国会未能延长医疗补贴，现在怎么办？

嘿。

Hey.

我是特蕾西·穆福德。

I'm Tracy Mumford.

现在发生了很多事情。

There is a lot happening right now.

《纽约时报》的头条播客将在十分钟内让你了解最新动态。

The headlines podcast from The New York Times will catch you up on the latest in ten minutes or less.

我们将带你走进《纽约时报》新闻室的突发新闻和重大调查，还会为你带来让你惊叹的故事。

We'll take you inside breaking news and big investigations from the Times newsroom, plus bring you the stories that make you go, Woah.

我不知道这件事。

I didn't know that.

每天工作日早上，请在你收听播客的平台收听我们的节目《头条》。

Listen to our show, the headlines, every weekday morning wherever you get your podcasts.

来自《纽约时报》，我是蕾切尔·阿布拉姆斯，欢迎收听《每日新闻》。

From the New York Times, I'm Rachel Abrams, and this is The Daily.

我平时不太祈祷，但每晚都会祈祷，希望发生点什么，让我早上醒来时查看新闻，发现补贴被延长了。

I don't really pray much, but I pray at night that something happened that I wake up in the morning, and I check the news, and that a subsidy was extended.

希望能让明年的费用别涨到55000美元。

Something that will make it not $55,000 next year.

随便什么都行。

Something.

本周，尽管一些众议院共和党人做出了最后的努力试图就医疗保健达成协议，但国会仍僵持不下，无法决定是否延长对数百万通过《平价医疗法案》获得医疗保障的美国人的支持。

This week, despite a last ditch effort by some House Republicans to strike a deal on health care, Capitol Hill remains deadlocked on whether to extend support for millions of Americans who get their health care through the Affordable Care Act.

如果没有补贴，每月最低也要1500美元，这根本不可能。

Without subsidies, would be the minimum of $1,500 a month, and there wasn't no way.

我最初的估算是一次1200%的涨幅。

My original estimate was about a 1200% increase.

得知这个消息后，我整个星期剩下的时间都在流泪。

I think I was in tears the entire rest of the week after I got that news.

这迫使这些美国人面临一个艰难的抉择。

That's left those Americans to confront a wrenching decision.

我问我丈夫：我们该怎么办？

I asked my husband, like, what should we do?

他說：也許我們干脆不買健康保險了。

He's like, maybe we go without health insurance.

我當時說：天哪。

And I was like, oh my god.

不可能。

No way.

是继续支付不断上涨的保险费用，还是冒险不买保险？

Keep paying for rising insurance costs or risk going without it.

过去几个月真的很难熬。

It's been a really tough couple of months.

我一直在心理上为明年的生活做准备，情况相当严峻。

A lot of just, like, mentally preparing for what this next year is going to look like, and it's pretty grim.

今天，我的同事马可·桑格·卡茨将解释谁将受到最大影响，以及这如何可能改变中期选举前的政治格局。

Today, my colleague, Marco Sanger Katz, explains who will be most affected and how this could all change the political landscape heading into the midterms.

今天是12月18日，星期四。

It's Thursday, December 18.

玛戈，欢迎回到《每日新闻》。

Margo, welcome back to The Daily.

非常感谢你。

Thank you so much.

感觉医疗保健和关于医疗保险的争论几乎每隔一天就出现在新闻里。

It really feels like health care and debates over health insurance have been in the news, like, every other day almost.

在很大程度上，这是因为国会山一直在进行重大、持续且不断变化的辩论。

And in large part, that's because there have been these really huge and ongoing and changing debates on Capitol Hill.

但感觉这一周尤其特别，我们似乎已经到达了一个转折点，这就是我们想请你上节目的原因。

But it really feels like this week in particular, we have reached an inflection inflection point, which is why we wanted to have you on the show.

上次请你上节目时，正值政府停摆谈判的高潮。

The last time we had you on, it was in the thick of the shutdown fight.

我们今天再次请你来，是想让你告诉我们目前的情况进展。

And we're bringing you back here so that you can bring us up to speed on where we are now.

正如你可能记得的，关于停摆之争的核心在于国会是否要延长那些帮助人们在《平价医疗法案》市场购买保险的补贴。

So as you may remember, the real crux of the fight over the shutdown was whether or not congress was going to extend these subsidies that help people buy insurance in the Affordable Care Act marketplaces.

这是民主党决定将其作为斗争核心的事项。

This was the thing that Democrats decided to make the centerpiece of their fight.

他们选择就这些补贴展开斗争，是因为我认为他们觉得这是一个对他们非常有利的议题。

And they chose to fight over these subsidies specifically because I think they felt like this was a really strong issue for them.

