《奥巴马医保》再遭重创,保费再度上涨 明年保费将上涨13%,尽管大部分涨价将由补贴抵消。但年收入超过6.4万美元的客户将支付更多,这还要叠加今年巨大的涨幅。
Obamacare Dealt Yet Another Blow as Premiums Rise Again Premiums will jump by 13 percent for next year, though much of the price increase will be offset by subsidies. But customers who earn over $64,000 will pay more, on top of this year’s huge increases.
数百万依赖《奥巴马医保》获得健康保险的美国人明年将面临另一轮两位数的价格上涨,这将加剧已经迫使数百万人自去年以来退保的财务压力。
Millions of Americans who depend on Obamacare for their health insurance face another double-digit price increase next year, adding to the financial toll that has already driven millions of others to drop coverage since last year.
价格上涨在很大程度上反映了全国医疗成本的上升。但这也是特朗普政府对《奥巴马医保》造成的最新打击的信号。该政府监督了帮助美国人支付保费的税收抵免到期,并设立了新的参保障碍,旨在根除其所描述的普遍欺诈行为。
The price increases largely reflect higher medical costs across the country. But they also are a signal of the latest blow to Obamacare under the Trump administration, which has overseen the expiration of tax credits that helped Americans pay for coverage and has erected new barriers to enrollment in an effort to root out what it describes as widespread fraud.
据健康研究机构KFF周五的一项分析,《奥巴马医保》市场的健康保险平均价格明年将上涨13%。
The average price of health insurance in the Obamacare marketplaces will rise by 13 percent next year, according to an analysis on Friday by KFF, the health research group.
特朗普政府周五公布了30个由联邦政府管理市场的州2027年的新价格。利用这些数据和州级数据,KFF计算了全国范围内的涨幅。
The Trump administration on Friday published new prices for 2027 in 30 states with markets managed by the federal government. Using that data and state figures, KFF calculated the increase nationwide.
《奥巴马医保》计划的大幅保费上涨与其他健康保险市场预期的变化相似,尽管略高一些。几家咨询公司的报告预测,覆盖约1.5亿人的雇主计划的保费2027年可能上涨约10%。联邦雇员的保费正在上涨超过10%。
The large premium increases for Obamacare plans are similar to changes expected in other health insurance markets, though slightly higher. Reports by several consulting firms projected that premiums for employer plans, which cover around 150 million people, could go up by about 10 percent in 2027. Premiums for federal workers are increasing by more than 10 percent.
民意调查显示,医疗保健成本一直是选民进入周二中期选举前的首要经济担忧之一。KFF最近的一项民调显示,约60%的登记选民表示担心自己和家人能否负担得起医疗保健费用。
Public opinion polls have shown that the cost of health care has been among voters’ top economic concerns going into the midterm elections on Tuesday. In a recent poll from KFF, about 60 percent of registered voters said they were worried about being able to afford health care for themselves and their families.
俄勒冈州乡村的一对夫妇凯特·德怀尔和马克·德怀尔一直在纠结,他们的预算能否承受又一次年度上涨。他们此前已经转向了最便宜的奥巴马医改计划,这让他们仍需自付数千美元的费用。
Kate and Mark Dwyer, a couple in rural Oregon, have been wrestling with whether their budget can handle another annual increase. They had already shifted to the cheapest available Obamacare plan, leaving them on the hook for thousands of dollars in out-of-pocket costs.
德怀尔女士说,明年最便宜的计划将使他们每月的费用增加500多美元,达到近3000美元。这相当于她在非营利组织收入的三分之一以上。
Next year, the least expensive plan will increase their costs by more than $500 a month, to nearly $3,000, Ms. Dwyer said. That amounts to more than a third of her earnings at a nonprofit.
“我们正在考虑明年就不投保了,”德怀尔女士说。“没有中间选项。要么3000美元,要么什么都没有。”特朗普政府本月向许多奥巴马医改客户寄出了500美元的支票,以抵消他们的保险费——这笔一次性付款恰在选举前夕发放,显然是对这类担忧的回应。
“We are looking at going without next year,” Ms. Dwyer said. “There is no middle ground. It’s either $3,000 or nothing.”In an apparent nod to such concerns, the Trump administration sent many Obamacare customers $500 checks this month to offset their insurance premiums — a one-time payment just before the election.
