Ukujonga kwiIcwangciso zokutshintsha i-Medicaid kunye ne-Medicare
UMongameli uDonald Trump wenza izithembiso kuMerika kwi-campaign. Ukuphindaphinda i-Obamacare nokugcina i-Medicare kwakuphezulu kwoluhlu. Ngaba uMongameli wethu uphila kwizo zithembiso?
Ukujonga i-Promump's Campaign Promises
Njengesikhumbuzo, uMongameli uTumpump ukhankasele kwisicwangciso sezempilo esixhenxe. Ngolu tshintsho olulandelayo, wenza isifungo sokunyamekela kwakhona impilo.
- Ukuphelisa uMthetho ojongene noNonophelo olungabonakaliyo, u-Aka Obamacare
- Vumela ukuthengiswa kwezicwangciso zempilo kuwo wonke umda welizwe njengoko nje izicwangciso zezempilo zilandela izikhokelo zelizwe
- Vumela abantu ukuba bathathe iipresimenti ze-inshorensi yezempilo kwiimbuyekezo zabo zerhafu
- Vumela abantu ukuba basebenzise ii- Akhawunti Zokulondoloza Impilo (HSA)
- Ukufuna ixabiso lentengiso kwi-system yonakekelo lwezempilo
- Ukuyeka ukunikezelwa kwezibonelelo zombuso ukuchaza iMedicaid
- Vumela ukunyuka kwiimarike zamahhala, kuquka ukuthenga izidakamizwa ezincinci ngaphandle kwezilwanyana, ukunciphisa iindleko zemithi yonyango
Ngaba uMongameli uTrump uhambisa izithembiso zakhe?
Ixilongo lithatha kwi-Medicaid
Kungakhathaliseki ukuba ukhangele njani, inkxaso- mboleko ye-Medicaid i-block block. Oku kunokuchaphazela ukuba baninzi abantu abakwazi ukufikelela kwiinkonzo zempilo ngeprogram.
Ukuphindaphinda i-Obamacare
Xa uMthetho woNonophelo ongenakunyanzeliswa wenziwa ngo-2010, kwakukho ama-Amerika angamawaka angama-48 angaqinisekanga, malunga neepesenti ezingama-15.7 zabantu.
Ngokweziko ze-Medicare kunye neeNkonzo zeMedicaid, ukugqithiswa komthetho kwanciphisa elo nani ukuya kuma-9.2 ekhulwini ngo-2015.
I-Obamacare yavumela abantu abaselula ukuba bahlale kwizicwangciso zabo zabafundi ixesha elide, banqanda iinkampani ze-inshorensi ukuba zandise iiprayimari ezisekelwe kwiimeko eziye zangaphambili , ezivunyelwe ukwandiswa kwiinkqubo ze-Medicaid ezikhoyo kwaye ziphuhlise indawo ye-Inshorensi yeMali ye-Inthanethi njengento enokuthethelela kwabo abangazange bahlangane imigaqo yeMedicaid.
Ukubeka nje, iindleko zee-inshorensi zangasese ngexesha langoku ziphakame kakhulu ukuba abantu abaninzi bakwazi ukulawula.
Abaninzi bathi u-Obamacare waqhubeka nokushiya izicwangciso zempilo ngaphandle kokufikelela kwimali. Iingxowa-mali ezininzi ezicwangcisiweyo ziye zaphakama kakhulu kangangokuba abantu abaninzi abanakukwazi ukuzithengela. Ngaba kungcono kunokungabikho nonyango yononophelo?
Ngokudlulisa uMthetho we-American Health Care Act (i-AHCA), uMongameli uTumpump uzimisele ukuguqula amaninzi yemigaqo ebekwe yi-Obamacare. Ngokwenza njalo, i-Ofisi ye-Congressional Budget iqikelela ukuba abantu abayizigidi ezili-14 baya kulahlekelwa ukufikelela kwi-inshurensi yempilo ngonyaka ozayo kunye nabantu abayizigidi ezingama-23 kwiminyaka eyi-10. Ukuba sichaze ngakumbi, ukuba silandela umkhondo okhoyo phantsi kwe-Obamacare, abantu abayizigidi ezingama-28 abangaphantsi kweminyaka engama-65 ubudala abayi kuba ngabasebenzi abangaqinisekanga ngo-2026 kodwa nge-AHCA, loo nombolo iya kufikelela kwiimitha ezingama-51.