选民更信任民主党在医疗保健方面的能力。

Voters trust them more on health care.

这是民主党最强势的议题之一，但此前并未成为人们最关注的焦点。

It's like one of the Democrats' strongest issues, but it has not been the biggest issue that was in the forefront of people's mind.

这是一次小小的冒险。

It was a little bit of a gamble.

你知道，他们能否让人们关注这个问题？

You know, were they gonna be able to get people to pay attention to this?

但他们做到了。

But they did.

嗯。

Mhmm.

但从通过立法的角度来看，这并没有成功。

And it didn't work from the perspective of getting legislation passed.

他们使政府停摆了创纪录的长时间。

They shut down the government for a record period of time.

最终，他们决定在不延长这些补贴立法的情况下重新开放政府。

Ultimately, they decided to reopen the government without legislation to extend these subsidies.

对。

Right.

民主党基本上在这场斗争中失败了。

Democrats basically lost that fight.

他们同意在没有达成这些医疗补贴协议的情况下重新开放

They agreed to reopen the

政府。

government with no deal on these health care subsidies.

他们达成的唯一协议是，可以在参议院全体会议上就此事进行投票。

The one deal they got is that they were gonna get to put up a vote on the senate floor.

他们确实这么做了。

They did that.

但共和党人没有投票支持。

Republicans didn't vote for it.

这件事最终没有取得任何进展。

It didn't go anywhere.

所以，他们唯一得到的只是在这个问题上一次失败的投票。

So that was all they got was a kind of failed vote on this issue.

从那以后，许多共和党议员，尤其是众议院中的温和派共和党人，开始担忧该如何应对，因为他们知道这些补贴的取消将影响他们的选民。

And then since then, a lot of Republican lawmakers, particularly moderate Republicans in the house, have been worried about what to do because they know that the loss of these subsidies is going to affect their constituents.

我认为，他们担心在中期选举到来时会面临政治后果。

And I think they're worried about political consequences when the midterms roll around.

因此，这些温和派共和党人与民主党人之间一直存在某种谈判和博弈。

So there's been this kind of deal making debate between some of these moderate Republicans and Democrats.

他们能达成妥协吗？

Could they form a compromise?

他们能通过一项修补补贴的法案，让其他共和党人也支持吗？

Could they pass something that would patch the subsidies and that other Republicans could sign on to?

但 enrollment 的截止日期在周一就到了，他们并没有通过任何类似的法案。

But the deadline for enrollment came on Monday, and they did not pass anything like that.

所以这就是我们现在从《平价医疗法案》中非常熟悉的开放注册期。

So this is the open enrollment that we're all quite familiar with at this point from the Affordable Care Act.

是的。

Yeah.

我的意思是，

I mean,

你们公司的工作保险应该也有类似的情况，就像我们在《纽约时报》一样。

you probably have the same thing for, like we have the same thing here at The Times for our work insurance.

有一段特定的时间，你必须选择并支付你的医疗保险，一旦登记，就覆盖一整年。

There's some period of time in which you have to pick and pay for your health insurance, and that signs you up for the whole year.

而且每年都有我们自己的截止日期。

And there are just our deadlines that happen every year.

所以，尽管现在还不是年底，但我们已经接近这些补贴的最后期限了。

So even though we're not at the end of the year now, we're kind of a little bit at the end of the line for these subsidies.

人们必须做出选择。

People had to make their choices.

对。

Right.

话虽如此，事情可能还没完全结束。

Now that said, it may not be totally over.

本周，发生了一件不太寻常的事。

This week, something kind of unusual happened.

几位对众议院议长不给他们投票机会感到愤怒的温和派共和党人，与所有民主党人联合签署了一项名为‘解除请愿书’的文件，这是一种绕过众议院议长同意、将法案提交全体表决的方式。

A couple of moderate Republicans who are really mad at the speaker of the house for not giving them a chance to vote on this joined up with all of the Democrats to sign what's called a discharge petition, which is a way to get a bill on the floor without the house speaker's cooperation.

而这项法案将把补贴延长三年。

And that bill would extend the subsidies for three years.

嗯。

Mhmm.

但这项法案可能还要几周才会进行投票，而且还不清楚它能否在参议院通过。

But that bill isn't gonna come up for a vote for probably a couple of weeks, and it's not clear whether it can pass the senate.

因此，目前看来这些补贴即将到期，许多人不得不为他们的医疗保险支付更多费用。

So for now, it looks like these subsidies are gonna expire, and a lot of people are going to have to pay more for their health insurance.

所以，我们在这里经常使用的关键词是补贴。

So the keyword that we have been using a lot here is subsidies.

但我希望确保大家真正理解这到底意味着什么。

But I wanna make sure that people actually understand what that means.

