Phakathi kweentetho zokuvuselela i-AHCA, ukungazinzi kubakho kwiimarike ze-inshorensi
Xa uDonald Trump ephumelele ukhetho loongameli ngoNovemba 2016, ikusasa loMthetho woNonophelo ongenakunqwenelekayo (aka Obamacare) ngokungazelelwe lingaqinisekanga .
I-ACA ibhekene neengxaki ezidlulileyo, kubandakanywa necala leNkundla ePhakamileyo le-2012 elifumene igunya lomthetho ukuba libe ngumgaqo-siseko (kodwa kungeyona imfuneko eyenza ukwandisa iMedicaid ukwenzela ukugcina inkxaso ye-Medicaid ekhoyo ) kunye necala leNkundla ePhakamileyo ye-2015 apho ii- ACA inkxaso-mali ye-premium yazimisela ukuba ibe ngumthetho kuwo wonke urhulumente.
Kwaye, kunjalo, kukho intambo yokubethelwa komthetho ukususela ekubeni yenziwe. Akukho nanye kula macandelo omthetho awazange abe khona ithuba lokwenene, nangona kunjalo, ngenxa yongoma-ka-Obama we-veto ipeni.
Izinto zibukeka zihluke kakhulu ngoNovemba 9, 2016. Ininzi lakwaRiphabliki kwimizi yomibini yeCongress, kunye neRiphabhliki kwiNdlu eNtshonalanga eyayiphakamise kwiqonga lokucima i-ACA ngaphandle kwamasango, kubonakala ngathi iyancipha i-GOP ekwenzeni okuhle kwiminyaka esixhenxe yesithembiso sokuphelisa i-ACA.
Kodwa i-ACA iye yaxhaswa ngokusesikweni kwisakhiwo senkonzo yomshuwalense wezempilo, kwaye inani labantu abane-inshurensi yezempilo linyuswe malunga nezigidi ezingama-20 ngenxa ye-ACA (ngokubanzi ngokunyuswa kweMedicaid kunye nokuthengiswa kwemakethi, nangona abanye bebancinci abadala abaye bafumana inkxaso phantsi kweeprogram zezempilo zabazali). Ukuphindaphinda kunye / okanye ukutshintsha i-ACA ibonakalise ukuba kunzima kunokuba ibonakale kuqala.
Yintoni eyenzekayo kangaka?
NgoJanuwari, ngaphambi kokuba iTrump ithathe isikhundla, iCongress yadlulisa i-S.Con.Res.3, isisombululo sesabelomali esiye sabhola ibhola kwinkqubo yokuphelisa iinkalo ezinxulumene nenkcitho ye-ACA. Isisombululo esilungiselele iikomiti zokudibanisa ukuba ziqulunqe i-bill yoxolelwano eya kusetyenziswa ukutshintsha okanye ukutshintsha ii-ACA ezichaphazela ngqo uhlahlo lwabiwo-mali (federal bills , nangona kunjalo, kumalungiselelo anokuchaphazela ngqo uhlahlo lwabiwo-mali).
Amacandelo amaninzi omthetho wokungaxolelani ngokumalunga ne-ACA aqaliswa ekuqaleni kowe-2017 , kodwa akukho namnye kubo oye waqhubela phambili ukuvota. Isilwayo soxolelaniso esibangelwa kwisisombululo seJaji kaJanuwari-uMthetho we-American Health Care Act, okanye i-AHCA-yaqaliswa ekuqaleni kukaMatshi.
Kodwa emva kweentsuku ezili-18 zokuthintana ngokukhawuleza kunye nezinguqu zemizuzu yokugqibela, uSomlomo kunye neNdlu uSomlomo uParry Ryan (R, Wisconsin) wathabatha umyalelo-mali ngaphambi kokuba iVota ihlelwe ngoMatshi 24. Kungekudala emva koko, uRyan wanikela inkomfa yenkcazelo emfutshane ngexesha athi i-ACA ilapha ukuhlala kwikamva elibonakalayo, kwaye abaRiphabhliki baya kuhamba kwezinye izinto kwi-ajenda yabo.
Noko ke, loo nto yayinokufutshane. Ekuqaleni kwiveki elandelayo, uRyan wathi i-AHCA ibuyele etafileni. I-House Freedom Caucus, iqela elilondolozayo labameli beRiphabhlikhi kunye nabanye abagwebi ekupheleni komgca wokuzimela, bebenomkhankaso omkhulu wokuthintela i-ACA, kwaye abazange bafune ukuyeka ngokukhawuleza.
