I-Senate Version Mhlawumbi ibe yinto ehlukileyo
NgoMeyi 4, ngo-2017, iNdlu yabameli ibidlulise uMthetho we-American Health Care Act (AHCA) kwaye uyithumela kwi-Senate. Ngokukhawuleza ukuba imilinganiselo idlulileyo, iiNdlu zeRiphabhuliki zajoyina uMongameli uTrump, i-Vice-President Pence kunye no-HHS uNobhala uTom Price ngokubhiyozela kwiNdlu ye-White House. Kodwa i-AHCA isenayo ikusasa elinokungaqiniseki.
Ivoti yeNdlu yavela emva kweeveki ezimbalwa zeemvume kunye nezilungiso ezenzelwe ukufumana inkxaso evela kubameli beRiphabhlikhi abachasene ne-AHCA ngoMatshi.
Kwiiveki ezi-6 ngaphambi kokuba igqityiwe ligqitywe kwiNdlu, inkokeli yaseRiphabliki yayisisitye phambi kwevoti ehleliweyo ngo-Matshi, xa kwacaca ukuba kwakungekho inkxaso eyaneleyo yokuyidlulisa.
Amademokhrasi aphikisana nomthetho ngokubanzi, kwaye nangona iRiphabhliki ininzi eNtendlwini, ukuba ngababameli abangaphezu kwe-22 beRiphablikhi bachasene nomthetho-mthetho, bekungeke kudlule. Ngo-Matshi, bekukho ubuncinane ama-33 aseRiphabliki aphikisana ne-ACHA. Kodwa xa kuvotelwa ukuvota ekuqaleni kukaMeyi, kuphela amaRiphabhlikhi angama-20 kuphela avotela umyalelo-mali, kwaye wadlulisa ngevoti enye ukuya kwinqanaba (217-213; kwakudinga ukuba i-216 idlule).
Akucaci ukuba i-Senate iya kudlula umlinganiselo we-ACA wokuphinda, nokuba ngaba bayakwenza, nokuba ngaba amakamelo abiri aya kukwazi ukuvumelanisa kwi-compromise egcina ubuncinci kwezinye i-AHCA.
Impembelelo yeBhili-mali yangoku
I-AHCA yaziswe ngokusemthethweni kwiNdlu ngo-Matshi 20, kwaye yadlula ngaphantsi kweeveki ezi-7 kamva.
Ngaloo xesha kwavela utshintsho oluthile ngeenguqulelo. Enye yemibandela enokuphikisana yevoti yeNdlu yayikuthi ngaphambi kokuba i-Office ye-Budget yeCongress of Budget (CBO) ingaboni ithuba lokuvavanya i-bill ehlaziyiweyo kunye neprojekthi yayo yempembelelo.
I-CBO yenza amanqaku omthetho-mali phakathi no-Matshi, kwakhona emva kweentsuku ezimbalwa emva kokuba abameli bomthetho batyelele ukulungiswa komphathi kumthetho.
Ukubonakaliswa kwamabini omabili kukuba i-AHCA yayiza kuba nezigidi ezingama-24 ezongezelelweyo zabantu abangaqinisekisiwe base-US ngo-2024 . Kodwa ibhilikhwe echitshiweyo yenzelwe ukunciphisa ukulahleka kweentlawulo ngeemali ezigidi eziyi-150 ezidlulileyo kwiinyanga ezizayo, ngokuchasene nokunciphisa i-$ 337 yezigidigidi ze-AHCA.
Emva kwesibini kwinqanaba le-CBO, iiRephabliki zeNdlu zongeze izilungiso ezintathu ezibalulekileyo kwi-AHCA:
- Isilungiso sokudala "inkqubo yokwabelana ngengozi engabonakaliyo" eya kubonelela nge-$ 15 billion kwiimali zenkxaso-mali ukuze incedise iindleko zamabango amakhulu kwimarike yempilo yomshuwalense.