具体来说，这些补贴是什么，它们是如何变化的？

Specifically, what were the subsidies, and how are they changing?

所以，如果你愿意的话，我认为最好回溯一下过去，谈谈《平价医疗法案》。

So if you will indulge me, I think it makes sense to go back in time a little bit and talk about Obamacare.

当然。

Definitely.

所以当民主党在2010年通过《平价医疗法案》时，他们建立了一个系统，让那些不通过工作或政府项目获得保险的人能够进入一个市场。

So when Democrats passed the Affordable Care Act in 2010, they set up a system where people who don't get their insurance through work or through a government program have access to a market.

如果他们的收入低于联邦贫困线的400%，也就是大约63,000美元。

And if they make less than 400% of the federal poverty level, that's like $63,000.

听起来挺合理的

Quite sound like

400%听起来很多，但这是

a lot, 400%, but that is

对于单个人来说，大约是63,000美元。

For a single person, it's like $63,000.

对于一个更大的家庭，可能指的是10万美元左右。

For a larger family, you know, might be talking about a $100,000.

如果你的收入低于这个数额。

You make less than that.

你就能获得购买保险的补贴。

You get some help buying your insurance.

嗯。

Mhmm.

而且这是按比例递减的。

And it's on a sort of sliding scale.

所以你越穷，获得的援助就越多。

So the poorer you are, the more help you get.

初衷是让那些没有保险的人能够负担得起保险。

And the idea was to make insurance affordable for people who didn't have it.

但随着时间推移，许多《平价医疗法案》的制定者意识到，对于这些无保险人群来说，医疗保险仍然相当昂贵。

But over time, what a lot of the authors of the Affordable Care Act realized is that the health insurance was still kind of expensive for these people who are uninsured.

嗯。

Mhmm.

在疫情爆发前，大约有1200万人注册了奥巴马医改计划。

So going into the pandemic, there were around 12,000,000 people who were signed up for Obamacare plans.

这个数字低于法案通过时人们的预期。

That was less than everyone had expected when the bill passed.

因此，当疫情发生时，联邦政府表现出更大的支出意愿，民主党重新审视了原有的补贴，并增加了新的补贴，使付款更加慷慨，要求人们为医疗保障支付更少的费用。

And so when the pandemic happened and there was this real openness to spending more money by the federal government, Democrats revisited those original subsidies, and they topped them off with new subsidies that made the payments even more generous and asked people to pay even less of the total bill for their health coverage.

那么，这些更慷慨的补贴具体是什么样子的呢？

So what did those more generous subsidies look like?

在民主党在疫情期间通过的体系下，基本上所有在这个市场购买保险的人都获得了更多的财政援助。

So under the system that Democrats passed during the pandemic, basically, everyone who buys insurance in this market got more financial help.

但我认为有两组人受益特别明显。

But there are two groups that I think benefited particularly.

第一组是这个市场中最贫困的美国人。

One group was the poorest Americans in this market.

《平价医疗法案》计算这一标准的方式是：任何一年收入低于联邦贫困线1.5倍的人。

The way the Affordable Care Act calculates that is anyone who earns less than one and a half times the federal poverty level in a given year.

今年这个标准略低于25,000美元。

That's a little less than $25,000 this year.

民主党重新调整了补贴，使这些人的自付费用为零。

The Democrats reset the subsidies so that those people have to pay nothing.

免费。

Nothing.

零。

Zero.

他们基本上可以免费获得保险计划。

They can get an insurance plan basically for free.

嗯。

Mhmm.

还有一群人，在最初的《平价医疗法案》设计中根本得不到补贴，但现在在增强的补贴结构下首次获得了帮助。

And then there's a new group who actually didn't get any subsidies under the original Obamacare design, who were now under this enhanced subsidy structure getting help for the first time.

这些人的收入超过联邦贫困线的400%。

So these are people who earn more than 400% of the federal poverty level.

这一群体包括许多企业家、在无法提供保险的小型企业工作的人员、农民和牧场主，以及提前退休的人——他们要么选择在符合联邦医疗保险资格前就提前退休，要么失去了工作，难以重返劳动力市场，只能靠积蓄生活。

And, you know, this is a group that includes a lot of entrepreneurs, people who work for small businesses that can't offer insurance, farmers and ranchers, and also early retirees who either chose to stop working early before they qualified for Medicare or maybe lost their job and were having trouble getting back into the job market and are living off their savings.

所以，基本上，民主党决定不仅

So, basically, it sounds like the Democrats decided that not only did the

补贴需要更加慷慨，但也需要覆盖更多的人。

subsidies need to get more generous, but they also needed to be available to a lot more people.

