I-BCRA Iintlawulo Ezinye iindawo ze-AHCA, kodwa ihluke kwezinye iindlela eziphambili
NgoJuni 22, ngo-2017, iNtloko yeSain yaseUnited States yavelisa i-bill yezohlengahlengiso zonyango yokuba beyilungisile ngokupheleleyo ingcango yokuvala kwiiveki ukususela ngeNdlu yadlulisela uMthetho we-American Health Care Act (AHCA) ngoMeyi 4. Nangona inomboro ye-bill16 (HR1628) ), i-Senate ebizwa ngokuba ngulo Mthetho we- Better Care Reconciliation Act (BCRA) ka-2017 . Umthetho-mali ugcinwe ezininzi ze-AHCA, kodwa unemibandela ethile.
Kwiiveki elandelayo, iSenate yazisa amanani ambalwa e-BCRA, kodwa baqhubeka nokuyila umthetho ngomgaqo-nxaxheba, ngaphandle kweengxoxo zekomiti okanye ingxoxo yebipartisan. Ukuhlaziywa kokuqala, okukhishwe ngoJuni 26, kubandakanywa imfuno eqhubekayo yokubhengezwa, eyayingazange ifakwe kwinguqu yangaphambili (ungabona zombini iinguqulelo zeBhili ye-Senate apha). Iinguqulelo ezongezelelweyo ze-BCRA zaziswa ngoJulayi 13 ( isishwankathelo secandelo-ngecandelo), kwaye ngo-Julayi 20 ( isishwankathelo secandelo-nge-section).
I-Senate nayo yazisa uMthetho wokuBuyeliswa koLungelelwano lwe-Obamacare (ORRA), owenza ngokuphindaphindiweyo umthetho owenziwe ngamagumbi aphela ngo-2015 (HR3762) ukuphinda amalungiselelo amanyathelo aphezulu e-ACA. Loo mithetho udlalwa ngokuthi "ukupheliswa nokulibaziseka" kuba awuququzeleli nasiphi na isakhelo sokwenza indawo ye-ACA. UMongameli uBabheti wanikezela ekuqaleni kwe-2016, kodwa abanye abameli beSeneti banomdla wokuphinda baphinde baphinde baphumelele ngoku ukuba uMongameli uTrump usekho (le mithetho yayinethuba elincinci lokudlulayo, ngenxa yokungafuni ukuba amaRephablikhi athile kwi-Senate abonise ukuba iza kuphelisa i-ACA ngaphandle kokutshintshwa okuqinileyo kwidonki; yafakwa kumgangatho we-senate ukuze ivotwe ngoJulayi 27, ize iphumelele kwi-45-55).
I-BCRA iphinde ifakwe kumgangatho we-Senate ngoJulayi 27, kwaye yahluleka kwivoti 43-57. I-Senate yama-46 kaMdemokhrasi kunye nama-Independents amabini (abo bobabini i-caucus kunye namaDemokhrasi) bavotele ngokumalunga nomlinganiselo, kwaye bahlanganiswa ngabase-Republican Senators abayisithoba. Kwimigudu yokugqibela yokuchithwa kwe-Obamacare, i-GOP Senators yaqalisa ukuchithwa kwe-"skinny" (iMpilo yoKhuseleko lweMpilo) emva kokuhlwa ngoJulayi 27.
Loo mlinganiselo uphinde wahluleka, 49-51 (iiSenators uColins, uMurkowski, noMcCain bavotela kulo, kunye nabo bonke abaDemocratic and Independents).
Kubalulekile ukuba uqaphele, nangona kunjalo, ukuba iSenate isenokuthi ivelise iBhili yeNdlu yokuqwalasela kwakhona, kwaye ezinye izilungiso ziqwalaselwa ukuba zitshintshwe endaweni yenguqu yowiso-mthetho eyadlulisela iNdlu (yile ndlela i-Senate ivote ngayo i-ORRA, i-BCRA, kunye noMthetho woLondolozo lwezeMpilo;
Nangona i-BCRA ingazange idlule, asiyazi ukuba ingaba yintoni okanye iya kuguqulwa kwaye iyahlolwa kwakhona. Ngoko makhe sijonge oko i-Senate Republican eyiqulunqe, kwaye siyiqonde indlela eyafana ngayo ne-AHCA yokuba iiphabliki zaseNdlu zidlulile (ekhumbula ukuba amakamelo amabini aya kufuneka avume ngokwemigqaliselo yecandelo lomthetho ukususa / ukubuyisela i-ACA ngaphambi kokuba angayithumela kuMongameli). Sinamaphepha amaninzi malunga ne-AHCA, ukukunceda uqonde ngakumbi malunga nesicwangciso seNdlu yokulungiswa kwempilo:
Ngoko makhe sijonge iindlela ezenziwa yi-BCRA kwi-AHCA.
