美国国家公共电台 NPR As Trump And Congress Flip-Flop On Health Care, Insurers Try To Plan Ahead

 

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Republicans in Congress say they are getting closer to an agreement on health care. House Speaker Paul Ryan said today we're going to go when we have the votes. It's unclear when that might be. Yesterday, lawmakers put forward an amendment¹ to allow states to opt² out of a couple provisions of the Affordable³ Care Act, also known as Obamacare. In a moment, we'll hear from a Republican lawmaker who is not won over. First, as NPR health policy correspondent Alison Kodjak reports, insurance companies are struggling to respond to the mixed signals they're getting from lawmakers and the White House.

ALISON KODJAK, BYLINE⁴: Tom Policelli is trying to run a health insurance company, but President Trump⁵ and members of Congress are not making it easy.

TOM POLICELLI: The current debate is largely not helpful and is heading things in a direction that will make things even worse.

KODJAK: Policelli is the CEO of Minuteman Health, which operates in Massachusetts and New Hampshire. He's trying to determine what to charge for Obamacare policies next year. The immediate⁶ issue is whether the government will keep paying so-called cost-sharing subsidies⁷ to insurance companies. The money covers discounts the insurers are required to give to low-income customers to offset⁸ deductibles and copayments.

The Trump administration seems to have agreed to make the payments for the short term, but the president is still threatening to cut them off later. Without the subsidies, at least one study shows, premiums⁹ could go up 20 percent. But Policelli says the markets have lots of other problems, too. It's technical stuff, he says, and starts telling me about medical loss ratios, risk adjustment schemes.

POLICELLI: And this is very - sounds very boring. It is very boring. I'm an insurance guy. I'm very boring.

KODJAK: (Laughter).

POLICELLI: But this stuff is killing¹⁰ the industry and driving out competition and driving prices up.

KODJAK: He says lawmakers could fix the problems if they want to. And if they don't, Trump could do a lot on his own. The question is, will they? It's still up in the air, so Policelli is preparing for next year without knowing what rules he'll have to play by.

POLICELLI: At times, it feels like, you know, you're building a boat while at sea in a storm at night. But that's what we're here to do.

KODJAK: Meanwhile, in Tennessee, Julie Mix McPeak, the state's insurance commissioner¹¹, is trying to recruit new companies into the areas of the state abandoned by other insurance companies.

JULIE MIX MCPEAK: Unfortunately, we haven't had a tremendous amount of success in some of those discussions.

KODJAK: A promise from Congress or the Trump administration to pay for the cost-sharing reductions, commonly known as CSRs, would help.

MIX MCPEAK: What I'm hearing from insurers in my state and actually from my colleagues nationally is that the CSR funding is critical in some of these participation¹² decisions that the insurers are contemplating¹³ for 2018.

KODJAK: Without that money, it's going to be very difficult to offer affordable policies next year, says Dave Anderson. He's the CEO of HealthNow, which operates Blue Cross and Blue Shield plans in upstate New York. Those payments account for as much as 20 percent of the premiums for his subsidized customers.

DAVE ANDERSON: If the funding is not adequate, then we have to make a decision of whether we want other policyholders to subsidize these or do we have to leave that segment. And both of those are real considerations.

KODJAK: Right now, his company is spending $1.08 in claims for every dollar it takes in in premiums for its Obamacare exchange customers. Continuing the cost-sharing payments isn't the only fix he wants, but it will sure help make his Obamacare plans viable¹⁴.

ANDERSON: We're not intending, frankly¹⁵, to make them profitable. We'd be satisfied with just breaking even, and we'd stay in the marketplace if we could break even.

KODJAK: And for now, that decision lies in Washington. Alison Kodjak, NPR News.

1 amendment   

n.改正，修正，改善，修正案

参考例句：

• The amendment was rejected by 207 voters to 143.这项修正案以207票对143票被否决。
• The Opposition has tabled an amendment to the bill.反对党已经就该议案提交了一项修正条款。

2 opt   

vi.选择，决定做某事

参考例句：

• They opt for more holiday instead of more pay.他们选择了延长假期而不是增加工资。
• Will individual schools be given the right to opt out of the local school authority?各个学校可能有权选择退出地方教育局吗？

3 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。

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 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。

6 immediate   

adj.立即的；直接的，最接近的；紧靠的

参考例句：

• His immediate neighbours felt it their duty to call.他的近邻认为他们有责任去拜访。
• We declared ourselves for the immediate convocation of the meeting.我们主张立即召开这个会议。

7 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》

8 offset   

n.分支，补偿；v.抵消，补偿

参考例句：

• Their wage increases would be offset by higher prices.他们增加的工资会被物价上涨所抵消。
• He put up his prices to offset the increased cost of materials.他提高了售价以补偿材料成本的增加。

9 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》

10 killing   

n.巨额利润；突然赚大钱，发大财

参考例句：

• Investors are set to make a killing from the sell-off.投资者准备清仓以便大赚一笔。
• Last week my brother made a killing on Wall Street.上个周我兄弟在华尔街赚了一大笔。

11 commissioner   

n.（政府厅、局、处等部门）专员，长官，委员

参考例句：

• The commissioner has issued a warrant for her arrest.专员发出了对她的逮捕令。
• He was tapped for police commissioner.他被任命为警务处长。

12 participation   

n.参与，参加，分享

参考例句：

• Some of the magic tricks called for audience participation.有些魔术要求有观众的参与。
• The scheme aims to encourage increased participation in sporting activities.这个方案旨在鼓励大众更多地参与体育活动。

13 contemplating   

深思，细想，仔细考虑( contemplate的现在分词 )； 注视，凝视； 考虑接受（发生某事的可能性）； 深思熟虑，沉思，苦思冥想

参考例句：

• You're too young to be contemplating retirement. 你考虑退休还太年轻。
• She stood contemplating the painting. 她站在那儿凝视那幅图画。

14 viable   

adj.可行的，切实可行的，能活下去的

参考例句：

• The scheme is economically viable.这个计划从经济效益来看是可行的。
• The economy of the country is not viable.这个国家经济是难以维持的。

15 frankly   

adv.坦白地，直率地；坦率地说

参考例句：

• To speak frankly, I don't like the idea at all.老实说，我一点也不赞成这个主意。
• Frankly speaking, I'm not opposed to reform.坦率地说，我不反对改革。