来源：《华盛顿邮报》
刊登日期：2021年3月15日
The covid-19 relief bill that President Biden signed Thursday was perhaps the most significant health-care reform policy to pass Congress since the 2010 Affordable Care Act (ACA). It is a major down payment on Mr. Biden’s promise to build on that law, also known as Obamacare, and move the nation closer to universal coverage without excessive cost.
拜登总统周四签署的新冠肺炎救助法案可能是自2010年《平价医疗法案》以来国会通过的最重要的医疗改革政策。这是拜登承诺的首期付款，用于在该法案(又称奥巴马医改)的基础上，让美国更接近全民医保，且不会产生过高的成本。
The ACA was supposed to cover people with very low incomes through the Medicaid program, and to cover everyone else who lacked employer-based insurance through private marketplaces, which would be regulated to guarantee a basic level of coverage and to protect people with preexisting conditions. People with moderately low incomes would get federal subsidies to help them buy private plans on these marketplaces.
平价医疗法案本应通过医疗补助计划为低收入人群上医保，并通过私人市场为所有没有雇主保险的人上医保。私人市场将受到监管，以确保基本的保障水平，并保护已有疾病的人。中低收入群体将获得联邦补贴，帮助他们在这些市场上购买私人保险。
But problems emerged. Many Republican-led states refused to expand their Medicaid programs, leaving millions of desperate people with no good option. Many other people earned too much to qualify for subsidies but still couldn’t afford the premiums. Some of them bought inadequate plans outside the marketplaces; others went without insurance altogether. The Trump administration made things worse by encouraging people to buy into those inferior plans.
但问题出现了。许多共和党领导的州拒绝扩大医疗补助计划，使数百万绝望的人没有好的选择。其他许多人的收入超过最低线，没有资格获得补贴，但仍然负担不起保费。他们中的一些人在市场外购买了不充分的保险计划；其他人完全没有保险。特朗普政府鼓励人们购买那些劣质保险计划，使情况变得更糟。
Those who opted out tended to be healthier, so insurance companies were saddled with high costs covering those who were left, forcing the insurers to raise premiums. This resulted in horror stories about premiums well above $1,000 a month. Because of these shortcomings, the ACA failed to meet its goal of ending “job lock,” in which employees feel they cannot go out on their own because they need employer-sponsored health-care coverage.
那些选择不交保险的人往往更健康，因此保险公司为那些留下来的人承担了高昂的费用，迫使保险公司提高保费。这导致了每月保费超过1000美元的恐怖故事。由于这些缺点，ACA未能实现其结束“要保险就得有工作”的目标，在这种情况下，雇员们觉得他们不能离职，因为他们需要雇主资助的医疗保险。
The relief bill addresses these problems. It offers more money to states that expand their Medicaid programs, increasing the incentive for them to cover their residents. It was already irrational for these states to refuse; now it is indefensible. The bill also enhances the subsidies available to people buying private insurance in the marketplaces, ensuring that no one, regardless of their take-home pay, must dish out more than 8.5 percent of their income on marketplace insurance premiums. The Congressional Budget Office reckons that a 64-year-old making $58,000 a year would see her monthly premium drop from $1,075 to $412.50 — still substantial but far more reasonable in proportion to her income.
救助法案解决了这些问题。扩大医疗补助计划的州能够得到更多的资金，这增加了他们为居民上医保的动机。这些州之前拒绝这样做已经是不合理的；现在，更没有理由拒绝了。该法案还提高了对在市场上购买私人保险的人的补贴，确保没有人，无论他们的实得工资，用于市场保险的费用超过其收入的8.5%。美国国会预算办公室估计，64岁年收入5.8万美元的女性，其每月保费将从1075美元降至412.50美元——这仍然相当多，但就她的收入来讲，比之前的要合理得多。
Underlying this shift is the notion that the government should ensure that all Americans can buy quality coverage they can afford, an aspiration the Affordable Care Act did not quite reach.
这一转变背后的理念是，政府应该确保所有美国人都能购买到他们能负担得起的高质量医疗保险，《平价医疗法案》并没有完全实现这一愿望。
Mr. Biden’s work is not finished. Some states still might refuse to expand their Medicaid programs. The marketplace subsidy reforms run for only two years; if they succeed, Congress should make them permanent and raise revenue to pay for them. Moreover, the covid relief package’s reforms do not address the astronomical amounts the United States spends on health care each year, a problem of generational importance.
拜登的工作还没有结束。一些州可能仍然拒绝扩大医疗补助计划。市场补贴改革只持续两年；如果改革成功了，国会应该使其永久化，并增加财政收入来支付这些费用。此外，新冠肺炎救济方案的改革并没有解决美国每年在医疗保健上的天文数字，这是一个具有代际重要性的问题。