Ukwenziwa kweRhafu
Umthetho wokuNakekelwa ongenakunqwenelekayo (ACA), ukuchithwa kweyona nto inenjongo yezoNdlu kunye neziphakamiso zeSenethi, zibandakanya iintlobo zerhafu entsha kwiimali eziphezulu eziMerika kunye nenkampani yokunakekelwa kwempilo, kunye neentlawulo zerhafu ezihambelana nomntu igunya kunye negunya lomqeshi .
Ingeniso evela kule ntlawulo isetyenziselwa ukunqumla inkqubo yokunakekelwa kwezempilo kwaye inikezele ngokubhekiselele, ukufumana ingeniso enokuthengelayo kubantu abaninzi. Isigunyazo ngasinye siyisxhobo sokukhuthaza abantu abanempilo ukuba bahlale bembalwa, kwaye igunya lomqeshi likhuthaza abaqeshi abaninzi ukuba banikeze umgangatho ophezulu, ukuthengwa ngokuthengelayo kubasebenzi bexesha elipheleleyo.
I-AHCA iphinda irhoxise irhafu, kwaye iinguqulelo zakuqala ze-BCRA ziphinda zitshitshise. Noko ke, iinguqu ezilandelayo ze-BCRA zigcina iirhafu ezibalulekileyo ezikhoyo: I-0.9 yepesenti ye-Medicare yerhafu yokuhlawula irhafu kubantu abafumana umvuzo ophezulu, kunye ne-3.8 ekhulwini yemali engenayo (okt, irhafu engenayo engenayo) kwiifayile zerhafu eziphezulu (ukuchithwa kwezi iirhafu ziza kunceda abantu abafumana ubuncinane iidola eziligidi ngonyaka.
I-AHCA kunye ne-BCRA zombini ziphumela ekunciphiseni i-revenue revenue, nangona iipilisi ezimbini zinehedyuli eyahlukileyo ngokubhekiselele kwiirhafu ezahlukahlukeneyo. Kwaye ukunciphisa i-revenue tax federal is a little severe in versions afterwards of BCRA, ekubeni igcina irhafu ye-Medicare kubantu abafumana umvuzo ophezulu (ngaphezu kweyhumi ezayo, ukugcina ezo ntlawulo ezimbini kubangela ukulahlekelwa kweerandi ezingama-231 kwiimali zentlawulo, ngokutsho Uhlalutyo lweHhovisi leBhunga loLawulo lweBhunga lika-BCRA ).
Ukunciphisa ukunyuswa kweerhafu (ezininzi zazo ziya kusetyenziswa phantsi kwe-BCRA), inkxaso ye-federal ye- Medicaid kunye ne- premium inkxaso iyancitshiswa.
Uxilongo
Inkxaso-mali eninzi yeMedicaid isetyenziselwa ukunakekelwa kwexesha elide kubantu baseMerika asebekhulile, kunye nokubonelela ngononophelo lwonyango kubantu abancinci abafumana imali, abafazi abakhulelweyo kunye nabantu abakhubazekileyo (malunga neyesibini kubathathu abahlali basekhaya abahlengikazi baxutywa yiMedicaid, kwaye phantse isiqingatha lwazo zonke ukuzalwa e-US zigqitywe nguMedicaid).
Ngaphantsi kwe-ACA, i-Medicaid iye yandiswa ukuze ikhuphe abantu abadala abafumana imali engenako. Bobabini i-AHCA kunye ne-BCRA ibuyisela kwakhona ukunyuswa kweMedicaid, kwaye igawula ngokukhawuleza inkxaso-mali ye-Medicaid. Ukunyuka kwe-Medicaid ukubuyela ngokuqinisekileyo kuya kuwela phantsi kwecandelo lokucima i-ACA (injongo echaziweyo ye-Republiki yokunakekelwa kwempilo yononophelo), kodwa ukuxhaswa kwemali yenkxaso-mali ye-Medicaid ihamba ngaphaya kwe-ACA.
Uhlalutyo lwe-Office of Budget Office (CBO), uhlalutyo lwe-Medicaid lwe-federal luya kuncitshiswa ngama-dollar ayi-834 yezigidigidi kwiminyaka elishumi ezayo phantsi kwe-AHCA. Uhlalutyo lwe-CBO lwangoJulayi 20 lwe-BCRA lwee-$ 756 zezigidigidi kwi-Medicaid inkxaso-mali ye-Medicaid iyancipha ngo-2026, kodwa kubonakala ukuba i-BCRA idonsa iMedicaid ngokukhawuleza ukuqala ngo-2025, ngoko ukucutshungulwa phantsi kwe-BCRA kuya kuba mkhulu kunezicucu phantsi kwe-AHCA xa sandisa ukuhlalutya kwesinye ishumi (i-CBO iqikelele ukuba ngo-2036, ukusetyenziswa kwemali yaseMedicaid kuya kuba ngama-35 eephantsi phantsi kwe-BCRA kunokuba bekuya kuba i-ACA igcinwa).