Ukunquma uxhaso lukaRhulumente kwiMedicaid
U-Obamacare wanikela ngenjongo yokukhuthaza ukuba bakhethe ukuqhubeka nokwandisa iMedicaid . Lezo zizwe zafumana i-dollar federal ukuba zibancede, ukuya kuma-100 ekhulwini kwindleko zokwandisa iminyaka emithathu kunye neepesenti ezingama-90 zeendleko nge-2020. Ukunyuka kwe-Medicaid kwakuya kumiswa phantsi kwe-AHCA, nangona ulawulo lweTrump luya kuqhubeka nokuxhasa imali nge-2020. .
Ngaphandle kokuphelisa i-Obamacare, i-AHCA ijolise ukunciphisa ezinye iinkxaso-mali kwiinkqubo zeMedicaid. Icebise imali yokunciphisa imali yokuvimba izibonelelo . Ukususela ngowe-1965, amazwe athe afumana i-dollar federal kwi-Medicaid ngokusekelwe kwinani labantu abafanelekile kule nkqubo. Ukukhutshwa kwezibonelelo kuya kutshintshela konke, ukunikezela ngemali engqalileyo yeMedicaid kungakhathaliseki ukuba yimfuneko yombuso. Utshintsho lwemali luya kuthintela onke amazwe, kungekhona kuphela abo bathathe inxaxheba ekunyuseni iMedicaid.
Ukuncedwa kwezemfundo zonyango kwiMedicaid kubeka umthwalo onzima kumazwe ukufikelela iziphumo. Amaninzi amaninzi anzima neengxaki zebhajethi njengoko kunjalo.
Ngo-2016, ngaphezu kwesahlulo selizwe lafumana imali engaphantsi kwezimali zabo ezicetywayo kunye ne-19 zazo zafuneka zenze uhlahlo lwabiwo-mali lube lunyaka phakathi kweminyaka.
I-Congressional Budget Office iqikelela ukuba i-AHCA iya kunciphisa inkxaso ye-Medicaid nge-$ 800 yezigidigidi kwiminyaka elishumi ezayo. Ngokubeka umthwalo ophezulu kumazwe ukubonelela ngemali, ngubani kunye nento edibaniswa nguMedicaid. Amanye amazwe angakhetha ukusetha iifowuni zokubhalisa okanye ukuseka uluhlu lwezinto zokulinda kwi-Medicaid inzuzo kubantu abahlangabezana neemfuno zokufaneleka. Amanye amazwe anganyanzeliswa ukuba anqumle iingenelo zokugcina iindleko zokujonga. Abanye banokwenza zombini.
Intonga ithatha kwi-Medicare
Kulo phulo, uMongameli uTrump wathembisa ukuba akayi kunciphisa inzuzo ye-Medicare, kodwa i-AHCA iya kuba nefuthe kwi-Medicare abaxhamli. Kwakhona wenza izithembiso ezininzi kubantu abadala baseMerika ukuba akakade athathe isinyathelo.
Ukujongana neendleko zeDrug
Amachiza afanayo asetyenziswa eUnited States ahlala ehlawula imali kumazwe angaphandle. Ngokomzekelo, i-Advair, iyeza eliqhelekileyo elisetyenziselwa ukuphefumula i- asthma , libiza i-$ 309.60 ngeenyanga e-United States kanti ixabisa i-$ 74.12 eCanada kunye ne-46.99 kwi-United Kingdom. Ngexesha langoku, i-Medicare ayivumeli ababhalisile ukuba bathenge amayeza abo ngaphandle kweli lizwe ukuba bafumane amayeza angabizi. UMongameli uTumpump ufuna ukutshintsha loo nto. Noko kunjalo, ishishini lokuxuba imveliso, lisetyenziswe kulo.
UMongameli uTumpump ufuna ukuxoxisana neenkampani zaseMelika zokuxuba iirhafu ezingcono. I-Medicare Ingxenye D izicwangciso zezilwanyana zonyango njengamanje zilawulwa ngamashishini e-inshorensi yabucala, kunye nemithetho ikhona ekuthintela urhulumente wephondo ukuba angenelele kwixabiso lentengo. Kwakhona, kukho ukunyanzeliswa okuphawulekayo kwiikhampani zokurhweba ukuqhuba le mithetho.
