Ukuguqulwa kwezempilo kwimibuzo yezopolitiko e-US iminyaka emininzi, kwaye kunye neCandelo loLawulo lweTrump esikhundleni, i-Future of the Affordable Care Act ayiqinisekanga. Iqela ngalinye lifuna ntoni? Makhe sijonge indlela iipolati ezisemthethweni zeDemocratic Party kunye nePublic Republic Party ezinokuchaphazela ngayo i-inshorensi yakho yempilo.
Isikhokelo soMthetho ononophelo loNonophelo
Amademokhrasi ngokubanzi axhasa i-ACA, kodwa angathanda ukulungisa iimpazamo zayo kwaye ngokubanzi ukuphucula umthetho.
Iidemokhrasi zicebise ithuba lokunyusa ii-ACA kwiindawo zase-US, kwaye zifuna ukuxhobisa amazwe ukuba asetyenzise ukukhishwa kwezinto ezintsha (1332 waivers) ukudala iindlela zabo zokulungiswa kweenkonzo zempilo ezinokuthi-okanye ezingcono kunoko-inkqubo yangoku. Abaninzi bamaDemokhrasi bancedisa ukulungisa i-ACA's " family glitch " ngokuqulunqa ukubala kokufumana umrhumo oxhaswe ngumqeshi kwiipresimesi zentsapho kunokuba i-premiums kuphela.
I-Trump kunye nabaninzi bamaRiphabhulikhi bafuna ukuphelisa i-ACA kwaye baqale ngeendlela ezintsha. Kukho ukulungelelanisa apha nangona kunjalo; Ababini baseRepublican Senators baqalisa umthetho ngoJanuwari 2017 obenokunika i-option yokugcina ii-ACA okanye ukutshintshela kwinkqubo entsha.
Ukwandisa iMedicaid
Ukwandiswa kweMedicaid yintloko yeCAA kunye neengxelo zengxenye ebalulekileyo yokwanda kwenani labantu baseMerika abanomshuwalense wezempilo.
I-ACA idinga ukuba iMedicaid ilandiswe kuwo wonke urhulumente, ukubonelela ngeenkcukacha kubantu abanomvuzo wekhaya ukuya kuma-138 ekhulwini kwinqanaba lehlwempu.
Kodwa iNkundla ePhakamileyo yagweba ngo-2012 ukuba ukwandiswa kweMedicaid kwakuya kukhethwa kwilizwe, kwaye ukususela ekuqaleni kuka-2017, kwakukho ama-19 athi ayengamkeli inkxaso ye-federal ye-Medicaid yokwandisa.
Ngama-18 kulawo mazwe (konke kodwa iWisconsin), kukho ikhefu leMediicaid; abantu abayizigidi ezi-2.6 banamathela ngaphandle kokufikelela kwiMedicaid OKANYE inkxaso-mali ye-premium kulezo zizwe.
Iidemokhrasi zifuna ukunyusa i-ACA's Medicaid ukwandiswa kweziganeko ezingama-19 ezingakhange zandiswe, kwaye zichasene neziphakamiso zokuvimba i-Medicaid inkxaso-mali kumazwe (iziphakamiso zezibonelelo zebhanki ziquka ukuphelisa inkqubo yangoku yemali ehambelanayo kunye ne-state based Medicaid mali, kwaye kunoko kunika ixabiso elimiselweyo leemali ezisetyenziselwa ukusetyenziswa njengokuba zibona zifanelekile kwinkqubo yabo yeMedicaid).
AmaRiphabhulikhi afuna ukuphelisa i-ACA, eya kubandakanya ukuphinda ukwandiswa kweMedicaid. Indlela ekhethwa ngayo kwiMedicaid ivimba ukunikezelwa, kwaye iqonga leqela lichaza ukuba baya kunika ilizwe ngesandla samahhala sokuphucula i-Medicaid nge-block-granting program ngaphandle kwemigqa. AmaRiphabhlikhi acebise kwakhona i-Medicaid izabelo eziza kuthiwa.
