PBS高端访谈:当你去世的时候,你的医疗账单不会就此消失

 　　GWEN IFILL: Our next story is about Medicaid. The government health insurance program recently expanded to millions of Americans. Although often considered free health insurance for the poor, federal law requires Medicaid to charge recipients¹ for certain services, and they are sometimes billed after they die. Medicaid then charges the expenses to their leftover² assets. It's called estate recovery, and it's making many people think twice.

　　Sally Schilling, a student at the University of California Berkeley Journalism³ School, brings us the story.

　　SALLY SCHILLING: The rollout of the Affordable⁴ Care Act and the expansion of Medicaid brought hope to people like Ruth and Rod Morgan, who had gone without health insurance for 10 years.

　　RUTH MORGAN: When I heard about the Affordable Care Act, we were very excited. We were finally going to have health coverage⁵.

　　SALLY SCHILLING: The Morgans live in Stockton, California. They are in their early 60s and are retired⁶, aside from Rod's occasional construction jobs.

　　RUTH MORGAN: We were pretty much forced into retirement⁷ because of the economic downturn. There just wasn't any work.

　　ROD MORGAN: And, I mean, we don't have much. But I would love to give our kids something. I would like to leave them a little something when we're gone.

　　SALLY SCHILLING: In states that have opted⁸ to expand Medicaid, like California, anyone making $16,000 or less per year now qualifies for Medicaid. But the Morgans were hesitant to sign up for California's Medicaid program, Medi-Cal. They had heard that Medi-Cal would bill their estate after they die.

　　ROD MORGAN: The first person I asked about estate recovery when we started to sign up said, oh, we can't possibly charge you — do something like that for you an insurance policy that we are forcing you to have.

　　SALLY SCHILLING: With that reassurance⁹, the Morgans signed up.

　　RUTH MORGAN: And then weeks later, we got a letter in the mail saying, congratulations, congratulations! You qualified¹⁰ for Medi-Cal. And then on the back page, this little paragraph says that you are subject to estate recovery, and do not contact your social worker about this.

　　SALLY SCHILLING: In 1993, Congress passed a law requiring states to recover the costs of long-term care services spent on Medicaid recipients over the age of 55 after they die, the exact burden the couple was hoping to avoid.

　　MATT SALO, National Association of Medicaid Directors: If you have the resources to pay for your own care, to pay for your own nursing home care, to pay for your own home health care, you should.

　　SALLY SCHILLING: Matt Salo is executive director of the National Association of Medicaid Directors. Medicaid recovery helps pay back a little for the massive amount spent on nursing homes and long-term care services.

　　MATT SALO: Medicaid is the largest payer of long-term care in this country. Medicaid shouldn't and cannot sustain itself if it continues to provide all long-term care to all people, especially those who have the means of paying for some of it on their own.

　　SALLY SCHILLING: Medi-Cal's managed care premiums¹¹ are typically hundreds of dollars per month. But recipients aren't notified of how much money is being spent on them. Rod says he asked a Medi-Cal representative how much money he was accruing¹².

　　ROD MORGAN: And she said, oh, we don't have any idea. We don't figure that out until after you die.

　　SALLY SCHILLING: Heirs could receive for a hardship waiver, but only if they can show that their parents' Medicaid bill would cause an undue¹³ hardship or that they were a caretaker for their parents in the family home.

　　Jo Ann Bell lives in Oakland, California, in the home her grandparents purchased in the 1940s. It was here that she cared for her mother with Alzheimer's.

　　JO ANN BELL: Where I went, she went. We had a wonderful time.

　　SALLY SCHILLING: Bell put her mother in adult day care while she went to work. Her mother's care was covered by Medi-Cal. Her mother passed away in 2012.

　　JO ANN BELL: And then I got, bam, this letter from the state of California saying, oh, you owe us $54,000. I was like, what?

　　SALLY SCHILLING: Bell applied¹⁴ for a hardship waiver. But because the family home was entrusted¹⁵ to her and her three brothers, the state only waived¹⁶ her quarter of the recovery fees. The state now has a lien¹⁷ on the house for $43,000 at 7 percent interest. She worries she might have to sell the family home to pay off Medi-Cal.

　　JO ANN BELL: And I would never be able to come down Adeline Street (ph) again, because the memories would be — it would be too hard. It would really be too hard.

　　PAT MCGINNIS, California Advocates for Nursing Home Reform: Having a home is one of the key factors in being able to escape poverty.

　　SALLY SCHILLING: Pat McGinnis, the executive director of California Advocates for Nursing Home Reform, says estate recovery hurts the people who need inheritance the most.

　　PAT MCGINNIS: What you're doing, again, destabilizing low-income communities and creating a cycle of poverty that people will never get out.

　　MATT SALO: In many cases, what we see across this country is people who are trying to — trying to have it both ways, trying to say the family home and the family estate are super important to me and I need to pass them on untouched to my children, but when the time comes to pay for health care, to pay for long-term care, that should be government's responsibility. And that's just not a sustainable policy for Medicaid.

