Kunzima kunokuba ukutshitshiswa nokutshintshwa ekugqibeleni kuhambisane
Xa uDonald Trump ephumelele ukhetho loongameli ngoNovemba 2016, ikusasa le-inshurensi yezempilo e-US ngokukhawuleza yayininzi kwi-limbo- xa abantu beqala ukusetyenziswa kwi-Care Act (aka, Obamacare).
Akungathandabuzeki ukuba ukuphunyezwa kwe-ACA kwakuninzi lwezinto ezinobunzima kwiminyaka embalwa edlulileyo, kodwa yayisungulwe kakuhle ngasekupheleni kuka-2016.
Ixesha lesine lokubhalisa elivulekileyo kwikarhwebo nganye (kunye nokutshintshiselana ) kuqhubeka. Abaqeshi babeya kunyaka wabo wesibini okanye wesithathu (kuxhomekeke kubukhulu bawo) bokuthobela igunya lomqeshi we-ACA . Abantu bebajwayele ukubuza imibuzo malunga ne-inshorensi yempilo kwiirejista zabo zerhafu, kunye nezohlwayo ezingenakuncedwa kunyaka.
Abantu babesebenzise ukuba iimeko eziye zangaphambili ziyiyona nto ingathintelo xa kufaka isicelo se-inshorensi yempilo, kunye nelokuba abantu abathengayo ukuthengwa kwemarike nganye, inkxaso-mali iyafumaneka ukuze ihlawule iindleko, kuxhomekeke kwingeniso ( Oku kuncedise ukuphakamisa intsimi yokudlala kubantu abathengayo i-inshorensi yabo yempilo , kuba abantu abane-inshorensi yempilo exhaswe ngumqashi baye bahlala benemali encedisayo.
Emva koko, yonke into yayisenyuka emoyeni. UMongameli uTrump wagxininisa ngesithembiso sokuthi uza kuphelisa i-ACA; i-website yakhe yephulo yathi, "Ngomhla omnye woLawulo lweTrump, siza kucela iNkongolo ukuba ikhuphe ngokukhawuleza i-Obamacare."
AmaRiphabhuliki agcina iindawo zabo ezinkulu kwiNdlu kunye neNkundla yeeNtekethi, kwaye baye baxoshelwa ukucima i-ACA ukususela ekubeni yenziwe ngo-2010. Imigudu yabo yangaphambili yayinqatshulwe nguPresident Obama we-veto ipeni, kodwa akusisithintelo phantsi koLawulo lweTrump.
Ukuphindaphinda i-ACA Akuyona into elula njengoko ithetha
Ngokukhawuleza ukuba iseshoni yomthetho we-2017 iqhutywe, uSenator Mike Enzi (R, Wyoming), uSihlalo weKomidi yoHlahlo lwabiwo-Senate, wenza isisombululo (SCRes 3) ukuqala inkqubo yokucima i-ACA ngokusebenzisa ukuxolelana kohlahlo lwabiwo-mali.
Isisombululo sika-Enzi sinikeza imiyalelo kwiikomiti ezine ukusebenzela umthetho, kubandakanywa nokunciphisa ukulahleka, okuza kuxelwa kwiKomidi yohlahlo lwabiwo-mali. Zombini amakamelo eCongress ayedlulise ii-SCRes 3 phakathi noJanuwari, kwaye iikomiti zendibano ziye zasebenza kwiinkcukacha zokususa umthetho ukususela ngoko.
I-Congressional Republicans icebo kwilo xesha yayiza kugqithisa ibhajethi yokubuyisana ngokukhawuleza ngokukhawuleza. Ukulindeleke ukuba kwakuya kufana ne-HR3762, eyadlula ekuqaleni kuka-2016 kodwa yavotelwa nguMongameli Obama.
Ukucaca, abanalo iivoti ezifunekayo ukugqithisa ngokupheleleyo i-ACA, njengoko oko kuya kufuna okungenani amavoti angama-60 kwi-Senate ukuze unqobe i-filibuster. Kodwa i-bill-reconciliation-enye ejongene nemali-mali kuphela-inokudlulela ngesininzi nje, kwaye ayixhomekeke ku-filibuster. Isilwayo soxolelaniso sokubuyisela imali kwi-ACA singadlulela kunye nama-51 aseSenatti ngokuvota, kwaye kukho iiSenamanethi ezingama-Republican ngo-2017.