Ngama-10 kuphela epesenti zemali echazwe ngamachiza, i-Ofisi ye-Congressional Budget (i-CBO) ithi abayikulindela ukunciphisa iindleko ezinkulu ngokungenelela kwe-federal. Ezinye iinkcazo zomgaqo-nkqubo zibonisa ukuba i-Medicare ingayigcina imali engama-R16 billion ngonyaka ngokuthetha kunye nokunciphisa iindleko zamachiza egama lomenzi kumanqanaba urhulumente wenkundla sele sele exoxaniswe kwiMedicaid kunye noLawulo lwezilwanyana .
Kuza kubekho namhlanje, akukho nyathelo elithatyathwe kumthetho elithathwe ekujonganeni nexabiso lemveliso.
Ugcino lwentlawulo
UMongameli uTumpump anganika amaMerika ithuba lokugcina kwiirhafu. Ngeli xesha, abaxhamli beMediare abavumelekanga ukuba bathathe inzuzo kwiakhawunti yokulondoloza impilo. Ngokutshintshwa komthetho, abaxhamli be-Medicare banokubeka bucala imali yerhafu ngaphandle kwenjongo yokuhlawula iindleko zonyango.
Ngokwenza iindleko zeerhafu ezichithweyo (imali ephuma kwi-$ 1,608 ukuya kwi-5,143 kwi-Medicare Part B ngo-2017) , abadala bayakwazi ukugcina ngaphezulu imali yabo yomhlalaphantsi.
Kwakhona, akukho mizamo ithathelwe ukubeka lo myalelo osemthethweni.
Ukuphindaphinda i- Obamacare kuthintela i-Medicare
Nangona ingqalelo ijoliswe kwi-Medicaid kunye ne-uninsured, ngokupheleleyo ukuchithwa kwe-Care Affordable Act kungaba neziphumo ezibalulekileyo kubantu abakwi-Medicare . I-Obamacare yanceda ukuseka iinkqubo zokuphucula ukunakekelwa kwebhedlele, ukunciphisa ubuqhetseba beMedare, kunye nokuvuselela imodeli yokuhlawula entsha enokugcina imali kwinkqubo. Kwakhona kwandiswe kwi-Medicare, kwenzelwa iinkonzo zokukhusela ezifana neentolonoscopies kunye nemimmograms mahhala xa ufumana unyameko kumniki-nxaxheba . Okubaluleke kakhulu, kunceda ukunciphisa iindleko zemithi yesigqirha kubantu kwiiplani zeCandelo D.
Ekuqaleni, kwakungacacanga ukuba i-AHCA iza kuyilungisa njani le micimbi, kodwa kubonakala ngathi akuyiyo yonke into eyenziwa yi-Obamacare kwi-block block. I-AHCA ayinakutshintsha utshintsho lwangoku, kwaye luya kuvumela umngxuma wokuvala ukuvala ngo-2020 njengoko kucetywayo.
Oko kutshintshwayo irhafu. I-AHCA izakuphelisa i-Medicare yokubuyisela i-paytarenta kwi-overtax yabanikeli abafumana umvuzo ophezulu, oko kuthetha ukuba imali encinci iya kufumaneka kwi-Medicare Trust Fund ngokuhamba kwesikhathi. Enyanisweni, kuqikelelwa ukuba i-Medicare Trust Fund iya kulahlekelwa yi-solvency ngo-2025, iminyaka emithathu ngaphambili ngaphambili kunokuba iqikelelwe ngo-2016, ukuba i-AHCA iya kwenzeka.
Yintoni esiya kuyenza xa i-Medicare iphelelwa yimali ?
I-Realality of Administration Trump
UMongameli uTrump waya emsebenzini kwaye wasayina umyalelo olawulayo ngoJanuwari 20, 2017, ngosuku lokuvulwa kwakhe. Umyalelo wathwala i-arhente ye-federal ukuba ibuyele emuva kwi-Obamacare "ukuya kumlinganiselo ovunyelwe ngumthetho". Lo myalelo awuzange uchithe uMthetho woNonophelo ongenakunceda kwaye awuzange ukhankanye ukuba i-arhente iya kuqhuba njani umbandela.
