美国国家公共电台 NPR Many Who Buy ACA Health Plans For 2019 Find Lower Prices And More Choice

 

STEVE INSKEEP, HOST:

We are in the middle of open enrollment¹ for the Affordable² Care Act. It goes until December 15. People can sign up for health insurance plans under Obamacare. And holiday health insurance shoppers are finding something new this year - lower prices. Let's talk this through with Kaiser Health News correspondent Jordan Rau, who has looked at all the prices of all the plans in all the counties in the 39 states which rely on the federal government's healthcare.gov for their marketplaces. And he's here with results. Hey there.

JORDAN RAU: Hey.

INSKEEP: So what did you find?

RAU: Well, big surprise - prices are dropping in a lot of counties - over half of the counties - and sometimes, by large amounts.

INSKEEP: We're not talking about every single plan in every single place going down, right? But what's the average thing happening?

RAU: Well, it goes from place to place. Some places, like D.C., are actually going up. But a lot of places that have had very high premium³ hikes over the last couple of years, like in Tennessee and in Arizona, are decreasing. And we looked at a couple of different types of plans. We looked at the lowest price plan. That's a bronze plan, a high deductible plan. And then we also looked at the silver plans, which are the plans that about two-thirds of the people get.

INSKEEP: And those are both going down by - what? - a few percentage points.

RAU: It really varies from county to county. I mean, it can change a lot. But in some places, they're going down 17 percent, 20 percent.

INSKEEP: Wow. So why would that be happening?

RAU: Well, a lot of it is that the market is correcting. The insurers went way, way high over the last couple of years because of all the political instability. You know, at the time, they were looking at the possibility that the whole thing would be repealed⁵ and replaced. And then also, there have been some changes that the Republicans and President Trump⁶ have made that have destabilized the market somewhat. They've let in some plans that people can sign up. There are short-term plans that don't offer all the benefits. And those the insurers fear would siphon away some of their healthier people. And they made some other changes as well. So the insurers just baked all that into their rates. And so for the last couple of years, people have really seen some sticker shock.

INSKEEP: You had mentioned that prices had gone up the last couple of years because of the Republican Congress and the Trump administration. Hadn't prices actually been going up for several years, even before the Trump administration?

RAU: Right. Well, they took a big jump when these markets were created in 2014 because suddenly, people could get insurance, even if they had expensive conditions. And insurers had to cover all sorts of things, whereas before, they could pick and choose.

INSKEEP: Oh, when the plans got better, they also got more expensive.

RAU: That's right. You want more, you pay more. And then they continued to increase because in a lot of places, insurers decided⁷ that they didn't want to participate, that they were worried that they wouldn't make a lot of money or lose it. In some areas of the country, there would only be one insurer that was offering plans. And that insurer could set its prices wherever they wanted. People had no choice.

INSKEEP: How will people feel that difference? - because a lot of these plans are subsidized anyway, right?

RAU: Yeah, that's a great question. There's two groups of people. So the people that are subsidized - and that is you get a subsidy⁸ if you're, you know, a family of four with income under $100,000. Those people may not see a big difference because they're already capped. And in some cases, one of the weird⁹ things that's happening is that because all the prices are dropping, the subsidies¹⁰ are dropping as well. So it's possible some people may even see a small increase. But the big difference is going to be for the people that don't get a subsidy at all. And they have the potential of seeing much lower prices.

INSKEEP: So let me ask you about the prospects¹¹ for the next couple of years because you mentioned that political instability - efforts to repeal⁴ and replace Obamacare - affected¹² the prices and helped to drive them up. Now we have a period where Democrats¹³ are about to take control of the House of Representatives. We can presume that although Republicans still have a lot of power, they're not going to repeal Obamacare now for at least the next couple of years. Does that create a stable situation where prices might come down further?

RAU: Yeah, I don't think so at all because the fundamental, underlying¹⁴ problems of the healthcare system are still in existence. You still have no price transparency that allows a functioning market where people can shop around and also, the ability of some providers, some hospitals, some doctors to dictate¹⁵ their own prices. So really, most of the fundamental elements that have led to increases for everybody are still in place.

INSKEEP: So the good news is prices are going down. The bad news is they're still very high, and there's a big risk of further increases over time.

RAU: That's right.

INSKEEP: Jordan, thanks so much.

RAU: Thanks for having me.

INSKEEP: That's Jordan Rau of Kaiser Health News.

1 enrollment   

n.注册或登记的人数；登记

参考例句：

• You will be given a reading list at enrollment.注册时你会收到一份阅读书目。
• I just got the enrollment notice from Fudan University.我刚刚接到复旦大学的入学通知书。

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 premium   

n.加付款；赠品；adj.高级的；售价高的

参考例句：

• You have to pay a premium for express delivery.寄快递你得付额外费用。
• Fresh water was at a premium after the reservoir was contaminated.在水库被污染之后，清水便因稀而贵了。

4 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。

5 repealed   

撤销，废除( repeal的过去式和过去分词 )

参考例句：

• The Labour Party repealed the Act. 工党废除了那项法令。
• The legislature repealed the unpopular Rent Act. 立法机关废除了不得人心的租借法案。

6 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。

7 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

8 subsidy   

n.补助金，津贴

参考例句：

• The university will receive a subsidy for research in artificial intelligence.那个大学将得到一笔人工智能研究的补助费。
• The living subsidy for senior expert's family is included in the remuneration.报酬已包含高级专家家人的生活补贴。

9 weird   

adj.古怪的，离奇的；怪诞的，神秘而可怕的

参考例句：

• From his weird behaviour,he seems a bit of an oddity.从他不寻常的行为看来，他好像有点怪。
• His weird clothes really gas me.他的怪衣裳简直笑死人。

10 subsidies   

n.补贴，津贴，补助金( subsidy的名词复数 )

参考例句：

• European agriculture ministers failed to break the deadlock over farm subsidies. 欧洲各国农业部长在农业补贴问题上未能打破僵局。
• Agricultural subsidies absorb about half the EU's income. 农业补贴占去了欧盟收入的大约一半。 来自《简明英汉词典》

11 prospects   

n.希望，前途(恒为复数)

参考例句：

• There is a mood of pessimism in the company about future job prospects. 公司中有一种对工作前景悲观的情绪。
• They are less sanguine about the company's long-term prospects. 他们对公司的远景不那么乐观。

12 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。

13 democrats   

n.民主主义者，民主人士( democrat的名词复数 )

参考例句：

• The Democrats held a pep rally on Capitol Hill yesterday. 民主党昨天在国会山召开了竞选誓师大会。
• The democrats organize a filibuster in the senate. 民主党党员组织了阻挠议事。 来自《简明英汉词典》

14 underlying   

adj.在下面的，含蓄的，潜在的

参考例句：

• The underlying theme of the novel is very serious.小说隐含的主题是十分严肃的。
• This word has its underlying meaning.这个单词有它潜在的含义。

15 dictate   

v.口授；(使)听写；指令，指示，命令

参考例句：

• It took him a long time to dictate this letter.口述这封信花了他很长时间。
• What right have you to dictate to others?你有什么资格向别人发号施令？