IiAkhawunti zokuSindisa iMpilo
Ii-Akhawunti ze-Savings Health (ii-HSAs) zi-akhawunti ezixhamliweyo zerhafu abantu abangayisebenzisa ukugcina imali yokuhlawula iindleko zonyango lwexesha elizayo. Ziba yi-trifecta yokulondoloza irhafu:
- Imali oyifakayo kwi-akhawunti iyancitshiswa kwi-tax return yakho (okanye u-pre-tax pre-tax) xa usenza igalelo kwi-HSA yakho nge-deduction payroll).
- Imali kwi-akhawunti ikhula ihlawula irhafu.
- Awusayi kuhlawulwa irhafu ngemali xa uyayigxotha, nje kuphela xa uyisebenzisela ukuhlawula iindleko zonyango ezifanelekileyo (abanye abantu basebenzisa ezi ngxelo njenge-IRA yeNdabuko, njengoko imali ingasuswa kwiinjongo ngaphandle kweendleko zonyango ngaphandle isohlwayo emva kweminyaka yobudala engama-65. Kodwa kwimeko apho, ukurhoxiswa kuya kuba phantsi kwentlawulo yengeniso rhoqo).
Imimiselo ye-IRS yangoku ivumela abantu abaneziCwangciso zezeMpilo eziPhezulu eziHloniphekileyo ze-HSA (HDHPs) ukufaka isandla kwi-HSA, kwaye kukho imingcele yegalelo: Ngo-2017, inani elininzi ongayinayo kwi-HSA yi-$ 3,400 umntu, okanye i-$ 6,750 i-HDHP yakho yentsapho.
Nangona i-HSA ngokuqinisekileyo iyilona eluncedo lokuxhasa iindleko zonyango lwexesha elizayo-kunye neentlawulo zabo zerhafu zibalulekile-kufuneka sihlale sikhumbula ukuba ukusetyenziswa kwazo kuphela kufana nokufikelela komntu kunye nokuzimisela ukuxhasa i-akhawunti. Ngaloo ndlela, bathambekele ekuthandweni ngabantu abanemali ephezulu.
Iidemokhrasi azange ziphakamise nayiphi na inguqu ebonakalayo kwimimiselo ekhoyo elawula iiAkhawunti ze-Savings Health.
AmaRiphabhulikhi, ngakolunye uhlangothi, ziqwalasela i-HSAs ukuba isisombululo sokwenza unonophelo lwezempilo. Umgca wokuqala wephepha le-Trump yephepha lokunakekelwa kwezempilo ngexesha lephulo lathi " Phinda uphinde ufake indawo ye-Obamacare nge-Akhawunti ze-Savings Health ." Ziye zacetywa utshintsho oluthile, kubandakanywa nemida ephakamileyo ephezulu (mhlawumbi ihambelaniswe neHDHP echithwayo), izithintelo ezimbalwa ukuba ngubani onokufaka isandla kwi-HSA kunye nemithetho ekhululekile ngokubhekiselele kwindlela imali ye-HSA ingasetyenziswa ngaphandle kweerhafu okanye izigwebo.
Iimali ezimbini eziye zaziswa ngamaRiphabliki aseJanuwari ngo-Januwari 2017 zibiza utshintsho olubandakanya ii-HSAs: UMthetho woKhuseleko weMpilo uya kutshintsha ii-HSAs kwi-Roth HSAs (iminikelo ayiyi kuhluthwa, kodwa ukukhula bekuya kuba yerhafu, kwaye ukuhoxiswa kweendleko zonyango kuya kuba yerhafu ezikhululekile), kwaye ziyakwandisa umda wenkxaso. Umthetho wokuTshintshiselwa kwe-Obamacare uza kuphelisa umda wegalelo ngokupheleleyo, kwaye uza kuvumela i-HSA ukuba isetyenziswe ngabantu abangenawo ama-HDHP.
Ukuxhaswa kweNkulumbuso kunye nokungaqiniseki
Inkxalabo ephambili ngokukhawuleza ngokwemivuzo ye-inshorensi yempilo kunye nokukwazi ukukwazi ukufikelela kwiindawo zentengiso , apho iirhafu zenyuka ngokukhawuleza ngo-2017. Iimarike zodwa ziyingxenye encinci yabemi, nangona kunjalo, kwaye izinga lokunyuka liye lafudulwa kakhulu lilonke labantu.
