Akungabazeki ukuba umongameli kaDonald Trump-kunye neninzi ehlala eRiphablikhi kwiCongress-iya kuba nefuthe elibi kuMthetho woNonophelo olungabonakaliyo (i-Obamacare) kunye nendlela i-inshurensi yezempilo isebenza ngayo e-US.
Kodwa emva kokukhankanya isithembiso sokuphelisa u-Obamacare "ngosuku olunye," iTrump yaxhaswa loo ndawo kwiintsuku ezalandelayo ukhetho, ekuboneni ukuba kukho ezinye iindawo zomthetho afuna ukuzigcina, kubandakanya ukukhutshwa okuqinisekileyo kungakhathaliseki ukuba imeko ekhona, kunye nokubonelela okuvumela abantu abadala ukuba bahlale kwisicwangciso sezempilo sabazali kuze kube se-26 ubudala.
Enyanisweni, loo miba yomthetho iyabonakala kakhulu kwaye inenkxaso enamandla ye-bipartisan, njengokuba imimiselo ethintela abaqinisekisi bempilo ukuba babeke ukunyusa i-year or lifetime caps kwi-coverage .
Kodwa kukho ezinye izibonelelo ze-ACA ezingabonakali kakhulu, kubandakanywa nemfuneko yokuba bonke abaseMelika-ngaphandle kokuba banelungelo lokuxolelwa -bafumana uncedo lwe-inshorensi yezempilo okanye bajongane nesohlwayo serhafu .
La malungiselelo athandwayo angaphantsi kweyona njongo "yokutshitshiswa nokutshintsha" imizamo eyenziwa yiCongress Republicansans ngosuku lwesinye iseshoni somthetho we-2017. Ngaphambi kokuba uMongameli uTrump ethathe isikhundla, iCongress sele idlulile isisombululo sebhajethi esichaza iikomiti zomthetho ukuba iqulunqe umthetho ukuphelisa iindawo ze-ACA ezinxulumene nenkcitho ngokubuyisana. Kwaye ngomhla wokuqala weTrump kwi-ofisi, watyikitya umyalelo olawulayo oyalela i-arhente ye-federal ukuba ibe yinyanzelo ekunyanzelweni kwabo kwentlawulo ye-ACA kunye nezohlwayo.
Inkqubo yomthetho yokuchithwa nokutshintsha i-ACA ingadlulisela ubuninzi be-2017, kodwa ukuba kwaye xa idlula, kuvumelana ngokubanzi kukuba ukuphunyezwa kwanoma yiziphi iinguqu ziza kulibaziseka kude kube ngu-2018, kwaye mhlawumbi u-2019.
Ukuphinda
Ukuba iCongress idlula ibhilidi yoxolelaniso (efuna kuphela isininzi esicacileyo kwaye i-filibuster-proof), inokukhupha izibonelelo ezinxulumene nenkcitho kwi-ACA.
Oku kuya kufaka izinto ezifana ne- premium inkxaso , inkxaso -mali yokwabelana ngeendleko , kunye nokwandiswa kweMedicaid , kunye nezohlwayo ezihambelana nomgunyazo womqeshi kunye negunya ngalinye .
Kodwa ibhilikhi yoxolelwaniso ayinakukwazi ukuphelisa iinkalo ze-ACA ezingahambelani nokuchitha-izinto ezifana nokubonelela ukuba zonke iifayili ziqinisekiswe-ngaphandle kwembali yonyango, kunye nemfuno yokuba zonke izicwangciso zeqela kunye namancinci zihlanganisa ezibalulekileyo zezempilo .
Ukulungiswa kwezi mfuneko kunokwenziwa ngomthetho oqhelekileyo, kwaye iiRiphablikhi zibeke iziphakamiso eziliqela kwiminyaka embalwa edlulileyo, kubandakanywa neempembelelo zomboniso wazo wezempilo kunye nemimiselo emininzi yomthetho, kubandakanywa nezinye iindleko eziye zafakwa kwiiveki zokuqala kwiseshoni yomthetho ka-2017.
Kwaye, ngokwenene, kukho iindlela ezininzi zokwenza utshintsho lwe-inshorensi yempilo kunye neenkqubo zonyango e-US Akungabazeki ukuba i-ACA ngokwayo yayidinga ukulungiswa kwiminyaka embalwa edlulileyo, kodwa yayiyizambane ezitshatileyo zezombusazwe ezenziwa ngabagwebi awakwazi ukufumana indlela yokuhlakulela ukunganyaniseki okuza kuphumelela amavoti alaneleyo.
