I-AHCA, kunye namanye ama-BOP eBills aphakanyisiwe ukuba atshintshe i-Obamacare
Xa uDonald Trump ephumelele ukhetho loongameli ngo-2016, ikusasa loMthetho woNonophelo ongenakuncedo (i-ACA, enye eyaziwa ngokuba yi-Obamacare) ngokukhawuleza yenyuka emoyeni . Umyalelo wokuqala wokulawula weTump, okhutshwe emva kweeyure emva kokuvulwa kwakhe, wagxila " ekunciphiseni umthwalo wezoqoqosho we-Care Affordable Act ," kwaye waqondisa ii-arhente zentlangano-njenge-IRS kunye ne-HHS ukuba ibe yindoda enyanzelisayo xa kunokwenzeka ukuthotyelwa kwezohlwayo ze-ACA nemimiselo .
Ekuqaleni, ngoNovemba noDisemba, ukugqithiswa komthetho kubonakala ngathi kukuphelisa i-ACA ngokukhawuleza kunokwenzeka kwiseshoni ye-2017, usebenzisa isilwayo soxolelwano esingayi kuthobela i-filibuster kwaye singadlulela ngamavoti ama-51 kuphela kwi-Senate ke, kodwa, kuba banokujongana neendleko zorhulumente, ngoko-ke ibhayisti yoxolelaniso yokuphelisa i-ACA iyakwazi kuphela ukuphelisa iinkalo zomthetho-ezihambelana nemali).
Umthetho kulindeleke ukuba ufanane no-HR3762, owavotelwa ekuqaleni kuka-2016 nguMongameli Obama, kodwa uya kuthintela ngokuthe ngqo imimiselo enxulumene nenkcitho ye-ACA kunye nokulibaziseka kokusetyenziswa kokusetyenziswa kweminyaka emibini (ngamanye amazwi, umthetho wawuya kwenziwa ekuqaleni kowe-2016, kodwa amaninzi okuphinda aya kuthatha ukusebenza ngo-2018). Iingcamango kukuba ukulibaziseka kweminyaka emibini ukunika ixesha kwiNgqungquthela yokunika ithuba lokumisela indawo yokuguquka.
Ngokukhawuleza ukuba iseshoni yomthetho ka-2017 iqale, uSenator Mike Enzi (R, Wyoming) wazisa isisombululo sesabelomali esichazela amane amakomiti e-congressional ukuba aqale ukuqulunqa i-bill ye-reconciliation ukuze aphelise ii-ACA ezinxulumene nenkcitho. Isisombululo esingabophayo, iScon.Res.3, sidlulile zombini amakamelo eCongress phambi kokusungulwa kweTrump, kwaye iikomiti zaqala ukusebenza kwi-bill.
I-AHCA idlule iNdlu ngoMeyi 4, 2017
Ngomhla wama-20 Matshi, iNdlu yazisa uMthetho wezeMpilo we-American Health Care (i-AHCA), owawunomthetho owadalwa ngenxa yesigqibo sesabelomali (umgaqo-mithetho wenziwa ngo-Matshi 6, kodwa wawungeniswa ngokusesikweni kwaMatshi 20 ). I-AHCA iyilwayo yokuxolelana, ngoko ayikwazi ukujongana neenkalo ezininzi ze-ACA. Kodwa kuyahluke kakhulu kwi-HR3762 ngeendlela ezininzi. I-AHCA yaphawulwa kwiinkomfa zeekomiti kwiveki leyo yaziswa, kwaye izilungiso ezininzi zongezwa kwiiveki ezintandathu ezalandelayo, ngaphambi kokuba umlinganiselo wenziwe kwiNdlu ngoMeyi 4, ngevoti ye-217 ukuya ku-213.
I-Ofisi ye-Budget ye-Congressional ichaze ukuba i-AHCA iya kunciphisa ukulahleka kwemali ngama-dollar ayi-337 yezigidigidi, kodwa kuya kubangela ukuba abantu abangaqinisekanga bakhule ngezigidi ezingama-24 kwiminyaka elishumi ezayo. I-CBO ikhishwe uhlalutya olutsha lomthetho emva kokuba luhlonyelwe ngo-Matshi 20, uqikelele ukuba umthetho oguqulwayo unokunciphisa kuphela ukulahleka kwemali ngama-dollar ayi-150 yezigidi, kodwa bekuya kubangela ukuba abantu abangaqinisekanga bakhule ngabantu abayizigidi ezingama-24. Izilungiso ezongezelelweyo zongeziweyo ngo-Ephreli no-Meyi, kodwa iNtlu yavotela kwimilinganiselo phambi kokuba i-CBO inexesha lokugqiba uhlalutyo lwabo lweempembelelo zezi zihlomelo.
