When lawmakers in the U.S. Senate and House of Representatives return to work in January, they will face the task of working out differences between major health care reform legislation. Informal talks were expected to get underway even earlier, and President Barack Obama has pledged to remain fully engaged in the process of achieving his major domestic priority.
当美国参众两院的议员们明年1月返回国会开始工作的时候，他们将面临着消除两院重要的医疗改革法案版本之间差别的重任。估计非正式的商谈可能甚至更早就要进行，奥巴马总统已经承诺将全力介入完成他这一首要国内问题的进程。
Legislation the Senate passed and the version the House of Representatives approved earlier have both been estimated by the independent Congressional Budget Office to cost in the upper $800 billion range.
美国参议院通过的医改立法版本和众议院早些时候批准的医改立法版本都经过独立的国会预算办公室的估算，耗资在8千亿美元以上。
Democrats and Republicans continue to argue what the true longer-term costs will be, with 10-year costs of the House measure put at more than $1 trillion.
民主党和共和党人继续就更长期的花费将在哪些地方产生而进行争论，众议院版本10年的花费投入超过1万亿美元。
Lawmakers who will negotiate the differences for the Senate and House will have to ensure that a final bill is below the $900 billion the president set as a maximum figure.
就弥合参议院和众议院医改法案版本之间不同进行磋商的国会议员们，将必须确保最终的法案耗资在9千亿美元这一总统确定的最高限额之下。
Senate Democrats were forced to make concessions to some of their members and to Independents, the most significant being the elimination of a government-run insurance option to compete with private companies whose practices have been the focus of sharp criticism for decades.
参议院的民主党人被迫为了本党的一些议员和独立参议员做出让步，其中最主要的让步是取消了一个由政府管理的、和私人公司进行竞争的保险机构的选项。私人保险公司的运作几十年来一直是人们严厉抨击的焦点。
Both bills seek to make health-insurance coverage accessible to between 94 and 96 percent of Americans, compared to the current 83 percent - adding about 30 million people. Most Americans would be required to obtain some form of insurance or face financial penalties.
两院版本都寻求让医疗保险覆盖百分之94到百分之96之间的美国人，目前的覆盖率只有百分之83，这意味着多覆盖大约3千万人。绝大多数美国人将被要求获得某种形式的保险，否则将面临罚金。
Both would also use tax increases on higher-earning Americans, various other taxes, and reductions in payments to medical-care providers under the government Medicare and Medicaid programs to pay the costs of expanded insurance.
两院版本都将采取向高收入美国人增税，征收其它各种税种，降低向得到政府联邦医疗保险和州医疗辅助项目支持的医疗服务提供者支出的费用，来弥补增加的保险费用的开支。
While the House bill would immediately bar private insurance companies from denying coverage or raising insurance premiums based on age or gender, the Senate would wait until 2014 for this to take effect, except for children who would be covered immediately. There would be no lifetime limits on coverage beginning immediately upon President Obama signing legislation.
尽管众议院版本将立即完全禁止私人保险公司基于年龄或者性别的原因拒绝向客户提供保险，或者提高保险费用，但是参议院的版本将一直到2014年才开始使这项规定生效，只有儿童会立即完全得到医疗保险的覆盖。奥巴马总统要签署的法案，将不会有立即开始享有医疗保险覆盖的年龄限制。
Under the House bill, the prohibition on denying coverage would begin one year earlier in 2013, with similar prohibitions on higher premiums based on pre-existing conditions or gender.
根据众议院的法案，禁止拒绝向客户提供保险的条款将早一年于2013年开始施行，禁止基于被保户已有的健康状况或者性别而收取更高保费的类似条款同时施行。
Of course, the biggest difference between the two bills, and one likely to cause the most friction in House-Senate negotiations, involves the so-called "public option" or competing insurance the government would offer.
当然，两院版本最大的不同，其中可能造成众议院和参议院磋商产生最大分歧的一处不同，包括所谓的“公共选择”，或者说是政府提供的与私人公司竞争的保险服务。
Using new public exchanges or marketplaces, a feature found in both bills, House lawmakers included such a government option in their bill, with rates to be negotiated by the government.
两院法案版本都包含运用新的公共交换或者市场的特色内容，而众议院议员们在法案中包含了一个政府经营的选项，政府经营保险的费率将由政府协商制定。
In the face of opposition from Independent Senator Joe Lieberman, and to gain his vote, Senate lawmakers first dropped the government insurance option and then an alternative plan to decrease the eligibility age for the existing government Medicare program.
面对独立参议员乔·利伯曼的反对，为了赢得他对法案的投票支持，参议院议员们起初放弃了政府保险选项，之后又放弃了一个替代性计划，该计划降低了现有政府联邦医疗保险项目的适用年龄。
The Senate measure relies on the new exchanges with emphasis on U.S. states retaining flexibility, to expand coverage to self-employed Americans, to small businesses and others currently without insurance.
参议院的法案依赖新的调换原则，同时强调美国各州保持灵活性，以此向自我谋生、小商业部门以及目前没有医疗保险覆盖的人员扩大提供保险。
In the year-long battle over reform, President Obama stressed the importance of billions of dollars in longer-term savings from reducing waste in the current health care system.
The Congressional Budget Office estimates the Senate and House bills would save $132 billion and $138 billion respectively.
国会预算办公室估计，参议院和众议院的法案将分别节省1320亿美元和1380亿美元。
Republicans who opposed both bills assert that President Obama and Democrats manipulated savings projections to conceal the true cost of reforms, while Democrats defended their figures.
反对两院法案的共和党人称，奥巴马总统和民主党人操纵炮制了储备金计划，来掩盖医改的真实花费。但是民主党人为自己的数字提出辩护。
"At the same time [the bill] cuts costs, the waste, the fraud, the duplication, endemic to our system and at the same time it covers 31 million people. Who would have thought we could do both in the same bill?," said New York Democrat Charles Schumer.
"The idea that the bill is going to create a situation to reduce debt is just not true," said Alabama Republican Jeff Sessions.
On new taxes, House lawmakers have proposed a 5.4 percent surtax on individuals earning more than $500,000 per year and families with incomes exceeding $1 million, along with with new fees for insurance companies, drug-makers, medical device manufacturers.
But there is pressure on the House to accept Senate provisions that would increase Medicare payroll taxes for individuals earning more than $200,000 annually, and families earning more than $250,000, with other taxes on so-called high-value insurance plans.
Both measures expand coverage under Medicaid, the existing government program servicing low income Americans, between 133 and 150 percent of the government's official poverty level, for the Senate and House plans respectively.
House-Senate negotiations will also focus on other issues, including provisions regarding abortion services, and those involving participation for illegal immigrants.
众议院和参议院的磋商还将集中在其它一些议题，这其中包括有关堕胎服务以及其它包括有关非法移民参加保险在内的条款。
In advance of formal talks, Democratic leaders are stressing the need to come up with a consensus that can deliver health care security and quality while controlling short and longer-term costs.
在正式商谈开始之前，民主党领导人正在强调达成在提供医疗安全和质量的同时，控制短期和长期花费的共识的必要性。
Republicans have made clear they will continue to underscore what they call the long-term deficit and debt risks for the economy of the legislation President Obama hopes to be able to sign not too far into the new year.
共和党人已经明确表示，他们将继续强调他们所说的奥巴马总统希望明年年内不要太久的时间就能够签署的这项法案为经济带来的长期赤字和债务风险。 |