Ukunyuka kwamayeza, ukuNqongophala koGqirha, kunye neNkcitho yeDrug
UMongameli uTump uthe wenza izithembiso ezininzi kwi-campaign . Enye yazo yayikugcina i-Medicare-oko kukuthi, akayi kugawula i-Medicare. Esinye isithembiso sasenza ukuba inkqubo ibe yindleko ephezulu kubaxhamli. Ngesiphakamiso sayo sesabelomali sika2019, wenza utshintsho oluthile kwi-Medicare olwenzayo kwaye alufezekisi eso sithembiso.
Ukuxhaswa kweMali kuNyango
Utshintsho lokuqala luchasene ngqo nento uMongameli athembise ngayo amalungu akhe.
Uhlahlo lwabiwo-mali lwe-2019 luphakamisa i-$ 236 kwi-Medicare idlula iminyaka engama-10.
I-White House ithi abaxhamli abayi kubona ukuhla kweentlawulo zabo. Esikhundleni saloo nto, bathi ukuba ukunciphisa iindleko kwakuvela kwezinye iinkalo zeprogram ye-Medicare. Izinto ezichaziweyo azange zichazwe kodwa zinciphise iintlawulo kwiingcali kunye nezibhedlele kulindeleke.
Ukugqithiswa kwezeMpilo zoLwazi
Umbutho weeNyuvesi zeMerika zezeMpilo uqhube isifundo ngo-2017 esomeleza oko inkqubo yezokwelapha isoloko iyika-ugqirha. Ngo-2030, leli lizwe lilindeleke libe lifutshane elifutshane kuma-40,800 oogqirha kuzo zonke iindawo ezizodwa.
Ngo-2016, kwakukho oogqirha abangama-953,695 abanelungelo lokusebenza e-United States. Kwaloo nani, iipesenti ezingama-27.1 zamagqirha zaziphakathi kweminyaka engama-56 no-65 ubudala. Enye i-13.1 pesenti yayineminyaka engama-66 nangaphezulu. Ngelo xesha, kwakukho kuphela aba-19 254 abaphumelele kwizikolo zezokwelapha ngaloo nyaka.
Ngama-40 engama-40 ekhulwini oogqirha abasondela kwiminyaka yokuthatha umhlalaphantsi kwaye ke bambalwa abangena emsebenzini, abayi kuba neenkokhelo zamagqirha ukuhlangabezana neemfuno ezikhulayo zabantu abalupheleyo, ukuba bangathethi inani elinyukayo labantu abaqinisekisiwe phantsi koMthetho wokuNakekelwa ongenakuncedo.
Nangona le nkonzo engenakulinganisela kunye nemfuno, uhlahlo lwabiwo-mali lwe-FY 2019 luphakamisa i-$ 48 yezigidigidi ezigqityiweyo ukugqiba imfundo yezokwelapha (GME) ngaphezu kweminyaka eyi-10.
Iimali ze-GME zihlawula uqeqesho lokuhlala kwizonyango . Izikolo ezininzi zonyango zingavula kwaye ziqeshe abafundi, kodwa zingenakho ukufumana uqeqesho lokuhlala, abo baphumeleleyo bajamelana ne-bottleneck kwinkqubo. Ukunciphisa imali yokuhlala yokuhlala kunokwenzeka ukunciphisa inani labahlali abaqeqeshwe kunanoma yimuphi unyaka onikezelweyo, okwenyuka ngakumbi kunyanzelekile.
IiAkhawunti zokuSindisa iMpilo
UMongameli uTrump ukhankasele kwi-Medicare ukuvumela ukusetyenziswa kwe- akhawunti yokulondoloza impilo (HSA) , kwaye kubonakala ukuba uhlala ethembekile kwisithembiso.
I-HSA yi-akhawunti yokulondoloza irhafu echithwe irhafu esetyenziselwa iindleko zempilo. Abantu bangakwazi ukugcina imali kwi-pre-tax base kwaye bahoxise ukuba imali yerhafu ngaphandle nje kokuba imali iya kwiindleko zonyango ezifanelekileyo. Kuze kube isiphakamiso sesabelomali se-FY 2019, i-IRS ayizange ivumele ii-Medicare abaxhamli ukuba banikele kwi-HSAs.
Ngo-2018, umntu unokugcina imali engama-3,450 kwi-HSA kunye nentsapho eninzi i-$ 6,900. Abantu abangaphezu kweminyaka engama-55 ubudala bangagcina i-$ 1,000 eyongezelelweyo ngonyaka xa bebengekho kwi-Medicare. Ziziphi iimali eziya kuvunyelwa ukuba abaxhamli beMedare bahlale bengacacanga.
I-Medicare Part B Medication
Ayikho yonke imishanguzo yonyango echazwe kwi- Medicare Part D. Amanye amayeza ahlawulwa phantsi kwe- Medicare Part B.
La mayeza aquka, kodwa awanamkhawulo, izidakamizwa zokungabikho komzimba, iziyobisi ezichasene nomhlaza, izidakamizwa ezichasayo, izidakamizwa ze-immunosuppressant, i-IV infusions, unyango lwe-nebulizer, unyango lwe-osteoporosis, izifo zethubhu kunye nezinye izitofu .
