消费者对食品和汽油价格的上涨感到不满，这是可以理解的。然而，与《平价医疗法案》（ObamaCare）所导致的保险费上涨相比，这些价格的涨幅实在微不足道。而且情况只会变得更糟，这引发了这样一个问题：我们是否应该将这项法案重新命名为“无法负担的医疗法案”（Unaffordable Care Act）？
Consumers are understandably grumbling that prices are way up on food and gasoline. But those price increases pale in comparison to the rise in Affordable Care Act (ObamaCare) premiums. And the situation will only get worse, raising the question of whether we should start calling it the Unaffordable Care Act?
彼得森-凯泽家庭基金会（Peterson-Kaiser Family Foundation）最近发布的一份报告调查了全美50个州的276家保险公司。报告显示，2027年《平价医疗法案》的保险费中位数将上涨15%；近90%的保险公司预计2027年的保险费涨幅将在20%至35%甚至更高。要知道，2026年的保险费就已经上涨了20%。
A recent report from the Peterson-Kaiser Family Foundation surveyed 276 health insurers in all 50 states. It found the median ObamaCare premium increase for 2027 would be 15 percent. Nearly 90 of those insurers expected 2027 ObamaCare premiums to increase between 20 percent and 35 percent or more. And that’s after a 20 percent increase in 2026.
因此，许多参加《平价医疗法案》的人在短短两年内可能会面临40%至50%的保险费涨幅。
Thus, many people with ObamaCare coverage could see their premiums rise between 40 percent and 50 percent in just two years.
民主党和大多数主流媒体都试图将这一价格上涨的责任归咎于特朗普总统和共和党人。但实际上，几乎所有的责任都应该由民主党人承担。
Democrats and most of the mainstream media want to blame President Trump and the Republicans for the increase. In fact, Democrats deserve virtually all the blame.
早在《平价医疗法案》通过时，我们就多次收到过警告。我们这些参与卫生政策制定的人就预测到保险费会上涨，进而导致参保人数减少。然而民主党人无视了这些警告和精算预测，坚称他们能够按照自己的意愿来运作这项医疗保险制度。
Democrats were warned — repeatedly. Those of us involved in health policy when ObamaCare passed predicted the price increases, which would lead to a declining number of covered individuals. Democrats disregarded the warnings and actuarial predictions, claiming they could make health insurance work the way they wanted it to work.
随着《平价医疗法案》的开放注册期（Open Enrollment）的开始，凯泽家庭基金会公布了有多少人已经退出或可能会退出该法案的参保行列。根据凯泽基金会的数据，“2025年6月至2026年6月期间，个人健康保险市场的参保人数下降了18%”。所谓“个人健康保险市场”，指的是那些无法通过雇主或政府获得医疗保障的人自行购买健康保险的市场（类似于他们购买汽车保险或人寿保险的方式）。凯泽基金会预计，参保人数将从约2050万人减少到约2004万人。
As ObamaCare’s Open Enrollment begins, the Kaiser Family Foundation is revealing just how many people have left or will likely leave ObamaCare. According to Kaiser, “Enrollment in the individual health insurance market fell 18% between June 2025 and June 2026.”The “individual health insurance market” is where individuals who don’t have access to employer-based or government coverage buy their own health insurance, like they do auto and life insurance. Kaiser anticipates a decline of some 4.6 million people, out of about 20.5 million people.
导致下降的一个重要因素是：“入学人数下降与增强保费税收抵免到期以及预计将减少入学人数的其他政策变化同时发生，”凯撒基金会表示。
One big factor causing the decline: “The enrollment decline coincides with the expiration of the enhanced premium tax credits and other policy changes that are expected to reduce enrollment,” according to Kaiser.
正如消费者在价格上涨时可能会减少购买汽油或食品一样，奥巴马医保参保人在保费上涨时也会越来越多地取消保险。退保者大多是年轻健康的人，他们认为即使保费有补贴，上涨的保费也不值得花这笔钱。这是一个经济和精算问题。
Just as consumers may buy less gas or food when prices go up, people enrolled in ObamaCare will increasingly drop coverage as the premiums rise. The dropouts will mostly be younger and healthier people who do not believe the increased cost of the premiums is worth the money, even if the premium is subsidized. That’s an economic and actuarial problem.
