美国国家公共电台 NPR Repeal Of Health Law Could Force Tough Decisions For Arizona Republicans

 

DAVID GREENE, HOST:

States are already preparing for changes that might come if the Republican replacement¹ for the Affordable² Care Act passes. That replacement bill, known as the American Health Care Act, is still working its way through Congress. And for one thing, there are huge implications for states that expanded Medicaid under Obamacare. Will Stone of member station KJZZ in Phoenix³ reports.

WILL STONE, BYLINE⁴: Connie Dotts is a big fan of her insurance.

CONNIE DOTTS: I like that we can choose our own doctors. They also have extensive mental health coverage⁵.

STONE: Dotts, who's 60 and lives east of Phoenix, isn't on some pricey plan, either. She's on Medicaid. Her eight prescriptions⁶ are cheap. She has no co-pays or premiums⁷. And that's allowed her to stay on top of her emphysema, depression and osteoarthritis.

DOTTS: I have torn ligaments in my ankles. And I can't take the time off from work to go to physical therapy or have surgery.

STONE: Dotts works retail⁸ and says without Medicaid, seeing a doctor would be too expensive.

DOTTS: It's just barely above what they consider livable income. Any extensive medical issues would put an excessive burden on me.

STONE: That's the situation for many of the 400,000-plus people who are now covered by Medicaid because of the Affordable Care Act. Arizona was one of the Republican-led states that expanded Medicaid. But the GOP's proposed replacement rolls back that expansion funding after 2020. And while it will still pay higher expansion rates for people already in Medicaid like Dotts, that's only if her income stays about the same, says Swapna Reddy with Arizona State University.

SWAPNA REDDY: What we know about the Medicaid population is that they kind of fall in and out of eligibility⁹ on a regular basis.

STONE: That's because how much money they make tends to fluctuate.

REDDY: So it has the real potential of eradicating¹⁰ Medicaid expansion over a period of time.

STONE: And the bill, championed by Speaker Paul Ryan, does more than pare back Medicaid's growth under the ACA. It fundamentally transforms the funding model. Instead of an open-ended entitlement, it would be capped so the federal government only gives the state a certain amount of money. And Reddy says that likely won't keep up with the growing cost of covering people.

REDDY: The states will have to come up with the remaining money to cover these folks. And if they're not willing to do it, then it really shifts the way that we look at the safety net.

STONE: The Republican legislation would eventually cost Arizona nearly half a billion dollars a year just to keep the group of adults with the lowest income covered. During the recession, that kind of financial pressure led state lawmakers to freeze enrollment¹¹. And there's another broader risk about overhauling¹² Medicaid, says Tom Betlach, who leads the program in Arizona. The state already spends as little as it can, so getting locked in at the current funding rates gives other states a leg up.

TOM BETLACH: If they're able to achieve improved outcomes and reduced costs, they're able to capture those savings¹³ versus¹⁴ we actually get penalized¹⁵ for being a good steward¹⁶ of taxpayer¹⁷ funds.

STONE: All of this puts the state's Republican governor, Doug Ducey, in a tricky¹⁸ situation. He would like the ACA repealed¹⁹ but has said he doesn't want hundreds of thousands of people to lose coverage. He's expressed concern the GOP bill doesn't give the state enough flexibility²⁰. And it wasn't on his watch that Arizona expanded Medicaid, either. It was actually Trump²¹ ally and former Governor Jan Brewer²². Just last month outside a court hearing on Medicaid expansion, she defended that decision.

(SOUNDBITE OF ARCHIVED RECORDING)

JAN BREWER: I think it was the right thing to do. It saved lives. It insured more people. It brought money into the state. It kept rural hospitals from being closed down. And today, there are tens of thousands of people that are very, very grateful.

STONE: To pull off the expansion, Brewer had to band with Democrats²³ and buck²⁴ her fellow Republicans like state Senator Debbie Lesko, who says she thought the day might come when the feds would go back on their promise.

(SOUNDBITE OF ARCHIVED RECORDING)

DEBBIE LESKO: I voted against Medicaid expansion not because, you know, I don't want people to get health coverage but because I'm a realist. And I know how much we can afford in our budget.

STONE: It's a reality that dozens of states and their legislatures could soon face as Washington tightens²⁵ the purse strings²⁶ of the country's largest insurer. For NPR News, I'm Will Stone in Phoenix.

(SOUNDBITE OF YPPAH'S "NEVER MESS WITH SUNDAY")

GREENE: And Will's story is part of a reporting partnership²⁷ with NPR, KJZZ and Kaiser Health News.