嗯，我

Well, I

我认为这个群体中的许多人确实被漏掉了。

think this was a group that a lot of Democrats felt were really slipping between the cracks.

所以我认为民主党人很高兴回来试图改进这个项目。

And so I think Democrats were kind of happy to come back and try to fix this program.

这实际上为一些人带来了巨大的经济差异。

And it actually made a very big financial difference for some of these people.

这就是民主党在2021年实施的计划。

So that's the plan that Democrats implemented in 2021.

起初，他们只将其设为短期措施。

And at first, they made it really short term.

但随后他们立即发现，有大量的人开始参保。

But then they immediately saw that tons more people were signing up for coverage.

我们知道是谁推动了这一激增吗？

Do we know who was really driving that surge?

是哪些人？

What kind of people?

是什么收入水平？

What kind of income level?

这种增长几乎全部来自最低收入群体。

Almost all of this growth is coming from that bottom income category.

所以，这些就是有资格享受零保费的人。

So those are the people that are eligible for these $0 premiums.

我认为这种情况发生有几个原因。

I think there are a couple of reasons why that happened.

一个是，这个群体更有可能没有保险。

One is just that's a group that's much more likely to be uninsured.

想想低收入人群从事的工作类型，他们几乎不可能获得医疗保险。

If you think about the kinds of jobs that low income people have, they're just much less likely to come with health insurance.

你知道，如果有人做很多零工经济工作，把这些工作拼凑在一起，或者有一份兼职工作。

You know, if there's someone who has a bunch of gig economy jobs that they're patching together or a part time job.

这些类型的工作通常没有医疗保险。

Those are the kinds of jobs generally don't have health insurance.

因此，这些人真的受益于能够去别处获得免费计划的能力。

And so those people are really benefiting from the ability to go get a free plan somewhere else.

事实上，免费也是一个非常重要的考量因素。

It's also like free is a really important horizon, it turns out.

即使让人们支付少量费用，也会极大地阻碍他们，尤其是低收入人群，参与这类项目。

Even asking people to pay a small amount can really discourage them, and particularly low income people from enrolling in these kind of programs.

许多非常低收入的人甚至没有银行账户。

A lot of really low income people don't even have a bank account.

所以，你想象一下，这个人要怎么支付每月的保费呢？

And so if you just imagine the mechanics of like, how is that person going to pay a monthly premium?

他们连支票都开不了。

They can't write a check.

他们没有信用卡。

They don't have a credit card.

并非不可能，但确实更困难了。

Not impossible, but makes it harder.

共和党人对这些针对奥巴马医改补贴的改动有何看法？

What did Republicans think of all these changes to the Obamacare subsidies?

我认为重要的是要记住，共和党人从来就不喜欢奥巴马医改。

Well, I think it's important to remember Republicans never liked Obamacare.

他们觉得这是浪费钱。

They felt like it was a waste of money.

他们认为这给医疗保险体系增加了太多规定。

They thought it was, putting too many rules on the health insurance system.

这是一次巨大的扩张。

And this was a huge expansion.

涉及的资金多了很多。

It's a lot more dollars.

它把更多人纳入了这个体系。

It was bringing more people into the system.

我认为他们也反对一些具体的政策变化。

And I think they also objected to some of the specific policy changes.

他们真的很不喜欢这些人都能免费获得保险的想法。

They really didn't like the idea that all these people were gonna get insurance for free.

这让他们觉得有点不公平。

It felt sort of unfair to them.

其他人都得为医疗保险支付一些费用。

Everyone else has to pay something for health insurance.

我认为许多共和党议员觉得，即使这些收入极低的人，如果他们真的重视自己的保险，也应该支付一点最低费用，以证明这是他们真正想要和需要的东西。

And I think a lot of Republican lawmakers feel like even these very low income people, if they really value their insurance, they should have to pay some minimal amount just to prove that it's something that they really want and need.

但当然，当时这并不重要，因为民主党控制了整个政府。

But of course, that didn't matter at the time because the Democrats controlled the entire government.

他们掌握了参议院、众议院和白宫。

They had the Senate, the House, and the White House.

所以到了2022年，民主党决定将这些更慷慨的补贴再延长一段时间。

So when 2022 rolled around, the Democrats decided to extend these more generous subsidies for even longer.

但他们没能将这些补贴永久化。

They just weren't able to make them permanent.

嗯。

Mhmm.

因为，正如你可能记得的那样，来自西弗吉尼亚州的保守派民主党参议员乔·曼钦坚持认为，不应将这一政策永久化。

Because, as you may remember, Joe Manchin, the conservative Democratic senator from West Virginia, insisted that they not make this a permanent policy.

