Ngomhla wama-22 kuDisemba, 2017, uMongameli uTrump wasayina uMthetho wokuThuthwa kweRhafu kunye neMisebenzi (HR1) kumthetho. Umthetho uquka utshintsho oluthile kumgaqo werhafu wase-United States, kodwa ukwaphulukana nomnyaka wokuhlukumeza umthetho wokulungiswa kwempilo. Unokuzibuza ukuba ngaba umrhumo we-GOP werhafu uza kuchaphazela i-inshurensi yakho yempilo, njengoko ukuchithwa kwe-ACA kuye kwaba yinto ephambili kubalawuli beRiphabliki kunye noLawulo lweTrump.
Kodwa umrhumo weerhafu awubandakanyi uninzi lwemimiselo ebeyinxalenye yemizamo yokutshitshiswa kwe-ACA kwangaphambili ngo-2017. Iphelisa isigwebo somntu ngamnye ngo-2019, kodwa yonke loo Mthetho ojongene noNonophelo ongenakunceda ushiywe endaweni. Kwaye nezinye iinguqulelo zokunakekelwa kwempilo zentlawulo eziye zacetyiswa kwangaphambili kunyaka, ezifana nokutshintsha imigaqo ephathelele kwi-akhawunti yokulondoloza impilo (ii-HSAs) ayifakiwe kwi-bill yerhafu.
Ukuphindaphinda ukuhlawulwa kweNkundla yoMntu
Ibhaso yerhafu iphinda ihlawulwe isigwebo somntu ngamnye ngo-2019. Ngoko kusekho isohlwayo kubantu abangaqinisekisiwe ngo-2018 (eso sigwebo siya kuvavanywa xa iintlawulo zerhafu zifakwe ekuqaleni kwe-2019). Oku kwahluke kwiimvavanyo ze-GOP ukuphelisa isigwebo somntu ngamnye ngaphambi kowe-2017, njengoko iimali ezidlulileyo zenze ukuba kupheliswe. Ekugqibeleni, ibhilikhi yentela igcina isigwebo somntu ngamnye phambi kwayo yonke iminyaka eyandulelayo, kwaye ngo-2017 no-2018.
Kodwa iirejista ze-2019 zerhafu ezifakwe ekuqaleni kwe-2020 aziyi kufaka isihlwayo sokungaqiniseki.
Ukuphindaphinda isigwebo esihamba kunye negunya le-ACA liye laba li phambili kwiCongress Republicans, kwaye ngokuqinisekileyo isigunyaziso ngokuqinisekileyo phakathi kwamalungiselelo athandwayo kakhulu kwi-ACA. Kodwa nangona kungabi nantoni, yinye yemimiselo evumela ukuba i-ACA ibe ngumgaqo-nkqubo oqinisekisiwe okhuselekile wokusebenza.
Umxholo oqinisekisiwe uthetha umrhumo okhutshwe kubo bonke abafake izicelo, kungakhathaliseki ukuba imbali yabo yonyango. I-ACA iphinda isebenzise ukulungiswa kommandla woluntu, oko kuthetha ukuba iipresimenti zomshuwalense ozinikezelweyo kwiimarike zeqela kunye namancinci zihluke ngokusekelwe kwiminyaka yobudala, ukusetyenziswa kwecuba kunye ne-zipcode. Ngaphambi kokuba i-ACA, iiprayimari zazixhomekeke kwizinto ezinjengezesini kunye nemo yezempilo.
Ukutshintsha imigaqo ukwenzela ukuba imbali yonyango ayisekho indima ekufanelekeni okanye iiprisimenti zithandwa ngokugqithiseleyo. Kodwa kulula ukubona ukuba abantu bangalingeka njani ukuba bahambe bengenasigxina xa besempilweni, kwaye babhalise xa begula xa beyazi ukuba abanako ukukhishwa-kwaye oko kuya kubakho ngokungaqinisekiyo. Ngoko i-ACA ibandakanye amalungiselelo amabini okuthintela oku: Isigunyazo ngasinye sokugweba abantu abakhetha ukuhamba bengena-inshurensi, kunye neefestile zokubhalisa ezivulekileyo ezingapheliyo kunye namaxesha okubhaliselwa okhethekileyo (okt, awukwazi ukubhalisa nayiphi na ixesha oyithandayo).
