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不加入奥巴马医保的州内，医院将面临风险

Nearly half of all U.S. states are rejecting a key component¹ of the new U.S. health care reform law popularly known as "Obamacare." These states - almost all with strong Republican majorities - are citing unsustainable costs as the reason for opting² out.  But, by not participating, states like South Carolina could lose billions of dollars in federal funds.

美国有近一半的州拒绝接受美国新医保法、也就是通常所说的“奥巴马医保”。这些州几乎都是共和党人占多数的州，他们拒绝的理由是成本太高，难以持续。但是，如果不加入奥巴马医保，南卡等州可能会失掉数十亿美元的联邦拨款。

At the Anderson Free Clinic in South Carolina, people line up early in the morning to see a doctor.  The clinic treats more than 2,000 people a year.  Most of the patients - like Ronnie Green, who is 60-years-old and living on a small pension - are either unable to work or have limited incomes.

在南卡的安德森免费诊所，人们一大早就开始排队，等候看医生。诊所每年接待2千多人，大部分病人要么不能工作，要么收入有限。比如60岁的格林，就全靠一份微薄的退休金生活。

“My nerves are real bad. I cry all the time. I shake. Can’t hold nothing. My nerves [are] just gone," said Green.

病人格林说： “我的神经很不好，我总是喊叫，发抖，拿不住东西。

Under the Affordable³ Care Act, also known as "Obamacare," almost all of these patients would have their costs covered by Medicaid - the government-funded health care program for the poor.

根据评价医保法，也就是奥巴马医保，几乎所有这些病人的医疗开支都由政府为穷人提供的医疗补助计划负担。

But because South Carolina has chosen not to expand Medicaid, free clinics remain are the only option for many people.

然而，由于南卡决定不扩大医疗补助计划，所以免费诊所就成了许多人的唯一选择。

Barb⁴ Baptista, the clinic's director, says there are not enough exam rooms to handle the growing number of patients.

诊所所长巴普蒂斯纳说，病人越来越多，但他们没有足够的诊室。

“The exam rooms are only a piece of it. Having the providers who are willing to volunteer at the free clinic and having the financial means to support our budget are a huge concern," said Baptista.

巴普蒂斯纳说： “诊室不够只是问题之一。邀请愿意来免费诊所义务服务的医生，想办法为诊所开源节流，这些都是特别费心的事。”

The clinic sends seriously ill patients to the AnMed hospital emergency room - often by taxi rather than ambulance to save money.

诊所通常用出租车把重病人送到安迈德医院急诊室，为了省钱，他们尽量不用救护车。

Hospitals that accept federal funds are required by law to provide emergency care regardless of an individual’s ability to pay.

根据法律，不管病人有没有钱看病，接受联邦拨款的医院都必须提供急救服务。

But Obamacare will phase out the federal program that reimburses⁵ hospitals for some of these bills - replacing it by covering more people under Medicaid.

但是，奥巴马医保将逐渐停止为这些医院报销部分急诊账单，而是把钱用来让更多的人享有医疗补助。

Bill Manson, who heads AnMed Health, says South Carolina’s decision not to expand Medicaid imposes on hospitals all of the law's cuts but none of the benefits.

安迈德医院院长曼森说，南卡决定不扩大医疗补助，结果，各医院必须承担医保法中所有的削减，而看不到任何好处。

“By not participating in the expansion, we kind of have almost a perfect storm of all the reductions that were built into the law without the resulting increase in coverage⁶ of the uninsured," said Manson.

曼森说：“也就是说，医保法规定的所有削减，我们一点都免不了，而医保覆盖面的增加又和我们毫不沾边。”

Under Obamacare, federal funds will pay 100 percent of added Medicaid costs - gradually reducing that to 90 percent by 2020.  But Conservatives like Ashley Landess with the South Carolina Policy Council say the costs are adding to a budget deficit⁷ that is unsustainable.

根据奥巴马医保法，增加了的医疗补助开支完全由联邦政府负担，这个比例到2020年将逐步减少到百分之90。但保守派人士、比如南卡政策委员会的兰迪斯指出，预算赤字原本就不可持续，这些开支无异于雪上加霜。

“The fix is not to continue the cycle of dependency on dollars that are really coming from debt for the most part but rather to cut that dependency and put control of health care back into the hands of providers and the patients," said Landess.

南卡政策委员会研究员兰迪斯说： “解决之道不是继续依赖基本靠借债得到的资金，而是停止这种依赖，把对医疗照顾的控制权重新交还给医生和病人。”

Unless some compromise is reached in states like South Carolina, the number of poor without health care will continue to grow and hospitals will face increasing financial risk.

除非南卡等州能够达成某种妥协，否则，没有医保的穷人将继续增多，医院将面临越来越大的财政风险。