保险池需要大量使用很少或不使用医疗服务的健康人群缴纳保费，以抵消少数大量使用医疗服务人群的费用。
An insurance pool needs lots of healthy people who use little or no care paying premiums to offset the cost of a smaller number of people who use a lot of health care.
随着年轻健康的人取消保险，健康保险池将变得更小、更不健康，这将迫使保费进一步上涨，导致下一轮退保。保费上涨导致保险覆盖率下降的这一循环，在保险行业被称为“死亡螺旋”。
As younger and healthier individuals drop their coverage, that will leave the health insurance pool smaller and sicker, which will force premiums even higher, causing the next wave of dropouts. This cycle of rising premiums resulting in declining coverage is what in the insurance industry is known as the “death spiral.”
这一死亡螺旋可能会因另一个问题而加剧。美国卫生与公共服务部在6月宣布：“2026年公开报名期间及之后的近期经验强烈表明，系统中存在持续且长期的欺诈、浪费和滥用。我们估计，仍有260万份不当和‘幽灵’报名，包括超过100万份没有社会安全号码的报名。”随着这些“幽灵参保人”——即不存在或已故的人，或拥有重复政府保险的人——从奥巴马医保名单中被移除，其纳税人提供的补贴将停止。
This death spiral may be exacerbated by another problem. The Department of Health and Human Services announced in June, “Recent experience during and after the 2026 Open Enrollment Period strongly suggests ongoing and persistent fraud, waste, and abuse in the system. We estimate 2.6 million improper and phantom enrollments remain, including over 1 million enrollments without a Social Security number.”As these “phantom enrollees” — that is, nonexistent or deceased people or people who have duplicate government coverage — are dropped from the ObamaCare rolls, their taxpayer-provided subsidies will cease.
这将留下更少的资金来支付日益减少的、病情更严重的奥巴马医保参保人不断增长的费用。这一发展应当加速死亡螺旋。
That will leave even less money to pay for the growing costs of a declining number of sicker ObamaCare enrollees. That development should accelerate the death spiral.
民主党和媒体一直将保费上涨归咎于共和党人和特朗普总统，原因是共和党人没有续签奥巴马医保的增强补贴。这是误导性的。奥巴马医保保费上涨迅速，是因为该法案的结构和强制规定。
Democrats and the media have been blaming Republicans and President Trump for the rising premiums because Republicans did not renew ObamaCare’s enhanced subsidies. That’s misleading. ObamaCare premiums have been rising quickly because of the law’s structure and mandates.
奥巴马医保在2010年3月通过时就包含了非常慷慨的补贴。这些补贴至今仍然存在。2021年，作为疫情支出的一部分，拜登总统和他的民主党同僚通过了立法，提供临时的增强补贴——即补贴之上的补贴。正是这些临时的增强补贴，共和党人没有续签。增强补贴只是掩盖了保费上涨的真实成本。
ObamaCare included very generous subsidies when it passed in March 2010. Those subsidies are still in place. In 2021, as part of their pandemic spending, President Biden and his fellow Democrats passed legislation providing temporary, enhanced subsidies — subsidies on top of subsidies. It’s those temporary, enhanced subsidies that Republicans did not renew. The enhanced subsidies simply masked the real cost of the premium increases.
如果进程继续照旧，奥巴马医保很快将成为一个非常小的项目，参保者大多是病人，保费将显著更昂贵。
If the process continues as is, ObamaCare will soon become a very small program with mostly sick individuals, and the premiums will be significantly more expensive.
有什么能阻止或扭转奥巴马医保的死亡螺旋吗？除非新一轮增强补贴，否则大概不行。
Can anything stop or reverse ObamaCare’s death spiral? Apart from a new round of enhanced subsidies, probably not.
如果民主党在2028年总统选举中控制国会和白宫，他们几乎肯定会试图通过另一轮增强补贴。在大幅增强补贴的情况下，参保者的流出可能会减少，并非因为奥巴马医保变得负担得起，而是因为纳税人承担了大部分成本。梅里尔·马修斯是我们共和党遗产组织的德克萨斯州州主席。
If Democrats take control of Congress and the White House in the 2028 presidential election, they will almost surely try to pass another round of enhanced subsidies. With significantly enhanced subsidies, the insureds’ exodus would likely decline, not because ObamaCare is affordable, but because taxpayers are paying most of the cost. Merrill Matthews is the Texas state chair of Our Republican Legacy.