- I-MacArthur Amendment, evumela amazwe ukuba aphume kwezinye ze-ACA zokukhusela abathengi. Amazwe angakhetha ukuvumela abatshutshisi ukuba baphakamise umlinganiselo wokulinganisa umyinge we-premium ngaphezu kwe-5: 1 ikhefu ebekwe ngu-AHCA, uhlaziye ii-ACA ezibalulekileyo zezempilo , kwaye usebenzise imbali yezokwelapha ukucacisa iiprayimamu zabafakizicelo abaye bafumana igalelo ekuhambeni kwangaphambili unyaka.
- I- Upton Uhlengahlengiso , uqalise usuku ngaphambi kokuba iNdlu ivotelwe ukuba idlule i-AHCA, yayijoliswe ekukhutsheni iingxaki zeRiphablikhi malunga neempembelelo ze-MacArthur Amendment. I-Upton Amendment inikeza i-$ 8 billion kwiimali zenkxaso-mali (ngo-2018 ukuya ku-2023) ukuba isetyenziswe ukucima ezinye iiprayimari eziphakamileyo ukuba abantu abaneemeko zangaphambi kokuba babekho kwiindawo ezikhethayo ukuvumela abaqinisekisi ukuba bazise iiprayimari kwimbali yonyango xa abafake izicelo isithuba esikwi-coverage.
I-MacArthur Amendment iphumelele kwi-Caucus ye-House Freedom Conservative, kwaye u-Upton Uhlengahlengiso ulondolozwe ngokwaneleyo inkxaso evela kumaRiphabhulikhi athatywayo ukuba ibhilikhi yakwazi ukuphumelela kwiNdlu.
Kodwa xa abameli beNdlu badlulisela umthetho-mali, abazange bazi ukuba yintoni umthendeleko wabo oza kuba nawo kwizinga elingagqitywanga, okanye kwimali yentlawulo. Bavotele kulo mthetho-mali emva kweeyure emva kokufaka isilungiso sokugqibela, kwaye kuthathe i-CBO phantse iiveki ezintathu ukugqiba amanqaku abo kwi-bill bill ehlaziyiweyo.
Amaphuzu ahlaziyiweyo: 23 Million Ngaphantsi kwama-insureni; I-119 Billion yeeRiphabhuliki zeNgcaciso
Ngo-Meyi 24, i-CBO yashicilele uhlalutyo oluhlaziyiweyo lwe-AHCA, ukubalwa kwezilungiso ezintathu.
Baphetha ukuba inguqu echitshiyelwe ye-AHCA (eyadlulisa iNdlu malunga neveki ezintathu ngaphambili) yayiza kubangela abantu abayizigidi ezingama-51 abangaxhaswanga ngo-2026, ukuya kwii-28 ezigidi phantsi kwe-ACA. Ukunyuka kwezigidi ezingama-23 ezingagqithwanga kwi-uninsured kwakuncinci kunokwanda kwangaphambili kwezigidi ezingama-24 ezongezelelweyo ezihlala zingenakuncedwa, kodwa kuseyi-trajectory ephazamisayo ngokwezinga elingenakususwa.
Iiprojekiti ezihlaziyiweyo ze-CBO ezidityanisiweyo zedolophu ziya kuncitshiswa nge-$ 119 yezigidigidi phantsi kwe-AHCA (ukugcina imali encinci kune-$ 337 yezigidigidi nezigidi eziyi-150 ze-CBO i-CBO iqikelele ngo-Matshi).
I-AHCA kwi-Senate: Ngaba iya kudlula uvavanyo lwe-Byrd?
AmaRiphabhuliki anesininzi kwi-Senate ngokunjalo, kodwa umda wabo uncinci kakhulu kwigumbi. Kukho amaRiphabhlikhi angama-52 kwi-Senate, kunye ne-46 yamaDemokhrasi kunye nama-Independents amabini, bobabini i-caucus kunye namaDemokhrasi. Ekubeni i-AHCA iyilwayo yoxilaniso, inokudlulela ngesininzi esilula kwi-Senate, kunokuba idinga amavoti angama-60.
