美国国家公共电台 NPR Republican Health Care Proposal Would Cover Fewer Low-Income Families

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STEVE INSKEEP, HOST:

More than a month ago, the president said he nearly had a plan to replace Obamacare. He told The Washington Post it was down to the, quote, "final strokes on insurance for everybody." One month later, in yesterday's press conference, the president promised there would soon be a plan.

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PRESIDENT DONALD TRUMP¹: We're doing Obamacare. We're in final stages. We should be submitting the initial plan in March - early March.

INSKEEP: That plan will come from Congress. House Republicans already have a skeleton proposal. And they've promised that any replacement² will be better. NPR's Alison Kodjak reports it may actually be less generous.

ALISON KODJAK, BYLINE³: Republicans discussed an 18-page proposal to replace Obamacare at a closed-door meeting yesterday at the Capitol. Michigan Congressman⁴ Bill Huizenga says the document gives members something to present to their constituents⁵ over the midwinter break, a sort of rough roadmap.

BILL HUIZENGA: We're going to be taking a six-lane highway or a four-lane highway. I don't think that's been determined⁶ yet. But we know the direction that we want to go and sort of the destiny.

KODJAK: Early analysis of the roadmap suggests it may leave more people without insurance. Caroline Pearson is a senior vice⁷ president at the health-care consulting firm Avalere.

CAROLINE PEARSON: Insurance coverage⁸ and affordability⁹ would both go down under the plan.

KODJAK: For example, the plan includes replacing the Obamacare subsidies¹⁰ that help people buy insurance with fixed¹¹ tax credit to buy coverage on the open market. Those credits are the same no matter how much money you make. So a rich business owner will get the same benefit as a poor, single mom. But there's no indication how big those tax credits will be. Pearson thinks they'll be less generous than Obamacare. And that could leave some low-income people uncovered.

PEARSON: People receiving generous subsidies or Medicaid today are not likely to be able to afford private insurance.

KODJAK: The Republicans' roadmap repeatedly says people will be able to buy so-called catastrophic coverage. That's a policy with limited benefits that pays major bills from a serious illness or accident. But it doesn't pay for everyday care. So some people would have to pay for checkups with health savings¹² accounts. These tax-free accounts are a favorite among conservatives because they encourage people to plan for their health spending and to shop around for low prices.

The Republican plan calls for doubling the amount people can save. But Democrats¹³ say they only help people who have extra money to put away, and they give the biggest tax cuts to people with the highest incomes. Finally, on Medicaid, the Republican plan would limit the amount of money that goes to states, either been giving a certain amount for each beneficiary or putting it in a block grant.

Paul Howard, the director of health policy at the conservative Manhattan Institute, says that might be a good thing. He says Medicaid today is ripe for waste and abuse.

PAUL HOWARD: The current, open-ended match system for Medicaid encourages an awful lot of state shenanigans.

KODJAK: Bottom line - this is the first proposal. And it's not clear how much will end up becoming law. President Trump has promised his plan will be better than Obamacare and cost less. Alison Kodjak, NPR News, Washington.

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