I-AHCA yayiqale ukulungiselela ukuvota ngoMatshi 24, kodwa yatsalwa emva kweeyure eziliqela zengxoxo ngaloo mini, xa kubonakala ukuba akukho inkxaso eyaneleyo yokuyidlulisa. Izilungiso ezazisetyenzwa kule iveki zilandelayo zenza umgudu wokunciphisa inkxaso yowomthetho, kwaye ekugqibeleni kwaphumela ekugqibeleni kwinqanaba elincinci, ngoMeyi 4.
I-AHCA ithunyelwe kwi-Senate emva kokuba idlulele iNdlu, kodwa iSeti ithe yaza kubhala ibhajethi yayo, iquka ininzi ye-AHCA ngokunokwenzeka. Amagumbi amabini aza kufuneka adibanise naluphi na ulwahlulo kwiimali zabo ngaphambi kokuba athumele umyalelo wokugqibela kumongameli ngokusayina kwakhe.
Nantsi into e-AHCA, njengokuba ithe yadlula iNdlu:
- Iphelisa iikhredithi zerhafu ye-premium emva kwe-2019, kwaye ithatha indawo yazo kunye neerhafu zerhafu ezihlaziywe ngokubhekiselele kwiminyaka yobudala, kwaye zandisa kubantu abanemali ephezulu. Iimali zerhafu ze-ACA zikhulu kubantu abanemivuzo emincinci, kwaye zinkulu kwiindawo apho i-inshurensi yezempilo iyabiza. Iingxelo ze-AHCA zerhafu ziya kufana nomntu ofumana i-20,000 $ okanye i-70,000 zama-dollar, kwaye uyahluka kuphela ngokususelwa kwiminyaka yobudala. Igalelo elipheleleyo liza kuba li-premium zeprayam. Yaye imali engenayo kunye nabantu abahlwempuzekileyo baza kufumana ngaphantsi kwe-ACA, ngelixa abantu abatsha kunye nabanemali ephezulu baza kufumana ngaphezulu.
- Ukwandiswa kweMedicaid kuya kuhlala kuqhubeka ngo-2019, kodwa bekuza kubakho iqhwa emva koko. Ababhalisi abatsha abanakukwazi ukujoyina, kwaye abantu abalahlekelwe ukufaneleka bangaze bakwazi ukubhalisa kamva. Amazwe angazange awandise iMedicaid ngo-Matshi 1, 2017, ayengeke afanelekele ukwandisa iMedicaid kunye nenkxaso eyongezelelweyo ye-federal eyamkelwayo okwangoku ngokubanzi (ngokukodwa, i-19 ithi ayinakwandisa iMedicaid ayayi kuba nayo nayiphi ukhuthazo lwezezimali ukwenza njalo ukuba i-AHCA isenziwa njengolu hlobo). I-Medicaid iya kuguqulwa ukusuka kwi-fayile ekhoyo evulekileyo evulekileyo kwimali yesabelo ngasinye okanye igranti ezivela kwi-federal government.
- I-penalty yomntu ngamnye iya kupheliswa, ngokukhawuleza ukuya ekuqaleni kuka-2016. Kunoko, i-AHCA incike kwi-"coverage continuation" yokubonelela: Emva kohlobo lokubhalisa oluvuliwe ngo-2018 (olucetywayo ngoNovemba 1, 2017, ngoDisemba 15, 2017), nabani na obhalisa kwisicwangciso ngasinye somrhwebo emva kwesithuba sokubhengezwa ubuncinane ubuncinane iintsuku ezingama-63 ezihlawulwe iiprojama ezingama-30 eziphezulu ngaphezu kwezinga eliqhelekileyo, kwiinyanga ezili-12. Ngaphandle koko, njengenxalenye ye- MacArthur Amendment eyongeziweyo kwi-AHCA, iyakuthi iyakwazi ukufuna ukukhupha okuza kwenza abaqinisekisi bangezelele ukwandisa iiprayimali ezisekelwe kwimbali yonyango (ngokuchasene nepesenti ezingama-30 ezingakhathaliseki ukuba yintoni imeko yempilo) kubafakizicelo beemarike ngabanye obenomngcipheko wokufikelela. Njengoko kunyuka izinga lokukhula kweepesenti ezingama-30, iiprayimari eziphezulu ezisekelwe kwimbali yonyango ziza kuhlala zihlala unyaka.
