美国国家公共电台 NPR Republicans' Proposed Medicaid Cuts Would Hit Rural Patients Hard

 

DAVID GREENE, HOST:

Those watching today as Senate Republicans unveil a health plan include people who depend on rural hospitals. These small facilities are sometimes the only hospitals for miles. Many serve the red parts of your political map, which voted for President Trump¹ and sent Republicans to Congress. And many rely on Medicaid, which would be reduced substantially under the House Republican version of the health bill. Bram Sable-Smith of member station KBIA reports from a hospital that would be affected².

BRAM SABLE-SMITH, BYLINE³: Kerry Noble says when a rural hospital closes, the effects ripple⁴ beyond health care...

KERRY NOBLE: We're the largest employer.

SABLE-SMITH: ...Through the economy, property values...

NOBLE: Housing is depressed⁵ enough here as it is.

SABLE-SMITH: ...Even education.

NOBLE: You could eventually even sacrifice some of your schools.

SABLE-SMITH: Noble is CEO of Pemiscot Memorial Health Systems, the lone⁶ public hospital in the poorest county in Missouri. Its struggle for survival shows how decisions made by state and federal lawmakers have put these small hospitals on the edge of collapse⁷.

NOBLE: OK. So...

SABLE-SMITH: In his office in Pemiscot County, Noble thumbs through blueprints⁸ from a happier time.

NOBLE: This was the master facility plan.

SABLE-SMITH: Back in 2005, things were very different. The hospital was doing well, and Noble commissioned a $16 million plan to replace the outdated⁹ facilities.

NOBLE: We were going to pay for the first phase of that with cash. We weren't even going to have to borrow any money for it.

SABLE-SMITH: But those renovations never happened. In 2005, way before the Affordable¹⁰ Care Act, Missouri cut Medicaid drastically. More than 100,000 Missourians lost their health coverage¹¹. Nearly half of the Pemiscot County hospital's Medicaid patients lost their insurance, but they kept coming to the hospital.

NOBLE: We're still providing care, but it's just that we're no longer being compensated¹².

SABLE-SMITH: And as the costs of treating the uninsured went up, the hospital's income went down. Forget renovations; the hospital went into survival mode.

SIDNEY WATSON: Medicaid cuts are always hard for rural hospitals.

SABLE-SMITH: Sidney Watson is a professor at Saint Louis University. She says rural hospitals were thrown a potential lifeline under the Affordable Care Act. States had the option to expand Medicaid. And in Missouri, that would have covered 300,000 people.

WATSON: It was the fundamental building block that was supposed to cover poor, low-income Americans.

SABLE-SMITH: And in 2013, Kerry Noble took to the state capitol to make a case on behalf of his hospital.

(SOUNDBITE OF ARCHIVED RECORDING)

NOBLE: We will no longer be in existence if this passage of this expansion does not occur.

SABLE-SMITH: But the Missouri legislature voted against expansion. The hospital is still in existence, for now at least. But they've cut expensive units. They no longer deliver babies. They outsource their ambulance service, and they're just barely breaking even.

NOBLE: People might look and say - well, see, you didn't need Medicaid expansion; you're still there.

Yeah. But how long are we going to be here if we don't get some relief?

SABLE-SMITH: But relief for rural hospitals is not what's being debated in Washington right now. Under the GOP House plan, even states like Missouri that did not expand Medicaid could see tens of thousands of people losing coverage. For NPR News, I'm Bram Sable-Smith in Missouri.

STEVE INSKEEP, HOST:

This story is part of a reporting partnership¹³ with NPR, Side Effects Public Media and Kaiser Health News.

(SOUNDBITE OF COMPOSITION, "AWE")

1 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。

2 affected   

adj.不自然的，假装的

参考例句：

• She showed an affected interest in our subject.她假装对我们的课题感到兴趣。
• His manners are affected.他的态度不自然。

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 ripple   

n.涟波，涟漪，波纹，粗钢梳；vt.使...起涟漪，使起波纹； vi.呈波浪状，起伏前进

参考例句：

• The pebble made a ripple on the surface of the lake.石子在湖面上激起一个涟漪。
• The small ripple split upon the beach.小小的涟漪卷来，碎在沙滩上。

5 depressed   

adj.沮丧的，抑郁的，不景气的，萧条的

参考例句：

• When he was depressed,he felt utterly divorced from reality.他心情沮丧时就感到完全脱离了现实。
• His mother was depressed by the sad news.这个坏消息使他的母亲意志消沉。

6 lone   

adj.孤寂的，单独的；唯一的

参考例句：

• A lone sea gull flew across the sky.一只孤独的海鸥在空中飞过。
• She could see a lone figure on the deserted beach.她在空旷的海滩上能看到一个孤独的身影。

7 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。

8 blueprints   

n.蓝图，设计图( blueprint的名词复数 )

参考例句：

• Have the blueprints been worked out? 蓝图搞好了吗？ 来自《现代汉英综合大词典》
• BluePrints description of a distributed component of the system design and best practice guidelines. BluePrints描述了一个分布式组件体系的最佳练习和设计指导方针。 来自互联网

9 outdated   

adj.旧式的，落伍的，过时的；v.使过时

参考例句：

• That list of addresses is outdated,many have changed.那个通讯录已经没用了，许多地址已经改了。
• Many of us conform to the outdated customs laid down by our forebears.我们许多人都遵循祖先立下的过时习俗。

10 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。

11 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。

12 compensated   

补偿，报酬( compensate的过去式和过去分词 )； 给（某人）赔偿（或赔款）

参考例句：

• The marvelous acting compensated for the play's weak script. 本剧的精彩表演弥补了剧本的不足。
• I compensated his loss with money. 我赔偿他经济损失。

13 partnership   

n.合作关系，伙伴关系

参考例句：

• The company has gone into partnership with Swiss Bank Corporation.这家公司已经和瑞士银行公司建立合作关系。
• Martin has taken him into general partnership in his company.马丁已让他成为公司的普通合伙人。