Ukutshintshelwa Kwangempela
Xa kuhla kumanethi kunye neebhanti zokutshintshwa kwe-Obamacare, kukho imingeni eya kuvela xa kugxininiswa ekugcineni imiba eqhelekileyo yomthetho ngelixa kupheliswa amalungiselelo athandwayo.
Ngaphantsi kolawulo lweTrump kunye neninzi yeRiphabhlikhi kwiCongress, kuqinisekiswe ukuba inkqubo yethu yangoku yinshurensi yezempilo yangasese iya kuhlala isendaweni, kunokuba ishintsho kumhlawuli omnye. Ngaloo nto ingqondweni, kufuneka kugxininiswe ekuqinisekiseni ukuba i-insurers inomtsalane wokuqhubeka nokubonelela nge-inshurensi yempilo.
Uninzi lwe-inshorensi yempilo yabucala yinkxaso-mboleko exhaswe ngumqashi, kwaye oko kuya kuqhubeka kube yimeko yekamva elibonakalayo: Ininzi yeenkampani ezinkulu zinikezela i-inshurensi kubasebenzi babo isikhathi eside ngaphambi kokuba i-ACA ifune ukuba benze njalo, kwaye ininzi iya qhubeka uyenza njalo nangona ukuba igunya lika-ACA lomqeshi lichithwe; i-inshurensi yezempilo iyinxalenye yeephakheji zokufumana ukhuphiswano abaqeshi basebenzise ukutsala kunye nokugcina abasebenzi.
Nangona ii-ACA zatshintshe ezinye iinkalo ze-inshurensi exhaswe ngumqeshi, uninzi lwazo lwenguqu lwalo lujoliswe kwiimarike zempilo yomshuwalense. Kukho abantu abayizigidi ezingama-22 e-US abanempilo yomshuwalense ngamnye (oko kuthetha intsingiselo abazithengayo ngokwabo, kunokuba bafumane umqeshi okanye urhulumente). Ukususela ngo-2016, malunga nesiqingatha sazo sasineengxelo kwiingxoxo ezazisungulwa phantsi kwe-ACA. Esinye isiqingatha sathengise i-coverage yabo ngqo kwii-inshurensi zempilo zomshuwalense ngaphandle kokutshintshiselana , okanye zineenkcazo ngaphantsi kwezicwangciso ezinkulu okanye ezicwangcisiweyo.
Yiyo le ntengiso-yodwa inshuwalense yezempilo-leyo iyenze utshintsho olunzulu phantsi kwe-ACA. Kwaye kukho iinkalo ezine eziphambili zomthetho eziye zenzelwe ukusebenza kunye ukuqinisekisa ukuba umntu ngamnye okhuseleko lwe-inshorensi yempilo uyifumaneka kuwo wonke umntu owufunayo:
- Inkxaso-mali yeeNkcazo zokwenza ukuhlawuleka okuthengelayo abantu abangenakukwazi ukuhlawula ii-premiums. Inkxaso-mali ye-Premium phantsi kwe-ACA ifumaneka ukuba ibhalise kunye neengeniso ukuya kuma-400 ekhulwini kwintlupheko, eyi-$ 97,200 yintsapho yabantwana ngo-2017.
- Inkcazo eqinisekisiweyo , oku kuthetha ukubhalwa kwezonyango ezingasetyenziswanga ukujonga ukuba ngaba abantu banokufumana ukuthengwa kwerhwebo nganye, okanye ukubeka iiprayimari zabo. Ngaphambi kuka-2013, bonke abahlanu bavuma ukuba iinkampani ze-inshorensi zempilo zenze iincwadi ezibhaliweyo zonyango ukuqinisekisa ukuba ngaba umfaki-sicelo unokufumana ingxelo, kwaye yiyiphi i-premium eza kuhlawulwa. Iiprayimari eziphezulu-okanye ukukhanyela ukugqithiswa-zijongwa rhoqo kwizinto zonke ukusuka ekukhulelweni ukuya kumlando womhlaza wokuba ukhuluphele ekubeni nesifo se-asthma.
- Ubhaliso obuncinane . I-ACA isungulwe ixesha lokubhalisa elivulekileyo lonyaka (elisetyenziswa kwiintengiso kunye nangaphandle kwezingxoxo), apho iHHS yayinomsebenzi wokucwangcisa. Isihlandlo sokuqala sokubhaliswa (ngo-2014) sihlala kwiinyanga ezintandathu. Ukususela ngoko, ixesha lokubhalisa lonyaka elivulekileyo lonyaka lide lide ezintathu, kwaye oku kulungele ukuba kube yimeko ye-2018.