(SOUNDBITE OF YPPAH'S "NEVER MESS WITH SUNDAY")

1 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。

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 phoenix   

n.凤凰，长生(不死)鸟；引申为重生

参考例句：

• The airline rose like a phoenix from the ashes.这家航空公司又起死回生了。
• The phoenix worship of China is fetish worship not totem adoration.中国凤崇拜是灵物崇拜而非图腾崇拜。

4 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。

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 prescriptions   

药( prescription的名词复数 )； 处方； 开处方； 计划

参考例句：

• The hospital of traditional Chinese medicine installed a computer to fill prescriptions. 中医医院装上了电子计算机来抓药。
• Her main job was filling the doctor's prescriptions. 她的主要工作就是给大夫开的药方配药。

7 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》

8 retail   

v./n.零售；adv.以零售价格

参考例句：

• In this shop they retail tobacco and sweets.这家铺子零售香烟和糖果。
• These shoes retail at 10 yuan a pair.这些鞋子零卖10元一双。

9 eligibility   

n.合格，资格

参考例句：

• What are the eligibility requirements? 病人被选参加试验的要求是什么？ 来自英汉非文学 - 生命科学 - 回顾与展望
• Eligibility for HINARI access is based on gross national income (GNI). 进入HINARI获取计划是依据国民总收入来评定的。

10 eradicating   

摧毁，完全根除( eradicate的现在分词 )

参考例句：

• Objective: To study the acute and chronic toxicity of Ten-flavor-acne eradicating-capsule. 目的：探讨复方中药合剂十味平痤胶囊的急性及慢性毒性。
• We are on the verge of eradicating polio in the world. 我们已在世界消除小儿？痹症的边缘了。

11 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。

12 overhauling   

n.大修；拆修；卸修；翻修v.彻底检查( overhaul的现在分词 )；大修；赶上；超越

参考例句：

• I had no chance of overhauling him. 我没有赶上他的可能。 来自辞典例句
• Some sites need little alterations but some need total overhauling. 有些网站需要做出细微修改，而有些网站就需要整体改版。 来自互联网

13 savings   

n.存款，储蓄

参考例句：

• I can't afford the vacation,for it would eat up my savings.我度不起假，那样会把我的积蓄用光的。
• By this time he had used up all his savings.到这时，他的存款已全部用完。

14 versus   

prep.以…为对手，对；与…相比之下

参考例句：

• The big match tonight is England versus Spain.今晚的大赛是英格兰对西班牙。
• The most exciting game was Harvard versus Yale.最富紧张刺激的球赛是哈佛队对耶鲁队。

15 penalized   

对…予以惩罚( penalize的过去式和过去分词 )； 使处于不利地位

参考例句：

• You will be penalized for poor spelling. 你拼写不好将会受到处罚。
• Team members will be penalized for lateness. 队员迟到要受处罚。

16 steward   

n.乘务员，服务员；看管人；膳食管理员

参考例句：

• He's the steward of the club.他是这家俱乐部的管理员。
• He went around the world as a ship's steward.他当客船服务员，到过世界各地。

17 taxpayer   

n.纳税人

参考例句：

• The new scheme will run off with a lot of the taxpayer's money.这项新计划将用去纳税人许多钱。
• The taxpayer are unfavourably disposed towards the recent tax increase.纳税者对最近的增加税收十分反感。

18 tricky   

adj.狡猾的，奸诈的；(工作等)棘手的，微妙的

参考例句：

• I'm in a rather tricky position.Can you help me out?我的处境很棘手，你能帮我吗？
• He avoided this tricky question and talked in generalities.他回避了这个非常微妙的问题，只做了个笼统的表述。

19 repealed   

撤销，废除( repeal的过去式和过去分词 )

参考例句：

• The Labour Party repealed the Act. 工党废除了那项法令。
• The legislature repealed the unpopular Rent Act. 立法机关废除了不得人心的租借法案。

20 flexibility   

n.柔韧性，弹性，（光的）折射性，灵活性

参考例句：

• Her great strength lies in her flexibility.她的优势在于她灵活变通。
• The flexibility of a man's muscles will lessen as he becomes old.人老了肌肉的柔韧性将降低。

21 trump   

n.王牌，法宝；v.打出王牌，吹喇叭

参考例句：

• He was never able to trump up the courage to have a showdown.他始终鼓不起勇气摊牌。
• The coach saved his star player for a trump card.教练保留他的明星选手，作为他的王牌。

22 brewer   

n. 啤酒制造者

参考例句：

• Brewer is a very interesting man. 布鲁尔是一个很有趣的人。
• I decided to quit my job to become a brewer. 我决定辞职，做一名酿酒人。

23 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》

24 buck   

n.雄鹿，雄兔；v.马离地跳跃

参考例句：

• The boy bent curiously to the skeleton of the buck.这个男孩好奇地弯下身去看鹿的骸骨。
• The female deer attracts the buck with high-pitched sounds.雌鹿以尖声吸引雄鹿。

25 tightens   

收紧( tighten的第三人称单数 )； （使）变紧； （使）绷紧； 加紧

参考例句：

• One set of provisions tightens emission standards. 一套使排放标准更加严格的规定。 来自英汉非文学 - 环境法 - 环境法
• Requires no special tools or fittings; hand tightens to relief valve outlet. 不需要专用工具或管件；用手将其紧固到安全阀上即可。

26 strings   

n.弦

参考例句：

• He sat on the bed,idly plucking the strings of his guitar.他坐在床上，随意地拨着吉他的弦。
• She swept her fingers over the strings of the harp.她用手指划过竖琴的琴弦。

27 partnership   

n.合作关系，伙伴关系

参考例句：

• The company has gone into partnership with Swiss Bank Corporation.这家公司已经和瑞士银行公司建立合作关系。
• Martin has taken him into general partnership in his company.马丁已让他成为公司的普通合伙人。