- Uninzi lwabalondolozi be-ACA luya kutshintshwa, kuba i-AHCA yintlawulo ye-bhalwano ejongene nemilinganiselo enxulumene neendleko (abalawuli be-GOP bathi amanye amalungiselelo aya kubhekiswa kwinqanaba lexesha elizayo lokucwangciswa kwezempilo, kodwa ukungabikho kokubuyisana beya kufuna amavoti angama-60 kwi-Senate ukuba ibe ngu-filibuster ubungqina). Nangona kunjalo, i-MacArthur Amendment iphinda ivumele ukuba ukulungelelanisa ukufuna ukuyeka ukuguqula ububanzi bezinto ezithathwa njengenzuzo ebalulekileyo yezempilo , kunye nokwandisa imilinganiselo yemigangatho yeminyaka yobudala ngaphaya komlinganiselo we-5: 1 obizwa ngokuba yi-AHCA (i-ACA ivumela kuphela Umlinganiselo we-premium we-3: 1 kubhalisi abadala kunye nabaselula).
- Ubungakanani obuya kuqinisekiswa ngezobuchwepheshe kungakhathaliseki ukuba zezifo zonyango, kodwa njengoko kuphawuliwe ngasentla, abantu bakwamanye amazwe bathi bathenge isicwangciso kwimarike nganye emva kokuba negalelo kwi-postage babenokubona iiprayimari eziphakamileyo ngokukhawuleza ngenxa yeemeko zabo zangaphambili . Iimeko ezilindelekileyo zangaphambili zokulinda kunye nezikhetho ziya kuvunyelwa, nangona kunjalo. Iimali zokuhlala zemihla ngemihla kunye neenzuzo zonyaka ziya kuqhubeka zivunyelwe ukuba zifumane izibonelelo zempilo ezibalulekileyo, kwaye iipasim e-out-of-pocket ziyakudinga ukuba zifakwe kwiimfuno zezempilo ezibalulekileyo. Kodwa njengoko kuphawuliwe ngasentla, iinqanaba liza kuba nenketho lokunciphisa ubukhulu bezinto eziyimfuneko zezempilo, eziza kunciphisa ukukhuselwa okusebenzayo kwimida yokuphuma ngaphandle kwexesha kunye nobomi bemivuzo yonyaka.
NgoMeyi 2017: I-Senate iya kuqwalasela i-AHCA
I-AHCA yadlulela iNdlu ngoMeyi 4 ize ibuyele kwi-Senate. Kodwa ukususela ekuqaleni, umthetho awuzange ube neenkxaso ezixhaphakileyo kubachaphazelekayo okanye nakwisigqeba esipheleleyo se-GOP. I-American Medical Association, i-AARP, kunye ne-American Hospital Association, kunye neminye imibutho, sele ithethe ngokuchasene ne-AHCA. Iidemokhrasi kwiNgqungquthela iphikisana ne-AHCA, kodwa iRiphabhlikhi yahlukana. Amanye amaRephabliki aseSenate ayamkelekileyo ayakholelwa ukuba i-AHCA ayifuni ngokukhawuleza ekutshitshiseni iindawo ze-ACA ukuba zicinge ingqalelo (iingeniso ezihlawulwayo zerhafu kunye nokunyuswa kweMedicaid, umzekelo).
Kwaye nangomnye umgca wembonakalo, ezinye ii-Republican Senators zenzelwe ukukhushulwa okanye ukungafuni ukuphelisa i-ACA's Medicaid ukwandisa nokuphunyezwa komthetho oza kwenza udaba olubiza kakhulu kubantu baseMelika abakudala nabangaphantsi.