Kutheni i-AHCA iphumelelise ixesha lokuqala?
AmaRiphabliki aninzi kunto kwiNdlu, kodwa ukuba ngaphezulu kwama-Republican angaphantsi kwe-22 aphule iqela kunye neqela lawo, umlinganiselo awuyi kudlula.
Ngethuba lokutshatyalaliswa kweMatshi phezu kwe-AHCA, bekukho ubuncinane ama-33 aseRiphablikhi abangengamkeli umthetho (abaDemokhrasi babechasene nehlabathi jikelele).
Kodwa loo maRiphabliki angama-33 ayengabumbene kwiimbono zabo; babenezizathu ezahlukileyo zokuchasana ne-AHCA. Amalungu e-Freedom Caucus ayekholelwa ekupheleni kombono, ukuba i-mthetho ayizange ihambe ngokukhawuleza ekutshitshiseni i-ACA, efuna ukuyijonga ngokupheleleyo (umthetho wokuxolelana awuyi kukwazi ukuphelisa ngokupheleleyo i-ACA, kodwa i-Freedom Caucus Amalungu ayifuna ibhilikhwe ubuncinane njenge-HR3762, eyayivotelwa nguMongameli Obama ngo-2016).
Kwaye ekupheleni kokumodareyitha komgca, abagwebi bakhathazekile malunga nokucwangciswa kwe-CBO ukuba inani labantu abangaxhaswanga liza kukhula ngabantu abayizigidi ezingama-24 kwiminyaka elishumi ezayo phantsi kwe-AHCA, kwaye malunga neenguqu ze-AHCA ekunyuseni iMedicaid kunye ne-Medicaid.
Yintoni eyenzekayo nge-2?
Ekuqaleni kuka-Epreli, iiNdlu zeRiphabhulikhi, ngokubandakanyeka ngamandla nguNobhala-ngameli uMike Pence kunye noNobhala we-HHS uTom Price, babonakala bephezu kokukhulula umthetho wabo wokuguqulwa, kodwa baqhubeka bexoxisana ngeenguqu eziza kubandakanywa.
Ingxaki ibangelwa kukuba ukungqubuzana kweRiphablikhi kwinqanaba lokuqala livela kwiimodareyitha kunye nabantu ekupheleni kwempembelelo yezopolitiko. Utshintsho olwenzelwe ukukhupha amalungu e-Freedom Caucus aqinisekisiwe ukuba ahlukanise amaRiphabhlikhi aqhelekileyo, kwaye ngokufanayo.
Ekuqaleni, iinkokheli zePence kunye neRiphabhliki zanikeza isiphakamiso sokubandakanya inkqubo yokukhutshwa kwemali echaza ukuba iya kukwazi ukuyisebenzisa ukuguqula iimfuno zezempilo ze -ACA ezibalulekileyo kunye nokuvinjelwa kwe-ACA kwiinkxaso-mali ze-inshurensi yezempilo kwiimbali zonyango zabafaki. Amalungu e-Freedom Caucus afuna amazwe ukuba akwazi ukuchaza izibonelelo zabo zezempilo ezibalulekileyo, ukwenzela ukunciphisa ububanzi bento ekufuneka ifunyenwe yinshuwalense yezempilo. Bafuna kwakhona ukuphelisa umgangatho okwangoku wokubhalisa abagulayo kunye nabagulayo ukuhlawula iipriyam ezifanayo.
Ngaphantsi kwe-ACA, iiprayimenti ziyahlukahluka ngokususelwa kwiminyaka yobudala (kunye nomlinganiselo we-3: 1 wabhalisa abadala nakubhalisile abancinci), ukusetyenziswa kwecuba (ngo-1.5: 1 isilinganiso) kunye nekhodi ye-zip. Kodwa imbali yonyango yomfaki-sicelo ayinxalenye ye-equation.
Ngaphambi kuka-2014, iinkampani ze-inshorensi zempilo kwiinkoliso ezininzi ziyakwazi ukuphonononga umlando wezonyango zabafaki kwaye zisebenzise loo nkcazelo ukuba iqinisekise iiprayimari. Baye banqabe izicelo ngokuchanekileyo ukuba iimeko zangaphambili ezikhoyo zizinzulu ngokwaneleyo. Ukuguqulwa okucetywayo ukuba i-AHCA ayinakuvumela abaqhankqalazi ukuba banqabe abafakizicelo ngokusekelwe kwimbali yonyango, kodwa abagxeki bathi ukuba iiprayimenti zinokunyuka ngokukhawuleza kubafakizicelo abagulayo, kuya kubakho ukukhusela i-ACA yokukhusela abantu abaneemeko ezikhoyo. Oku kunjalo ngokwenene ukuba i-state nayo iya kuguqula iimfuneko zezempilo ze-ACA ezibalulekileyo, njengoko umfaki-sicelo angafumanisa ukuba izimo zabo zangaphambi zikhoyo "zihlanganisiwe" kodwa isicwangciso asiboneleli ngeendawo ezifunekayo zokunyamekela.