Ngaphantsi kwe-ACA, urhulumente wephondo uhlawula iipesenti ezingama-95 zeendleko zokubambisa inani labantu abaye bafaneleka kwi-Medicaid phantsi kwe- ACA yokwandiswa kwenkqubo . Oku kusetyenziselwa ukunciphisa ukuya kuma-90 ekhulwini ngowe-2020, kwaye uhlale kwinqanaba eliya phambili.
I-AHCA ayiyi kuvumela ukuba nawaphi na amazwe amasha ukwandisa iMedicaid emva koMatshi 1, 2017, kwaye iya kutshintshela kwipesenti eziqhelekileyo zelizwe leMedicaid (phakathi kwama-50 ekhulwini kunye ne-75 ekhulwini; amahlwempu afumana umdlalo omkhulu) ngo-2021. ukuphelisa ukubhaliswa okutsha kweMedicaid, njengoko iifesi ziza kuhamba ngeepesenti ezingenakulungelelaniswa kwebhili.
I-AHCA ibuye iguqulwe iMedicaid (yonke inkqubo, kungekhona nje ukwanda kwe-ACA's Medicaid) kwinkqubo yesabelo somntu ngamnye, kunye nenkxaso-mali nganye kwi-federal government eguqulwa ngonyaka nge-CPI-Medical +1 (inxalenye yonyango yomthengi isicatshulwa samanani, kunye nesinye sepesenti). Kubalulekile ukuqaphela ukuba abantu baseMedicaid bahlala begula ngaphezu koluntu jikelele, ngoko inombolo ye-CPI-yezokwelapha ayibonakali ngokuchanekileyo ukukhula kweendleko zonyango kwi-Medicaid.
I-BCRA nayo iya kunqanda ukunyuswa kweMedicaid ukutsho ukuba yandile ngo-Matshi 2017. Kodwa endaweni yokunciphisa i-federal finance for Medicaid ukwandisa yonke enye indlela, isantya esifanayo esifanayo sasiya kuma-85 ekhulwini ngo-2021, i-80 ekhulwini ngowe-2022, kwaye Iipesenti ezingama-75 ngo-2023. Ukususela ngo-2024, kwakuya kubuyela kwi-Pericaid ye-Medicaid. Oko kuthetha ukuba amazwe awayi kuphinda alahlekelwe ngokukhawuleza yonke i-federal finance eyongezelelweyo eyenziwa njengamanje kwi-Medicaid yokunyusa inani labantu, kodwa kukho amazwe amaninzi apho umthetho welizwe uza kuphelisa ukunyuselwa kweMedicaid ukuba umdlalo wezemidlalo uwela ngaphantsi kweepesenti ezingama-90 (iA Arkansas, eArizona, e-Illinois , E-Indiana, eMichigan, eNew Hampshire, eNew Mexico naseWashington).
I-BCRA nayo iya kutshintsha iMedicaid kwi-system-allocation capt system, kodwa esikhundleni sokuguqula ixabiso le-CPI-Medical + 1, i-BCRA iya kulungiswa kuphela yi-CPI-yezoPhepha ngo-2024, kwaye nge-CPI rhoqo (ayiyiyo yonyango) ukususela ngo-2025. I-CPI-yezoPhakamiso ngokuqhelekileyo inani elikhulu kune-CPI jikelele, kuba iindleko zonyango zivame ukukhawuleza ngaphezu kwezinye iindleko. I-CPI yonke ingaba yinto engafanelekanga, enokubangela ukuba unqunywe imali ye-Medicaid. Ngaloo ndlela ziza kubona ukunyuka okukhulu kwi-federal Medicaid inkxaso njengoko amaxesha ahamba phantsi kwe-BCRA.
Isimiselo sokuGcina iNgcaciso yoMshuwalense wezeMpilo
I-ACA idinga abantu abaninzi ukuba bagcine i-inshorensi yempilo okanye bajongane nesohlwayo sentela. Kukho uluhlu olukhulu lokuxolelwa kwesohlwayo , kodwa i- IRS yabika ekuqaleni kuka-2017 ukuba ii-6.5 yezigidi zerhafu zihlolwe malunga ne-3 billion zeebhilidi kwizigwebo zokungaqiniseki ngo-2015.
I-AHCA kunye ne-BCRA zombini iyakususa ihlwayo, ibuyele emva kokuqala konyaka we-2016. I-AHCA iyishintsha yonyaka owodwa, ukunyuka kweepesenti ezingama-30 kwiiprayimari zabantu abanomngcipheko wokufikelela kwiintsuku ezingama-63 okanye ngaphezulu kwiinyanga ezili-12 ezidlulileyo (okanye, njengoko kuchaziwe ngezantsi, amazwe angakhetha ukuvumela abaqinisekisi ukuba baseke iiprayimari kwimbali yezonyango xa abafaki-zicelo banesithuba kwi-coverage).
