来源：《洛杉矶时报》
原文刊登日期：2021年3月9日
The 2010 Affordable Care Act created the state Obamacare exchanges to serve people not eligible for coverage by a large group health plan, with income-based subsidies for Americans earning up to four times the federal poverty level.
2010年的《平价医疗法案》创建了州奥巴马医改交易所，为没有资格购买大型集体医疗保险计划的人提供服务，为收入不到联邦贫困线四倍的美国人提供基于收入的补贴。
For people who were still earning more than a minimal amount of money, however, the coverage could be costly even with subsidies. Premiums were capped at almost 10% of household income for people earning three to four times the federal poverty level, and there was no cap for people with higher incomes. Combined with steadily rising deductibles, high premiums have been one of the biggest challenges not just for the ACA but for the entire U.S. healthcare system.
然而，对于那些收入仅仅高于最低线的人来说，即使有补贴，保险仍是昂贵的。对于收入是联邦贫困线三到四倍的人，保费上限为家庭收入的近10%，而对于收入高于此的人则没有上限。加上自付额的稳步上升，高额保费不仅是ACA面临的最大挑战之一，也是整个美国医疗体系面临的最大挑战之一。
This week, Congress is expected to take a major step toward easing the costs of Obamacare plans. The version of President Biden's $1.9-trillion COVID relief bill that lawmakers are poised to approve includes larger premium subsidies for ACA policies, lowering the percentage of income that anyone would have to spend on insurance through 2022. Even people earning more than four times the poverty level will pay no more than 8.5% of their income for coverage this year and next year.
本周，国会有望朝着降低奥巴马医改计划价格迈出重要一步。国会议员准备批准的拜登总统1.9万亿美元的新冠疫情纾困法案包括为ACA政策提供更高的保费补贴，降低所有人在2022年底之前必须支付的保险费用占收入的比例。即使是收入超过贫困线四倍的人，今年和明年的医保费用也不会超过其收入的8.5%。
That's a big (albeit temporary) improvement in affordability, especially for working-class Americans with moderate incomes. In California, for example, the average savings could be $100 a month for people earning less than four times the poverty level, said Peter V. Lee, executive director of Covered California. But it's not cheap — the Congressional Budget Office estimated that the extra subsidies will cost taxpayers about $34 billion.
对于中等收入的工薪阶层美国人来说，这是负担能力的一个巨大改善(尽管是暂时的)。以加州为例，“保障加州”的执行董事彼得·v·李说，收入低于贫困线四倍的人平均每月可以节省100美元。但这并不便宜——国会预算办公室估计，额外补贴将耗费约340亿美元的财政收入。
The challenge for Congress will be to find a permanent solution to the affordability problem, and not just for people enrolled in the ACA. Treatment costs have been growing faster than inflation for years, and though the ACA experimented with ways to give doctors and hospitals more incentive to limit spending, the industry remains on an unsustainable path.
国会面临的挑战将是为负担能力问题找到一个永久的解决方案，而不仅仅是为参加ACA的人。多年来，治疗费用的增长速度一直快于通货膨胀，尽管ACA尝试了各种方法，让医生和医院更有动力限制支出，但医疗行业仍处于不可持续的发展道路上。
Higher subsidies are a straightforward response to the growing costs, but they're the equivalent of a pill that treats the symptoms without curing the disease. Actually restraining the growth of healthcare spending — reducing unnecessary procedures and getting more value out of every dollar spent — is hard and controversial work. Biden's relief bill buys lawmakers a little time, but they need to get cracking.
提高补贴是对不断增长的医疗价格的直接回应，但这相当于一粒治标不治本的药片。实际上，限制医疗支出的增长——减少不必要的医疗程序，让所花的每一美元都更有价值——是一项艰难而有争议的工作。拜登的救济法案为立法者争取了一点时间，但他们需要开始行动。