Ukunciphisa amaRiphabhulikhi aphantsi, esinye isiphakamiso siye sanyuka. Ingavumela ukuba amazwe athathe iinqununu zokuguqula izibonelelo zezempilo ezibalulekileyo kunye ne-ACA's premium ratio yobudala (ngoko ke abafaki zicelo abadala bahlawuliswa amaxesha angamahlanu ukuya kubafake izicelo, kunokuba kathathu), kodwa akuyi kuvumela iiprayimari ukuba zisekelwe imbali yezobugqirha.
Ngo-Ephreli 5, ukungafani phakathi kwezi ziphakamiso ezibini kuye kwabangela ukuba iintetho ziphule, ubuncinane okwethutyana. Amalungu e-Freedom Freedom Caucus awafuni ukuqhubeka ngaphandle kwesiqinisekiso sokuthi iza kuba nako ukuvumela abaqinisekisayo ukuba babuyele ekusebenziseni phantsi kwezokwelapha ukubeka iiproyamu, njengoko bakholelwa ukuba oku kubalulekileyo ekunciphiseni iiprayimari kubaninzi babemi (oko kukuthi, abo bangenayo imeko ekhoyo ngaphambili).
Kwaye nangomnye umva weembambano, amaRiphabhulikhi ayingcipheko akholelwa ukuba ukubuyela kwiipriyamu ezisekelwe kwimbali yezobugqirha kuya kubangela ukuba ukhuseleko lwe-ACA lwabantu abaneemeko esele ikhona ngaphambili, enye yeyona miqathango ethandwa kakhulu.
Abenzi bomthetho bacebise ukusebenzisa imali eyabelwe kwi-AHCA kumazwe ukuzinzisa iimarike zee-inshorensi zabo, kwaye endaweni yoko zibeke kwiindawo zokuzonwabisa ezikhuselekileyo . Ezi zixhobo ezinobungozi obuphezulu ziza kubambisa abantu abaneemeko zangaphambili ezithe zavela kwiimarike zangasese ukuba iimali-mali zixhomekeka kwiimeko zempilo zabhalisile. Amazwe angama-35 anemithombo yamanzi ephambili phambi kwe-ACA, kwaye ahlala ehlawulwa ngemali. Ukubuyela kwiindawo ezinobungozi obuphezulu njengendlela isisombululo, kwaye kuya kufuna imali engaphezulu kunezo zamachibi ezifunyenwe ngaphambili.
Siya Kuvelaphi Kulapha?
Nangona iTrump kunye nePence ziye zatsho ukuba idibaniselwano izayo ngokukhawuleza, iingxoxo zibonakala zide zide, kwaye akuzange kubekho izilungiso ezikhoyo zikarhulumente kwi-AHCA. Ingxoxo ingaqhubeka emva kokupheka kwentwasahlobo, kodwa mhlawumbi akukho nto inokwaneleyo yomhlaba ophakathi kuzo zombini iziphelo ze-Republican delegation ukuba zivumelane ngendlela eya phambili.
Ukuba umthetho awugqitywanga ukuphelisa okanye ukutshintsha ii-ACA, kuya kuhlala umthetho welizwe. Nangona kunjalo, ikusasa layo lixhomekeka kakhulu kwizenzo zokuLawula uTywala.
Abatshutshisi baye baqaphela iinyanga ezifunekayo ukuze babone ezinye iindlela zokumanyaniswa kweemakethi ezibekwayo ukuze ziqhubeke nokunika inkxaso ngo-2018. Ababambiseneli ababini-i-Humana kunye ne-Iowa Wellmark-sele bhengeze ukuba abayi kuthatha inxaxheba kwi-ACA- omnye umakethi ohambelana nomnyaka ozayo, kwaye abanye bangayilandela xa beva ukuba kuninzi kakhulu ukungaqiniseki ngokwenzekayo ngokuzayo.