Inkxaso-mali ye-Premium, inkxaso-mali yokwabelana ngeendleko, kunye nokwandiswa kweMedicaid konke kungaqedwa kunye ne-bill reconciliation. Ingaba i-ACA irhafu ifana nesigwebo somqeshi, isigwebo somntu ngamnye kunye nezinto ezifana neerhafu zedivayisi kunye ne-Cadillac Tax.
Isibhengezo soxilongo asiyi kukwazi ukuphelisa ii-ACA ezinxulumene nonxulumene neentengo ezingenakuthatha-mali, kungakhathaliseki ukuba imbali yonyango, inzuzo ebalulekileyo yezempilo , nokuvumela abantu abadala ukuba bahlale kwizicwangciso zabo zezempilo kuze kube se-26 ubudala. Kodwa ukuba i-ACA iyahlawulwa, iindawo eziseleyo aziyi kuphila ngaphandle kokuba kuthathwe inyathelo elongezelelweyo lomthetho ukuze kuzinze imarike yomshuwalense.
Yintoni ezayo elandelayo?
AmaRiphabliki aseCongress afudule ngokukhawuleza ukuba aqale inkqubo yokucima i-ACA ngokuyifumana, kodwa ayikazange aqokelele nge-proposal. Iziphakamiso ezininzi ze-GOP zokutshintsha i-ACA ziye zaziswa kule minyaka embalwa edlulileyo, kuquka iPromo yeNdlu uSomlomo uParry " Indlela Eyona Ngcono" , kunye noTom Price wokunika amandla Umonde Wokuqala wo-2015 (HR2300) -thatha ukubaluleka okubalulekileyo xa ixabiso likhethwe ukukhokelela i-HHS phantsi kolawulo lweTrump (iSanate yaqinisekisa ukutyunjwa kwayo ngoFebruwari 2017).
Iziphakamiso zivame ukuba namaqela amaninzi ngokufanayo, ngoko sineengcamango ezintle malunga nolwalathiso apho amaRiphabliki aseCongress afuna ukuqhubeka.
Iinqununu ezintsha ezitsha ziye zaziswa kwiiveki zakuqala zeeseshoni zomthetho we-2017, ngokubanzi zilandela imigaqo eminye echazwe kwiiphakamiso zokunakekelwa kwempilo yeRiphabliki yangaphambili. Kodwa akukho namnye wabo oye wafumana inkxaso ye-bipartisan okanye inkxaso epheleleyo evela kwicala laseRiphabhlikhi yendlela yokuhlala.
Ngamafutshane, iinkcukacha ezithile zezinto ezingathatha indawo ye-ACA azikho. Abanye abantu baseMelika baphumelele phantsi kwe-ACA, kwaye ezinye zibi kakhulu, kodwa akukho namnye kubo oye wafumana ithuba lokubona ngokuchanekileyo ukutshintshwa kwezinto eziza kubonakala ngathi. Kwaye mhlawumbi kubaluleke kakhulu kuyo yonke into, iinshorensi yezempilo kunye namaziko okunakekelwa kwempilo ayayiqinisekanga oko kuza okulandelayo.
Iinkokeli zeCongress ziye zathi ukususela ekuqaleni ukuba bekungekho nciphiso kwi-coverage. Nangona besithi ngokuphindaphindiweyo ukuba isicwangciso sabo kukuphinda i-ACA ngokukhawuleza, akunakunqwenela ukuba ukupheliswa kuthathe ukusebenza ngokukhawuleza. Ukulibaziseka kweminyaka emibili ukuya emine ukuphelisa ukuphunyezwa, kunentsingiselo yokuba banokuvota ukuphelisa i-ACA ekuqaleni kwephakathi ko-2017, kodwa ukuphinda kuthathe ixesha eliphakathi kwe-2019 no-2021.
