美国国家公共电台 NPR New Rules May Make Getting And Staying On Medicaid More Difficult

 

ARI SHAPIRO, HOST:

The Trump¹ administration has moved quickly to let states impose work requirements on some Medicaid recipients². Kentucky got the green light today. Indiana is likely to get approval soon. Some people consider the work requirement good politics, but bad policy. From Indianapolis, Side Effects Public Media's Jake Harper reports.

JAKE HARPER, BYLINE³: Indiana submitted plans for a work requirement last year, and the approval letter could come any day now. Under the proposal, people would have to average 20 hours a week of work or another qualifying activity such as volunteering or education in order to get Medicaid. The goal - to increase employment among Medicaid recipients. But Sara Rosenbaum, a professor at George Washington University, says there's a problem with that - most people on Medicaid are already working.

SARA ROSENBAUM: Or they're looking for work. And if they're not working or looking for work, it's typically because they're either caring for very young children, or they're caring for a sick family member, or their own health is bad.

HARPER: Many of those people would be exempt⁴ from a work requirement, and states could make some allowances for people battling addiction⁵. When you consider those exemptions⁶...

ROSENBAUM: There is this very, very tiny slice of people who can work and simply choose not to work and, you know, apply for public assistance.

HARPER: But Rosenbaum says even if states create programs that help people find jobs and provide things like child care and transportation, there's no evidence that they lead to more employment. And those programs are expensive.

ROSENBAUM: If you do a work program, that costs real money. And the federal government has said, we won't pay any of those costs.

HARPER: So Rosenbaum says what's more likely is that states will basically say, get a job on your own or get off of Medicaid. So what that does is create a hurdle⁷ for everybody on Medicaid. People who are working are going to have to prove it, so even people with jobs could stand to lose their insurance due to red tape. In fact, Indiana's own projections⁸ show that with a work requirement Medicaid will cover fewer people and cost more. Adam Mueller is an attorney at Indiana Legal Services, which helps people navigate⁹ the state's Medicaid program. He says people already lose coverage¹⁰ because the program can be confusing and there are administrative¹¹ errors.

ADAM MUELLER: Somewhere along the way paperwork gets lost, there's a miscommunication. Folks have sometimes had difficulty proving things that should be as easy as residency.

HARPER: And he says people on Medicaid often deal with crises. They may move a lot or change phone numbers, which makes it hard to keep track of paperwork.

MUELLER: There are a lot of things that could trip folks up. And that could lead to falling through the cracks.

HARPER: Judy Solomon of the Center for Budget and Policy Priorities points out that expanded Medicaid helps some employers, too.

JUDITH SOLOMON: We have an economic structure where there are people whose employment doesn't provide health care.

HARPER: If people lose Medicaid, get sick and can't make it to work, she says that's bad for business. Seema Verma, who's in charge of Medicaid, said on a conference call yesterday the requirement is supposed to help people.

(SOUNDBITE OF ARCHIVED RECORDING)

SEEMA VERMA: People moving off of Medicaid is a good outcome because we hope that that means that they don't need the program anymore, that they have transitioned to a job that provides health insurance so that they can afford to pay for health insurance on their own.

HARPER: But advocates say the main purpose of Medicaid is to provide health insurance, not increase employment. And until now, the federal government agreed. Susan Jo Thomas heads Covering Kids and Families of Indiana, which advocates for health coverage in the state. She says under new management, the philosophy surrounding work requirements has changed.

SUSAN JO THOMAS: I don't know that it jives with my view of Medicaid, but my view of Medicaid now is irrelevant¹². It's what Seema Verma and the administration decide.

HARPER: Thomas says the details of the work requirement have yet to be ironed out. She says if too many people lose insurance, she'll be raising concerns with the state. For NPR News, I'm Jake Harper in Indianapolis.

(SOUNDBITE OF JUSTIN TIMBERLAKE SONG, "WHAT GOES AROUND...COMES AROUND")

SHAPIRO: This story is part of an NPR partnership¹³ with WFYI and Kaiser Health News.

(SOUNDBITE OF JUSTIN TIMBERLAKE SONG, "WHAT GOES AROUND...COMES AROUND")

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 recipients   

adj.接受的；受领的；容纳的；愿意接受的n.收件人；接受者；受领者；接受器

参考例句：

• The recipients of the prizes had their names printed in the paper. 获奖者的姓名登在报上。 来自《简明英汉词典》
• The recipients of prizes had their names printed in the paper. 获奖者名单登在报上。 来自《现代英汉综合大词典》

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 exempt   

adj.免除的；v.使免除；n.免税者，被免除义务者

参考例句：

• These goods are exempt from customs duties.这些货物免征关税。
• He is exempt from punishment about this thing.关于此事对他已免于处分。

5 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

6 exemptions   

n.（义务等的）免除( exemption的名词复数 )；免（税）；（收入中的）免税额

参考例句：

• The exemptions for interpretive rules, policy statements, and procedural rules have just been discussed. 有关解释性规则、政策说明和程序规则的免责我们刚刚讨论过。 来自英汉非文学 - 行政法
• A: The regulation outlines specific exemptions for some WPM. 答：该规定概述了某些木质包装材料的特定的例外情形。 来自互联网

7 hurdle   

n.跳栏，栏架；障碍，困难；vi.进行跨栏赛

参考例句：

• The weather will be the biggest hurdle so I have to be ready.天气将会是最大的障碍，所以我必须要作好准备。
• She clocked 11.6 seconds for the 80 metre hurdle.八十米跳栏赛跑她跑了十一秒六。

8 projections   

预测( projection的名词复数 )； 投影； 投掷； 突起物

参考例句：

• Their sales projections are a total thumbsuck. 他们的销售量预测纯属估计。
• The council has revised its projections of funding requirements upwards. 地方议会调高了对资金需求的预测。

9 navigate   

v.航行，飞行；导航，领航

参考例句：

• He was the first man to navigate the Atlantic by air.他是第一个飞越大西洋的人。
• Such boats can navigate on the Nile.这种船可以在尼罗河上航行。

10 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。

11 administrative   

adj.行政的，管理的

参考例句：

• The administrative burden must be lifted from local government.必须解除地方政府的行政负担。
• He regarded all these administrative details as beneath his notice.他认为行政管理上的这些琐事都不值一顾。

12 irrelevant   

adj.不恰当的，无关系的，不相干的

参考例句：

• That is completely irrelevant to the subject under discussion.这跟讨论的主题完全不相关。
• A question about arithmetic is irrelevant in a music lesson.在音乐课上，一个数学的问题是风马牛不相及的。

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。