PBS高端访谈:私人医疗补助的广泛普及

 　　JUDY WOODRUFF:Ever since the Supreme¹ Court ruled that states do not have to expand Medicaid as part of the Affordable² Care Act, there have been big battles over that issue.

　　One bipartisan alternative has emerged in Arkansas that appeals to some other red states as well, most recently Virginia. It allows Medicaid dollars to be used to buy private insurance for low-income residents.

　　But now the Arkansas program is facing a crucial vote in the state Senate this week and its fate may be jeopardized³.

　　Hari Sreenivasan has our story.

　　MAN: We didn’t make a big yield this year, but it’s not bad.

　　MARY FRANCES PERKINS, Private Option Patient: OK.

　　HARI SREENIVASAN:It’s been a while since Mary Frances Perkins last visited the green bins⁴ on the family farm.

　　MAN:This is…

　　MARY FRANCES PERKINS:What’s it made out of, brass⁵?

　　MAN:This is brass.

　　MARY FRANCES PERKINS:OK.

　　HARI SREENIVASAN:She used to help out with almost everything on this strip in land in Carlisle, Arkansas, but after a recent diagnosis⁶ of Parkinson’s, even basic cures became too much.

　　MARY FRANCES PERKINS: Can you hold my hand?

　　MAN:Just get ahold of him.

　　HARI SREENIVASAN:Like many family farmers, Perkins didn’t have access to employer-based health insurance. And a preexisting condition meant she was denied repeatedly when she tried to buy her own plan.

　　MARY FRANCES PERKINS:So, I was out here with no health insurance whatsoever⁷. I spent days and weeks in the bed, couldn’t walk. Went to different doctors throughout Little Rock, had to pay cash for everything, slowly paid off the debt, a little each month until it was paid off. Had different tests that cost $5,000, $6,000. Paid it all off, but kind of held back from what I really needed to do because, number one, they couldn’t figure out what was wrong, and, number two, it cost so much money. And had an MRI.

　　HARI SREENIVASAN: At first, the Affordable Care Act didn’t help much either. That’s because Perkins fell into a coverage⁸ gap that’s opened up in states refusing to expand traditional Medicaid.

　　She didn’t make enough to qualify for a subsidized plan, and too much to enroll⁹ in the existing Medicaid program. But then came an unexpected twist from the state capital: A new program would allow Arkansas to use federal Medicaid dollars to purchase private health plans for low-income residents.

　　Perkins was among the first to sign up, and her new insurance kicked in at the start of the year.

　　MARY FRANCES PERKINS:The first thing I did was go to my general practitioner¹⁰, and I walked in the room and she looked at me and she said, OK, we have insurance now. Where do you want to start?

　　Even my doctor knew how much care I needed, and she was happy for me that I had insurance.

　　HARI SREENIVASAN:It’s known as the private option, and it’s designed to pay the premiums¹¹ of nearly 250,000 uninsured Americans who make less than 138 percent of the federal poverty level and didn’t already qualify for Medicaid.

　　MAN: The question before the House, the passage of House Bill 1219.

　　HARI SREENIVASAN:The idea became law last spring with overwhelming bipartisan support in the House and Senate.

　　MAN:Cast the ballots¹², 70 yeas, 23 nays¹³. House comes to order.

　　HARI SREENIVASAN:Followed by a waiver from the federal government to use Medicaid expansion funds to pay for it.

　　Immediately after passage, it was championed as a health reform approach that both parties could tolerate. Conservatives liked the idea that private option patients would access their health care through insurance plans like Blue Cross and Blue Shield, as opposed to the traditional government-run Medicaid program, which many Republicans feel is inefficient¹⁴ and offers first poor-quality care.

　　Supporters say it achieves the same results as traditional Medicaid expansion by saving hospitals and taxpayers¹⁵ millions in uncompensated care costs and bringing billions of federal dollars into the state economy. The federal government will pick up 100 percent of the cost in the first three years, with states eventually paying 10 percent thereafter.

　　About 100,000 people have enrolled¹⁶ so far. At the nonprofit Arkansas Advocates for Children and Families, Anna Strong and her team say the expansion has gone well in the state, which has some of the lowest percentages of insured residents in the country and some of the worst health outcomes.

　　ANNA STRONG, Arkansas Advocates for Children and Families:I consider our state a big leader in trying to say, you know what? You’re going to do what’s right for our state. We’re going to maybe do it a little bit differently than folks would have expected, but this is good move for Arkansas.

　　HARI SREENIVASAN:While the state is alone among its conservative neighbors in expanding a version of Medicaid, the idea is catching¹⁷ on elsewhere. Iowa has passed its own form of the private option, and lawmakers in New Hampshire, Pennsylvania and Utah are looking into it as well.

　　Part of the appeal comes from the fact that so many young people, including students like 28-year-old Tyler Pearson, are signing up. Since they’re enrolling¹⁸ in private plans, rather than a separate Medicaid program, the influx¹⁹ of young, healthy people expands the general risk pool, and keeps costs down for everyone else.