Kodwa oko kuthetha ukuba ukuba ngaphezulu kwababini baseRepublican Senators bayayinqabela imilinganiselo, ayiyi kudlulela (I-Vice-President Pence inokufaka ivoti yokuphula i-tie ukuba inani lokugqibela li-50-50). Kwakhona kuthetha ukuba iiDemokhrasi azikwazi ukulawula isigqibo salo mthetho; Wonke uMdemokhrasi kwi-Senate angavota, kunye neRiphabliki enye okanye ezimbini, kwaye kuya kuqhubeka.
Inyaniso yokuba i-AHCA iyilwayo yokuxolelanisa ithetha ukuba inemithetho ecacileyo ekufuneka ihambelane nayo. Iingxowa-mali zokuxolelana ziyakwazi ukujongana nemiba echaphazela ngokuchanekileyo imali. I-Byrd Rule ivimbela iNational Senate ukuba ingacingi "into engaphandle" (oko kukuthi, izinto ezingabandakanyekanga ngqo imali yentlawulo) njengenxalenye yesikhokhelo soxolelaniso.
Kukho ingxoxo eninzi malunga nokuba i-MacArthur Amendment iya kudlula uvavanyo lwe-Byrd; kungagqiba ukuhlaselwa yi-Senate ngenxa yokuba ayihlangabezananga novavanyo lwento enokufakwa kwi-bill ye-reconciliation. Ngamanye amazwi, iPhalamende yeSeneti, uElizabeth MacDonough, unokuthi ulwimi kulomhla wokuLungiswa kweMacArthur luya kufuna ukuba amavoti angama-60 adlule, kunokuba angama-51; Ngoko kuya kufuneka ukuba isuswe kumthetho-mthetho, njengoko iiSept Republican aziyi kukwazi ukufumana amavoti angama-60 ukuba adibanise i-ACA.
Ukuze kusebenze inkqubo yokuxolelana, iSeti iya kufuna kwakhona amanqaku avela kwi-CBO kwinguqu abayiphakamisayo; ukuvota ngaphandle kwamanqaku, njengoko iNdlu yenze, ayikho inketho yesikhokhelo soxolelaniso, kuba igalelo kwibhajethi yesigqeba kufuneka ibe yinto eyaziwayo.
I-Senate Ubhala iBhili Yabo. Ziza kuhlala zihlala phi kwiNcwadi yeNdlu?
Ngaloo mini, i-AHCA yadlulela iNdlu, iindawo zentengiso zaqala ukunika ingxelo yokuba iNational Senate yayilungiselela ukubhala i-bill yayo endaweni yokuguqula iNguqulelo yeNdlu. Kungekudala emva koko, i-Senate Republican yamemezela iqela elisebenza ngamalungu angama-13 eliza kubumba i-bill ye-Senate, kwaye icacise ukuba loo mithetho yayiya kubhalwa ngasese, kunokuba kuqhutywe iindlebe kunye noluntu lweekomiti.
Kodwa ingakanani inani leNdlu iya kuthi iSenate igcine? Ngaba iNdlu iya kuvuma ukungafani okugqityiweyo phakathi kweNdlu kunye neeNdlu zeBhunga?
Kwiiveki emva kokuba i-MacArthur Amendment yongezwe endlwini ukuze iphumelele kumaRiphabliki angama-conservative kuloo gumbi, kwakukho ingxoxo enzulu malunga nombango wokukhusela abantu abaneemeko zangaphambili. Oku kwaba ngongoma wokuthetha ngoJimmy Kimmel, owayesebenzisa ibali lokuhlinzwa kwentliziyo yonyana wakhe osandul 'ukuzalwa ukubonisa ukubaluleka kokugubungela imeko ekhoyo ngaphambili ngaphandle kokunye.