Ngoku ukuba imilinganiselo ye-Senate, ibhekane nobunzima kunokuba yenzeke kwiNdlu. Ngaphandle kokusebenzisa ukuxolelana (okufuna kuphela amavoti angama-51, ngaphezu kwe-60), i-Senate inokukwazi ukulahlekelwa yiRiphablikhi ezimbini ukuba ibhaso-mali iya kudlula. Ngokukhawuleza ukuba i-AHCA idlulise iNdlu, iNational Senate yabonisa ukuba iya kubhalela imilinganiselo yazo, ithathe isikhokelo kwi-AHCA, kunokuthi iguqule i-AHCA kuphela. Ngako-ke kunokwenza kubekho inkqubo ebalulekileyo yomthetho kunye neli lizayo, kwaye ikamva lide likude kwi-Senate.
Eminye iMithetho yoLondolozo lwezeMpilo
Nangona ingqwalasela ijoliswe kwi-AHCA ukususela ngo-Matshi, ezinye iindleko ziye zafakwa kwiiseshoni ze-2017, zonke ezijoliswe ekutshintsheni okanye ekutshintsheni i-ACA okanye iindawo ezithile (ungasebenzisa esi sixhobo kwiKaiser Family Foundation ukuthelekisa ezinye zazo ngeenxa-nhlangothi)
Makhe sijonge ezinye zee-billing ezazisetyenziswe ngo-2017 ngaphambi kwe-AHCA, kwaye ziziphi iimpembelelo eza kuba nazo. Ukuba i-Senate ayidluli i-AHCA-okanye enye inyathelo apho iNdlu iyavuma-enye yee-billing ingagqiba ukuhlaziywa ngo-2018, njengabameli beRiphabhulikhi abayinakwenzeka ukuyeka imizamo yabo yokucima i-ACA, nokuba i-2017 yabo ilinge ayiphumelelanga.
ZeBhunga leMithetho
UMthetho woKhuseleko weMonde
UMthetho woKhuseleko weMonde waqaliswa ngoJanuwari 23, 2017, ngabaSebenzi uBill Cassidy (R, Louisiana) noSusan Collins (R, Maine).
Umthetho osayilwayo unyanzelekile kunezinye iziphakamiso zeRiphablikhi eziye zanyuka kwiminyaka emininzi edlulileyo, njengoko unikeza inketho yokugcina i-ACA njengento, okanye ukutshintshela kwinkqubo entsha kunye nobunzima belizwe. Kodwa i-bill ye-compromise ayinakuphela ukufumana inkxaso eyaneleyo ukusuka kwicala le-esitele, kwaye umyalelo wokubuyisela uya kufuna ukufumana ubuncinane amavoti angama-60 kwi-Senate ukunqoba i-filibuster.
UMthetho woKhuseleko weMonde uya kuhanjiswa ngokubanzi kwinkqubo yokwenza iinqununu kumazwe kwaye uza kubanika iindlela ezintathu (ngokukwazi ukutshintsha rhoqo ngonyaka ukusuka kwindlela enye ukuya kwelinye):
- Gcina i-ACA njenge-.
- Amalungiselelo amaninzi e-ACA aya kuchithwa, kodwa amaphesenti angama-95 emali ebeyichithwa ukuhlawula inkxaso-mali ye-premium, inkxaso-mali yokwabelana ngeendleko kunye nokwandiswa kweMedicaid kwilizwe kuya kusetyenziswa ukuxhasa i-Roth Health Accounts Accounts (Roth HSAs) abahlali baseburhulumenteni abafanelekileyo. Abahlali abangaqinisekanga babeza kubhalisa ngokuzenzekelayo kwizicwangciso zempilo eziphambili ezichithwayo eziphezulu (ukubhaliswa ngokuzenzekelayo kuya kuthatha indawo yecala lomntu ngamnye).
- Amalungiselelo amaninzi e-ACA aya kubanjiswa, kwaye ulawulo luya kulawulwa kwindlela yokuyila nokugcina inkqubo entsha (ngaphandle kwemimiselo echazwe kwi-Option 2). Kodwa urhulumente akayi kufumana nayiphi na inkxaso yemali.
Kungakhathaliseki ukuba yiyiphi indlela ukhetho olukhethwa nguRhulumente, uMthetho woKhuseleko lweMonde uya kuqhubeka kunye nokukhuselwa kwabathengi be-ACA: Umda wokuphila kunye nomvuzo wonyaka uya kunqatshelwa, njengoko kwakuya kubakho imeko ekhoyo ngaphambili. Ubungakanani buya kuqhubeka nokuqinisekiswa, kwaye abadala abaselula baya kuqhubeka bevunyelwe ukuba bahlale kwisicwangciso sezempilo sabazali kuze kube seminyaka eyi-26 . UMthetho woKhuseleko weMonde awufuneki ukuba izicwangciso zezempilo zihlawule zonke iinkonzo zezempilo ze- ACA ezibalulekileyo , kodwa kuya kufuna ukuhanjiswa kwezempilo yengqondo kunye nokusetyenziswa kakubi kweziyobisi.
