Many families who have enrolled in Obamacare are finding ittoo expensive. In fact, some are choosing not to seek care because of theexpense. (Joe Raedle/Getty Images)
很多参与奥巴马医改方案的家庭认为其费用过高。事实上，有一些家庭由于费用原因选择放弃治疗。
When the Affordable Care Act was passed in 2010, itssupporters celebrated the legislation, calling it a landmark bill that wouldmake Americans healthier and lower health care costs for families. Eight yearslater, it’s clearer than ever the ACA’s “Obamacare” exchanges have done quitethe opposite. Not only are health care costs skyrocketing, the health insuranceprovided by Obamacare is so expensive for people to use that millions moreAmericans are now choosing not to go to the doctor — even when they’re sick orinjured.
《平价医疗法案》于2010年通过伊始，其支持者弹冠相庆，称本法案在保障美国人民健康和享受低价医保方面具有里程碑意义。然而八年过去了，种种迹象显示，该法案的直接成果-奥巴马医疗法案极大加重了患者的经济负担。不仅医疗费用再创新高，就是法案下数以百万投保人员如今都不去就医-就算他们患病或者受伤了也不去。
According to a survey by the West Health Institute and NORCat the University of Chicago, 47 percent of respondents said within the past 12months they chose not to see a doctor or dentist because of the high cost ofhealth care. Four-in-10 said they elected not to pursue a recommended medicaltreatment or test.
根据一份由西方健康研究所和设在芝加哥大学的国家民意研究中心共同调查的报告显示，47%的受访者表示，由于费用高昂，过去12个月他们没有去过门诊部或者牙医诊所。40%的受访者称他们决定不遵医嘱进行治疗或者诊断。
Even more disturbingly, 44 percent claimed they avoidedseeing a doctor on at least one occasion while sick or injured because ofcosts. Twenty-nine percent said they chose not to see a doctor while sick orinjured “more than once.” Forty percent said they are “extremely/very afraid”of getting “seriously ill” because of high health care costs.
更令人作呕的是，44%的受访者称由于费用因素，他们不去就医或者在患病或受伤时有过一次不去就医的经历。29%的受访者称他们“不止一次”在患病或受伤时选择放弃寻求治疗。40%的受访者称他们因为医疗费过高而“非常惧怕”自己“患大病。”
The survey included only those who self-identified asinsured. About two-thirds of respondents reported having private healthinsurance. Twenty-seven percent said they received their insurance fromMedicare. Only 7 percent said they were enrolled in Medicaid.
本次调查中只有2人认为自己有医保。三分之二的受访者表示他们有私人医疗保险。27%的受访者表示他们有联邦医疗照顾保险。仅有7%的人有贫困医疗补助保险。
These results are a dramatic departure from several similarsurveys conducted over the past two decades. For instance, in 2014, theAssociated Press and NORC conducted a survey that found only 19 percent ofprivately insured individuals choose not to go to the doctor because of costs.Only 18 percent said they avoided “preventive and recommended care.”
本次调查的结果与近二十年来的数份同类调查的结果大相径庭。例如，2014年美联社和国家民意调查中心的共同调查显示已投保私人医保公司的调查人群中仅有19%因为费用原因拒绝就医。只有18%的受访者表示自己不会寻求“预防性和推荐治疗。”
Similarly, a Gallup survey found in 2001 that 19 percent ofAmericans said they or a family member had over the previous 12 months “put offany sort of medical treatment because of cost.” In 2014, Gallup determined theanswer to that question had risen to 33 percent, which is a remarkable increasebut still 10 percentage points lower than the recent West Health-NORC survey.
与上文那份报告相似，盖洛普咨询公司在2001年的调查报告中称有19%的美国民众表示他们自己或者亲属在过去12个月“因为费用原因而放弃任何形式的治疗。”在2014年，盖洛普表示这个数字攀升至33%，虽然与19%比已经有了显著的增加但与西方健康研究所和国家民意调查中心发表的报告中的数据对比还是少了10个百分点。
Further, from the mid-2000s to the passage of the AffordableCare Act, there was virtually no movement in Gallup’s survey results on thisquestion. Only after Obamacare was instituted did significantly more Americansbegin to claim they had to stay away from their doctors, even while sick,because health care had become too expensive.
