美国国家公共电台 NPR Tax Credits, Penalties And Age Rating: Parsing The GOP Health Bill

 

STEVE INSKEEP, HOST:

Today in Your Health, we answer some of your questions about the Republican plan to replace the Affordable¹ Care Act. You've sent us many questions. And we've lined some of them up with NPR's health policy correspondent, Alison Kodjak, as well as Julie Rovner of our partner Kaiser Health News.

Good morning to you both.

JULIE ROVNER, BYLINE²: Good morning.

ALISON KODJAK, BYLINE: Good morning, Steve.

INSKEEP: They're in our studios. We're going to get pretty wonky, pretty detailed³. But let's start with the basics. Orient me on what the basic Republican plan is.

KODJAK: Well, Steve, the biggest change in this plan is that it gets rid of what's called the individual mandate⁴, which is the requirement that everybody have health insurance.

INSKEEP: OK.

KODJAK: And it also gets rid of the Affordable Care Act's income-based tax credits and subsidies⁵. It replaces those with a fixed⁶ tax credit, a single amount that everybody whose income is under $75,000 gets.

INSKEEP: Based on their age, right?

KODJAK: Based on their age. So it go up as you get older. And you use that tax credit to buy a health insurance plan on the open market.

INSKEEP: So you change these rules - some people get a little bit more; some people get less; some people feel they're getting an awful lot less, Julie Rovner.

ROVNER: That's right. And the other big thing that this bill does is it eliminates the expansion of the Medicaid program for low-income people - gradually, but it does make it go away. And of course, it repeals⁷ almost all the taxes that were raised in the Affordable Care Act to pay for the benefits since it's going to have fewer benefits.

INSKEEP: OK. So every single provision of this affects somebody's bottom line - personal bottom line - millions of people. And we're getting lots of questions about it. The first one that we're going to listen to is from Nkonye Adaikpoh in San Antonio, Texas.

(SOUNDBITE OF ARCHIVED RECORDING)

NKONYE ADAIKPOH: What provisions are there for those who experience financial hardships - such as a job loss, death in the family, divorce - and can't buy insurance?

INSKEEP: OK. If you're broke, what do you do, Alison Kodjak?

KODJAK: Well, there's no specific provision to help people if they don't qualify for Medicaid. No matter what your circumstances, as we said before, you get this age-based tax credit. The idea is that Republicans eventually will get rid of enough regulation that lower-cost, sort of stripped-down health insurance policies will be available for people who can't really afford more comprehensive coverage⁸.

INSKEEP: That's the hope. But the reality right now, according to the Congressional Budget Office, is some people just realistically aren't going to be able to use this subsidy⁹ to pay for insurance. Is that right?

KODJAK: Exactly. As the market stands now, there's really not a lot of insurance policies, or any, available for, like, the $2,000 a year is the tax credit for people under the age of 30.

INSKEEP: OK. Let's go on to another question here. Mollie Gelburd asks the question from Washington, D.C., and wants to know this.

(SOUNDBITE OF ARCHIVED RECORDING)

MOLLIE GELBURD: What's the policy behind providing age-based tax credits as opposed to income-based?

INSKEEP: There we go, Julie Rovner. Why do that?

ROVNER: Well, I think there are two main reasons. One is simplicity¹⁰. Right now, the tax credits are income-based, and so you have to verify your income. And you have to - they use last year's tax returns. It's very complicated, and sometimes people end up paying more at the end of the year.

INSKEEP: OK.

ROVNER: The other thing about age-based tax credits is the hope is that it will get more younger, healthier people into the individual market. That's what the Affordable Care Act was trying to remake. There have not been enough of those people. And that's one of the reasons that costs have gone up. But...

INSKEEP: Let me just make sure I understand this. So if I'm 25 or 30, I got out of college. I got a decent job as opposed to a poor-paying or low-paying job, I might have no subsidy now. But I might have a couple thousand dollars under this plan, is that right?

ROVNER: That's exactly correct. It will definitely make it easier for younger people to afford health insurance. But the trade-off - as you mentioned, there's lots of winners and losers - is that older people, people who are not quite old enough for Medicare but between about age 50 and 64, will pay a lot more. That's the now-famous Congressional Budget Office estimate, that a 64-year-old will go from paying $1,700 a year now to $14,000 if this were to become law.

INSKEEP: And these are a lot of Republican voters. And this is the provision that's causing a lot of Republicans to say - wait a minute - not a final plan yet. We'll try to work on that if we can.

KODJAK: Exactly. And that's one of the things that has happened over the weekend. Republicans in Congress, especially Paul Ryan, have said they're going to look at that part of it because it's gotten so much pushback that they're trying to see what else they can do, possibly increase the tax credit amount for those older people who don't get employer-based health coverage.

INSKEEP: Although that means it would cost more. And there are conservative Republicans already concerned about how much this costs, right?

KODJAK: Yes. And that's why this is thorny¹¹ (laughter).

INSKEEP: OK. Well, let's get another question on the table here from Leslie Shatz (ph) of Deer Park, N.Y.

(SOUNDBITE OF ARCHIVED RECORDING)

LESLIE SHATZ: Could you please explain the difference between tax credits and subsidies? Will there be quarterly tax credits or just year-end?

INSKEEP: What's the difference, Julie - tax credit, subsidy?

ROVNER: Well, actually, this is a common misunderstanding. The main way that the Affordable Care Act helps people pay their premiums¹³ is a tax credit. It's just everybody refers to it as a subsidy. So basically, the...

INSKEEP: Which effectively is - they're just not necessarily writing me a check.