UCassidy no-Collins balindele ukuba amaninzi amazwe aya kukhetha i-Option 2. Ivumela ulungelelaniso loluntu ngokubhekiselele kwisicwangciso sobongamela kunye neemfuno zokukhawulela, kodwa lubonelela ngemali ebalulekileyo yemali eya kufakwa kwi-Roth HSAs yabemi.
UMthetho woKhuseleko weMonde uya kugqiba ukusetyenziswa kwe- HSAs yendabuko kwaye uza kuthatha indawo yabo kwiRoth HSAs. Okwangoku, iminikelo ye-HSA irhoxiswa yerhafu, kodwa iyancipha ( ngo-2017 ) ingabi ngaphezu kwama-3,400 e-$ enye, okanye i-$ 6,750 kwintsapho.
Imivuzo kwi-Roth HSA ayayi kuhlawulwa irhafu kodwa abantu babeza kuba negalelo elifikelela kuma-5,000 e-ngamnye ngomntu ngamnye (ngoko intsapho yezine iya kuba negalelo lee-20,000 zamawaka ngonyaka, ephezulu kakhulu ngaphezu kwama-6,750 angama- HSA yendabuko).
Iminikelo yayiza kukhula ngaphandle kweerhafu, kwaye iyakhutshwa irhafu-ntlawulo yokuhlawula iindleko zonyango (le micimbi ye-Roth HSA iya kufana ne-HSAs).
UMthetho woKhuseleko weMonde awuchazi kakuhle ukuba urhulumente uza kuba negalelo kumntu ngamnye weRoth HSA. Bakulindele ukuba kuya kuba yimali eninzi, kodwa ukulungelelaniswa kwemirhumo karhulumente kuya kwandisa kubantu abanemali ephezulu, ekusasazeni imali kwiqela elikhulu kunokuba i-ACA iyenze.
Imali kwi-Roth HSAs (kubandakanywa iminikelo karhulumente kunye negalelo lomntu ngamnye) ingasetyenziselwa ukuhlawula iiprimimenti ze-inshorensi yempilo kwakunye neendleko ze-pocket.
Umthetho wokuTshintshiselwa kwe-Obamacare
I-Senator Rand Paul (R, eKentucky) yazisa uMthetho we-Obamacare Replacement Act (S.222) ngosuku olulandelayo emva kokuba uCassidy no-Collins baveze i-bill yabo.
USeninari uPaul uye waxela inkolelo yakhe ukuba akukho nto ingayithandabuzeki ukuba iCongress idlule umthetho ukuze ichithe i-ACA ngaphandle kwemithetho efanayo. ukuba i-ACA ifanele ichithwe, akafuni ukuqhubeka nokuchithwa komthetho ongabandakanyi umthetho wokutshintshwa).
UPawulos wayephikisana nabalingani bakhe beRiphabliki kwiintsuku ezikhokelela ekukhululweni kwe-AHCA, ukucacisa ukuba ibhilikhwe yayibhalwe ngasese (iibill aziqhelekanga kuluntu ize ziqaliswe kwikomiti, kodwa uPawulos wayefuna ubona umthetho owakhutshwa yiRiphabhuliki yaseNdlu).
Ngenkcaso eqhubekayo kwi-AHCA, uPawulos ubiza ngokuba yi-"Obamacare-Lite" kwaye uphinde wachaza umnqweno wakhe wokupheliswa ngokupheleleyo kwe-ACA esikhundleni.