Ubhaliso oluvulekileyo kunye neefestile zokubhalisa ezizodwa ziya kuhlala zingatshintshi, okwenza kube nzima ngabantu ukuba balinde baze bagule ukubhalisa kwi-inshurensi yempilo nganye yemarike (inshorensi yempilo exhaswe ngumqeshi sele isetyenzisiwe ixesha lokubhalisa elivulekile; abantu abakwazi ukubhalisa ngesicwangciso sezempilo somqeshi naliphi na ukuthanda).
Kodwa ukuchithwa kwegunya lomntu ngamnye kuya kuba nempembelelo embi kwiimarike zempilo yomshuwalense. Iiprojekti zeBhunga leNgxowa-mali ye-Congressional (CBO) , ngo-2027, kuya kuba nezigidi ezili-13 abantu abambalwa abanomshuwalense wezempilo kunokuba bekungekho ukuba isigwebo senkundla sasigcinwe. Kuzo zigidi ezi-13 ezi-insureds ezimbalwa, izigidi ezi-5 zaziza kubandakanywa ngenye indlela kwimarike nganye. Kwaye inxalenye ebalulekileyo yemarike nganye, eqikelelwa kubantu abangaphantsi kwezigidi ezili-18 ngo-2017 (malunga nemibono, iiprojekthi ze-CBO ezizigidi ezi-2 ezigidi ezili-13 ezi-insureds ezimbalwa ziya kuba ngabantu abaya kuba neengxelo phantsi koxhasi oluxhaswe ngumqeshi izicwangciso zempilo, kunye nabantu abayizigidi ezili-158 banomsebenzi phantsi kweeplani ezixhaswe ngumqeshi).
Abantu abaya kunciphisa ukuxhaswa kwabo ngaphandle kokugunyazwa bahlala besempilweni, njengoko abantu abagulayo ngokubanzi baya kwenza konke okufunekayo ukuze kugcinwe i-coverage yabo. Ukujikela kwi-pooler risker kubangele iiprayimari eziphezulu, ekugqibeleni ziqhuba abantu abanempilweni.
Ngokubanzi, ii-CBO ziqikelela ukuba ii-premiums kwimarike yomshuwalense ziza kukhula ngeepesenti ezili-10 ngonyaka, ngaphaya kwexabiso abaya kulikhula ukuba isigunyaziso ngasinye sasihlala sisebenza.
Kodwa i-CBO ibhala kwakhona ukuba imarike yomshuwalense iya "iya kuhlala isigxina phantse zonke iindawo zelizwe kulo lonke elizayo." Ngamanye amazwi, bakholelwa ukuba ezininzi iinkalo zelizwe ziya kuba ne-insurers zinikezela ukuthengiswa kwemakethe nganye, kwaye inani elaneleyo labhalisile ukugcina izicwangciso zizinzile. Oku kubangelwe, kwinxalenye enkulu, ukuba i- ACA ye-premium inkxaso ye-premium ikhula ukuze ihambisane nama-premium. Nangona ukupheliswa kwegunya lomntu ngamnye kuya kuqhuba iiprayimari eziphezulu, inkxaso-mali ye-premium iya kukhula ngokubanzi njengoko kuyimfuneko ukugcina ama-premium enqanaba eliphezulu.