　　The way Pearson sees it, the fact that more than half of new private option patients are under 40 helps prove that young people do care about insurance.

　　TYLER PEARSON, Private Option Patient:I consider myself a very healthy individual. I’m in good shape. I exercise frequently. I eat right. I take care of myself. But I have still had things that I have had to go to a doctor for. I still need to have my teeth cleaned. I still need to have checkups. I could still break my arm at any moment, you know, and I know that.

　　HARI SREENIVASAN:But while Pearson received his new insurance card at the beginning of February, he knows he may lose it again soon if the legislature doesn’t renew funding for the upcoming fiscal²⁰ year. The prospect²¹ of that happening is looking increasingly cloudy.

　　Under state law, appropriations²² must be reapproved every year by a three-fourths majority. But the two votes in the Senate that put the private option over the top last year are now in jeopardy²³. One was lost after a supporter of the private option resigned recently and was succeeded by John Cooper, who won a special election last year on a platform opposing the Affordable Care Act. Around the same time, state Senator Missy Irvin decided²⁴ to change her yes vote to a no in part due to the disastrous²⁵ rollout of the federal law.

　　So, if no one changes their currents position, the private option in Arkansas will be dead. Governor Mike Beebe says that would be a shame, given the overwhelming support.

　　GOV. MIKE BEEBE, D-Ark.:We don’t have a problem with the majority of the legislature being for this. We don’t have a problem with a supermajority of the legislature being for this. We don’t have a problem with the majority of Republicans and Democrats²⁶ being for this. They are. But it takes 75 out of 100 House members and 27 out of 35 senators. So one senator or one House member could sway the entire — the entire effort.

　　HARI SREENIVASAN:But in the prosperous Northwest corner of the state, home to world headquarters for companies like Wal-Mart and Tyson Foods, Republican state Senator Bart Hester says the federal government simply can’t afford it. Hester believes states like Arkansas will either end up paying more than expected or sit by and watch the federal government pile up debt.

　　The real answer to widespread coverage, he says, is jobs and business-friendly policies, not a government giveaway. As proof, he points to companies like toy manufacturer Redman and Associates, which is in the process of bringing jobs back to his district from China.

　　BART HESTER, State Senator:For the country that’s already $17 trillion in debt, each child that is born in America already has $50,000 debt associated with their Social Security number. Alright? And so I think we as a society have to be conscious of that and have to understand that at some point those debts are going to come due.

　　HARI SREENIVASAN:With federal dollars coming in and the private option expected to save the state money, Arkansas passed $85 million in tax cuts last year. If the plan loses funding, the state will be millions in the hole, and that could mean big cuts for other programs. But many say the personal impacts will be deepest of all.

　　MARY FRANCES PERKINS:Do you guys want a cookie?

　　HARI SREENIVASAN:Mary Frances Perkins says she’s just starting to get the proper treatment for her Parkinson’s and cannot imagine losing ground.

　　MARY FRANCES PERKINS:It would just be a nightmare. It would just be a — I would feel like my government had absolutely turned their back on me.

　　HARI SREENIVASAN:Without money for the private option, the insurance and everything that comes with it will end June 30.

1 supreme   

adj.极度的，最重要的；至高的，最高的

参考例句：

• It was the supreme moment in his life.那是他一生中最重要的时刻。
• He handed up the indictment to the supreme court.他把起诉书送交最高法院。

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 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。

4 bins   

n.大储藏箱( bin的名词复数 )；宽口箱（如面包箱，垃圾箱等）v.扔掉，丢弃( bin的第三人称单数 )

参考例句：

• Garbage from all sources was deposited in bins on trolleys. 来自各方的垃圾是装在手推车上的垃圾箱里的。 来自辞典例句
• Would you be pleased at the prospect of its being on sale in dump bins? 对于它将被陈列在倾销箱中抛售这件事，你能欣然接受吗？ 来自辞典例句

5 brass   

n.黄铜；黄铜器，铜管乐器

参考例句：

• Many of the workers play in the factory's brass band.许多工人都在工厂铜管乐队中演奏。
• Brass is formed by the fusion of copper and zinc.黄铜是通过铜和锌的熔合而成的。

6 diagnosis   

n.诊断，诊断结果，调查分析，判断

参考例句：

• His symptoms gave no obvious pointer to a possible diagnosis.他的症状无法作出明确的诊断。
• The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做一次彻底的调查分析。

7 whatsoever   

adv.（用于否定句中以加强语气）任何；pron.无论什么

参考例句：

• There's no reason whatsoever to turn down this suggestion.没有任何理由拒绝这个建议。
• All things whatsoever ye would that men should do to you,do ye even so to them.你想别人对你怎样，你就怎样对人。

8 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。

9 enroll   

v.招收；登记；入学；参军；成为会员（英)enrol

参考例句：

• I should like to enroll all my children in the swimming class.我愿意让我的孩子们都参加游泳班。
• They enroll him as a member of the club.他们吸收他为俱乐部会员。