ROVNER: Right. We're swapping¹⁴ one tax credit for another tax credit. And what makes you not realize these are tax credits is that neither one of them comes at the end of the year when you file your taxes. They are both what's called advanceable, which means you can get them in advance to pay your monthly premiums, and refundable¹⁵, which means that even if you don't earn enough to owe taxes, you are entitled to that tax credit. Those two things would remain the same. It's just, as we pointed¹⁶ out, the amount of the credits would change, and the way you get the credits would change.

INSKEEP: OK, not technically¹⁷ a subsidy. Are there are also subsidies that are part of this plan - actual subsidies, payments to people?

ROVNER: There aren't. But there are actual subsidies (laughter) in the Affordable Care Act. Those are for people who earn less than two and a half times poverty. And that's to help them pay not their premiums but to pay their out-of-pocket spending, their deductibles and co-insurance.

INSKEEP: OK. One quick last question from Anne Paulson of Los Altos, Calif.

(SOUNDBITE OF ARCHIVED RECORDING)

ANNE PAULSON: If I were 62 and I decided¹⁸ health insurance was too expensive and I'd wait for Medicare, I wouldn't get a penalty - right?

INSKEEP: Would you, Alison?

KODJAK: No, you wouldn't actually, unless you got sick, at which point your penalty would be that you'd have to pay for your health care out of your own pocket because you wouldn't have any insurance.

INSKEEP: Or pay to get health insurance back - right? - because they can't deny you with a preexisting condition.

KODJAK: No, they can't deny you with a preexisting condition. The risk is that you would have to wait for the open enrollment¹⁹ period. So there would be this period of time, perhaps, between when you found out you were ill and when you could buy an insurance policy to pay for that.

INSKEEP: That's feeling like casino gambling²⁰.

KODJAK: A little bit (laughter).

INSKEEP: OK.

ROVNER: And there's a 30 percent premium¹² increase for that year.

INSKEEP: OK. Well, thanks very much, guys, for answering some of the many, many, many questions about the Republican replacement²¹ to the Affordable Care Act.

Julie Rovner of Kaiser Health News, good to see you again.

ROVNER: Thank you.

INSKEEP: And NPR's Alison Kodjak, thanks to you for coming by.

KODJAK: Thanks, Steve.

INSKEEP: OK. We're going to be answering more questions as this debate goes on. You can tweet us @morningedition using the hashtag #ACAchat.

1 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。

2 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

3 detailed   

adj.详细的，详尽的，极注意细节的，完全的

参考例句：

• He had made a detailed study of the terrain.他对地形作了缜密的研究。
• A detailed list of our publications is available on request.我们的出版物有一份详细的目录备索。

4 mandate   

n.托管地；命令，指示

参考例句：

• The President had a clear mandate to end the war.总统得到明确的授权结束那场战争。
• The General Election gave him no such mandate.大选并未授予他这种权力。

5 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》

6 fixed   

adj.固定的，不变的，准备好的；(计算机)固定的

参考例句：

• Have you two fixed on a date for the wedding yet?你们俩选定婚期了吗？
• Once the aim is fixed,we should not change it arbitrarily.目标一旦确定，我们就不应该随意改变。

7 repeals   

撤销，废除( repeal的名词复数 )

参考例句：

• The measure repeals a previous law that prevented local governments from targeting specific breeds for sterilization. 这项法令的出台将废止之前一项限制地方政府针对某种犬类采用绝育措施的法律。

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 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。

10 simplicity   

n.简单，简易；朴素；直率，单纯

参考例句：

• She dressed with elegant simplicity.她穿着朴素高雅。
• The beauty of this plan is its simplicity.简明扼要是这个计划的一大特点。

11 thorny   

adj.多刺的，棘手的

参考例句：

• The young captain is pondering over a thorny problem.年轻的上尉正在思考一个棘手的问题。
• The boys argued over the thorny points in the lesson.孩子们辩论功课中的难点。

12 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。

13 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》

14 swapping   

交换，交换技术

参考例句：

• The slow swapping and buying of horses went on. 马匹的买卖和交换就是这样慢慢地进行着。
• He was quite keen on swapping books with friends. 他非常热衷于和朋友们交换书籍。

15 Refundable   

adj.可归还的，可退还的

参考例句：

• All deposits for holiday cottages are refundable. 度假别墅的抵押金可全数退还。 来自《简明英汉词典》
• Empty bottles are not refundable. 空瓶不退。 来自《现代汉英综合大词典》

16 pointed   

adj.尖的，直截了当的

参考例句：

• He gave me a very sharp pointed pencil.他给我一支削得非常尖的铅笔。
• She wished to show Mrs.John Dashwood by this pointed invitation to her brother.她想通过对达茨伍德夫人提出直截了当的邀请向她的哥哥表示出来。

17 technically   

adv.专门地，技术上地

参考例句：

• Technically it is the most advanced equipment ever.从技术上说，这是最先进的设备。
• The tomato is technically a fruit,although it is eaten as a vegetable.严格地说，西红柿是一种水果，尽管它是当作蔬菜吃的。

18 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。

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。

20 gambling   

n.赌博；投机

参考例句：

• They have won a lot of money through gambling.他们赌博赢了很多钱。
• The men have been gambling away all night.那些人赌了整整一夜。

21 replacement   

n.取代，替换，交换；替代品，代用品

参考例句：

• We are hard put to find a replacement for our assistant.我们很难找到一个人来代替我们的助手。
• They put all the students through the replacement examination.他们让所有的学生参加分班考试。