Ngenxa yokuba ulwimi lwe-MacArthur Uhlengahlengiso lungahambelani noMthetho we-Byrd, ukunyanzeliswa kokukhusela abantu abaneemeko zangaphambili kunokuthi bangenzi kwiNgqungquthela ye-Senate yomthetho. I-Senator uSusan Collins (R, Maine) uthe esidlangalaleni ukuba akayi kuxhasa iNguqulelo yeNdlu ye-AHCA, okanye nayiphi na enye ibhilikhi ekhokelela kwizigidi ezingama-23 ezingabikho abantu abangaqinisekisiwe, okanye i-850 yeepesenti yokunyuka kwabangaphantsi (abadala be-CBO) ingxelo kwingxelo yeNdlu ye-AHCA ibonisa ukuba umntu oneminyaka engama-64 ubudala ofumana i-$ 26,500 / ngonyaka, emva kwe-premiums-subsidy mali iza kunyusa ukusuka kuma-1,700 / ngonyaka phantsi kwe-ACA ukuya kwi-16,100 / ngonyaka phantsi kwe-AHCA ekuthiwa kugcina i-ACA yokukhusela abathengi, kunye ne-13,600 zama-dollar kwiindawo ezikhusela i-ACA ukukhusela abathengi; nayiphi na indlela, ukwanda okwenyukayo).
Kodwa kukho inkalo enkulu kumsebenzi-ongenakufumana ingqwalasela enkulu njengoko iqinisekisa ukuba i-AHCA yayiseNdlu. I-AHCA yayiza kubetha i-Medicaid yaseburhulumenteni yenkcitho ngama-dollar ayi-834 yezigidigidi kwiminyaka elishumi ezayo, ngokokuhlalutya kwe-CBO.
Ukulondolozwa kuvela kumabonakalo amabini ahlukeneyo: Ukukhawulwa kwe- ACA's Medicaid ukwandisa (akukho nanye i-19 ithi ayenako ukwandisa iMedicaid inokukhetha ukwenza njalo, kwaye ithi ukunyusa i-coverage ayikwazi ukubhalisa abaxhamli abatsha kwizinga lokunyusa yenkxaso-mali emva kokuphela kuka-2019), kwaye uguqule inkxaso-mali jikelele ye-Medicaid evela kwikhompyutha ehambelana neendlela ezivulekileyo ezikhoyo ukukhupha izibonelelo okanye izabelo ze-per capita. Enoba yeyiphi ikhetho iya kugqitywa kunye namazwe anesibonelelo esincinci seMedicaid kwixesha elide.
Inkomfa yeMedicaid inokuthi ibe yinto ekhuselekileyo kwi-Senate. Kukho abantu abaninzi beRiphabliki-kuquka amanye amazwe avela kwiMedicaid-abaye babonisa ukukhathazeka malunga nokucutha kwe-AHCA kwimali ye-Medicaid kunye nefuthe eliza kuba nelokuba baxhomekeke kwi-Medicaid, kubandakanywa ukwandiswa kweMedicaid kunye neMedicaid.
Yintoni eyenzekayo xa iSenate idlula i-Its Own Version?
Ngenxa yokuba iiSenethi zamaRiphabhuliki kufuneka zidibanise phantse onke amalungu awo-ukulahlekelwa ngaphezu kweebini-ukuze zigqityize iinguqu zabo ze-AHCA, inqaku alinakuqinisekiswa. Kodwa kwenzeka ntoni emva koko ukuba i-bill ye-Senate ifake ama-garners ubuncinane ngamavoti angama-51 (kubandakanywa nokuvota okukhethiweyo kunye ne-Vice-President)?
Ngenxa yokuba i-Senate ibhala umthetho wayo, kwaye ngenxa yezinto ezixhalabisa ukuba iMacArthur Uhlengahlengiso ayinakuhambelana noMthetho we-Byrd, kwaye ngenxa yokuba abaninzi abemi baseRephabliki bavakalise ukukhathazeka ngefuthe leBhili yeNdlu kwi-Medicaid, kuqinisekiswa ngokuqinisekileyo ukuba iNdlu neSeti iindleko ziya kuba neengxaki ezininzi.