民主党选择让这项政策在2025年到期，因为他们希望届时能掌控足够的政府权力，从而促成两党妥协，进一步延长补贴。

Democrats chose to have the policy expire in 2025 because they were hoping that they would have enough control in the government, that they would be able to eke out a bipartisan compromise to extend the subsidies further.

但当然，事情并没有如他们所愿。

But, of course, that's not what happened.

共和党在2024年大获全胜，这就是为什么我们现在陷入这种局面——他们唯一能推动这项政策的方式，就是让政府停摆。

Republicans swept to power in 2024, and that's why we're now in this situation where the only way that they were able to advocate for this policy was by shutting down the government.

好的。

Okay.

这就把我们带到了补贴即将到期的这一刻。

And so that brings us to this moment where the subsidies are expiring.

尚未达成任何协议。

No agreement has been reached.

我们了解哪些人会受到这些补贴取消的最严重影响吗？

What do we know about the people who would be most impacted by the fact that these are going away?

基本上，这个市场中的每个人都会在某种程度上受到影响。

Basically, everyone in this market is going to be affected to some degree.

我说过，在额外补贴之前，这个市场大约有1200万人。

I said there were around 12,000,000 people in the market before the extra subsidies.

现在，这个市场大约有2400万人。

Now there are about 24,000,000 people in the market.

哦，天哪。

Oh, wow.

我们刚才谈到的低收入群体，是人数最多的群体。

This low income group we were just talking about, that's the biggest group.

这相当于市场的一半。

It's like half the market.

这些人的保险费用将从完全免费变为每月支付大约50美元。

And those people are gonna have to go from paying nothing for their insurance to paying somewhere around $50 a month for their insurance.

然后是这个中等收入群体。

Then there's this kind of middle income group.

这些人也得为保险多花钱，平均每月可能要多付150美元左右。

And those people are also going to have to pay more for their insurance, probably somewhere in the neighborhood of, like, a $150 more per month on average.

然后是收入超过65,000美元的这个群体。

And then you get to this group earning more than $65,000.

这个群体在市场中所占比例很小。

And that is a small share of the market.

但从金额上看，受到最大影响的是这些人。

But in dollar terms, those are the people that are facing the biggest effects.

如果没有这些增强的补贴，其中一些人每月的保费上涨幅度可能达到1000甚至2000美元。

Some of those people are looking at price increases in the neighborhood of 1 or even $2,000 more per month without these enhanced subsidies.

对。

Right.

因为对于这个群体，也就是最高收入者，他们的补贴将完全取消。

Because for that group, those highest earners, their subsidies are going away entirely.

因此，他们将面临最大的潜在价格上涨。

And so they'll see the biggest potential increase.

是的。

Yeah.

没错。

That's right.

他们面临的将是极其巨大、天文数字般的涨价，对一些人来说可能根本无力承担。

They are looking at just absolutely huge and astronomical price increases that may be impossible for some of them to pay.

所以在过去的几周里，随着这些不同收入群体的人们在权衡自己的选择，并思考华盛顿持续的动荡，我认为许多人已经开始考虑一些非常艰难的抉择。

So over the last few weeks, as people in all of these income categories have been looking at their options and thinking about the ongoing drama in Washington, I think that a lot of them have started to consider some really difficult choices.

他们是否应该选择保障较少、免赔额极高的计划，以减少支出？

Should they buy a less generous plan with a really high deductible so they don't have to pay as much?

他们是否应该调整工作安排，以便收入降低，刚好低于补贴资格门槛？

Should they try to rearrange their work so maybe they earn less and they get right under that threshold where they could qualify for a subsidy?

他们是否需要赚更多钱、找第二份工作，或削减一些生活开支，才能负担得起保费？

Do they need to earn more money, get a second job, or cut back on some of their living expenses in order to be able to pay the premium?

所有这些问题在这个星期达到了顶点，因为截止日期到了，补贴并未延长，人们必须最终决定选择哪种保险，甚至是否选择任何保险。

And all of that has really come to a head this week when the deadline hit, the subsidies were not extended, and people had to ultimately decide what kind of insurance they were gonna choose, if any insurance at all.

我们马上回来。

We'll be right back.

嘿。

Hey.

我是《纽约时报烹饪》的沃恩·布雷兰德。

It's Vaughn Breland from New York Times Cooking.

如果你把一些你最喜欢的节日元素，比如家庭电影夜、和朋友们一起吃冷盘、一杯舒适的睡前饮品，全都变成一盒饼干，会发生什么？

What would happen if you took some of your favorite things about the holidays, like family movie night, charcuterie with the girls, a nice nightcap, and you turn those into a big box of cookies.

这看起来像一只小小的粉红色贵宾犬。

This looks like a little pink poodle.