Iidemokhrasi zicebise izicwangciso ezahlukeneyo zokwenza ingxelo kunye nokunyamekela. Zibandakanya iikhredithi zerhafu zabantu abachitha imali engaphezulu kweefomenti ezi-5 zengeniso yabo, kunye nokwandisa inkxaso-mali ye-premium ukuqinisekisa ukuba akukho mntu kufuneka ahlawule ngaphezulu kwe-8.5 pesenti yengeniso yee-premiums, eza kuphelisa "i-cliff". ikhona kubhalisi abathile.
Iidemokhrasi ziye zacetywa "ukhetho loluntu" icebo lempilo eliza kukhuphisana nabathwali bomshuwalense bezempilo ngasese ngenzame yokuphuhlisa amaxabiso, kunye nekhono labantu abaneminyaka engama-55 nangaphezulu ukuthenga kwi-Medicare, okwangoku ihlinzeka ngokukhawuleza ukuqala xa abantu bejika 65 .
Iidemokhrasi nazo zifuna ukunika igunya likarhulumente ukuvimba ukunyuka kwezinga elithathwa njengento engafanelekanga. Okwangoku, ukuba kube neprogram "yokuphononongwa kwezinga lokuphumelela", urhulumente-okanye urhulumente-federal-ufanele uhlaziye iirhafu ezicetywayo kwaye unqume ukuba ngaba ulungelelwanga okanye cha. Kodwa ngaphandle kokuba urhulumente enze umthetho obavumela ukuba bavimbele amaxabiso angenakulungiswa, akukho nkonzo eyakhelwe kuyo. Kufuneka kuqatshelwe, nangona kunjalo, ukuba imithetho yokulahlekelwa kwelahleko yangoku ifuna i-insurers ukuba ithumele izibonelelo kumalungu ukuba iindleko zabo zokulawula zidla ngaphezu kwama-20 eepesimenti; oku kudala ukukhuselwa okuzakhelwe ngaphakathi kwintengo yokugubha ngenjongo yokuqhuba inzuzo okanye ukuhlawulwa komlawuli.
AmaRiphabhliki ancomele ukuvumela abantu ukuba bathathe ngokupheleleyo iiproyamu zabo zee-inshurensi kwiirhafu zabo, eziza kunciphisa iindleko zangempela zokubhengezwa. Iimali-mali ze-inshorensi zempilo zenkxaso-mali ezixhaswe ngumqeshi zihlawulwa kwangaphambili phambi kwentela, kwaye abantu abaqeshwe ngabanye banokubamba iiprayimari zabo.
Kodwa abantu abangaqeshwanga abazithengayo zabo iinshurensi zempilo abakwazi ukukhipha iipriyamu zabo njengamanje ngaphandle kokuba baxhomekeke kwiintlawulo zabo. Ukuba bayenza loo nto, bavunyelwe kuphela ukuba bathathe iindleko zonyango-kuquka iiprayimari- ezigqithisa iipesenti ezili-10 zengeniso yabo . Oku kunenzuzo kakhulu kubantu ngabanye kunemithetho yangoku yomshuwalense oxhaswe ngumqeshi kunye nabantu abaqeshwe ngabanye.
AmaRiphabhulikhi afuna ukuvumela abantu ukuba bathenge i-inshurensi yezempilo kwimida yelizwe ukwenzela ukwandisa ukhuphiswano kunye nokuhla kwexabiso. Nangona kunjalo, akucaci ukuba ngaba ngaba-inshurensi banomdla wokwandisa iinkalo zabo zangoku, ngenxa yemingeni echaphazelekayo yokwakha inethiwekhi kwindawo entsha.
Kukho nemibuzo malunga nokulawulwa kokulawula, njengoko ukulungiswa kwamanje kuvumela uKomishinala we-Arhente ngamnye welizwe ukuba alawule onke amaplani athengiswayo kwimeko (nangona iinkampani ze-inshorensi zihlala zihlala kwelinye ilizwe), oko kuthetha ukuba abathwali kufuneka batshintshe ukuhanjiswa okunikezelwa urhulumente ngamnye uhambelana nemimiselo ethile yombuso. Ukuba lolawulo lolawulo lwasuswa ngenxa yezicwangciso zelizwe kwaye i-ACA yachithwa ngokufanayo, ukukhuselwa kwabathengi kuya kuncipha njengokuba abaqhankqalazi bayakukhetha ukuhlala kwiindawo ezinemimiselo ye-lax.