Okuthakazelisayo, inguqu ye-BCRA eyakhishwa ngoJuni 22 ayizange ithathe indawo yokutshatyalaliswa kwesohlwayo nantoni na. Kuye kwayichitha nje, kwaye ayizange ifake nayiphi na ilungiselelo lokukhuthaza abantu ukuba baqhubeke nokukhawuleza.
Kodwa ngokukhawuleza, kwakukho amahemuhemu ukuba kukho uhlobo oluthile olufunekayo lokufakela umrhumo oluza kudibaniswa kumhla kamva, kwaye enye inguqulelo yomthetho yapapashwa ngoJuni 26, equka ukufunwa kokuqhubekayo (ungabona kwicala iikopi zee-Juni 26 noJuni 22 iinguqu ze-BCRA apha; icandelo elitsha malunga nokukhutshwa okuqhubekayo kuqala kwiphepha 135 kwenguqu ye-Juni 26). Imfuneko yokuqhubekayo yokugcinwa kwemali igcinwe kwiinguqulelo ze-BCRA.
Ngaphantsi kwe-BCRA ehlaziyiweyo, abantu babeza kuqhubeka nokukhawuleza okanye bajongane nexesha lokulinda ngaphambi kokuba bafumane ukufumana ingxelo kwiimarike zempilo yomshuwalense. Nantsi indlela eya kusebenza ngayo:
- Abantu abahlala kunye neengxelo eziqhubekayo (okt, kwiinyanga ezili-12 ezidlulileyo, babengenalo ikhefu kwi-63 okanye ngaphezulu kweentsuku) baya kuba nako ukubhalisa ngexesha lokubhalisa okuvulekileyo okanye ixesha lokubhalisa olulodwa , kunye nemihla efanelekileyo yokusebenza (yokuqala inyanga elandelayo okanye kwinyanga yesibini elandelayo, kuxhomekeke ngosuku lokubhalisa).
- Abantu abangenayo i-postage yokuqhubekayo ababhalise ngexesha lokubhalisa okuvulekileyo okanye ixesha lokubhalisa elizodwa liza kuxhomekeka kwiinyanga ezilithandathu zokulinda ngaphambi kokuba i-coverage iqalise ukusebenza.
- Abantu abangenazo iincwadi eziqhubekayo zokubhalisa ngaphandle kobhaliso oluvulekileyo kwaye ngaphandle kwexesha lokubhalisa elizodwa kufuneka balinde emva kweenyanga ezilithandathu zokulinda okanye ukuqala kwesicwangciso sonyaka esilandelayo ngaphambi kokuba i-coverage ifumaneke ukusebenza (ngokubhalisa ngoFebhuwari ngaphandle ixesha lokubhalisa elikhethekileyo lithetha ukuba ukufihla kwakho kuya kusebenza ngoJanuwari olandelayo).
- Abantu abanomsebenzi ngamnye wokuthengiswa kwemarike ngentsuku ngosuku ngaphambi kokuba isicwangciso sabo semarhwebo esitsha sisebenze, asiyi kuba phantsi kweenyanga ezintandathu zokulinda, nokuba ngaba babe negalelo ekuhambeni kwithuba kunyaka ongaphambili (umzekelo, Umntu obhalisa ngexesha lokubhalisa okuvulekile, phantsi kwexesha lemizuzu ezintandathu yokulinda, aze abe nesiganeko esifanelekileyo ngokukhawuleza emva kokuba isicwangciso esitsha sisebenze, siya kukwazi ukutshintshela kwisicwangciso esitsha ngexesha lokubhalisa okhethekileyo ixesha elingenalo ixesha lokulinda, nangona isithuba sakhe sangaphambilini esisekuhlaleni sasisesithuba seenyanga ezili-12 zokugqibela).
- Iintsana ezitsha kunye nabantwana abasanda kuthotyelwa abayi kuba phantsi kwexesha lokulinda nje kuphela xa bebhaliswe kwiintsuku ezingama-30 zokuzalwa okanye ukuthotyelwa (phawula ukuba i-ACA inika abazali abatsha iintsuku ezingama-60 ukubhalisa umntwana osandul 'ukuzalwa okanye umntwana osandul' umntwana).
Izibonelelo zezeMpilo ezibalulekile
I-ACA idinga ukunikezelwa kwezibonelelo zezempilo ezibalulekileyo kuzo zonke izicwangciso zeqela elincinci, ezingenakulinganisekanga, ezicwangcisiweyo. Izibonelelo zezempilo eziyimfuneko nazo zifuneka ukuba zifakwe kuzo zonke izicwangciso zokwandisa iMedicaid.