Nantsi indlela umThetho ka-Paul Obamacare Replacement Act uza kusebenza ngayo:
- Ininzi yamagunya e-ACA aya kuchithwa, kubandakanywa nezigunyaziso zomntu ngamnye kunye nomqeshi, umbandela oqinisekileyo kunye nokubonelelwa kwemilinganiselo yoluntu, kunye neemfuno zezempilo eziyimfuneko. Ngenxa yoko, abantu abayi kuba nako ukuthenga i-inshorensi, abaqeshi abayi kuba ne-inshuwalense, iinkampani ze-inshorensi zempilo ziyakwazi ukukhanyela izicelo okanye ukwandisa ama-premiums asekelwe kwimbali yezonyango zabafaki-zicelo, kwaye izicwangciso ezingenakho ukukhutshwa kwezibonelelo ezahlukeneyo zezempilo ziya ziyafumaneka ukuze zithengwe (ezo zicwangciso ziya kuba zibiza kakhulu, kodwa ziza kubashiya abathengi ngaphandle kwengxelo xa ziphela zifuna unyango olungazange lufakwe kwisicwangciso).
- Kuza kubakho ithuba lokubhalisa lokuqala lokuqala lokubhalisa apho abantu abaneemeko zangaphambili bezokwazi ukuthenga ukuthengwa kwiimarike. Emva koko, ukuhanjiswa kuya kuqinisekiswa kuphela (ngaphandle kokubhaliswa kwezonyango) kubantu abagcina i-coverage. Kubantu abafumana i-inshurensi evela kumqeshi, imithetho ye-HIPAA iya kusebenza, oku kuthetha ukuba izicwangciso zinokumisela ixesha elilindelekileyo lokulinda kubhalisile abatsha abangazange balondoloze i-coverage phambi kokubhalisa kwisicwangciso somqeshi.
- Abantu abathengayo i-inshurensi yabo yempilo baya kuvunyelwa ukuba bathathe indleko ye-premium kwiholo yabo kunye neerhafu zomvuzo (okwangoku, imithetho iyanqanda ngakumbi abo bathengela i-inshurensi yempilo ngamnye , ngelixa iiplani zempilo ezixhaswe ngumqeshi zingasebenzisa ngaphambi kokuhlawula irhafu iimali zokuhlawula ii-premiums zabo).
- Kuza kubakho inkokhelo yerhafu engabuyiselwa imali engama-5,000 ukuya ku-$ 5,000 ukuze ivuselele igalelo kwiAccounts Savings Accounts (HSAs) . Iintlawulo ezingabuyiselwayo zithetha ukuba i-credit iyakufumaneka kuphela ukuba ihlawule inani lemali ehlawulwa ngumntu, kwaye ayikwazi ukuba yinkulu kuneentlawulo umntu ahlawulwa kunyaka. Oku kuhambelani neenkxaso-mali ze-premium ze-ACA , eziyi-credit tax refundable; ukuba i-ACA yentlawulo yerhafu ayikho ngaphezu kweentlawulo, i-IRS iya kunika umahluko.
- Kwakungayi kuba khona umda ophezulu malunga nokuba unokuba negalelo kangakanani kwi-HSA. Iminikelo ye-HSA inokwenziwa ngabantu abangagcinwanga phantsi kwezicwangciso zezempilo ezidityanisiweyo, kunye ne-HSA iimali zingasetyenziselwa ukuhlawula iiprimiyamu ze-inshorensi zempilo.
- Abaqinisekisi bempilo baya kuba nako ukuthengisa izicwangciso kumanqanaba karhulumente. Umthetho osayilwayo uthi amanqaku karhulumente alawula iimveliso zomshuwalense yezempilo ayakunyaniswa, ngoko ukuba amazwe akayi kuvunyelwa ukuba avimbele izicwangciso zecandelo elingaphantsi kwee-intanethi ekuthengiseni i-coverage kummandla.
UMthetho we-ObamaCare wokuPhinda
NgoJanuwari 12, I-Senate uTed Cruz (R, waseTexas) yazisa iS.106, uMthetho we-ObamaCare Repeal Act. Incwadi ekhokhwayo yephepha elilodwa elibiza nje ukuba uMthetho woNonophelo ongenakunqwenelekayo uchithwe ngokupheleleyo ngoJanuwari 1, 2018, nayo yonke into ebuyela endleleni eya kuba yintoni ukuba i-ACA ingakaze yenziwe.
Lo mthetho-mali awunakuze ufumane inqanaba lokuxhaswa yi-bipartisan efunekayo ukugqithisa, kodwa yithuba lokuba uSeninari Cruz ahambe ebhalweni njengokuba sele esetyenzisiwe ukuphelisa ngokupheleleyo umthetho, oko kubangele ukuba abamele bakhe bafuna ukubona i-ACA ichithwe.