据福利顾问和行业分析师称,在私营和公共医疗领域,费用上涨的驱动因素包括医院价格上涨、一项改变了部分医生薪酬方式的消费者保护法下的高额支付,以及人工智能在诊室中的日益广泛使用。几家大型雇主还指出,癌症药物和GLP-1药物等昂贵 specialty 处方药的账单不断上升。
Across the private and public health sectors, the increases have been driven by rising hospital prices, high payments under a consumer protection law that changed how some doctors are compensated, and the growing use of artificial intelligence in doctor’s offices, according to benefits consultants and industry analysts. Several large employers also pointed to a rising bill for expensive specialty prescriptions, like cancer drugs and GLP-1 medicines.
特朗普政府周五下午以数据文件的形式悄然公布了这些数字。此后不久发布的一份关于开放投保的政府情况说明书没有提及保费上涨,但指出四分之三享有补贴的奥巴马医改客户仍然能找到每月费用低于50美元的计划。
The Trump administration released the numbers quietly on Friday afternoon as a data file. A government fact sheet about open enrollment published shortly afterward did not mention the premium increase, but noted that three-quarters of Obamacare customers with subsidies can still find plans for less than $50 a month.
开放投保和选购计划于周日开始,距离中期选举仅两天,而可负担性和食品杂货、汽油及医疗保健价格上涨一直是此次选举的核心议题。
Open enrollment and shopping for plans begins Sunday, just two days before the midterm elections in which affordability and the higher prices for groceries, gasoline and health care have been a central issue.
尽管联邦政府报告称今年早些时候有1920万人参加了奥巴马医改保险,但更近期的估计显示总人数更低。
Although the federal government reported that 19.2 million people were enrolled in Obamacare coverage early this year, more recent estimates indicate a lower total.
大约10%是年收入超过63,840美元的老年消费者,这一群体主要由自雇人士组成,如脊医、牙医、牧场主和农民,以及许多提前退休者。其中许多人在2026年已经面临每月超过1000美元的保费上涨。
Roughly 10 percent are older consumers who earned more than $63,840, a group largely composed of self-employed workers, such as chiropractors, dentists, ranchers and farmers, as well as many early retirees. Many already faced premium increases exceeding $1,000 a month in 2026.
“这是一个人数非常少的群体,”KFF《平价医疗法案》项目主任辛西娅·考克斯说。“但这些人承受着不断上升的医疗成本的最大冲击,却得不到任何帮助。”考克斯女士表示,对于一名50岁的单身人士,最便宜的高免赔额青铜计划的平均费用约为每月700美元。
“This is a really small number of people,” said Cynthia Cox, the director of KFF’s program on the Affordable Care Act. “But these people are getting hit the hardest by rising health care costs, and they don’t get any help.”The average cost for the cheapest bronze plan with a high deductible will be about $700 a month for a 50-year-old single person, according to Ms. Cox.
年收入低于64,000美元的奥巴马医保客户构成了该计划参保者的大多数,他们仍将从基于收入的补贴中受益,明年无需支付更高的自付保费成本。对这些人来说,纳税人的钱将承担额外费用。
Obamacare customers who earn less than $64,000 a year make up most of the people enrolled in the program and will still benefit from income-based subsidies and will not have to pay higher out-of-pocket premium costs next year. For those people, taxpayer dollars will cover the extra cost.
但许多家庭预算紧张的人,自2026年奥巴马医保保费上涨以来,一直在努力支付自己的那部分费用,许多人被迫转为免赔额更高的计划。
But many with strained household budgets are struggling to pay their portion since their Obamacare premiums went up in 2026, and many have been forced to switch to plans with higher deductibles.
2026年,保费平均上涨了26%,在共和党主导的国会决定让临时联邦补贴到期后,所有消费者的同一计划平均成本翻了一倍多。
In 2026, premiums rose by an average of 26 percent, with the cost for all consumers more than doubling on average for the same plan, after the Republican-led Congress decided to let temporary federal subsidies expire.
基于保险公司向监管机构提交的备案,KFF最近的估计显示,截至6月,参保人数减少了近500万人。
Recent estimates from KFF, based on insurance filings with regulators, suggest that enrollment fell by nearly five million people, as of June.
由支持《平价医疗法案》的基金会和研究机构联邦基金最近发布的一项大型调查发现,与两年前相比,劳动年龄成年人的无保险率已上升。
A recent large survey released by the Commonwealth Fund, a foundation and research group that supports the Affordable Care Act, found the uninsured rate among working-age adults had risen since two years ago.