它们看起来很可爱，想抱抱。

They look huggable.

如果我把越南咖啡做成饼干会怎么样？

What if I took Vietnamese coffee and made that into a cookie?

这些是豪华饼干。

These are deluxe cookies.

酸味糖果太疯狂了。

The sour candy is crazy.

什么？

What?

这简直疯了，但却美味至极。

It's absolutely unhinged, but completely delicious.

闻起来真香。

It smells so good.

你一定会想烤这些饼干。

You're gonna wanna bake these cookies.

相信我。

Trust me.

我都试过了。

I've tried all of them.

它们太棒了。

They are fantastic.

所以快来和我们一起烤饼干吧@nytcooking.com。

So come bake with us@nytcooking.com.

喂？

Hello?

早上好。

Good morning.

我是Lizzie。

This is Lizzie.

嘿。

Hey.

我是安娜，来自

This is Anna from

《纽约时报》。

The Times.

你最近怎么样？

How are doing?

还不错。

Alright.

我能怎么帮您？

How can I help you?

每日制作人安娜·福利一直与通过《平价医疗法案》市场购买保险的人交谈，了解他们如何应对补贴减少的情况。

Daily producer Anna Foley has been talking to people who get their insurance through the Affordable Care Act marketplace to hear more about how they're navigating the reduction in subsidies.

你不妨先跟我讲讲你自己吧？

Why don't you just go ahead and start by telling me a little bit about yourself?

我住在田纳西州的山城。

I live in Mountain City, Tennessee.

我曾经是亚马逊的送货司机。

I was a delivery driver for Amazon.

我在一家小型家族企业工作。

I work for a small family business.

我经营我女儿的纹身店。

I run my daughter's tattoo shop.

所以我是个小企业主。

So I am a small business owner.

你喜欢当自己的老板吗？

Do you like being your own boss?

你知道吗，这很符合我的性格类型。

You know, it suits my personality type.

我不喜欢别人告诉我该做什么。

I don't like people telling me what to do.

但说实话，像医疗保健这样的压力因素，情况已经变得非常棘手了。

But, honestly, the the stressors of things like this, of health care, it's gotten really hairy.

这变得真的、真的很难了。

It's gotten really, really difficult.

真的没有任何好的选择。

There were truly no good options.

每一个计划都迫使我在费用、医疗服务提供者和处方药上做出妥协，每一个都是如此。

Every single plan forced me to compromise on cost, on providers, and on prescriptions, every single one of them.

我患有一种罕见的慢性病，叫做嗜酸性粒细胞哮喘，我需要每月接受一次特殊的生物制剂注射，才能正常呼吸。

I have a rare chronic illness called, eosinophilic asthma, and I need to receive a specialty biologic injection every month in order to be able to breathe.

仅这种药物的自付部分每月就是350美元，这使我的整体医疗费用达到每月约700美元。

And the co pays on that drug alone are $350 a month, which takes my overall health care costs to about $700 a month.

能拥有空气进入肺部竟然成了一种奢侈，这真令人悲哀。

It's a shame that it's a luxury to have air in my lungs.

为了支付这笔医疗费用，你不得不在生活上做出哪些改变？

What are you gonna have to change in your life to now cover this health care cost?

我不得不根据我的医疗保险做出全面的职业决策。

I'm having to make wholesale decisions about my career based on my health insurance.

经过这么多年的积累和经验，我难道要去星巴克打工，拿微薄的薪水，只为换取家人能有重大疾病保障吗？

Like, after all these years and all this expertise I've built, do I go down to Starbucks and just work at Starbucks for benefits and make nothing, but at least I have catastrophic coverage for my family.

我已经过着非常节俭的生活了，现在只能让这种生活更极端一些。

I already live a very frugal lifestyle, so it's just gonna be that on steroids.

你知道的。

You know?

多用优惠券，走路去上班，不再开车。

More couponing, walking to work instead of driving my car.

哦，

Oh,

哇。

wow.

走路要走多远？

How far is that walk?

三英里。

Three miles.

哦，这可不是小事。

Oh, that's not nothing.

确实不是小事。

It isn't nothing.

没错。

No.

而且今年的圣诞节已经很难过了。

And Christmas this year has already been difficult.

我本来想给妈妈买助听器当圣诞礼物，但现在只能改买几支杨基蜡烛了。

I wanted to get my mom hearing aids for Christmas, but now I've settled on a couple Yankee candles instead.

我今年也结婚了，但这在经济上改变了情况。

I also got married this year, but that changes things monetarily.

对吧？

Right?

因为如果你的家庭人口是一人，作为一个人的收入上限远高于两个人的情况。

Because if your family household size is one, you are able to make significantly more as one person than you are as two people.