Ngaphantsi kwe-Medicare kwiNgxenye B, ezininzi zezi ziyobisi zibuyiselwa xa zinikezelwa kwaye zilawulwa kwiofisi yonyango okanye kwisebe eligulisa izibhedlele. Ngenxa yeendleko ezongeziweyo zokulungiswa, ukugcina nokulawulwa kwezi gulane zokusetyenziswa kwesigulane, ezi ndawo ziye zavunyelwa ukuba zihlawulise abaxhamli beMedare kangangokuba ama-6 ekhulwini aphezulu ngaphezu kwexabiso eliqhelekileyo lokuthengisa kwiyeza ngalinye.
Isiphakamiso sesabelo-mali se-FY sika-2019 sijolise ekupheliseni ugalelo lweNgxenye B yemithi kunye nokutshintsha iindleko zonyango kwiCandelo D. Ngokuhambisa isahlulelo B kwiNgxenye D, ababoneleli beMedare abayi kuba noxanduva lokulawula amayeza kwiofisi. Endaweni yoko, isigulane siza kugcwalisa isigqirha kwaye siyizise ugqirha wabo ukulawula. Oku kuya kususa nayiphi na inzuzo yomncedisi onokuthi abe nayo xa echaza amachiza aphezulu axabisekileyo. Ngexesha elifanayo, kuba nzima kakhulu ukuba isiguli singene kumanyathelo angaphezulu.
Iindleko zeeDrug zokunciphisa
Ukunciphisa iindleko zemithi yokugonywa ngamayeza kuye kwaba yinto ephambili, kwaye uhlahlo lwabiwo-mali lwe-FY 2019 lugxininisa ekwenzeni oko. Iphepha elimhlophe yiBhunga labacebisi ngezoQoqosho lichaza iindlela ezininzi, nangona kungasayi kucacisa ukuba zeziphi iimodeli eziza kulandelwa.
Iphepha elimhlophe lidibanisa ngokucacileyo ukulungiswa kwemali kaRhulumente . I-GOP ihlala ikholwa enamandla kwimarike yamahhala. Kananjalo ayincedisi ukungenisa izidakamizwa ezingabizi ngaphantsi. Injongo kukukhuthaza amashishini aseMerika.
Enye indlela kukukwenza kube lula kwi-FDA ukukhawulezisa izicelo zeziyobisi zamachiza omzimba okanye imishanguzo emachiza engenayo i-generic evumelekileyo. Kule ngcamango, oku kuya kunyusa ukhuphiswano kwiindawo zokuthengisa kunye nokunciphisa iindleko.
Enye indlela yokuphucula ubudlelwane phakathi kwezigulane kunye noshishino lwempilo. Abatshutshisi bangafuneka ukuba babelane ngezaphulelo abazifumana kwiinkampani zonyango kunye nezigulane. Izilungiso zingaphakanyiswa ukwenzela ukuba abaxhamli be-Medicare bangasebenzisa iifowuni zonyango.
Inkqubo exhaswa nguMongameli Trump iza kuphelisa ukwabelana ngeendleko , oko kukuthi iifayili kunye nokudityaniswa kwemali, kuba abantu abanezindleko zonyango eziphezulu kwi-$ 8,418 okanye ngaphezulu ngonyaka. Ngelishwa, ukulungelelanisa ezo ndleko, iindleko ezingaphandle kweefowuni ziya kukwandisa kubaxhamli abangayithobeli loo mda.
ILizwi
Isiphakamiso sesabelomali se-FY sika-2019, ukuba sidlulile, siya kubakho kunye kunye noGawulayo. Nangona kunokunceda ukunciphisa iindleko zeziyobisi zonyango zabanye abadala (ukwandisa abanye) kwaye bavumele ukuba basebenzise i-akhawunti yokulondolozwa kwempilo, kuya kunciphisa imali yeprogram ye-Medicare ngokubanzi kwaye ibe yinto ebenzileyo kunokungena kwezadokotela.
> Imithombo:
> Ukuhlaziywa kwe-2017: Ukuxhamla kweZibonelelo kunye neNqununu yeeMpilo - Izilungiso ukusuka ngo-2015 ukuya ku-2030 . Umbutho weeNyuvesi zaseMerika zezoNyango. https://aamc-black.global.ssl.fastly.net/production/media/filer_public/c9/db/c9dbe9de-aabf-457f-aee7-1d3d554ff281/aamc_projections_update_2017_final_-_june_12.pdf. Ipapashwe ngoFebhuwari 28, 2017.
> IsiHlomelo kunyaka-mali we-2019 uhlahlo lwabiwo-mali. Ofisi yoLawulo kunye neBhajethi. https://www.whitehouse.gov/wp-content/uploads/2018/02/Addendum-to-the-FY-2019-Budget.pdf. Kukhutshwa ngoFebruwari 12, 2018.
> Unyaka wezeMali 2019: iBhajethi yaseMelika. Ofisi yoLawulo kunye neBhajethi. https://www.whitehouse.gov/wp-content/uploads/2018/02/budget-fy2019.pdf. Kukhutshwa ngoFebruwari 12, 2018.
> Ukuhlaziywa kwexabiso le-Biopharmaceutical Pricing ekhaya nakwamanye amazwe. IBhunga labacebisi bezoQoqosho. https://www.whitehouse.gov/wp-content/uploads/2017/11/CEA-Rx-White-Paper-Final2.pdf. Epapashwe ngoFebruwari 2018.
> I-Young A, uChaudhry HJ, Xiaomei Pei X, uArnhart K, uDugan M, uSnyder GB. Ubalo beeNgcali zoLwazi oluQinisekile kwiUnited States 2016 . J Med Regul. 2017; 103 (2): 2-21.http: //www.fsmb.org/globalassets/advocacy/publications/2016census.pdf.