I-AHCA ayitshintshi iinzuzo ezibalulekileyo zempilo kwinqanaba lezemfundo, kodwa liya kuvumela amazwe ukuba afune ukuxoshwa phantsi apho aya kuphinda ahlaziye iimfuno zezempilo eziyimfuneko kwilizwe.
I-BCRA nayo ayitshintshi iinzuzo ezibalulekileyo zempilo kwinqanaba lezemfundo, kwaye alibandakanyi uhlobo lwenkqubo yokukhishwa kombuso echazwe kwi-AHCA. Kodwa ayivumelekile ukuba kufumaneke kakhulu ukufikelela kwi-ACA ye-1332 yeivers. Ezi "ukukhishwa kwezinto ezintsha" zivumela amazwe ukuba afike kwiindlela ezizodwa zokulungiswa kwezempilo (iHawaii ngoku igosa elide kuphela elinemvume evuyiweyo ye-1332 phantsi kwe-ACA).
I-ACA inomlinganiselo oqinileyo wemigaqo yokukhusela abathengi ukuqinisekisa ukuba abantu abafakela phantsi kwe-1332 waiver bafana kakuhle, abafihla abantu abambalwa, kwaye akubibi kubi ngaphezu kokuba kungabikho ukukhutshwa. I-ACA idinga ukuba ama-1332 aivers abe yi-bhajethi-engathathi hlangothi kurhulumente wephondo, kwaye le mfuneko igcinwa yi-BCRA. Kodwa ukukhuselwa kwabathengi kupheliswa, kuthathelwe indawo yokuba umgaqo-nkqubo uchaze indlela abaza kuhamba ngayo "ukunyuka kokufikelela kwiinkcukacha ezipheleleyo, ukunciphisa iiprayimari eziqhelekileyo kunye nokunyusa ukubhaliswa." Ngoko-ke ilizwe liyakwazi ukutshintsha imithetho ebalulekileyo yokunceda impilo i-1332 yaiver phantsi kwe-BCRA, kuba bekungekho mfuneko yokuba i-coverage ihlala iphelele njengoko ikhutshwayo ngaphambili.
Uhlobo lwesi-13 lwe-BCRA lwaluquka i-Cruz Amendment (ebhalwe nguSenin Ted Cruz, waseTexas). I-Cruz Amendment ayikabikwa yi-CBO, kwaye akucaci ukuba ngaba iinkokheli zeSenethi ziceba ukuzibandakanya kwinguqulelo yowiso-mthetho oziswayo ukuvota (ukuba oko kwenzeka ngokwenene).
I-Cruz Amendment iya kuba nempembelelo ebalulekileyo ekunikweni kweenkonzo ezibalulekileyo zezempilo. Kuya kuvumela abaqinisekisi ukuba bathengise izicwangciso ezingavumelananga nje kuphela xa bathengisa ubuncinane isicwangciso sesilivere esinye, isicwangciso esisodwa segolide, kunye ne-58 yepesenti ye-actuarial value plan ( oku kuya kuba yiplani yesilinganiselo phantsi kwe-BCRA ). Ngokuxhomekeke kwimithetho kaRhulumente, i-Cruz Amendment iya kubavumela abaqinisekisi ukuba baphephe imimiselo ekhoyo ngokuphathelele kwimpilo, kuquka neenzuzo ezibalulekileyo zempilo.
Ubungakanani beemeko eziPhambi kwexesha
I-ACA idinga ukuba zonke izicwangciso zeqela kunye namancinci ziqinisekiswe-kungakhathaliseki ukuba imbali yonyango.
I-AHCA iya kuvumela amazwe ukuba afune ukuxhomekeka phantsi koomatshini baso-inshorensi, ngenxa yesicwangciso esinye sonyaka, iiprayimamu zentloko kwimbali yonyango ukuba umfaki-sicelo unesithuba sokubhengezwa kweentsuku ezingama-63 okanye ngaphezulu kwiinyanga ezili-12 ezidlulileyo. Abatshutshisi abayi kunakho ukugatya isicelo ngokupheleleyo ngokusekelwe kwimbali yezonyango (njengokuba banako kwiinkalo ezininzi phambi ko-2014), kodwa baya kuba nako ukuhlawulisa iiprayimamu eziphezulu-kungekho nqoko-eyayiza kubangela ukuba abantu ababenokubhengezwa kwangaphambili bangabonakali. iimeko ezikhoyo kunye neengcambu ekujoliswe kuzo.