Isizathu sokulibazisa ukuphunyezwa kokuphunyezwa kukunika abameli umthetho ithuba lokusebenza ngeenkcukacha zebhilikhi yokutshintshwa, bayidlulise, kwaye ube nexesha lokufumana zonke izicwangciso ezikhoyo ukuze ziphunyezwe ngokufanayo kunye ne-ACA yokutshitshiswa. UChris Collins (R, eNew York), oyilungu leqela leTrans Transition, wathi ekuqaleni kukaJanuwari 2017 ukuba umyalelo wokutshintshwa wawuza kuqaliswa ngoJuni okanye ngoJulayi 2017. Wachaza nokuba akukho nto iya kutshintsha ngempilo izicwangciso ngo-2017 okanye ngo-2018, kodwa wathi ukucinywa ngokukhawuleza kwe-ACA kwakuyimfuneko kuba abameli babenqwenela ukuphelisa ngokukhawuleza izinto ezifana "nentlawulo yecandelo lezonyango, irhafu yonyhorensi yezempilo kwiinkampani zomshuwalense, igunya lomqeshi, igunya lomqeshwa [ngokubhekiselele igunya]. "
Indlebe uSomlomo uParry Ryan (R, Wisconsin) uthe ukulindele ukuba ivoti lokuchithwa lenzeke ngo-Matshi okanye ngo-Ephreli, kodwa uMongameli uTumpump, owayeqale ukuthetha ngokuchithwa kwevoti ekupheleni kukaJanuwari, ekuthethwe ngawo ekuqaleni kukaFebruwari ukuba ukutshitshiswa kuvota akunakwenzeka ngo-2018.
Ziziphi iindalo ezithethwa
Isigijimi esivela kwiCongress Republic Republicans sichitha ngokucacileyo kubantu abaninzi baseMerika:
- Ukuphelisa i-ACA, kodwa ngexesha elide ukwenzela ukuba abantu bangaphumeleli ukuxhomekeka kwabo ngelixa belinde ukutshintshwa.
- Isicwangciso sokutshintshwa kwabathengi abasithembisayo siya kuba ngcono kunokuba i-ACA (nangona ingabonanga umthetho, abantu bafanele bathathe ilizwi labo), kwaye kuya kucwangciswa ukuba kusebenze ngexesha elilodwa kunye nokucinywa kwe-Obamacare, kungekho gap esiphakathini.
- Ukutshatyalaliswa ngokukhawuleza kweentlawulo ze-ACA, kubandakanywa negunya lomqeshi kunye negunya lomntu ngamnye, ezo zombini azizange zithandwe.
Oko Kuthetha ngoku
Ngokuqinisekileyo kuyavakala kuhle. Kodwa xa sibheka ngaphantsi kwe-hood, kukho izicatshana ezimbalwa ezingekhoyo. I-Ofisi ye-Budget ye-Congressional ibonise ukuba igunya lika-ACA lomqeshi kunye nezohlwayo zaso, kunye ne-Cadillac Tax, ziza kuzisa i-$ 297 yezigidigidi kwimali evela kwi-2016 ukuya ku-2025. Le ntlawulo isetyenziselwa ukuncedisa iindleko ze-ACA, equka imali kwi-premium inkxaso kunye nokwandiswa kweMedicaid.
Ukuba ezo zinto ezivelisa ngeniso ze-ACA ziyakusasaza kwixesha elizayo, zingaphelela ukuba zibe yingxaki kwimali ukuqhubeka nokubonelela ngemali kunye nokunyuswa kweMedicaid.
Kodwa zikhona ezinye iingxaki ezinkulu ezinokuvela xa iivoti zeCongress ziza kuphelisa i-ACA (nangona kuphunyezwe ukulibaziseka) kwaye ikulinda iinyanga eziliqela ukuzisa imithetho emiselweyo. Ezi zibini ezibaluleke kakhulu kukudityaniswa kwemakethe yomshuwalense wempilo kunye nokuba kungenzeka ukuba ibhilikhi yokutshintshwa ayinakuyidlula.
Uthi ukuthini, "Ukutshabalalisa iMarike yomshuwalense wezeMpilo"?