10 practitioner   

n.实践者，从事者；(医生或律师等)开业者

参考例句：

• He is an unqualified practitioner of law.他是个无资格的律师。
• She was a medical practitioner before she entered politics.从政前她是个开业医生。

11 premiums   

n.费用( premium的名词复数 )；保险费；额外费用；（商品定价、贷款利息等以外的）加价

参考例句：

• He paid premiums on his life insurance last year. 他去年付了人寿保险费。 来自《现代英汉综合大词典》
• Moves are afoot to increase car insurance premiums. 现正在酝酿提高汽车的保险费。 来自《简明英汉词典》

12 ballots   

n.投票表决( ballot的名词复数 )；选举；选票；投票总数v.（使）投票表决( ballot的第三人称单数 )

参考例句：

• They're counting the ballots. 他们正在计算选票。 来自《简明英汉词典》
• The news of rigged ballots has rubbed off much of the shine of their election victory. 他们操纵选票的消息使他们在选举中获得的胜利大为减色。 来自《简明英汉词典》

13 nays   

n.反对票，投反对票者( nay的名词复数 )

参考例句：

• The tally was two ayes and three nays. 投票结果是两票赞成，三票反对。 来自《简明英汉词典》
• The tally was three yeas and two nays, so the yeas have it. 投票结果是三票赞成两票反对，投赞成票者胜利。 来自《现代英汉综合大词典》

14 inefficient   

adj.效率低的，无效的

参考例句：

• The inefficient operation cost the firm a lot of money.低效率的运作使该公司损失了许多钱。
• Their communication systems are inefficient in the extreme.他们的通讯系统效率非常差。

15 taxpayers   

纳税人，纳税的机构( taxpayer的名词复数 )

参考例句：

• Finance for education comes from taxpayers. 教育经费来自纳税人。
• She was declaiming against the waste of the taxpayers' money. 她慷慨陈词猛烈抨击对纳税人金钱的浪费。

16 enrolled   

adj.入学登记了的v.[亦作enrol]( enroll的过去式和过去分词 )；登记，招收，使入伍（或入会、入学等），参加，成为成员；记入名册；卷起，包起

参考例句：

• They have been studying hard from the moment they enrolled. 从入学时起，他们就一直努力学习。 来自《简明英汉词典》
• He enrolled with an employment agency for a teaching position. 他在职业介绍所登了记以谋求一个教师的职位。 来自《简明英汉词典》

17 catching   

adj.易传染的，有魅力的，迷人的，接住

参考例句：

• There are those who think eczema is catching.有人就是认为湿疹会传染。
• Enthusiasm is very catching.热情非常富有感染力。

18 enrolling   

v.招收( enrol的现在分词 )；吸收；入学；加入；[亦作enrol]( enroll的现在分词 )；登记，招收，使入伍（或入会、入学等），参加，成为成员；记入名册；卷起，包起

参考例句：

• They lashed out at the university enrolling system. 他们猛烈抨击大学的招生制度。 来自辞典例句
• You're enrolling in a country club, Billy. 你是注册加入乡村俱乐部了，比利。 来自辞典例句

19 influx   

n.流入，注入

参考例句：

• The country simply cannot absorb this influx of refugees.这个国家实在不能接纳这么多涌入的难民。
• Textile workers favoured protection because they feared an influx of cheap cloth.纺织工人拥护贸易保护措施，因为他们担心涌入廉价纺织品。

20 fiscal   

adj.财政的，会计的，国库的，国库岁入的

参考例句：

• The increase of taxation is an important fiscal policy.增税是一项重要的财政政策。
• The government has two basic strategies of fiscal policy available.政府有两个可行的财政政策基本战略。

21 prospect   

n.前景，前途；景色，视野

参考例句：

• This state of things holds out a cheerful prospect.事态呈现出可喜的前景。
• The prospect became more evident.前景变得更加明朗了。

22 appropriations   

n.挪用（appropriation的复数形式）

参考例句：

• More commonly, funding controls are imposed in the annual appropriations process. 更普遍的作法是，拨款控制被规定在年度拨款手续中。 来自英汉非文学 - 行政法
• Should the president veto the appropriations bill, it goes back to Congress. 假如总统否决了这项拨款提案，就把它退还给国会。 来自英汉非文学 - 政府文件

23 jeopardy   

n.危险；危难

参考例句：

• His foolish behaviour may put his whole future in jeopardy.他愚蠢的行为可能毁了他一生的前程。
• It is precisely at this juncture that the boss finds himself in double jeopardy.恰恰在这个关键时刻，上司发现自己处于进退两难的境地。

24 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。

25 disastrous   

adj.灾难性的，造成灾害的；极坏的，很糟的

参考例句：

• The heavy rainstorm caused a disastrous flood.暴雨成灾。
• Her investment had disastrous consequences.She lost everything she owned.她的投资结果很惨，血本无归。

26 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》