Ukukhulelwa nokukhupha isisu
Igama lokukhipha isisu lisetyenziswe ngamaxesha angama-35 kwiPlatiphi yePublic Republic, kodwa zihlandlo ezithandathu kuphela kwiDemocratic Party Platform. I-GOP yenza ukuba kucaciswe ukuba bafuna ukuphelisa yonke inkxaso ye-federal kwimibutho efana ne-Planned Parenthood enikezela ngeenkonzo zokukhipha isisu. Nangona iDemocratic Party ikholelwa ukuba "ukukhupha isisu okukhuselekileyo makube yinxalenye yokunakekelwa kwempilo yabantwana kunye nabesifazane," i-GOP "imelene" nokukhipha isisu. I-Trump iye yamkela imimiselo efana nokukhipha isisu .
I-Hyde Amendment sele isendaweni ukususela ngowe-1976, kwaye ivimbela ukusetyenziswa kweemali zika-federal ukuhlawula ukukhupha isisu kwiimeko ezininzi. Nangona iDemocratic Party Platform ifuna ukuchithwa kwe-Hyde Amendment, iSiphathamandla sePublic Republic Party sibiza ukuba ikhodification yayo kunye "nesicelo kulo lonke urhulumente, kuquka u-Obamacare."
Iidemokhrasi ngokubanzi zixhasa uxhaso lwe-ACA ukuba zonke izicwangciso ze-inshorensi yezempilo kufuneka zibandakanye i-contraceptive ngaphandle kokubiza iindleko, kwaye iinkokheli zeDemocratic ziyimpumelelo ekwenzeni ukukhulelwa kwexesha elingxamisekileyo kwi-counter-counter.
ISiphathamandla sePublic Republic Party sichasene neeklinikhi ezisekelwe ezikolweni ezibonelela ngemithi yokukhusela, kwaye zigatya ingcamango yokuvumela "i-contraceptive ezinamandla" ukuba ithengiswe ngaphaya kwe-counter. Kodwa iTump ixelele ukuba uvumelekile ukuvumela ukuthengiswa kwemithi yokukhusela ngaphandle kwemithi.
Iimeko eziPhambi kwexesha
I-ACA isitshintshe ubuso bomshuwalense wezempilo ngamnye ngokwenza ukuba kuqinisekiswe ukukhutshwa kuzo zonke iinkalo, kungakhathaliseki ukuba sele zikhona. Iiprogram ze-inshorensi zempilo yeqela sele zifuneka zikhusele izimo zangaphambili ezikhoyo, kodwa zinokumisela iimeko zangaphambili zokulinda ngaphambi kokuba kube ngu-2014 (ukuba kucace, abaqinisekisi bavunyelwe ukuhlawula abaqeshi amaphammamu aphezulu kumazwe amaninzi asekelwe kwimbali yamabango, kodwa Abasebenzi ngabanye abakwazanga ukukhishwa kwisicwangciso seqela ngenxa yeemeko zangaphambili).
Ngoku ukuba i-ACA iphunyeziwe, izimo ezandulele zikhona zifakwe kuzo zonke izicwangciso (ngaphandle kweemarike ezizimeleyo). Abaqeshi banako ukulinda ixesha elide ukuya kwiintsuku ezingama-90 phambi kokuba i-postage iqalise ukusebenza, kodwa xa yenze njalo, iimeko ezikho ngaphambili zihlanganiswe ngaphandle kwexesha lokulinda elongezelelweyo.
Iidemokhrasi zifuna ukugcina i-ACA, kubandakanywa nemimiselo ekhusela abantu abaneemeko ezikhona ngaphambili.
Ezinye iziphakamiso zeRiphabhlikhi zifuna ukuchithwa ngokupheleleyo kwe-ACA, oku kuthetha ukuba imeko ekhona ngaphambili iyakwazi ukuvumela kwakhona umshwalense ukuba anqabe ukukhawulelwa kumakethi athile, okanye afune ixesha lokulinda kwiimarike zeqela. Ezinye iziphakamiso zeRiphabhlikhi zifuna ukugcina ukukhuselwa kwabantu abaneemeko ezikhoyo ngaphambili.