　　SALLY SCHILLING: Last August, health advocates put forward a bill that would have limited estate recovery in California to the federal minimum requirement, recovering only for long-term care.

　　It also would have eliminated the rule that allows only portions of a claim to be waived, the problem that Bell ran into. Both houses passed the bill unanimously, but at the advice of his budget staff, Governor Jerry Brown vetoed it. Brown's office declined an interview request. But in a veto message he said: “Allowing more estate protection for the next generation may be a reasonable policy goal. The cost of this change, however, needs to be considered in the budget process next year.”

　　PAT MCGINNIS: The money we collect from the Medi-Cal recovery program is a drop in the bucket. It's absolutely nothing compared to the misery¹⁸ and the burdens that it causes on the economy. So, if that's — somehow, we can't seem to get that through to the finance people for the governor.

　　SALLY SCHILLING: So far, three states have scaled back their recovery programs. Washington, Oregon and Connecticut made these changes, citing concerns over estate recovery being a barrier to enrollment¹⁹.

　　California will hear a new bill aimed at scaling back estate recovery tomorrow.

　　For the PBS NewsHour, I'm Sally Schilling in Oakland, California.

1 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》

2 leftover   

n.剩货，残留物，剩饭；adj.残余的

参考例句：

• These narrow roads are a leftover from the days of horse-drawn carriages.这些小道是从马车时代沿用下来的。
• Wonder if that bakery lets us take leftover home.不知道那家糕饼店会不会让我们把卖剩的带回家。

3 journalism   

n.新闻工作，报业

参考例句：

• He's a teacher but he does some journalism on the side.他是教师，可还兼职做一些新闻工作。
• He had an aptitude for journalism.他有从事新闻工作的才能。

4 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。

5 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。

6 retired   

adj.隐退的，退休的，退役的

参考例句：

• The old man retired to the country for rest.这位老人下乡休息去了。
• Many retired people take up gardening as a hobby.许多退休的人都以从事园艺为嗜好。

7 retirement   

n.退休，退职

参考例句：

• She wanted to enjoy her retirement without being beset by financial worries.她想享受退休生活而不必为金钱担忧。
• I have to put everything away for my retirement.我必须把一切都积蓄起来以便退休后用。

8 opted   

v.选择，挑选( opt的过去式和过去分词 )

参考例句：

• She was co-opted onto the board. 她获增选为董事会成员。
• After graduating she opted for a career in music. 毕业后她选择了从事音乐工作。

9 reassurance   

n.使放心，使消除疑虑

参考例句：

• He drew reassurance from the enthusiastic applause.热烈的掌声使他获得了信心。
• Reassurance is especially critical when it comes to military activities.消除疑虑在军事活动方面尤为关键。

10 qualified   

adj.合格的，有资格的，胜任的，有限制的

参考例句：

• He is qualified as a complete man of letters.他有资格当真正的文学家。
• We must note that we still lack qualified specialists.我们必须看到我们还缺乏有资质的专家。

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 accruing   

v.增加( accrue的现在分词 )；（通过自然增长）产生；获得；（使钱款、债务）积累

参考例句：

• economic benefits accruing to the country from tourism 旅游业为该国带来的经济效益
• The accruing on a security since the previous coupon date. 指证券自上次付息日以来所累积的利息。 来自互联网

13 undue   

adj.过分的；不适当的；未到期的

参考例句：

• Don't treat the matter with undue haste.不要过急地处理此事。
• It would be wise not to give undue importance to his criticisms.最好不要过分看重他的批评。

14 applied   

adj.应用的；v.应用，适用

参考例句：

• She plans to take a course in applied linguistics.她打算学习应用语言学课程。
• This cream is best applied to the face at night.这种乳霜最好晚上擦脸用。

15 entrusted   

v.委托，托付( entrust的过去式和过去分词 )

参考例句：

• He entrusted the task to his nephew. 他把这任务托付给了他的侄儿。
• She was entrusted with the direction of the project. 她受委托负责这项计划。 来自《简明英汉词典》

16 waived   

v.宣布放弃( waive的过去式和过去分词 )；搁置；推迟；放弃（权利、要求等）

参考例句：

• He has waived all claim to the money. 他放弃了索取这笔钱的权利。 来自《简明英汉词典》
• I waived the discourse, and began to talk of my business. 我撇开了这个话题，开始讲我的事情。 来自辞典例句

17 lien   

n.扣押权，留置权

参考例句：

• A lien is a type of security over property.留置是一种财产担保。
• The court granted me a lien on my debtor's property.法庭授予我对我债务人财产的留置权。

18 misery   

n.痛苦，苦恼，苦难；悲惨的境遇，贫苦

参考例句：

• Business depression usually causes misery among the working class.商业不景气常使工薪阶层受苦。
• He has rescued me from the mire of misery.他把我从苦海里救了出来。

19 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。