I-BCRA igcina iimfuno eziqinisekisiwe ze-ACA kunye nokulinganisa uluntu, oko kuthetha ukuba abantu abanakho ukuhlawuliswa ngaphezulu ngokusekelwe kwimbali yabo yezonyango. Kodwa ngenxa yezinto ezifumanekayo ngokukhawuleza ezingama-1332, izifundo ziya kukwazi ukuhlaziya iindleko zempilo ezibalulekileyo, okubangele ukukhutshwa okungenakukhusela abantu abaneemeko zangaphambili. Ngokomzekelo, ukuba izicwangciso zempilo akusayi kuphinda zibandakanye uluhlu oluninzi lwezilwanyana zemithi kunye nemeko yakho ekhoyo ngaphambili idinga iziyobisi ezibizayo, ukuba iimeko ezide zikhona "zihlanganiswe" ayiyi kuba luncedo.
Ukongeza, i-BCRA ibeka ithuba lokulinda inyanga ezintandathu ukuya kubani na obhalisa kwi-postage emva kokufumana isithuba kwiinkcukacha ezingaphezulu kweentsuku ezingama-63 kunyaka ongaphambili. Ngoko umntu ongenakho ukukhutshwa angeke akwazi ukufumana ubuncinane ubuncinane ubuncinane kweenyanga ezintandathu, nokuba ngaba kufuneka abhalise ngexesha lokubhalisa okuvulekileyo. Ngako oko kuya kuba kubaluleke kakhulu kunoma ubani onenkqubela ngaphambili ukuba agcine i-coverage ngaso sonke ixesha.
IiNkumali ezisekelwe kwi-Age Age
I-ACA ivumela abaqinisekisi ukuba bahlawulise ababhalisile abadala ukuya kathathu ngokumalunga nabhalisi abaneminyaka engama-21 ubudala. Kodwa inkxaso-mali ye-premium kwi-ACA isekelwe kwingcamango yokuba ama-premium (emva kwe-subsidy) afunekayo alinganayo kubantu abaneengeniso ezilinganayo (kuma-400 kwinqanaba le-intlupheko, apha ngasentla apho inkxaso-mali ye-ACA ayifumanekanga). Ngoko ngelixa iiproyamu ziphezulu kubabhalisi abadala, inkxaso-mali ye-premium inkulu kubabhalisi abadala ukuze banqunyulwe ama-premium aphezulu.
I-AHCA iya kuvumela abaqinisekisi ukuba bahlawulise abhalisa abadala bephindwe amahlanu ngokuphindaphindiweyo njengoko bahlawula abhalisi abaneminyaka engama-21 ubudala (okanye i-multiple even more if the states choose to allow it). Umthetho wawuza kunika inkxaso-mali ye-premium esekelwe kwixesha elide eliza kuba likhulu kubabhalisi abadala, kodwa kungekhona ngokwaneleyo ukukhuphula umbahluko kwiiprayimari. Abantu abadala baya kugqiba ukuhlawula ngaphezulu kwiiprayimari kunabantu abaselula, nangona emva kokufumana inkxaso.
I-BCRA iya kubavumela abaqinisekisi ukuba bahlawulise abhalisa abadala bephindwe kabini kuba bahlawula abhalise abancinci. Inkxaso-mali ye-Premium iya kuba yindalo kubantu abadala, kodwa kungekhona ngokwaneleyo ukukhupha iiprayimari eziphezulu, kwaye umgaqo-nkqubo uquka ngokukhethekileyo ukulungiselela abantu abadala ukuba bahlawule ipesenteji enkulu kwinzuzo yabo emva kwe-premiums-subsidy.
Uncedo lweNkulumbuso
I-ACA inikeza inkxaso-mali ye-premium esekelwe ekugcineni i-premium kwisicwangciso sokutshekisha (iplani yesibini ephantsi kwexabiso lesilivere) kummandla ngamnye kwizinga elifikelelekayo. Oko kuthetha ukuba inkxaso inkulu kwiindawo apho ukuthengwa kubiza kakhulu, kwaye kukhulu kubantu abadala. Inkxaso-mali ye-Premium phantsi kwe-ACA ayitholakali kubantu abanemali engaphantsi kwinqanaba lehlwempu-kuba kufuneka babe ne-Medicaid endaweni-kwaye ayifumanekanga kumntu onomvuzo wekhaya ngaphezu kwe-400 ekhulwini lentlupheko (kwindlu ezine, i-$ 97,200 ngo-2017).
I-AHCA inama-flat premium inkxaso axhomekeke kwixesha elide, kwaye ungacingi ukuba iiprayimari ziphakamileyo kakhulu kwiindawo ezithile zelizwe kunezinye. Kwaye njengoko kuphawuliwe ngasentla, ukulungiswa kwenkxaso-mali kwi-premium inkxaso akuyi kuphelisa ngokukhawuleza iiprayimari eziphezulu ukuba abantu abadala baza kuhlawulwa. Kodwa inkxaso ye-AHCA iya kufumaneka kubantu abanemali ephezulu (efumanekayo ngokupheleleyo kubantu abanemali engenayo ukuya kwii-75,000 zama-dollar kumntu oyedwa kunye no-150,000 kwi-isibini esitshatileyo, kunye nokugqitywa ngaphaya kwelo nqanaba), ngaloo ndlela ukwandisa inkxaso-mali kukunceda kakhulu Umgangatho ophakathi phakathi kwe-ACA inkxaso.