去年,民主党人试图以政府拨款为筹码,换取补贴或医保税收抵免的延长,导致联邦政府停摆43天,创下历史纪录。众议院少数党领袖、纽约州民主党人哈基姆·杰弗里斯的助手表示,如果民主党在中期选举中赢得多数席位,他将在新一届国会开幕的最初几天安排投票,恢复额外补贴。
Democrats forced a record 43-day government shutdown last year, as they tried to leverage government funding on an extension of the subsidies or health care tax credits. Aides to House Minority Leader Hakeem Jeffries, a Democrat from New York, have said he will schedule a vote to restore the extra subsidies in the first days of the next Congress if Democrats win a majority in the midterm elections.
保费成本数据于周五公布,正值明年投保期开始之前。投保期从11月1日持续至1月15日。在大多数州,想购买明年奥巴马医保的人需要在此期间登记。(少数州的投保期开放时间更长。)续保现有计划的消费者面临的涨幅可能高于平均涨幅。
The data on premium costs were published on Friday just before the start of next year’s enrollment period, which runs from Nov. 1 to Jan. 15. People in most states who want to buy Obamacare insurance for next year need to sign up during that period. (A handful of states keep the enrollment period open longer.) Increases for consumers who renew their current plans could be higher than the average increase.
左倾消费者权益组织“美国家庭联合会”执行主任安东尼·赖特表示:“我们确实鼓励人们在所提供的计划中货比三家。”他说,平均价格涨幅可能掩盖不同保单成本之间的巨大差异。
“We really do encourage people to shop and compare” among the plans they are offered, said Anthony Wright, the executive director for Families USA, a left-leaning consumer advocacy group. The average price increase can mask tremendous variation in the cost of a policy, he said.
为了降低保费成本,今年许多人从覆盖更全面的计划转向所谓的“青铜级”保险,后者通常保费更低,但免赔额高得多。2026年,《平价医疗法》计划平均免赔额升至近4000美元的历史新高。在考虑明年的计划时,这些人可能再也无法通过改选保障更少的计划来避免涨价。
To lower the cost of coverage, many people switched from more comprehensive plans to so-called “bronze” coverage this year, which often offers lower premiums and much higher deductibles. The average A.C.A. deductible rose to a record high of nearly $4,000 in 2026. As they consider plans for next year, those people may no longer be able to avoid a price increase by switching to a skimpier plan.
专注于降低医疗支出的彼得森医疗保健中心执行主任卡罗琳·皮尔逊表示,鉴于去年价格大幅震荡,她一直在密切关注市场有无不稳定迹象。但她称,对雇主及其员工而言,新公布的涨幅“与我们预期的费率涨幅一致”。
Caroline Pearson, the executive director at the Peterson Center on Healthcare, a group focused on lowering health care spending, said she had been watching the market closely for signs of instability, given last year’s big price shock. But she described the newly published increase as “consistent with the rate increases we are expecting” for employers and their workers.
但很少有参加雇主健康计划的人像没有补贴的“奥巴马医改”消费者那样,直接承担保险的全部费用。雇主为典型的职场参保人支付了超过一半的费用,而且这类保险保费可以从个人税款中扣除。
But few people covered by an employer health plan are exposed to the full cost of insurance like unsubsidized Obamacare consumers. Employers pick up more than half of the tab for the typical person in work-based coverage, and such insurance premiums are deductible from people’s taxes.
政府官员将部分参保人数下降归因于其打击欺诈参保的努力,称经纪人曾让虚假消费者参加有补贴的保险计划。
Administration officials attribute some of that drop-off to its efforts to reduce fraudulent enrollment, arguing that brokers had enrolled fake consumers in subsidized coverage.
9月,副总统万斯宣布,政府取消了经纪人据称为约75万名记录中缺少社会安全号码、且截至8月未使用或联系过其健康保险公司的人安排的保险。他和其他政府官员辩称,有证据显示存在更多欺诈行为。
In September, Vice President JD Vance announced the government had canceled coverage that he said brokers arranged for about 750,000 people whose records lacked Social Security numbers and who had not used or contacted their health insurer through August. He and other administration officials argued there was evidence of additional fraud.
但“联邦基金会”的调查表明,一些退出“奥巴马医改”保险的人可能现在完全没有任何健康保险。
But the Commonwealth survey suggests that some people who have dropped Obamacare coverage may now be going without any health insurance.
里德·阿贝尔森报道医疗保健商业领域,重点关注财务激励如何影响医疗服务的提供,从消费者成本到提供者利润。
Reed Abelson covers the business of health care, focusing on how financial incentives are affecting the delivery of care, from the costs to consumers to the profits to providers.
玛戈·桑格-卡茨是《纽约时报》“Upshot”版块的记者,报道医疗保健政策和公共卫生。
Margot Sanger-Katz is a reporter covering health care policy and public health for the Upshot section of The Times.