Nangona wathi akayi kuthintela inkqubo ye-Medicare, uMongameli uTrump ogama lakhe lingummeli uTom Price njengoNobhala wezeMpilo kunye neNkonzo zoLuntu eziqinisekisiweyo ngo-Febhuwari 10 emva kokuvalelwa kweengxoxo zeSenate. Ixabiso liye lalingaphezu kokuthetha ngokufuna ukugqithiswa okukhulu kweMedare. Uye wavuma ukunyuswa kobutyebi be-Medicare ngecebo "leNgcono" elivezwe yi-GOP ngo-2016. Ukongeza koko, uye wakhuthaza ukutyunjwa okukhulu kwiProgram yeMedicaid.
UMongameli uye wathinta iSema Verma ukuba aqhube amaziko e-Medicare kunye neeNkonzo zeMedicaid (CMS). Umcebisi wezempilo kunye nomsekeli weSVC. Inc., umsebenzi wakhe e-Indiana uholele kwimfuno yokuba abantu kwiMedicaid bahlawule iindleko zenyanga okanye mhlawumbi balahlekelwa ukuvalelwa kwenyanga ezintandathu. Kwamanye amazwe, usebenze kwiziphakamiso ezifuna abantu kwiMedicaid ukuba bahlawule inxalenye yabo yononophelo okanye abafuna ukuba basebenze okanye bajonge umsebenzi. Kuze kube yimini, uye waba negalelo kwinqanaba likarhulumente, kodwa kwindlalifa, angatshintsha imigangatho ehlabathini lonke.
Zininzi izithembiso ezenziwe kwaye abaninzi abantu baya kuthinteka. UMongameli uTumpump uthumele iimpawu ezixubekileyo kubantu baseMelika. Oko akuthembisile kwiphulo lokukhankanya alisoloko lilungelelaniswe nezenzo zakhe njengoMongameli. Ukuchithwa kwe-Obamacare kunokwenzeka ukuba kwenzeke, ubuncinci, ukuba i-AHCA idlula. Ukucutshungulwa koxilongo kuqinisekiswe ukulandela. Yintoni eya kwenzeka kwi-Medicare, nangona kunjalo, ngumdlalo wokuqagela.
ILizwi
I-AHCA ecetywayo yadlulisela iNdlu yee-Abameli be-US, kodwa ide ivunyiwe yiSeneti, uMthetho ojongene noNonophelo ongenakunceda uhlala ngumthetho welizwe. UMongameli uTumpom wathembisa ukutshabalalisa i-Obamacare, kodwa i-AHCA njengoko ibhaliwe iya kulahla kuphela iindawo zomthetho. Wathembisa ukugcina i-Medicare ingafunyanwa, kodwa i-AHCA iya kunciphisa imali kwi-Medicare. Kusengaphambili ekuphathweni koongameli, kwaye ixesha elilodwa liza kuxela ukuba uMongameli uya kuphila kwizithembiso azenzile kubantu abavotelwe kulo mkhankaso wephulo.
> Imithombo:
> Unonophelo loNonyango lweMpilo yaseMerika: Ixabiso lokuqikelela. IHhovisi leBhajethi yeCongress. https://www.cbo.gov/publication/52486. Ishicilelwe ngoMatshi 24, 2017.
> Indlela engcono: Umbono wethu wokuqinisekisa i-America - Uncedo lwezeMpilo. Bhetele.GOP. http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf. Ishicilelwe ngoJuni 22, 2016.
> Ifama yeLimi L. Iingxowa-mali ezifihlakeleyo ezilindelwe kwiiNinzi zeMerika ukususela emva kokubuya. KwiWebhusayithi yeWindows.com. http://www.governing.com/topics/finance/gov-nasbo-state-spending-survey-2017.html. Ipapashwe ngoDisemba 13, 2016.
> Ukuxoxisana ngeendleko zeeMfuno eziNcinci kwiMedari yeNgxenye D. IKomiti yeSizwe yokuLondoloza iNgcaciso yeNtlalo kunye neweMedare. http://www.ncpssm.org/EntitledtoKnow/entryid/2061/thintelo-
> Inombolo yobhaliso lwe-Obamacare. Obamacare Facts website. http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/. Kufumaneka ngo-Ephreli 18, 2016.