Kubantu abafumana inkxaso-mali ye-premium, equka intsapho yabantwana abafumana i-$ 98,400 ngo-2018, ukwanda kweeprayimesi kuya kunqunyulwa ngokunyuka ngokukhawuleza kwindleko zenkxaso-mali. Kodwa kubantu abangenakufumana inkxaso-mali ye-premium, ukuxhaswa kwemarike nganye kuya kuba nzima kakhulu kwiminyaka ezayo. Kubalulekile ukuqonda ukuba igalelo kwiiplani zomhlalaphantsi zangaphambili zentela kunye / okanye i-HSA (ukuba uthenge isicwangciso sempilo esifanelekileyo se-HSA ) kuya kubangela ukufumana ingeniso epheleleyo echitshiyelweyo (ACA-ethile; ayifani efanayo ne-MAGI rhoqo), kwaye inokukwenza ube nelungelo lokuthetha nentlawulo yenkxaso-mali kunye nomcebisi weerhafu ngaphambi kokuba ucinge ukuba awufanelanga ukufumana inkxaso-mali.
Kodwa ngokubanzi, ukwanda kweprayimenti okubangelwa ukupheliswa kwesigwebo somntu ngamnye kuya kubetha abantu abathengayo kwiimarike kwaye abafanelekanga ukufumana inkxaso-mali ye-premium (oko kukuthi, abo baneengeniso zomakhaya abangaphezu kwama-400 ekhulwini lobuhlwempu, kwi-Medicaid gap coverage, okanye ayinakufanelekela inkxaso-mali ngenxa yentsapho ye-glitch ). Kwaye nangona iiprojekthi ze-CBO ukuba iimarike ngamnye ziya kuhlala zizinzile kwiindawo ezininzi zelizwe, kukho indawo ethile apho imarike nganye iphela, kwaye akukho banikezeli bunikezelo. Oku kuya kufuneka kulandelwe kwimeko-nge-case basis, enokuthi ibe nomthetho wesigqeba kunye / okanye wombuso. Kodwa yinto efikelelekayo engenzeka okanye ayiyi kwenzeka.
Impembelelo kwiNtshuwalense yeMpilo eNkxaso-mali
Uninzi lwabantu baseMelika abangewona asebekhulile bafumana i-inshorensi yabo yempilo kubaqeshi babo, kwaye ibhajethi yerhafu ayitshintshi nantoni na ngomshuwalense wezempilo oxhaswe ngumqeshi. Isigunyazo somqeshi siya kuhlala sisasebenza , njengoko iya kuyenza yonke imithetho eyahlukeneyo yokuba i-ACA ibeka kwizicwangciso zempilo ezixhaswe ngumqeshi.
Iimali ezahlukileyo ze-ACA zokuphinda zicatshangwe ngasekuqaleni ngo-2017 ziya kuphelisa zombini igunya kunye nomgunyazo womqeshi, kodwa umrhumo werhafu ususa kuphela igunya lomntu ngamnye. Abaqeshi abaninzi (abaqeshwa abalinganayo abangama-50 okanye ngaphezulu) baya kuqhubeka befuneka ukuba banikeze i-inshurensi yempilo kubasebenzi besikhathi esigcwele.
Kodwa abo baqeshwa abayi kuphinda bahlawulwe yi-IRS xa behluleka ukugcina ingxelo. Ngoko iiprojekthi ze-CBO eza kuthi ngo-2027, kuya kuba nezigidi ezi-2 zabantu abambalwa abanomvuzo oxhaswe ngumqashi kunokuba bekungekho ukuba isigunyaziso ngasinye sasihlala endaweni. Kodwa ngokubanzi, ukuhla kwehla kuya kubangelwa kubaqeshwa behla ukunikezelwa kwezibonelelo zabaqeshi, njengoko abaqeshi bekuya ku funeka banikezele ngokukhawuleza ukwenzela ukuphepha izigwebo ezingaphantsi kwegunya lomqeshi.
Imirhumo ye-HSA kunye neMithetho ayitshintshiyo
I-akhawunti yokulondoloza impilo (i-HSA) ivumela abantu abane-HSA-abaqeqeshelwa izicwangciso zezempilo ezidityanisiweyo (HDHPs) ukubeka bucala imali engekahlawulwanga yonyango ( okanye ukusebenzisa njenge-akhawunti yomhlalaphantsi ). Abameli beRiphabhulikhi baye bajolisa kwiinzame zokwandisa ii-HSA ngokunyusa imida yokunika inkxaso kunye nokuvumela imali ukuba isetyenziswe ukuhlawula iiprimiyam zomshuwalense. Ngoku kutshanje, abagwebi be-GOP baye bazama ukunciphisa ukunyuka kwelohlwayo oMthetho ononophelo olungabonakaliyo owenzelwe ukurhoxiswa kweendleko ezingekho phantsi kwezonyango ngaphambi kweminyaka yobudala engama-65.