Ixesha lokubhalisa elivulekileyo le-2017 liphela kuphela, kodwa izithuthi zomshuwalense yezempilo sele sele zijolise kakhulu ekucwangciseni u-2018. Kubaphathi abanqwenela ukubonelela izicwangciso kwiindawo zemarike ezenziwe ngokusemthethweni (oko kukuthi, i-HealthCare.gov) ngo-2018, amaxabiso kunye nokucwangciswa kwecebo kufuneka zingeniswe ngoMeyi 3, 2017 kwiindawo apho urhulumente wephondo oqhuba inkqubo yokuhlaziya izinga (eMissouri, e-Oklahoma, eTexas nase-Wyoming), kwaye ngo-Julayi 17 kumazwe aseleyo.
Ukuba umthetho we-ACA ukutshitshiswa sele udlulile ngolu hlobo, kodwa ukutshintshwa akuzange kuqaliswe kwaye / okanye kudluliselwe, abathwali be-inshorensi yezempilo baya kubhekana nokungaqiniseki okukhulu ngokucwangcisa kwabo.
Ngokufanayo malunga nabathwali ukuba akukho nto eyenzekayo ngokusemthethweni-kuquka ukuchithwa komthetho-ngamaxesha kunye nezicwangciso kufuneka zifakwe. Abathwali bayazi ukuba yonke into iphakanyisiwe emoyeni, loo nto iyachithwa etafileni, kwaye ukutshintshwa akuqinisekanga.
Ezinye iithwali zingaphumelela kwaye zifake iifayile kunye nezicwangciso ze-2018 (ezininzi zinamazinga aphezulu abaza kufakalisa ngaphandle kokungaqiniseki ngoku zijikeleze imarike nganye). Kodwa abanye banokugqiba isigqibo sokuba ukungaqiniseki kuyingozi kakhulu, kwaye ukhethe ukuphuma kwimashishini okanye yonke imarike ekupheleni kuka-2017.
Ukuba isigunyaziso somntu ngamnye siyakususwa kodwa ukuhanjiswa kuya kuqinisekiswa-ngo-2018, kulula ukubona ukuba kutheni ama-inshorensi angase ahlasele ingcamango yokuqhubeka ethatha inxaxheba kwiintengiso. Kwimeko enjalo, kuya kuba lula kunanini ngaphambili ukuba abantu abanempilo bahambe bengenabala, kwaye amachibi omngcipheko aya kuqhutyelwa phambili kubhalisa abagulayo, oku kuthetha ukuba abaqinisekisi bafuna ukuba bangathathi nxaxheba kuwo onke, okanye bathathe inxaxheba ngama-premium aphezulu.
Ulawulo lweTrump luthi luya kukhupha imimiselo ejoliswe ekuqiniseni imarike yempilo yomshuwalense, kodwa iyaqhubeka ibonakala ukuba imimiselo iya kuba yaneleyo yokugcina i-inshurensi kwiimarike ngo-2018, kwaye ukukhusela ama-premium ukususela ngokukhawuleza.
Kwabaninzi bomshuwalense wezempilo, nganye imarike yincinci encinane kwishishini labo jikelele. Ubuninzi bezoshishino zabo ziquka izicwangciso zeqela (okanye zisebenza njengabalawuli bezicwangciso zeqela elizimeleyo), izicwangciso ze-Medicare Benevantage, kunye nezicwangciso zokunyamekela eziMedicaid. Ukuphuma kumashishini ngamnye akuyiyo isigqibo abayithathayo, kodwa akusisigqibo esichaphazela ukusebenza kwabo bonke.
Ukuba ukutshintshwa akuzange kudlule
Enye ingxaki ngokucinywa ngoku (ngokuphunyezwa kokulibaziseka) kwaye ke ukusebenza ekuphuhliseni ukutshintshwa kukuba ukutshintshwa kungenakuze kube phantsi komhlaba. Mhlawumbi iNgqungquthela ayinakuvumelana malunga nokuyila, okanye mhlawumbi abayikwazi ukwenza amanani asebenze ngokwemimiselo yekarhulumente kwisicwangciso sokutshintshwa.
Njengoko kubonakaliswe yinkqubo ende, inzima yokuphikisana nokudlulisa i-ACA emuva ngo-2009/2010, kucacile ukuba ukufumana isivumelwano malunga ne-bill entsha yokulungiswa kwempilo kungeyi kube lula.