INdlu v. Intengo: I-Cost-Sharing Subsidy Lawsuit
Ii- ACA zenkxaso-mali zokwabelana ngeendleko ngoku zixhomekeke kumgwebo (iNdlu v. Intengo, eyayisakuba yiNdlu v. Burwell) eyayifakwe yiRephablikhi yeeNdlu ngo-2014. ukutyunjwa yiTrump ukukhokelela i-HHS, apho yena ngoku kungummangalelwa kwimeko) ixela ukuba inkxaso-mali yokwabelana ngeendleko ihlawulwa ngokungemthetho, njengoko imali yayingabelwe ngumthetho. I-suit yabo yayifanelekileyo, kwaye ijaji yenkundla yesithili yalawula ngokufanelekileyo ngoMeyi 2016.
Ulawulo lwe-Obama luthintele, olwalugcina i-inkxaso-mali yokwabelana ngeendleko ezigeleza kubaxhasi-mali. Emva koko uTrump ephumelele ukhetho, iiNdlu zeRiphabhulikhi zacela ukuba ityala libekwe xa belungiselela ikamva le-ACA. Ingxelo yesimo ibanjelwe enkundleni ngoMeyi 22.
Ukuba iiNdlu zeRiphabhliki zityhila le nkundla, okanye ukuba iCongress ithatha isigqibo sokudlulisa umthetho ukulungiselela inkxaso-mali yokwabelana ngeendleko, iNdlu v. Ngakolunye uhlangothi, ukuba ulawulo lweTrump liye lahla isibheno sokuba ulawulo luka-Obama luqalise, ukuthengwa komntu ngamnye kuya kubakho ukuwa kwebalaseleyo (abagcini-bhantshi banesigqeba sokusinda kwiikontraki zabo nge-HealthCare.gov ezivumela ukuba baphume ekutshintshisweni ukuba iindleko -eenkxaso-mali iphela).
Uzinzo lweMarike
NgoFebruwari 2017, i-HHS icebise iindidi zeenguqu zolawulo ezijoliswe ekuzinzeni imarike nganye. Kodwa ngexesha elifanayo, umhla kaTumpump owodwa olawulayo oyalela i-arhente ye-federal ukuba ibe yinyanzelo ekunyanzelweni kwawo kwe-ACA ineempembelelo ezichaseneyo.
Ngokomzekelo, ii-IRS zacwangcisa ukuba ziqine ngakumbi malunga nendlela abaye baqhuba ngayo iintlawulo zerhafu ngo-2016 ngokubhekiselele kumgunyazo ngamnye we-ACA. Kodwa ngokulandela umyalelo olawulayo, baphinde baphendule inkambo kuloo nto, kwaye baqhuba ukubuyisela ngendlela efanayo naleyo ababeyenzayo kwiminyaka yangaphambili . Nantoni na eyenzela ukuba buthathaka isigunyaziso somntu ekugqibeleni iyanciphisa ukuzinza kweemarike ze-inshorensi, kuba bambalwa abantu abanempilweni abanobhaliso.
Yintoni elandelayo?
Kule ngongoma, ikusasa le-ACA kunye ne-2018 nganye yemarike yempilo yomshuwalense yenyuka kakhulu emoyeni. Abameli beRiphabhliki kunye neNdlu ye-White House bazama ukuvuselela i-AHCA, kodwa akucaci ukuba baya kuba nako ukwenza njalo. Nangona i-ACA ihlala ihambile, kunjalo, iimarike ze-inshurensi eziyimpumelelo zifuna imithetho ezinzile, inkxaso-mali eyaneleyo kunye ne-pool efanelekileyo enobungozi. Asisazi ukuba zonke ezo ziza kuphuma ngaphaya kweenyanga ezizayo.
> Imithombo:
> Congress.gov, HR1628 - UMthetho wezeMpilo waseMelika ka-2017. I-Congress ye-115 (2017-2018).
> Congress.gov. S.Con.Res.3. I-Congress ye-115 (2017-2018)
> I-Congressional Budget Office I-Estimate Cost, uMthetho we-Health Health Act , ngo-13 Matshi 2017. (kunye nokucwangciswa kokulungiswa ngoMatshi 23, 2017)
> Isebe lezeMpilo kunye neNkonzo zoLuntu, uMkhuseli weMonde kunye noMthetho woNonophelo oThengisekayo , uMgangatho woKhuseleko , isaziso se-rulemaking ecetywayo. Fe bruwari 2017.
> Garrett, Bowen; Gangopadhyaya, Anuj; I-Urban Institute, Ngubani Ofumana Ubungqina Bomshuwalense Wezempilo Ngaphantsi kwe-ACA kwaye Baphilaphi ? Disemba 2016.