KwiiNdlu zeBhili
Iindleko zongeziweyo ezongezelelweyo zafakwa kwiNdlu yabameli ngoJanuwari, nganye ijoliswe ekutshitshiseni okanye ekutshintsheni iinkalo ezithile ze-ACA okanye indlela yokuphunyezwa ngayo:
I-HR708 , uMthetho we-"Age Age Rating Flexibility Act ka-2017," owenziwe ngu-Rep. Larry Bucshon (R, e-Indiana, kwisiThili sesi-8). Lo mthetho-mali uza kusebenza ngoJanuwari 2018, kwaye uza kuvumela abathwali bee-inshorensi zempilo ukuba basebenzise umlinganiselo wesihlanu ukuya kwelinye xa izicwangciso zexabiso lokubhalisa abadala. Ngamanye amazwi, umfaki-sicelo oneminyaka engama-64 unokuhlawulwa ngokuphindwe kabini kunomntu oneminyaka engama-21 ubudala. I-ACA ibeka umda wokuba ungabi ngaphezu kweyesithathu ukuya kwenye.
HR628 , "Umgangatho Wezempilo Oqinisekisiweyo weMimiselo ye-Pre-existing Act of 2017," eyenziwe nguR. Rodney Davis (R, Illinois, iSithili se-13). Lo mthetho-mali uyilungiselelwe ukukhusela abantu kwiinkcazo zokukhanyela okanye ukungahlawulwanga ngenxa yeemeko zangaphambili. Kuya kuthatha ukusebenza xa kwaye i-ACA ichithwa. Kuza kufuna iiplani zezempilo kunye nezicwangciso zomntu ngamnye ukuba zamkele bonke abafakizicelo, ngaphandle kweemeko zangaphambili ezikhoyo. Njenge-ACA, kuya kuvumela abaqinisekisi ukuba babe nexesha lokubhalisa elivulekileyo lonyaka kunye nezikhathi zokubhalisa ezizodwa ezibangelwa ziziganeko ezifanelekileyo.
HR710 , uMthetho we-"Health Couverture State Flexibility Act ka-2017," owenziwe nguNgqungquthela uBill Flores (R, waseTexas, eSithili se-17). Lo mthetho-mali uza kusebenza ngoJanuwari 2018, kwaye uza kufutshane ixesha lobabalo lwee-premium ze-inshorensi zempilo. Ngaphantsi kwe-ACA, abantu abafumana inkxaso-mali ye-premium banexesha leenyanga ezibabini xa behlelwa emva kwee- premium zabo (kufuneka bahlawule ngokupheleleyo ekupheleni kweenyanga ezintathu; azikwazi ukuhlala zihlala emva kweenyanga ezintathu). I-HR710 inganciphisa ixesha lokubambela kwiintsuku ezingama-30, ngaphandle kokuba umthetho welizwe unesithuba esithile sothando. Okubalulekileyo, ixesha lobabalo liya kuba yinto efanayo kubo bonke abantu, kungakhathaliseki ukuba bafumana inkxaso-mali (okwangoku, ixesha lebabalo kwiinkoliso ezininzi kubantu abangafumani inkxaso-mali zingama-30 iintsuku).
HR706 , "uMthetho wokuQinisekisa nokuBulungiswa koMthetho we-2017," owenziwe nguMe. Marsha Blackburn (R, Tennessee, kwisiThili sesi-7). Lo mthetho-mali uzakufuna ukuba abantu babhalise ngokutshintshana ngaphandle kobhaliso oluvulekile (okt, ngexesha lokubhalisa okhethekileyo elibangelwa ngumcimbi ofanelekileyo ) ukubonelela ubungqina besiganeko esifanelekileyo. Oku kuye kwaba yinkinga yokubambisana kwiminyaka embalwa edlulileyo, kwaye urhulumente wezepolitike wenza ukuqinisekiswa kweziganeko ezifanelekayo ngo-2016 phakathi kwezixhala abantu ababenokuthi babe "badlale inkqubo" xa kungadingeki ukuqinisekiswa.
HR184 , "Khusela uMthetho Wokuvuselelwa Kwezonyango ka-2017," owenziwe ngu-Erik Paulsen (R, Minnesota, kwisiThili sesithathu). Eli bhili liya kuphelisa irhafu yecandelo lezonyango ze-ACA, kuzo zonke iintengiso ezenziwe emva kukaDisemba 31, 2017.
