来源:《华盛顿邮报》
原文刊登日期:2022年4月9日
Congress passed the Affordable Care Act more than a decade ago, but reflexive GOP opposition to the law — with Republicans demanding repeal or nothing — prevented lawmakers from clarifying its sometimes confusing language and mitigating its unintended consequences. President Biden announced Tuesday that his administration was finally moving to patch up one of Obamacare’s most glaring problems, potentially helping millions.
国会十多年前就通过了《平价医疗法案》,但共和党对该法案的本能反对——共和党要求要么废除该法案,要么什么都不改——使得议员们无法澄清该法案有时令人困惑的措辞,并减轻其意外后果。拜登总统周二宣布,他这届政府终于开始着手解决奥巴马医改最突出的问题之一,这可能会帮助数百万人。
The Biden administration is proposing a rule that would fix the so-called family glitch, an obscure issue of wording buried deep in the law’s text that prevents millions from getting cheaper health premiums. The law provides people government subsidies for health insurance plans, but only if their employers do not offer them affordable health coverage. The law deems an employer-sponsored plan unaffordable if premiums would top about 10 percent of an employee’s household income. So, if workers would have to pay sky-high premiums for their employer-sponsored plan, they could always seek coverage on the Obamacare marketplaces and receive assistance from government subsidies.
拜登政府正在提出一项法规,以解决所谓的“家庭差错”,这是《平价医疗法案》文本中隐藏的一个晦涩的措辞问题,该问题阻止数百万人获得更便宜的医疗保险。《平价医疗法案》为人们提供医疗保险计划的政府补贴,但前提是他们的雇主不为他们提供平价医疗保险。《平价医疗法案》认为,如果保费超过雇员家庭收入的10%,雇主资助的保险计划就不是平价的。因此,如果雇员得为雇主资助的计划支付天价保费,他们可以在奥巴马医保市场上购买保险,并从政府补贴中获得援助。
The problem comes when workers try to add spouses or children to their employer health plans. Doing so could raise employees’ premiums substantially. But a 2012 Internal Revenue Service interpretation of the law says that does not matter; as long as the cost of covering a worker, and only the worker, on an employer-sponsored plan remains south of 10 percent of that worker’s household income, the employee is ineligible for government help.
当员工试图将配偶或子女加入雇主的医疗保险计划时,问题就来了。这样做可能会大幅增加雇员的保险费。但2012年美国国税局对《平价医疗法案》的解释称,这无关紧要;只要在雇主资助的计划中为一名员工(且仅为该员工)支付的费用仍低于该员工家庭收入的10%,该员工就没有资格获得政府的帮助。
This is not the only plausible reading of the law’s words, and it is an absurd one in the context of the law’s broader purposes. The Kaiser Family Foundation reckons that the family glitch affects some 5 million people. More than 4 million of them have accepted employer-sponsored coverage, meaning they are paying a huge share of their incomes — an average of about 16 percent — on premiums, even though Congress designed Obamacare to help people in their situation. Others simply go without coverage.
这并不是对法律条文的唯一合理解读,从《平价医疗法案》更广泛的目的来看,这更是荒谬的解读。凯撒家庭基金会估计,这种“家庭差错”影响了大约500万人。他们中有400多万人接受了雇主资助的保险,这意味着他们收入里的很大一部分——平均约16%——用于支付保费,尽管国会制定奥巴马医保的初衷就是为了帮助这些处境艰难的人。其余几十万人干脆没有医保。
The Biden administration is finally proposing to interpret the law more sensibly, providing subsidies to families who would have to pay more than 10 percent of their incomes to cover every member on an employer-sponsored plan. Doing so will cost money — about $45 billion over 10 years. But that is relatively small in the context of national health-care reform. Moreover, those caught in the family glitch skew younger and healthier than those currently buying plans in the Obamacare marketplaces. If they buy subsidized plans, the stability of the marketplaces’ risk pools will improve, which could lower premiums for all those on Obamacare plans.
拜登政府终于提议更合理地解释这项法律,向那些在雇主资助计划中家庭保费支出超过收入10%的家庭提供补贴。这样做需要花费资金——10年大约450亿美元。但在国家医疗改革的大背景下,这一数字相对较小。此外,与目前在奥巴马医改市场购买计划的人相比,那些陷入“家庭差错”的人更年轻、更健康。如果他们购买补贴计划,市场风险池的稳定性将得到改善,这可能会降低所有奥巴马医改计划参与者的保费。
But there is only so much Mr. Biden can do on his own. Democrats in Congress are considering long-term Obamacare fixes that would restrain marketplace premium costs and ease the still-high burdens some families face paying for health insurance. This should be a priority in the coming months.
但拜登能做的也就这么多了。国会的民主党人正在考虑对奥巴马医改进行长期修正,以限制市场保费价格,减轻一些家庭在支付医疗保险方面仍面临的沉重负担。这应该是未来几个月的首要任务。