My name is Sherry Glied, and from 2010 to 2012 I was the assistant secretary

我的名字是雪莉吉爾德，從2010年到2012，擔任助理秘書

for planning and evaluation at the department of Health and Human Services

在衛生與人群服務部們從事規劃與檢測

in the Obama administration.

於歐巴馬任職期間

When you think about whether the Obamacare is collapsing,

如果你思考歐巴馬健保案是否正在瓦解

I think you really have to sort of think about the current situation and the counterfactual.

我認為你真的要將現狀和反事實思維列入考量

Would it naturally collapse or is it collapsing in part because

它是自然的就崩解了，或者是因為

the administration is causing it to collapse.

政府造成他崩解

Premiums last year that is coming into this year's cycle,

去年的保費即將進入今年的循環

increased quite a lot.

增加了不少

There are couple of things administration has done that may be contributing to

有幾點是因為政府的作為導致

weak performance of exchanges.

交易所表現不佳

The first thing is that

第一件事是

when almost the first thing that the Trump,

幾乎是川普做的第一件事

the president Trump did when he entered the office is to put out

川普上任後提出了

an executive order saying that they would not be

一個行政命令，表示政府不會

strenuously enforcing the individual mandate.

強制執行健保法下的個人條款

So that likely led to some reduction in signups

因此可能導致註冊人數的減少

He also turned off the marketing spigot a little bit earlier this year than had been done in prior years.

他也比以往更早關閉了市場營銷樞紐

But the most important concern, I think,

但最重要的因素，我想，

in terms of stability and future of these markets is that

就這些市場的穩定性與未來而言，

they are supposed to have stream of money come in

他們應該有一筆金費

to pay for reductions in the cost sharing for low-income subscribers.

用於支付低收入用戶的成本分攤

So, the way that the Affordable Care Act is set up,

因此，平價醫療法的成立是

if you are low-income person and you buy a health plan,

如果你是低收入用戶，而你買了健保

that health plan gets an extra subsidy so that

健保方案獲得額外的補貼，因此

your deductibles, your cost sharing, what you have to pay when you go to the doctor, isn't too high.

你的成本就會被分攤，當你看醫生需要負擔時，費用就不會太高

There's been an argument between Republican congress and President Obama

有個爭議一直存在於共和黨議院與前總統歐巴馬

when he was still in office about whether the money that was flowing

當還在他的任職期間，這些流動資金

under that piece of the legislation had correctly followed Congressional rules.

在立法規定下是否遵循著國會規則

But, President Trump has not been clear about whether he will let those payments flow or not.

但是，總統川普尚未表明是否會支付這些款項

If the payments don't flow,

如果這些費用不流通

insurers will be responsible for giving better coverage to low-income people,

保險公司就會負責提供較好的保險方案給低收入用戶

but they won't be subsidized for that.

但這些用戶不會得到補貼

And they're building that into their premiums, and raising them accordingly.

他們將這個反映在保費上，因此提高了保費