I-BCRA igcina isiseko senkxaso efana ne-ACA, kodwa ngezinye iinguqu ezibalulekileyo. Ukuqala ngowe-2020, iifom ziza kufumaneka kubantu abanemali evela kwi-0-350 yepesenti yezinga lobuhlwempu, ngokuchasene neepesenti eziyi-100-400 zezinga lobuhlwempu phantsi kwe-ACA. Oko kwakuya kuthi, ekufundiseni, ukuphelisa isithuba sokungena kweMedicaid , kuba inkxaso iya kufumaneka kubantu abanemali engaphantsi kwinqanaba lehlwempu kwiindawo ezingazange zandise iMedicaid.
Kodwa i-coverage etholakalayo kubantu abanomvuzo ophantsi kuya kuba namandla ngakumbi kunokuba kubonelelwe nge-Medicaid okanye iiplani ze-ACA zangoku. Oku kuya kuba yinyani ngokukhethekileyo emva kokunciphisa ixabiso lokunciphisa indleko kupheliswa ngo-2020 njengelungiselelo le-BCRA. Kwaye kubantu abasemaphethelweni angaphezulu kwenkqubo yenkxaso-mali ye-ACA, inkxaso-mali iza kupheliswa ngabantu abanomvuzo phakathi kwe-350-400 ekhulwini lelihlwempu. Ukuba lo mgaqo wawusebenza ngo-2017, kuya kuthetha ukuba intsapho yezine iya kulungeleka kuphela inkxaso-mali ye-premium eneholo elingama $ 85,050 esikhundleni se-$ 97,200. xa i-BCRA imisela ukusebenza).
Kwaye i-BCRA iya kubambelela inkxaso-mali kwisicwangciso esitsha sokubakho, esiza kufikelela kumyinge wama-58 ekhulwini lweendleko zonyango oluntu. Ukubhekiselele, inkxaso-mali ye-premium ye-ACA ihlanganiswe kwisicwangciso sokubaluleka esithintelayo kwisilinganiso sama-68-72 ekhulwini kwiindleko zomlinganiselo ophakathi. Oku kuthetha ukuxothwa kwemali kunye neendleko zokuphela kwee-pocket ziza kuba ziphakamileyo kakhulu phantsi kwe-BCRA.
Kubantu abavela kwamanye amazwe, i-BCRA nayo iya kunciphisa ukufaneleka kwe-subsidy ukuba " ngabafokazi abafanelekileyo ," oko kuthetha ukuba abantu emsebenzini wexeshana kunye neefayuni zabafundi abayibe besakwazi ukufumana inkxaso-mali, njengoko bephantsi kwe-ACA .
Ukuxhaswa ngeendleko
I-ACA inikeza inkxaso -mali yokwabelana ngeendleko zokunciphisa iindleko ezingaphandle kweefowuni ezijongene nabhaliso abaphantsi. Abantu abaneengeniso ukuya kwii-250 zeepesenti zentlupheko banelungelo lokufumana inkxaso-mali ngokuzenzekelayo kubandakanya inkxaso-mali yokwabelana ngeendleko, nje kuphela xa bekhetha icebo lesilivere.
I-AHCA iya kuphelisa imali-mali yokwabelana ngeendleko emva ko-2019. Kodwa ngokucacileyo, ayizange ifake inkxaso ngemali kwixeshana. Inkxaso-mali yokwabelana ngeendleko zixhomekeke kumgwebo oqhubekayo oziswa yiNdlu yamaRiphabhulikhi ngo-2014, ngenxa yokuba iifom zange zange zenziwe yiCongress. Kukho ukungaqiniseki okukhulu malunga neenkxaso-mali zokwabelana ngeendleko ngo-2017, kwaye kubangela ukuba abaqinisekisi bentengiso bacebise iiprayimari eziphezulu ngo-2018 kunokuba babekukuzibophezela ngokuzimisela kwi-federal government ukuxhasa inkxaso-mali yokwabelana ngeendleko.
I-BCRA nayo iya kuphelisa imali-mali yokwabelana ngeendleko emva ko-2019. Kodwa ikwabeka ngokukhethekileyo inkxaso-mali yokuyihlawula ngoku. Oku kuya kunceda ukunciphisa ukungaqiniseki ukuba abo baqhankqalazi bajongene nayo kwimarike nganye, nangona ukupheliswa kweenkxaso-mali zokwabelana ngeendleko emva ko-2019 kuya kubangela abantu abangenayo imali engenako ukukwazi ukunceda ukunakekelwa kwempilo.
