些陷入困境的人。

WILLIAM BRANGHAM: These were things mandatedunder the ACA.(105)
WILLIAM BRANGHAM:这些是ACA规定的事项。

MARGOT SANGER-KATZ: These are all things thatwould be required.(106)
MARGOT SANGER-KATZ:这些都是必需的。

The ACA plans all have to cover a standardset of benefits, to include drugs, hospitalization,(107)
ACA计划都必须涵盖一系列标准福利,包括药物,住院,

maternity care.(108)
产科护理。

And then they also have to provide you witha certain amount of financial protection,(109)
然后他们还必须为您提供一定的财务保护,

so the Obamacare plans can't limit how muchthey will pay in a year for your medical care.(110)
因此,奥巴马医改计划不能限制他们一年内为您的医疗服务支付的费用。

So most people don't pay $250,000 worth ofmedical bills.(111)
因此,大多数人不支付价值25万美元的医疗费用。

But if you're one of those people who hasa really bad cancer diagnosis, has a child(112)
但如果你是癌症诊断非常糟糕的人之一,那么就生孩子了

with a genetic disorder or some other seriousdisease, you want to have that kind of high-end(113)
对于遗传性疾病或其他一些严重疾病,你想拥有那种高端疾病

coverage.(114)
覆盖。

So, that is one worry.(115)
所以,这是一个担心。

But the other worry is that these short-termplans are going to be much less expensive.(116)
但另一个担心是,这些短期计划将会更便宜。

And so if you're a healthy person, you don'thave any preexisting conditions...(117)
所以如果你是一个健康的人,你就没有任何先前存在的条件......

WILLIAM BRANGHAM: That's a big draw.(118)
WILLIAM BRANGHAM:这是一个很大的吸引力。

MARGOT SANGER-KATZ: Yes, you could qualifyfor it.(119)
MARGOT SANGER-KATZ:是的,你有资格获得它。

I mean, like I said, the Obamacare plans costsa lot of money.(120)
我的意思是,就像我说的那样,奥巴马医改计划要花很多钱。

For a lot of middle-class people, it's a hugestretch.(121)
对于很多中产阶级来说,这是一个巨大的延伸。

So, if they can qualify for a cheaper plan,they're, I think, totally rational to go there.(122)
所以,如果他们有资格获得更便宜的计划,我认为他们完全有理由去那里。

And what that means is that the pool of peoplewho are left in the Affordable Care Act plans(123)
这意味着那些留在“平价医疗法案”计划中的人群

are going to tend to be sicker.(124)
会变得更加病态。

And that's going to further drive up premiumsand further make the plans unaffordable for(125)
这将进一步提高保费,进一步使计划难以承受

people who really want that kind of comprehensivecoverage and don't get a subsidy to help them(126)
那些真正想要那种全面覆盖并且没有获得补贴来帮助他们的人

buy it.(127)
买它。

WILLIAM BRANGHAM: Margot Sanger-Katz, thankyou.(128)
WILLIAM BRANGHAM:Margot Sanger-Katz,谢谢。

MARGOT SANGER-KATZ: Sure.(129)
MARGOT SANGER-KATZ:当然。


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