Kwaye kwenzeka ntoni ukuba awanakukwazi ukufumana nantoni na idlulayo ngokubhekiselele ekutshintsheni? Kuloo meko, ibhilikhwe yokuphinda iyakuthi isetyenziswe, ngokuphunyezwa ngokupheleleyo ku-2019 okanye kamva. Kwaye ukuba akukho nto ekhoyo yokuyithatha indawo, ukuhlaselwa kwemarike echazwe ngasentla kuya kuba yinto ephawulekayo, kuba ezinye iinkalo ze-ACA (njenge-certified-issue coverage) ziya kuhlala zikhona, kanti ezinye (njengegunya lomntu kunye ne-premium subsidies) iza kupheliswa.
Kuphakathi kwezigidi ezingama-20 kunye nezigidi ezingama-30 abantu baya kulahlekelwa ngumshuwalense xa i-ACA ichithwe kwaye ingasetyenziswanga yinto enamandla ngokulinganayo. I- Ofisi yeBhajethi ye-Congressional eqikelelwa ngoJanuwari 2017 ukuba abantu abayizigidi ezili-18 baya kulahleka ukuxhaswa kunyaka wokuqala emva kokuba ibhajethi efana ne-HR3762 idluliselwe, kwaye ukuba inani labantu abalahlekelwa ngumyinge liya kukhula ukuya kwizigidi ezingama-32 ngaphezulu kweminyaka elishumi.
I-Trump ithi Imithetho iya kuba yinto efanayo
Phakathi kwenkxalabo malunga neengqungquthela zomthetho ezaziswa ngeenyanga eziliqela, amaqela amaninzi aseRepublican aqala ukubonisa ukungathandabuzeki kwesi sicwangciso. IRandi uPaul (iKentucky) uLamar Alexander (Tennessee), kunye noTom Cotton (Arkansas) bonke bathi bekube ngcono ukulibazisa ukuvota kokuvota kuze kube yilapho isicwangciso sokutshintshwa sifumaneka. Kukhona ithuba elincinci kodwa elikhulayo lokuba ibhajethi yokuphinda ngokukhawuleza ayinakudlula ukuba umthetho wokumisela awulungele ukuya ngexesha elifanayo.
Ngenkomfa yenkomfa ye-10 kaJanuwari, uTrump wathi iinqununu zokutshitshisa nokutshintsha ii-ACA ziya kuqaliswa "ngokukodwa" emva kweNgxelo. Ixabiso liqinisekisiwe ukukhokela iHHS (Ixabiso laqinisekiswa ngoFebhuwari 10). I-Trump yacacisa, ithi "Kuya kuba ngamacandelo ahlukeneyo, uyaqonda, kodwa iya kuba yinto enye okanye ngeveki enye, kodwa mhlawumbi ngaloo mini.
Oko kubeka uxinzelelo olunzulu kubalawuli bomthetho ukuba bahlangane kunye necebo lokutshintsha ngokukhawuleza kunokwenzeka, kodwa oko kungase kube lula kunokuba kwenziwe. Okwangoku, ikusasa le-ACA lihlala liphezulu emoyeni. Kodwa xa i-pundits ikhuluma malunga nokuba akukho ngxaki "yokuphelisa nokulibaziseka" kuba isicwangciso esitsha siya kugqithwa njengoko i-ACA ikhupha, khumbula ukuba inzima kakhulu kunokuba.
> Imithombo:
> Inkomfa yaseUnited States, iHhovisi leBhajethi yeCongress. Ukuhlaziywa kohlahlo lwabiwo-mali, 2015 ukuya ku-2025 . Matshi 2015.
> Isebe Lempilo Neenkonzo Zoluntu. 2018 I-Letters to Isers in Marketplace-Facilitated Marketplace. Disemba 16, 2016.
> DonaldJTrump.com. Ukuguqulwa kwezeMpilo. 2016.
> Ixabiso, uTom, iNdlu yaseMelika yabameli. Ukunika amandla Umthetho Wokuqala Wokugula ka-2015. NgoMeyi 11, 2015.
> IKomiti yeeNtektha yeZizwe e-United States kwiBhajethi. I-Senate ukuba iqalise ingxabano kwi-Obamacare Impendulo yokuPhepha. NgoJanuwari 3, 2017.