Kodwa ngokuqala ngo-2019, ukubhaliswa okuvulekileyo kuya kuba mfutshane , ukusukela ngoNovemba 1 ukuya kuDisemba 15 ngamnye ngonyaka (iHHS icingisisa ngesiphakamiso sokunciphisa ixesha lokubhalisa elivulekileyo le-2018, okwenza ukutshintshela ixesha elifutshane elibhalwe kunyaka ngaphambi kwexesha elidlulileyo). I-ACA ibuye ivumele ixesha lokubhalisa olukhethekileyo elinika abantu ithuba lokufikelela kwiimali zecandelo lokuthengisa ngaphandle kobhaliso oluvulekile, ukuba ngaba nesiganeko sokuphila esifanelekileyo esibangela ixesha lokubhalisa elikhethekileyo .
Imizekelo isatshatile, inomntwana, okanye ilahlekelwe ukufikeleleka kwisicwangciso se-inshurensi yezempilo. Kodwa ngaphandle kwesiganeko esifanelekileyo, umshuwalense wezempilo awukwazi ukuthengwa ngaphandle kobhaliso oluvulekile, mhlawumbi ngokutshintshiselana okanye ngqo kwi-inshurensi yezempilo. Ingongoma yeefestile zokubhalisa ezincinci kukukhusela abantu ekubeni bangabhaliseli ukubhalisa baze bafune ukunakekelwa. - Igunya ngalinye elifuna ukuba wonke umntu abe ne-inshorensi yezempilo okanye ahlawule isohlwayo sentela. Isohlwayo esiphezulu ehlolwe abantu abangenakunikwa inkxaso ngo-2014 yayingama-dollar ayi-210 kuphela, kodwa yanda ukuya kuma-470 ayi-$ kubantu abangabancedwa ngo-2015, kwaye kuya kuba phezulu nangaphezulu xa iirhafu ze-2016 zihlolwa kwiirhafu zentlawulo efihliweyo ngo-2017.
Inkcazo eqinisekisiweyo yokukhupha i-popularity distribution. Inkxaso-mali ye-Premium ine-degree of popularity, nangona ezininzi iziphakamiso zokutshintshwa kwe-ACA zixhomekeka kwiirhafu ezingenakunyaniswe kwimali engenayo, kodwa leyo ingenakho ihlawulwe kwiindleko zentsholongwane yezempilo. Iingxowa zerhafu ezinjalo zingabonakali njengoko ixesha lihamba xa iindleko zonyango lwezempilo ziqhubeka zikhula ngokukhawuleza kunexabiso lokunyuka kwamaxabiso.
Kodwa isigunyaziso somntu ngamnye sihle singathandabuzeki, kwaye iziphakamiso zokulungiswa kwempilo yeRiphablikhi zihlala zibiza ukuba zipheliswe (nangona iinjongo zomntu ngamnye zithandwa ngabantu abathandekayo kunye namagunya okucinga ngokuphindaphinda kuma-80 no-90).
Ngaba Unako Ukufumana Ingqinisiso-Inkcazo Enesiqinisekiso?
Ukuba ugcina ukunikezelwa okuqinisekileyo kwe-ACA kodwa ukuphelisa isigunyaziso somntu ngamnye, usebenza ngokubhekiselele kwingxaki ebalulekileyo: Abantu banokungena kwi-uninsured xa bephilile, baze babhalisele i-inshorensi xa befuna unyango. Iziphumo zepayimali zomshuwalense ophazamisayo zilula kakhulu ukuqikelela kwimeko.
INew York iphumelele ukukhutshwa okuqinisekisiwe kweminyaka emibini ngaphambi kokuba i-ACA ivelise umgaqo wonke, kodwa ayinalo igunya elilodwa. Isiphumo sasiyi-premiums eziphakamileyo kakhulu kunelizwe lonke (nangona ngo-2017, ii-premium zee-inshurensi zempilo zorhwebo zingaphaya kwama-50 ekhulwini eNew York kunokuba zikho ngo-2013).
Enyanisweni, le nto iyingxenye yenkinga eyenziwa yi-ACA kwiminyaka emibini edlulileyo: ababhalisile ngabathengi ngabanye baye bekhulile kwaye begula kunokuba babelindelekile (kuba bengenelanga ngokwaneleyo, abantu abaphilileyo baye babhalisela ukulinganisa i-pool risk), kwaye iipriyam ayinelanga ngokwaneleyo ukufihla iindleko abafaki bomshuwalense abaye bazenza kwiimarike. Kukho izizathu ezahlukahlukeneyo zezi zinto, kubandakanywa nokuba i-ACA isigunyaziso somntu ngamnye ayigxininiswanga, kwaye ukuba ukubhaliswa kwexesha elilodwa lokubhalisa elilodwa lilungelekile; akukho sizathu esinye seenombolo ezingaphantsi-ezilindelekileyo zokubhalisa eziphilileyo.