Ukuba oko kwenzeka, inkomfa yenkomfa iya kubunjwa, equkethe amalungu avela kwiNdlu kunye neSeti. Umsebenzi wabo uza kuba ukulungelelanisa ukungafani phakathi kweebhili ezimbini kunye nokwenza ingxelo yenkomfa. Ukusuka apho, zombini iNdlu kunye neNkundla yeeNkundla kufuneka idlulise ingxelo yengqungquthela, enokuxutyushwa ngabagwebi kodwa ingahlonywanga .
Ukuba zombini iNdlu kunye neSeti yidlulisela ingxelo kwingqungquthela, ithunyelwa kumongameli ngokusayina. UMongameli uTrump unokusayina nawuphi na umrhumo owenziwe kuye ophelisa okanye utshintsho ubuncinci kwezinye iindawo ze-ACA. Akuqinisekanga, nangona kunjalo, nokuba zombini amagumbi eCongress aya kukwazi ukuvumelana malunga nomlinganiselo wokuthumela kumongameli.
Kungenzeka ukuba abanomnqweno womthetho abanomnqweno wokuphelisa ubuncinane i-ACA-isithembiso sephulo kubo abaninzi-kuya kubangela ukuba bavotelwe ibhajethi abangayixhasi ngokupheleleyo.
Ngakolunye uhlangothi, i-House Freedom Caucus yashiya inkxaso yabo kwi-AHCA ngo-Matshi, kwaye ayivumelanga ukuvota kulo mthetho-mali kuze kube yenziwe i-MacArthur Amendment, ivumela amazwe ukuba aphule imithetho ephathelele kwimpilo ebalulekileyo kunye nokuhanjiswa kwangaphambili imeko ekhoyo. Ingaba i-Caucus inkululeko iyavuma ukuvuma ukuba ingxelo yenkomfa ingabonakalisa ukuba uguquguquko? Mhlawumbi, kodwa asikwazi ukuthetha ngokuqinisekileyo.
ILizwi
Nangona ubuKhokheli beNdlu kunye noLawulo lweTrump bhiyozela i-AHCA kwiNdlu, umthetho usenendlela ende yokuhamba. Ukuba i-Senate idlula ingqungquthela yayo, mhlawumbi iyahluke kakhulu kwi-House version, kwaye akukho siqinisekiso sokuba zombini amagumbi aya kuvuma ukulungelelaniswa okuya kubakho ukudibanisa le mibini.
Ngeli xesha, i-ACA ihlala ngumthetho welizwe. Intshuwalense yezempilo kwimarike nganye iyaqhubeka iqinisekisiwe kuwo onke amazwe, kungakhathaliseki ukuba yintoni imbali yezokwelapha ( iziganeko ezifanelekileyo ezifunekayo ukuze ubhalise ngaphandle kobhaliso oluvulekile). Inkxaso-mali ye-Premium , ngokusekelwe kwingeniso kunye neendleko zokubhengezwa kummandla ngamnye, ziyafumaneka kwi-exchange exchange, kwaye ukwandiswa kweMedicaid akutshintshi kumazwe angama-31 kunye ne-DC apho iye yandiswa khona. Imfuneko ye-ACA yokugcina i-postage okanye ibhekane nesohlwayo serhafu nayo isasebenza, kwaye kuya kuba yinto yomthetho isetyenziselwa ukuyichitha.
> Imithombo:
> Congress.gov. HR1628, uMthetho wezeMpilo waseMelika ka-2017. Ukwaziswa ngoMatshi 20, 2017.
> I-Ofisi yeBhajethi ye-Congressional, uMthetho we-American Health Care Act . Matshi 13, 2017.
> I-Ofisi yeBhanjethi yeCongress, uMthetho we-American Health Care Act , ngoMatshi 23, 2017.
> I-Ofisi yeBhajethi ye-Congressional, i- HR1628, uMthetho wezeMpilo waseMelika , ngoMeyi 24, 2017.
> IHolo M; kunye ne-Bagley N, Ukwenza Ingqiqo "Yokwabelana Ngengozi Engabonakaliyo" Imicimbi yezeMpilo, ngo-Ephreli 12, 2017.
> I-House of Representatives yase-US, iKomiti yeMithetho, isishwankathelo soMthetho we-Byrd.