HR173 , "uMthetho wokuPhelelwa kweRhafu weMali yeNkcubeko yamaBanga aphakathi koMhlaba we-2017," owenziwe nguMike Kelly (R, ePennsylvania, kwisiThili sesi-3). Eli bhili liya kuphelisa irhafu ye-ACA ye-Cadillac . Kuya kuthatha ukusebenza ngo-2018, nangona irhafu yeCadillac ngokwayo ayilungiselelwe ukusetyenziswa ukususela ngowe-2020.
HR 247 , "uMthetho wokuNyuselwa kweAkhawunti yokuThengiswa kweMpilo ka-2017," owenziwe nguDe. Dave Brad (R, waseVirginia, iSithili se-7). Lo mthetho-mali uza kukwandisa inani elongezelelweyo legalelo le-HSA, kwaye iza kuvumela abantu ukuba bafake isandla kwi-HSA nangona bengenaso isicwangciso sezempilo esinqunyiwe. Kuya kuvumela abantu ukuba basebenzise iimali ze-HSA ukuhlawula iimali-mali ze-inshorensi yezempilo, ukuvumela i-HSA imali ukuba iphinde isetyenziswe kumachiza amaninzi, kunye nokunciphisa isohlwayo esetyala xa abantu basebenzisa iimali ze-HSA ngeendleko ezingezizo zonyango (okwangoku Ama-20 ekhulwini, kwaye ubuya kubuyela kwiipesenti ezili-10, ngendlela ebeyiyo phambi kwe-ACA).
HR285 , "UMthetho woNcedo lwezeMpilo kunye neNkundla yokuLawula iMithetho," echazwe nguNgqongqoshe uMichael R. Turner (R, Ohio, kwi-10 Distrit). Leli bhili liya kuphelisa igunya lika-ACA ngamnye kunye negunya lomqeshi. Ngoko abantu abayi kufunwa ukuba bagcine i-inshorensi yezempilo, kwaye abaqeshi abayi kufunwa ukuba bayinike.
Zonke ezo zindleko zijoliswe kumalungiselelo athile e-ACA, okanye iindlela ezenziwe ngayo umthetho ngokulandela imimiselo elandelayo (umzekelo, i-HHS inikwe umsebenzi wokumisela iimfuno ezithile kunye neenkcukacha zezihlandlo ezizodwa zobhaliso, kwaye okokuqala ukhethe ukusebenzisa inkqubo yozuko kunokuba ufune ubungqina bemeko ezifanelekileyo).
ILizwi
I-AHCA ngoku i-Senate, kwaye asiyazi ukuba ikusasa layo lingaba liphi. Asinakutsho ngokuqinisekileyo ukuba i-ACA iya kupheliswa okanye ithathelwe indawo, nangona leyo yinjongo jikelele kubamkeli abaninzi baseRiphabhulikhi kwaye banabininzi kumagumbi amabini eCongress.
Kodwa iqela alizange lilungelelanise malunga nesisombululo, kwaye kukho ukungavumelani okukhulu phakathi kwamaRephabliki aseSenenari ngokwemiqathango eya phambili. Abalawuli bezomdemokhrasi bafunge ukuvimbela i-ACA ukutshitshiswa nangayiphi na indlela abanokuyenza ngayo, kwaye ngokude nje ukuba bafumane iiNtanethi ezintathu zeRephablikhi ukuba bavumelane nabo, ukuphinda umthetho akuyi kukwazi ukudlula.
Ngexesha, akukho nto ishintshile, kwaye i-ACA isengumthetho welizwe.
> Imithombo:
> Cassidy.Senate.gov. UMthetho woKhuseleko weMonde. UmThetho osayilwayo ukuphucula ukhetho lwezigulane ngokuvumela amazwe ukuba athathe iindlela ezisekelwe kwimarike kwi-Care Affordable Act, eyandisa ukwanda kwe-inshurensi yempilo enokuhlawulekayo nokunciphisa iindleko ngexesha lokuqinisekisa ukukhuselwa kwabathengi abalulekayo nokuphucula ukunakekelwa kwezigulane . Ukwaziswa ngoJanuwari 23, 2017.
> Congress.gov. S.106. ObamaCare Ukuphelisa uMthetho. Ukwaziswa ngoJanuwari 12, 2017.
> Congress.gov. S.222, uMthetho we-Obamacare Replacement Act. Kwaziswa ngoJanuwari 24, 3017.