你知道吗，结婚后，你的收入最多只能达到84,600美元，才能保持在贫困线400%以下。

You know, like, so when you get married, you can only make up to $84,600 to stay under that 400% poverty level.

所以，我们是不是干脆离婚算了？

So it's like, do we just get divorced?

你懂我的意思吧？

You know what I mean?

我们其实正在考虑离婚这件事。

Like, it's something we're considering is getting divorced.

真的吗？

Really?

是的。

Yes.

如果没有这些补贴，我们基本上别无选择。

We're kind of stuck with no option, basically, without these subsidies.

所以，幸运的是，我们尽量保持健康，但只能寄希望于最好的结果，需要时自己掏钱支付。

So, you know, thankfully, we stay as healthy as we possibly can, but, you know, we're just gonna have to hope for the best and just pay out of pocket as needed.

所以目前来说，你们2026年没有健康保险吗？

So as of right now, you don't have health insurance for 2026?

没错。

Correct.

是的。

Yeah.

我们今年的保险只到12月31日为止。

We only have it through December 31 this year.

我有一些家人说，他们希望国会能尽快采取行动，通过一些援助措施。

I've had some some family members to say, and they're hoping they'll get the congress to get their act together and get something passed to help out.

否则，他们不得不放弃保险。

Otherwise, they're gonna have to drop their insurance.

世界上有一些事情是我自己无法控制的。

There are a few things out in the world that I cannot control myself.

我是个十足的控制狂。

I'm a total control freak.

我只需要政府在极少的情况下提供帮助。

I need the government to help in very few situations.

其余的，我保证我会自己处理。

The rest, I promise I will take care of.

这是一个极其明亮的光，人们需要帮助。

This is a blinding bright light where people need help.

我只是觉得

I just feel like

我这一生一直做得对，可我就是觉得被坑了。

I've done everything right my whole life, and and I just feel like I've just been sold a bag of shit.

那现在我该怎么办？

And now now what am I gonna do?

就像是，好吧。

It's like, okay.

我真得好好重新思考我的未来了。

I gotta really, really rethink my future.

因此，这让我感到一种失落、困惑和悔恨。

And so it gives me a sense of loss and bewilderment and regret.

我们的同事、《每日新闻》的制片人安娜·福利，最近花了很多时间与那些正在做出这些艰难医疗决策的人交谈。

Marco, our colleague, Anna Foley, who's a producer here on The Daily, has been spending a lot of time talking to people who are in the middle of making these really difficult health care choices right now.

我不禁想，你能否为我们展望一下未来？

And I wonder if you might be able to project forward for us a little bit.

比如，对于这些人来说，明年及以后的情况可能会变成什么样？

Like, what might this start to look like heading into next year and beyond for these people?

我们其实并不确定。

We don't really know for sure.

国会预算办公室，也就是那些帮助国会分析其法律影响的专家们，

The congressional budget office, so they're the nerds that help congress figure out what their laws are going to do.

他们认为将有大约两百万人失去医疗保险。

They think that about 2,000,000 more people will become uninsured

嗯。

Mhmm.

到2026年，由于这项政策，未来十年内将有近400万人失去保险。

In 2026 as a result of this policy and almost 4,000,000 people over the course of the next decade.

但还有其他严肃的分析人士估计，影响会大得多。

But there are other serious analysts who have estimated a much larger impact.

自2021年实施这项政策以来，市场上的参保人数翻了一番。

Enrollment in the marketplaces has doubled since they put this policy in place in 2021.

因此，如果你考虑到所有因这一市场而新获得保险的人，那就是1200万人，而现在我们正逐渐回归到之前的政策状态。

So if you think about all of the people who newly became insured in this market, that's 12,000,000 people, and we're kinda snapping back to the policy from before.

一方面，这对那些再也负担不起医疗费用，或不得不大幅重新考虑自己能负担的医疗方案的人来说，确实是巨大的冲击。

And on the one hand, that is really disruptive for the folks who can no longer afford their health care or have to dramatically rethink the health care they can afford.

但在某种程度上，这也意味着回归到一种常态。

But in some ways, it also represents a reversion back to kind of a status quo.

因此，我在想，你如何看待我们即将进入的这个世界。

And so I'm wondering how you are thinking about the world that we are about to enter.

是的。

Yeah.

我认为民主党人在谈论这个问题时实际上有些误导性。

I think Democrats actually have been somewhat misleading in the way that they've been talking about it.

他们一直表现得好像补贴即将取消。

They keep acting like the subsidies are gonna go away.

我认为这引起了一些人的恐慌，以为所有的补贴都会消失，所有人都得全额支付医疗保险费用。

And I think that has caused some alarm among some people that all of the subsidies are going away, that people are gonna all have to pay the full cost of their health insurance.