Ezinye okanye zonke ezi migaqo zifakwe kwii- bills ezahlukeneyo ze-ACA zokuchithwa kwabagwebi ababhekiselele ku-2017 . Kodwa akukho namnye wabo owenziwe kuMthetho weCandelo loKwenziwa kweRhafu kunye neMisebenzi. Abalawuli be-GOP banokuqwalasela umthetho owongezelelweyo ngo-2018 ukwenza utshintsho kwii-HSA, kodwa ngexesha elikhoyo, abazitshintshiyo.
Imingcele yegalelo ye-2018 yi-$ 3,450 yezigidi kubantu abanomyinge ongaphantsi kwe-HDHP, kunye ne-6,900 zamaRandi kulabo abaneentsapho. Kukho isohlwayo se-20 kwipesenti ezithatyathwe ngaphambi kokudala iminyaka engama-65 ukuba imali ingasetyenziselwa iindleko zonyango, kwaye iipresimenti ze-inshorensi yezempilo ayinakuhlawulwa nge-HSA-mali, ngaphandle kwee-premium ze-COBRA, ii-premiums ezihlawulwa ngelixa ufumana ukungasebenzi , kunye nama-premium kwi-Medicare Parts A, B, kunye / okanye D.
Ukuchitha iindleko zonyango kuya kuba lula ngo-2017 no-2018
Iindleko zonyango zichithwa irhafu, kodwa kuphela xa zigqithisa i-7.5 ekhulwini yengeniso yakho. Kwakusisithuba se-7.5 ekhulwini, kodwa i-ACA isitshintshile ibe yi-10 ekhulwini kwinqanaba lokugcina imali. Abantu abaneminyaka engama-65 okanye ngaphezulu bavunyelwe ukuba baqhubeke nokusebenzisa i-7.5 yeepesenti kuze kube sekupheleni konyaka we-2016, kodwa i-10% yemingcele ibingene kuyo ngo-2017 kubo bonke abafakela iirhafu.
Ngomzamo wokunambisa umrhumo werhafu kwabathengi, uSenator uSusan Collins (R, Maine) wancincizela ukuba abuyele kwi-7.5 yepesenti. Ekugqibeleni, ibhaso yerhafu yayibandakanya le nguqulelo, kodwa yesikhashana. Ngo-2017 no-2018, abafakela iirhafu bangaphinda bathathe iindleko zonyango ezingaphezu kwe-7,5 ekhulwini yengeniso yabo. Kodwa ukususela ngowama-2019, i-10 percent threshold iya kusebenza, kwaye iindleko zonyango kuphela ngaphezu kwaloo mda ziya kutsalwa irhafu.
> Imithombo:
> Congress.gov. I-HR1 - UMthetho wokubonelela ukuxolelana ngokwemiqathango yesi-II kunye ne-V yesisombululo esifanayo kwisabelo-mali se > mali ka-2018. Ingenwe kumthetho 12/22/2017.
> I-Ofisi yeBhajethi yeCongressal. Ukuphindaphinda umyalelo we-Intshuwalense yempilo yomntu ngamnye: Ukulinganiswa okuhlaziyiweyo . Novemba 2017.
> Kaiser Family Foundation. Thelekisa iimphakamiso zokufaka uMthetho woNonophelo ojongene noNcedo.
> Kaiser Family Foundation. UmNyango weNtsholongwane wezeMpilo yoBonke abaLuntu 2016
> Mark Farrah Associates. Ngomfutshane Jonga kwiNkcazo yeMpilo yomshuwalense weMpilo. Julayi 19, 2017.