美国国家公共电台 NPR Obamacare Repeal Could Threaten Provisions That Help Older Adults

 

SCOTT SIMON, HOST: 

Congressional Republicans are trying to figure out when to repeal¹ and how to replace the Affordable² Care Act. Whatever happens, there's a lot at stake for older Americans. NPR's Ina Jaffe covers aging. She joins us for our regular conversation we call 1 in 5, which refers to the 1 in 5 Americans who, by the year 2030, will be 65 years of age or older. Ina, thanks so much for being back with us.

INA JAFFE, BYLINE³: It's good to be back with you, Scott.

SIMON: Now, don't Americans over 65 have Medicare?

JAFFE: Well, they do. But what people don't always realize about the Affordable Care Act is it's not just a discrete⁴ program in and of itself. It changed other government programs, too, and that includes Medicare.

SIMON: What was the biggest change for Medicare?

JAFFE: Well, the one that's gotten the most attention is the change to prescription⁵ drug coverage⁶. You may have heard about something called the doughnut hole. That's where Medicare would get you a discount on prescriptions⁷ but only up to a point. After that, you had to pay full price for drugs until you shelled out around 1,300 bucks⁸. Then Medicaid would help you out again.

Now, some people never really reached that point because when they had to pay full price, they just started skipping some of their prescription meds. So the Affordable Care Act has been phasing out this gap. It saved people on Medicare more than $23 billion. But this program could go away with the repeal of the law.

SIMON: That could go away, and we should say, once again, that we don't know yet what any replacement⁹ will look like. What have you heard among the ideas being proposed that might affect older Americans?

JAFFE: Well, a few members of Congress, Republicans, have circulated their own proposals for replacing the Affordable Care Act. And one thing that comes up in some of them, including in House Speaker Paul Ryan's plan, is a major change to Medicaid. Now, that's known as the program that provides health care for the poor. But it's also the program that pays for long-term care for a lot of older people. In fact, Medicaid pays the bills for most nursing home residents.

SIMON: That could be jeopardized¹⁰?

JAFFE: Well, certainly the people putting forth¹¹ these plans don't think it would be. What they want to do is change Medicaid from a guaranteed benefit to a block grant to states. So a state would get a fixed¹² amount of money from the federal government and decide for itself how to spend it. The idea is that states know their needs better than the feds, and this would give them flexibility¹³.

What critics of this idea worry about is, what happens in an economic downturn when demand on Medicaid goes up? They say states could be left with a sort of Sophie's choice. Do you cut back on services for poor children or for the frail¹⁴ elderly?

SIMON: I know we've talked about Medicare and Medicaid. Are there proposed changes that would affect older Americans who might buy their own health care coverage?

JAFFE: Yeah. In fact, there's a little-known feature of the law that helps people in their 50s and early 60s, people who aren't yet eligible¹⁵ for Medicare. Insurance companies used to be able to charge them many times more than they charge a younger person for the same policy. The Affordable Care Act put a limit on that.

Now insurance companies can only charge them three times as much. But the various replacement proposals that are out there either set the limits higher at five or six times more or they don't have any limit. And researchers say that could result in around 400,000 older adults being unable to afford to buy health insurance anymore.

SIMON: NPR's Ina Jaffe, thanks so much.

JAFFE: You're welcome.

(SOUNDBITE OF JULIAN LAGE AND CHRIS ELDRIDGE'S "BUTTER AND EGGS")

SIMON: This is NPR News.

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 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 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。

4 discrete   

adj.个别的，分离的，不连续的

参考例句：

• The picture consists of a lot of discrete spots of colour.这幅画由许多不相连的色点组成。
• Most staple fibers are discrete,individual entities.大多数短纤维是不联系的单独实体。

5 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。

6 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。

7 prescriptions   

药( prescription的名词复数 )； 处方； 开处方； 计划

参考例句：

• The hospital of traditional Chinese medicine installed a computer to fill prescriptions. 中医医院装上了电子计算机来抓药。
• Her main job was filling the doctor's prescriptions. 她的主要工作就是给大夫开的药方配药。

8 bucks   

n.雄鹿( buck的名词复数 )；钱；（英国十九世纪初的）花花公子；（用于某些表达方式）责任v.（马等）猛然弓背跃起( buck的第三人称单数 )；抵制；猛然震荡；马等尥起后蹄跳跃

参考例句：

• They cost ten bucks. 这些值十元钱。
• They are hunting for bucks. 他们正在猎雄兔。 来自《简明英汉词典》

9 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。

10 jeopardized   

危及，损害( jeopardize的过去式和过去分词 )

参考例句：

• The soldier jeopardized his life to save his comrade. 这个士兵冒生命的危险救他的同志。
• The occasional failed project or neglected opportunity does not jeopardized overall progress. 偶然失败的项目或失误的机会并没有影响总的进展。

11 forth   

adv.向前；向外，往外

参考例句：

• The wind moved the trees gently back and forth.风吹得树轻轻地来回摇晃。
• He gave forth a series of works in rapid succession.他很快连续发表了一系列的作品。

12 fixed   

adj.固定的，不变的，准备好的；(计算机)固定的

参考例句：

• Have you two fixed on a date for the wedding yet?你们俩选定婚期了吗？
• Once the aim is fixed,we should not change it arbitrarily.目标一旦确定，我们就不应该随意改变。

13 flexibility   

n.柔韧性，弹性，（光的）折射性，灵活性

参考例句：

• Her great strength lies in her flexibility.她的优势在于她灵活变通。
• The flexibility of a man's muscles will lessen as he becomes old.人老了肌肉的柔韧性将降低。

14 frail   

adj.身体虚弱的；易损坏的

参考例句：

• Mrs. Warner is already 96 and too frail to live by herself.华纳太太已经九十六岁了，身体虚弱，不便独居。
• She lay in bed looking particularly frail.她躺在床上，看上去特别虚弱。

15 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。