但这并不真实。

And that's not true.

我们正在回归的是奥巴马医改最初的结构，民主党人在2010年曾仔细思考并制定通过了这一结构。

What we're reverting back to is the original structure of Obamacare that Democrats thought really carefully about and wrote and passed in 2010.

所以我们知道，有了这些额外的财政援助，购买保险的人数大大增加。

So we do know that way more people bought insurance with this extra financial help.

这确实对人们的生活产生了影响，也极大地改善了人们的医疗保障。

It definitely does make a difference in people's lives, and it does make a big difference in people's coverage.

但关于这些市场中补贴的适当水平，以及人们应当承担多少医疗保险费用，确实存在真实争议。

But there is a real debate about what level of subsidization is appropriate in these markets and whether and how much people should be asked to pay for their health insurance.

因为在过去这段时期，我们为帮助人们购买保险支付了大量额外资金，而保险本身的成本也大幅上涨。

Because in part, over the same period of time in which we've been paying all this extra money to help people buy insurance, the cost of insurance itself has gotten a lot more expensive.

那么，为什么过去几年健康保险变得如此昂贵呢？

And why is it that health insurance has gotten so expensive over the last few years?

人们喜欢指责健康保险公司，而且几乎没人喜欢它们。

So people love to rag on health insurance companies, and no one really likes them.

它们不喜欢保险的高昂价格。

They don't like how expensive they are.

它们对保险公司还有许多其他不满之处。

There are lots of other things they don't like about them.

但健康保险如此昂贵的原因在于，美国的医疗保健本身非常昂贵，且成本随时间不断上升。

But the reason why health insurance is so expensive is because health care in The United States is really expensive, and the costs are growing over time.

这其中有多方面的原因。

And there are a bunch of reasons for that.

最近，当然，我们有了这些GLP-1减肥药物，它们是具有变革性作用的药物。

Recently, of course, we've had these GLP one anti obesity medications, super transformative drugs.

它们确实能帮助很多人改善健康，但价格昂贵，而且很多人想使用它们。

They really could help a lot of people improve their health, but they're costly and lots of people wanna take them.

这是美国医疗体系更广泛趋势的一个例子，即我们热衷于使用新技术。

And that's an example of a much broader trend in The US health care system, which is that we love to use new technology.

当出现新的药物或处于前沿的治疗方法，且确实对公共健康产生显著影响时，即使它们会花费大量金钱，我们也希望使用它们。

When there are new drugs or treatments on the cutting edge that really seem to make a difference in public health, we wanna use them even though they're going to cost a lot of money.

我知道你之前提到，在停摆以来的几周里，共和党人一直在努力制定一项医疗法案。

I know you mentioned earlier that in the weeks since the shutdown, Republicans have been trying to get some kind of health care bill together.

而现在，我们有了这个解除请愿程序。

And now we have this discharge petition.

但截至周三下午，你觉得这一切最可能的解决方式是什么？

But I do wonder as of Wednesday afternoon, what appears to you like the most likely resolution to all of this?

我觉得真的很难说。

I think it's just really hard to say.

我们正处在这一辩论的中心。

We are right in the middle of this debate.

我认为，从这个解除请愿书可以看出，有一些共和党人对这个问题在政治上感到担忧。

I think what you can see with this discharge petition is that there are some Republicans who are really worried about this issue politically.

但你也能看到，还有其他共和党人根本不喜欢奥巴马医改，不愿再往里面投入更多资金，他们正在党内展开这场斗争。

But you can also see that there are other Republicans who really just don't like Obamacare and don't wanna be pouring more money into it, and they're kind of having this fight within their own party.

他们掌控着政府，而民主党人自己无法推动这项政策落地。

They control the government, and the Democrats cannot get this policy done by themselves.

所以我认为，我们只能在未来几周内密切关注，看看是否能达成某种妥协。

So And I think we're just gonna have to watch over the next few weeks to see if there's some kind of compromise.

嗯。

Mhmm.

但即使在未来几周或几个月内通过了其中一项法案，情况依然会很复杂，因为很多人已经选好了今年的保险计划。

But even if one of these bills comes together in the next few weeks or months, it's still gonna be kind of complicated because a lot of people have already picked their plans for the year.

他们选择保险时，并不知道这些补贴会重新恢复。

And they wouldn't have chosen their insurance knowing that these subsidies are coming back.

但我认为最可能的情况是，我们只是回到疫情前的政策状态：人们确实能获得购买保险的补贴，但远不如之前那么多

But I think the most likely scenario is we're kinda just snapping back to this pre pandemic policy where people do have help buying their insurance, but not nearly as much as they've