Bangaphi Abantu Abaya Kulahleka Umyinge?
Ngaphantsi kwe-AHCA, ii-CBO ziqikelele ukuba inani labantu abangaqinisekanga liza kukhula ngama- 23 wezigidi ngo-2026 . Oku kuya kubandakanya abantu abayizigidi ezili-14 abambalwa abaneMedicaid, abantu abayizigidi ezi-6 abancinci abaneemarike (ngaphandle kweqela), kunye nezigidi ezi-3 zabantu abambalwa abane-inshorensi exhaswe ngumqeshi.
Ngaphantsi kwe-BCRA, ii-CBO ziqikelele ukuba inani labantu abangaxhaswanga liza kukhula ngezigidi ezili-22 ngo-2026. Oku kuya kubandakanya abantu abayizigidi ezili-15 abambalwa abaneMedicaid, kunye nezigidi ezi-7 zabantu abambalwa abanomsebenzi ngamnye wokuthengisa.
Siya Kuvelaphi Kulapha?
Ukwahluka okuchazwe ngasentla akuluhlu olupheleleyo, kodwa jongana nezinto ezininzi abathengi abaziqaphela ukuba umthetho uya kuphunyezwa.
Asisazi ukuba yiyiphi i-Senate eya kugqiba ukuyenza-ukuba nantoni-ngokubhekiselele ekuguquleni kwezempilo kwiseshoni ye-2017. UMongameli uTrump uye watshitshisa ngokusemthethweni abenzi bomthetho ngokulahlekelwa yi-inshurensi yezempilo yonyango abaxhaswe ngumqeshi xa bengagqithanga umthetho ukuba bachithe (kwaye mhlawumbi bathathe indawo) i-ACA ( nantsi inkcazo yendlela amalungu eCongress kunye nabasebenzi abafumana ngayo i-inshorensi yabo ). I-Trump nayo isongela ukuvumela u-Obamacare ukuba "athandaze" ngokunciphisa into awabhekisela kuyo ngokuthi "ukuxhaswa kwemali" kwiinkampani ze-inshorensi (inene, uthetha ngemali- mali yokwabelana ngeendleko , okwangoku urhulumente wephondo ohlawula i-insurers ukubonelela ngeyona ndlela Ababhalisi abangenayo imali encinci; ngokuqinisekileyo akuyiyo ibheyili).
I-Senators Lindsey Graham, uBill Cassidy, kunye noDean Heller baye bazisa izilungiso eziya kuguqula ezininzi zeemali zenkxaso phantsi kwe-ACA ukuvimba izibonelelo zelizwe. Kuza kugcina ezinye ze-ACA zokukhusela abathengi, kodwa ziya kuphelisa umyalelo ngamnye ofuna ukuba abantu bathenge ukuthenga. Akucaci ngoku ngolu hlobo ukuba loo milinganiselo iya kubangela inkxaso eyaneleyo yokufumana ibhilikhwe yokulungiswa kwempilo yeNdlu emva komgangatho we-Senate kwenye ivoti.
Ngeli xesha, akukho nto ishintshile, nangona imarike yempilo yomshuwalense yempilo ibhekene nokungaqiniseki okukhulu kunye neengxaki zokuLawula iTrump zokuvumela ukuba u-Obamacare "acele." Oku kunyanisekileyo kunikezelwa ukuba kukho iindlela zokuLawula iTrump ngokuqinisekileyo zingabhuqa imarike nganye ngaphandle kweCandressional action.
Imithombo:
> I-Ofisi yeBhanjethi yeCongress , i- HR1628, uMthetho wezeMpilo waseMelika ka-2017, uhlalutyo lweendleko . NgoMeyi 24, 2017.
> I-Ofisi yeBhajethi ye-Congressional, i- HR1628 , uMthetho woNxibelelwano olungcono lwe-Care7 ka-2017, Uhlalutyo lweendleko . NgoJuni 26, 2017.
> I-Ofisi yeBhajethi ye-Congressional, i- HR1628, uMthetho woNxibelelwano woNxibelelwano olungcono lwe-2017: Uhlengahlengiso kwiNdawo yeRenferensi [ERN17500], njengoko isetyenziswe kwiWebhusayithi yeKomiti yeKomiti yeBethi-mali ngoJulayi 20, 2017 . Julayi 20, 2017.
> Kaiser Family Foundation. Ipesenti ye-Federal Medical Assistance (FMAP) ye-Medicaid kunye ne-Multiplier.
> IKomidi yohlahlo lwabiwo -senethi , Umbhalo we-HR1628, uMthetho woNxibelelwano woNxibelelwano olungcono ngo-2017 . Juni 22, 2017.
> United States Isebe Labasebenzi, i-Bureau of Labor Statistics. Ukuguqulwa kwexabiso loTshintsho lweZonyango kwi-CPI.