Kwiiphakamiso zeRiphablikhi eziza kuphelisa umbandela oqinisekisiwe we-ACA, kukho iifowuni zokuvuselela izixhobo zamanzi ezikhuselekileyo ezisemgangathweni ukwenzela ukuba bakhonze abathengi abaneemeko ezikhoyo ngaphambili. I-Trump ithe kwakhona isisombululo sakhe esisekelwe kwiimarike (njengokuvumela ukuthengiswa kwezicwangciso kwiinkalo zombuso) kuya kuvumela abathwali ukuba baqhubekele ukugqithisa imiqathango ekhoyo ngaphambili ngaphandle kwemimiselo eyimfuneko, kodwa kukho ubungqina obuncinane obuya kuba yimeko.
Iindleko zeDrug
Iidemokhrasi zifuna ukunciphisa iindleko zokuphuma kwenyanga kwimizi-mveliso (ukuxhalabisa apha iindleko eziphambili zeendleko, ezixutywe nge-coinsurance-iphesenti yeendleko-kunokuba i-copays plates; iindleko zokufumana imimiselo).
Iidemokhrasi nazo zifuna ukuphelisa " ukuhlawulela ukulibazisa ," (umkhuba ogcina izidakamizwa eziphantsi kweendleko ze-generics ngaphandle kweemarike). Iqela leqela libandakanya ukuvumela ukungenisa okusemthethweni kwemigqaliselo evela kwamanye amazwe, nokuphakamisa ukuvinjelwa kwangoku kwi-Medicare ukuthethisana namaxabiso eziyobisi kunye nabenzi bezobisi.
I-Platform yePublic Republic Party ayiqwalaselisi imiqathango ngaphandle kwimeko yesifo se-opioid kunye nemigudu yokujongana nokusetyenziswa kakubi kweziyobisi. Ngethuba lophulo, uTrump wathi ufuna ukuxoxisana neendleko kunye ne-shishini lezobisi, kwaye ukuvumela ukungenisa izidakamizwa eziphantsi kwamanye amazwe. Nangona kunjalo, isikhundla sakhe ekuxoxweni kwexabiso leziyobisi sasitshintshile ngasekupheleni kukaJanuwari.
Mandate
Igunya lomntu ngamnye we-ACA (ukunikezelwa komntu ngamnye wabelwe uxanduva) ludinga abaninzi baseMelika ukuba bagcine i-inshorensi yempilo okanye bajongane nesohlwayo serhafu. Abanini-mali baqinisekisa ukuba le yindlela eyodwa yonyanzeliso ye-inshurensi yezempilo inokufezekisa, kwaye amava angaphambili akwazi ukuxhasa le mabango.
Amademokhrasi ngokubanzi axhasa igunya lomntu ngamnye.
AmaRiphabliki awanxamnye nawo, nangona, ekuqaleni kuka-2016, iTump yabonakala ibonisa ukuba iyayithanda. Wabuyela ngokukhawuleza isikhundla sakhe, ebona ukuba uncedisa ukupheliswa ngokupheleleyo kwe-ACA, kubandakanywa nomyalelo ngamnye.
Igunya lomntu linye yimiba ephikisanayo ne-ACA, kwaye isohlwayo esinxulumene nalo singasuswa kunye ne-bill-proof proof-reconciliation bill. Oku kungabangela ukungazinzi kwimarike yempilo yomshuwalense, nangona kunjalo, kwaye umcimbi usabonwa ngabamthetho, kunye negalelo evela kwishishini lomshuwalense kunye nabameli bemboleko.
> Imithombo:
> Barnett JC, Vornovitsky MS. I-Ofisi yoBalo-mabango base-United States, iNgcaciso ye-inshurensi yempilo e-United States: 2015 . Kukhutshwa ngoSeptemba 2016
> Blumberg LJ. I-Urban Institute. Ukuthengiswa kwe-inshurensi kummandla welizwe, ngo-Juni 2016.
> Amasebe e-Medicare kunye neeNkonzo zeMedicaid, iZiko loLwazi loThengi kunye noLawulo lweNtshuwalense. Icandelo 1332: i-State Innovation Waivers
> Garfield R, iDamico A. Kaiser Family Foundation, I-Gap Coverage: AbaNcinci abaNcinci kwiiNkampani ezingenakwandisa iMedicaid - Isibuyekezo. NgoJanuwari 21, 2016.