2017年10月29日

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
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



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.
AHP:組合医療計画は,中小企業が各社単独で医療保険に加入するよりも,多数の企業が医療保険組合を結成して保険に加入すれば規模の利益が生まれ,有利な保険にすることができるという考え方による。しかし,過去の会計検査院の調査などでは効果を挙げていないし,問題も多いと報じられている。

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. 

subject:条件規則に従わねばならない
entice away:おびき出す
exchanges:やり取り
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. 

pop:突然持ち上がる.
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。
discretion:自由裁量

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.
artefact:(特に史的価値のある)遺物
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
outlays:資金
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. 

spooked:怖がらせる
better-off:裕福な

トランプのオバマケアに対する対応の仕方を議論している。AHP(組合医療計画)を彼は持ち出しているが、その効果は疑わしい。かと言って、今のままのオバマケアでは予算が持たない。資金を抑えなければならない反面、トランプの案では中間所得層が被害を被ってしまう。中間選挙の年である2018年には900万人が税金の控除を受けられなくなってしまう。トランプの賭けはリスクが相当高い。背景にはオバマに対しての功績を否定しようとする彼の執着があるようだ。話がいつもこの件でややっこしいのはこうした背景があるからで、ロジックが読みにくいのだ。


月曜日。ではまた明日。

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海野 恵一
1948年1月14日生

学歴:東京大学経済学部卒業

スウィングバイ株式会社
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アクセンチュア株式会社代表取締役(2001-2002)
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