Kodwa ukulahlekelwa kwemali kumashishini athile kuba kutheni inani elininzi labatshutshisi bekhethe ukuphuma kwiintengiso okanye lonke iimarike zonyaka ka-2017. Kwakungekho nje ukuba kungabikho inxalenye yeemarike ezixhamlayo kubo, kwaye inxalenye encinci yemakethe nangoko, ngaba inshurensi abashiya ngaphandle kweemarike zodwa kunokuthi bagxininise kumacandelo amakhulu ekarhwebo, kuquka i-inshorensi exhaswe ngumqeshi, i- Medicare Advantage , kunye ne-Medicaid.
Ngamafutshane, abaqhankqalazi abayi kunika ingxelo kwiimarike ngaphandle kokuba baqiniseke ngokuqinisekileyo ukuba iimarike ziya kuhlala zizinzileyo, kwaye abantu abanempilo ngokwaneleyo baya kubhalisa ukukhupha iindleko zokubambisa ababhalisile abafuna unyango lwezempilo.
Kukho iindlela ezahlukeneyo zokuhamba ngoku, kodwa zonke zibandakanya uhlobo oluthile lokwenza kube nzima okanye akunakwenzeka ukuba abantu bahambe ngaphandle kokubhengezwa xa bephilile. Ingaba ngumntu ngamnye, okanye ingaba iiprayimari eziphakamileyo ngokungafaniyo kubantu abangabhalisi xa beqala ngokufanelekileyo (yiyo indlela ye-Medicare Part B kunye ne-Part D). Okanye ingaba iiprayimari eziphezulu ezisekelwe kubhaliso lwezonyango kubantu abangagcinanga ukugcinwa kwengxelo eqhubekayo (le nxalenye yesiphakamiso esakhishwa yiRephabliki yaseNdlwini ngo-2016).
Kodwa enye indlela, kufuneka kubekho inkuthazo yokubhalisa abantu, ngokungakhathaliseki ukuba sithembele kwinkqubo esebenzisa inshorensi yempilo yabucala kunye nokubhalisa ngokuzithandela. Ngaphambi kuka-2013, loo nto inokubangela ukuba ingxelo ingaqinisekanga kwiindawo ezininzi, ngoko ke abantu babefanele babhalise ngelixa besempilweni-kwaye bahlale bebhaliswe-ukwenzela ukuba baphephe ukungaqiniseki ukuba naxa bavelise imeko ekhoyo.
Singabuyela kuloo nkqubo, kodwa ukubuyela kwiimeko ezikhoyo ngaphambili kunye nokubhala phantsi kweyonyango yonxweme akuyi kuba yintando yezopolitiko. Ngaphezulu, ukukhutshwa okuqinisekileyo-kukhupha ukuhlala, ngezinye iindlela. Kwaye oko kuthetha ukuba uhlobo oluthile lwesigwebo sokungabhalisi lukhona apha ukuhlala, ngenye indlela. Kungaba iiprayimari eziphakamileyo kubantu abhalisa kamva okanye uhlobo oluthile lokubhaliswa kwezonyango kubantu abangagcinanga ukukhutshwa okuqhubekayo. Kodwa akukho ndlela yokugcina ukukhutshwa okuqinisekisiwe kwe-ACA ngaphandle kokuqinisekisa ukuba abantu abanempilo ngokwaneleyo bayabhalisa kwi-coverage ukuze balinganise i-pool yengozi.
> Imithombo:
> Amasebe e-Medicare kunye neeNkonzo zeMedicaid, ngoMatshi 31, 2016, iStapshot yeStroll
> Indlu yabameli, I-GOP Proposal Healthcare. Eyona ndlela ilungileyo, Umbono wethu wokuqinisekisa i-America . NgoJuni 22, 2016.
> I-Kaiser Family Foundation, iNgcaciso yoMshuwalense wezeMpilo yoBonke abantu, 2015.
> UKoskinen, uJohn, iNkonzo yeNgeniso yangaphakathi, Ileta yeNgqungquthela kwimiphumo yokuqala yangonyaka we-2015 ngokumalunga noMthetho ojongene noNonophelo ongenakunceda ngo-Oktobha 2015 . NgoJanuwari 8, 2016.
> UKoskinen, uJohn, iNkonzo yeNgeniso yangaphakathi, iNcwadi yeNgqungquthela malunga neentlawulo zerhafu ze-2016 ezihambelana noMthetho wokuNakekelwa ongenakuncedo. NgoJanuwari 9, 2017.