NPR News:美众院公布替代奥巴马医改方案 面临党内外挑战

House Republicans have released the text of a bill that's designed to remake the Affordable Care Act, also known as Obamacare. Congressional Republicans have voted dozens of times in the past to repeal the ACA. But that was when President Obama was in office, and he vetoed those attempts. That is expected to change under President Trump.
And joining us now with more on the changes being proposed in Congress is NPR health policy correspondent Alison Kodjak. And Alison, give us the main points here. I assume the Republicans are getting rid of the requirement that everyone have health insurance, the individual mandate.
ALISON KODJAK, BYLINE: Yeah. They're getting rid of that by repealing the penalty that people would have to pay if they don't have insurance. And that they're doing that retroactively, meaning people who didn't have insurance even last year, if this bill goes through, would not have to pay that tax penalty.
And what they're going to do is change that — what they call the stick approach to a carrot by offering refundable tax credits to people to allow them to use that money to buy a health plan in hopes that more and more people will actually buy in voluntarily, rather than have to do it under a mandate.
SIEGEL: Refundable in this case means it could actually be in excess of what somebody owes in income taxes?
KODJAK: Yeah. It does. The tax credits that they have put forth are $2,000 for individuals under the age of 30. And they go up to about $4,000 if you're over 50 years old. They're per person, so a family could, you know, accumulate a lot of those tax credits up to $14,000.
But that refundable part is actually a point of contention. There are some of the most conservative Republicans who don't appreciate the refundable tax credit because that means people, like you said, who don't even pay federal income tax could get that money back. They see that as an additional entitlement.

SIEGEL: What about Medicaid? More than 10 million low-income Americans have gotten coverage under the Obamacare expansion of Medicaid. Does that survive in this House bill?
KODJAK: It survived in a way. The bill proposes that they freeze the program in 2020. And all of those people who are covered under Medicaid can stay covered. But if they leave Medicaid because they get a job or something, they can't then re-enroll if they are over the regular Medicaid limit, which was much lower — the poverty line, rather than 130 percent of the poverty line, which is what the expansion allowed.
So it's sort of a compromise between those who are afraid of throwing people off Medicaid and those people who don't want to see that expansion stay in place.
SIEGEL: This is a House bill. As you've mentioned, there are some conservatives who object to provisions of it. I assume the Democrats object to it very broadly. What are its chances?
KODJAK: Well, that's a bit of a question because yes, there are several conservatives in the House who object to it. All Democrats don't want to see this — the Obamacare repealed at all. And in the Senate it's even more complicated because there are already several conservative senators who've come out against this whole plan calling it, quote, "Obamacare-lite" and several senators who have said they're concerned that it is not generous enough and people will be thrown off their health insurance.
The Republicans only have a small majority in the Senate. So it'll be hard for them to lose any Republican senators and still be able to get this bill through.
SIEGEL: What happens next?
KODJAK: Well, this week, two House committees will mark up the bill, which means they'll vote it out to the House. And then we'll see where it goes from there.
SIEGEL: OK. That's Alison Kodjak. Thank you.
KODJAK: Thanks, Robert.