Donald Trumpの健康法案は中間所得層と自営業のアメリカ人に損害を与える オバマケアでは資金が不足してしまうので、ホワイトハウスは政治的な賭けをしている

Donald Trump’s health-care orders will hurt middle-class, self-employed Americans
By starving Obamacare of cash, the White House is taking a political gamble
Oct 13th 2017by H.C. | WASHINGTON, DC

Donald Trumpの健康法案は中間所得層と自営業のアメリカ人に損害を与える

THE strange thing about Donald Trump’s new executive actions on health care is the identity of those who will suffer their consequences. On October 12th Mr Trump kicked off a deregulatory process to permit widespread formation of so-called Association Health Plans (AHPs), insurance policies run by groups of small firms. Then his administration announced that it would stop paying cost-sharing subsidies, payments to insurers to compensate them for lowering deductibles and other out-of-pocket costs for the poorest buyers. Both moves are likely to end up inflicting the most pain on self-employed, middle- to upper-income folk—in other words, on a Republican constituency. 

find out the identity of the stalker:そのストーカーの正体を見破る.

Like employer-sponsored insurance, AHPs would not be subject to many of Obamacare’s regulations. They could therefore entice young and healthy people away from Obamacare’s marketplaces. Depending on how easy it becomes to join an AHP, the effect would be more or less dramatic. In an extreme case, most healthy people could leave Obamacare’s exchanges. If any insurers stuck around—not a sure thing—the exchanges would come to resemble high-risk pools, where the ill go to buy subsidised coverage. 

entice away:おびき出す
stick around:⦅くだけて⦆その場でしばらく待つ, そのあたりにいる.

However, they would only function as such for those earning less than 400% of the poverty line (that is, less than $48,240 for an individual in 2017). Obamacare offers no subsidies for buyers at higher incomes, and premiums would rise too high to be affordable. In this world, you would not want to be high-earning self-employed person with a chronic health condition. 

AHPs will not pop up any time soon. The deregulatory process takes time, and could be delayed by legal challenges. By contrast, CSR payments were always at the discretion of the administration, and could stop immediately. Even the legality of the payments was doubtful. Congress has never authorised them as part of a budget, and during Mr Obama’s presidency, Republicans in the House of Representatives sued to stop them. A judge ruled the payments unconstitutional, but the ruling was delayed pending an appeal. 

CSR:コスト・シェアリング・リダクション 保険加入者による自費払い分の医療費を引き下げる補助金制度。CSRは保険会社に給付されるため,保険会社に対する救済策と批判されるが,元々の目的は中低所得者保険料負担を軽減するために設けられたものである。

Now the legal issue is largely irrelevant. Yet the requirement that insurers offer discounts on out-of-pocket costs for the poor is written into law. They must continue to do so, but without recompense. (This is why Mr Trump’s argument that the funds are an “insurer bailout” is bunk; that the cash goes to insurers, rather than directly to poor buyers, is just an artefact of the law’s design.) Firms must still recoup their costs, so the result is higher premiums for everyone—20% higher, if the Congressional Budget Office is to be believed. Many insurers anticipated the end of the payments and so have already raised their prices for next year. 

recompense:償い, 賠償(金), 弁償; 報酬, 返礼
bunk:bunkum ナンセンス, たわごと.
recoup:…を差し引く, 控除する.

Poorer buyers are protected, because the tax credits they receive rise in tandem with premiums. (The CBO projects that outlays on tax credits will rise so much that scrapping the CSRs will end up costing the government money.) The people who will suffer are, again, those who earn more than 400% of the poverty line—in other words, the middle-class, usually self-employed Americans whom Republicans have always said they are trying to help by scrapping Obamacare. Many, particularly in states with fragile markets, are likely to forego health insurance in 2018. But that is not an option for those who have chronic medical conditions. 

in tandem:と同時に
CBO :アメリカ議会予算局
forego:〈楽しみなど〉を我慢する; …を差し控える, 遠慮する.

There are 9m Americans who buy coverage in the individual market but do not receive tax credits. Mr Trump is poised to cause a lot of pain to this group—a Republican-leaning constituency—in 2018, an election year. He is gambling that voters will continue to blame high premiums on Obamacare, not on the Republicans, and that Democrats will be spooked enough by the sorry condition of the market to start negotiations on health-care reform. But Democrats have never expressed much concern about these better-off, unsubsidised buyers, who have been suffering from high premiums for a while. Mr Trump’s gamble is a risky one. 




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