在这，从2005年到《平价医疗法案》通过的2010年，盖洛普的调查数据基本没有过明显变化。而就在奥巴马医疗方案实施后，越来越多的美国民众开始认为他们应该远离医生，就算病了也是如此，就是因为医疗成本实在太高了。
The sharp increase in the number of people avoiding theirdoctors is almost certainly the result of the increasing health insurance coststhat have occurred in the wake of the Affordable Care Act’s passage. In 2018alone, health care premiums for Silver Plans — the benchmark ACA insurance plan— sold on an Obamacare exchange increased by a shocking 31 percent, accordingto an analysis by Health Pocket. Health Pocket also reports the averageObamacare Silver Plan premium is now $477 for a 30-year-old and greater than$1,100 for 60-year-olds.
拒绝就医人数的攀升几乎就可以归结于法案通过带来的医疗费用的增加。用一位来自保险公司健康口袋的分析师的话来说，仅2018年白银计划（译注：奥巴马医保有四个等级，青铜、白银、黄金、白金，其中白金最高）-医保中较为基础的一款计划-续费费用就增加了31%。该公司还称在白银计划中平均一位30岁的投保人年费是477美元（约合人民币2993.13元），而平均一位60岁的投保人保费是1110美元（约合人民币6902.39元）！
Premiums are just the tip of the Obamacare iceberg, however,especially because many people who purchase their insurance plans on Obamacareexchanges receive government subsidies. Deductibles — the total amount thatmust be paid out of pocket for many services before a health insurer picks upthe full cost of a service — are a much better indicator of just how bad theObamacare crisis has become.
年费的问题还只是奥巴马医改方案中众多问题中的一个，毕竟不少该方案下的投保人会得到政府补贴。自付额-即投保人在保险公司结算之前必须自己支付的金额-是奥巴马医改方案中明显有缺陷的一环。
The average deductible for a family purchasing a Bronze Planon an Obamacare exchange is now $12,186. The average family Silver Plandeductible is $8,292, although the average maximum annual out-of-pocket costfor Silver Plan families is greater than $13,700.
一个家庭投保青铜计划后平均的自付额是12186美元（约合人民币76465.93元）。投保白银计划的家庭平均自付额是8292美元（约合人民币52031.47元），而一个家庭投保白银计划最多情况下需要支付13700美元（约合人民币85966.13元）的年费。
With deductibles this high, health insurance for most lower-and middle-income individuals and families becomes useless, even if they areeligible to receive subsidies that help offset higher health insurancepremiums.
鉴于自付额之高，就算他们可以获得政府补贴以减轻高昂年费带来的压力，医保对于中低收入者和家庭而言已然无用。
The problem isn’t limited to Obamacare, either. The ACAimposed significant regulations, fines, and mandates that distorted the entirehealth insurance marketplace, causing health care costs to rise for everyone,regardless of whether they receive health insurance from an employer or from anObamacare exchange.
当然，这不全是奥巴马医改方案的错。《平价医改法案》中制定了相当数量的规章、罚款、审批，搅得整个医疗保险市场不得安宁，最终导致医疗费用超出了所有人的负担能力，无论他们是否有员工保险还是有符合奥巴马医改方案规定的保险。
It’s true that people enrolled in Medicare or Medicaid arepartially immune to some of these health insurance cost increases, but theyface plenty of unique health care challenges of their own. For instance, about30 percent of doctors don’t accept new Medicaid patients, in large part becausereimbursement rates are so low. In some states, such as New Jersey, researchhas shown a majority of doctors refuse to see new Medicaid patients. In manycases, finding a good specialist is particularly difficult for Medicaidrecipients.
联邦医疗照顾保险和贫困医疗补助保险的投保人群的确在一定程度上没有受到医保费用增加带来的冲击，但此类人群就医仍然困难重重。比如，约有30%的医生拒绝接受有贫困医疗补助保险的新病人，很大程度是由于给医生的报酬太低。以新泽西州为例，调查人员发现医生拒绝有贫困医疗补助保险的新病人是一个普遍现象。不少实际情况中，找到一个有针对性的医师对于此类参保人员尤为困难。
America’s health care system has had numerous problems for manydecades, but Obamacare did nothing to fix them. Instead, it created an evenmore dysfunctional, bloated, bureaucratic model and forced everyone to join itor be greatly affected by it. Obamacare has been a complete and utter disaster,and without significant reforms, it will only get worse in the coming years.
数十年来，美国的医疗体制有着数不清的问题，然而奥巴马医改方案并未针对性的解决这些问题。相反，它使得现行体制变得更加运行不畅、臃肿官僚；它强迫人人加入或者因为不加入而深受其苦。奥巴马医改方案是一个不折不扣的灾难，倘若不进行重大改革，它会在未来带来更大的麻烦。