U-2017 wawungumnyaka wokuxhatshazwa wokuguqulwa kwezempilo, kodwa malunga nayo yonke imizamo ye-GOP ekhokelwayo yokuqhawula uMthetho ojongene noKhathalelo (ACA, odla ukubizwa ngokuba yi-Obamacare) ayiphumelelanga. Akunakwenzeka ukuba uhlobo lokutshintshwa kunye nokuthatha iindleko eziye zaziswa ngo-2017 ziya kubuya ngo-2018, kodwa ikusasa le-ACA kunye nokulungiswa kwezempilo kusenokuqinisekiswa phantsi kolawulo lweTrump kunye neRiphabliki yeNkcubeko.
Enye yemibandela ebekwe ngaphambili kunye neziko ziimeko ezikhoyo ngaphambili. I-ACA ikhiphe ukubhaliswa kwezonyango kwiimarike zempilo yomshuwalense weqela kunye neyincinci, ngoko ke izicwangciso zeqela kunye namancinci ngoku zikhutshwe kubo bonke abafaki-sicelo ngaphandle kwembali yezonyango, kwaye kungabikho ukuhluka kweentengo ezisekelwe kwiimeko zempilo.
Oku kuye kwaba yintlupheko kubantu abaneemeko esele ikhona kunye namashishini amancinci anembali ebalulekileyo yeemangalo zezokwelapha, kwaye inika uxolo lwengqondo kubantu abangenazo iimeko zangaphambili, njengoko iimeko zonyango zinokuvela nanini na, ngamanye amaxesha zingenasilumkiso.
Kulula ukubona ukuba kutheni ukuhanjiswa kweemeko zangaphambi kwexesha elikhoyo kukho enye yezona nkalo ezithandwa kakhulu kwi-ACA. Kodwa enye yimiqathango eqhubekele iindleko zemboleko nganye yemarike. Inkxaso-mali yeeNkulumbuso ihoxise ezo ndleko kubuninzi babantu abanomyinge ngokubambisana, kodwa kwabo bangenayo inkxaso (kuquka bonke abantu abathengayo ngaphandle kokuthengisana), ngokuqinisekileyo iiprayimesi zibe ngumthwalo onzima.
Ngoko nangona udumo lwemiqathango ye-ACA efuna ukuba izicwangciso zezempilo zihlasele iimeko ezikhoyo ngaphambili, umba uhlala uphazamisekile. Eminye yomthetho abagwebi be-GOP bacebise beza kubuyisa imimandla eyahlukeneyo ye-ACA yokukhusela iibhola kubantu abanemeko esele ikhona, kwaye kubalulekile ukuqonda indlela oku kuza kusebenza ngayo, ngokukodwa kubonelelwe ukuba izitatimende ezisemthethweni malunga nale miqathango yomthetho ngokubanzi zibonelela Iingcamango malunga nendlela abantu abaneemeko zangaphambili eziza kubakho.
I-AHCA kunye neemeko eziPhambi kwexesha
NgoMeyi 4, ngo-2017, iiRephabliki zaseNdlu zadlulela uMthetho we-American Health Care Act (AHCA), waza wawuthumela kwi-Senate. I-AHCA yaba ngumphumo wesigqibo sebhajethi kaJanuwari 2017 owayalela iikomiti zeCongress ukuba ziqulunqe umthetho wokuxolelana ukuze kupheliswe iinkalo ezinxulumene nenkcitho ye-ACA (izinto ezinjengeenkxaso, ukwandiswa kwemida , igunya lomntu ngamnye kunye nomqeshi ).
Iingxowa-mali zokuxolelana zi-filibuster-proof, ngoko zifuna kuphela uninzi olulula kwi-Senate. Kodwa zikhawulelwe kumalungiselelo achaphazela ngqo imali yokusetyenziswa kwemali, kwaye ngoko ayikwazi ukujongana nayo yonke imiba ye-Care Affordable Act. Abaphengululi bezomthetho bangabazeki ukuba ilungiselelo lokuphazamisa i-ACA ye-pre-existence protection protections iya kuvunyelwa ukuba iqhubeke kwi-Senate njengesilwayo soxolelaniso.
Nangona kunjalo, i- MacArthur isilungiso kwi-AHCA, eyongezwa kwiNdlu ngo-Ephreli kwimzamo yokuphumelela abameleli abazimeleyo, babeya kwenza oko kanye. Ngaloo ndlela, bekukho ukucinga ukuba ibhilikhwe iya kufuneka ifatshintshwe kakhulu ukuze iphumelele i-Senate. Ekugqibeleni, iiSenethi zeRiphabliki zincomele iiinguqu ezine ezahlukeneyo zebhilikhi, zonke ezo zahluleka ukudlulela ("i-skinny" ukuchithwa, uMthetho woNxibelelwano wokuThuthukiswa koLondolozo olungcono, uMthetho we-Obamacare Repeal Reconciliation Act, kunye no-Graham-Cassidy-Heller-Johnson ukulungiswa).
Ngenxa yoko, iinzame ze-2017 zokuphinda nokubeka iindawo ezinkulu ze-ACA aziphumelelanga. Abalawuli be-GOP baphumelele ekutshitshiseni isigwebo segunya le-ACA somntu ngamnye njengenxalenye yerhafu yeerhafu eyenziwa ngoDisemba 2017, kodwa ukutshitshiswa akusebenzi kuze kube ngo-2019 ( kusekho isohlwayo sokungaqinisekiswa ngo-2018 ).
Uninzi lwayo yonke i-ACA lugxininisekile ekuqaleni kuka-2018, kubandakanywa nokubonelelwa kwe-ACA okufuna ukuba abagcini besikhokhelo banciphise iindleko ze-pocket zokubhalisa abancinci. Ezi zincinci zokunciphisa izindleko (CSR) azixhaswanga ngokuthe ngqo ngurhulumente wephondo, kodwa izibonelelo ziyafumaneka nakwiibhalisi ezifanelekileyo.
Kodwa iingxoxo zeengxoxo zokunakekelwa kwempilo zide zide, kwaye akucaci ukuba i-ACA ingaqhiphulwa okanye iguqulwe kwiinyanga ezizayo ngokulandela imithetho emiselweyo kunye / okanye imiyalelo yolawulo. Ngoko kubalulekile ukuqonda imizamo yangaphambili yokutshintsha imigaqo malunga neemeko zangaphambili, njengoko singakwazi ukubona imizamo efanayo kwixesha elizayo.
Ulungiso lweMacArthur
Ngo-Apreli 2017, uMnu. Tom MacArthur (R, eNew Jersey) wazisa isilungiso kwi-AHCA ejolise ekuncedeni inkxaso evela kwi-Cowcus ye-House-Conservative. Yaphumelela, kwaye inkxaso evela kwiCaucus Freedom eventually yaba nevoti elaneleyo yokuba i-AHCA idlule kwiNdlu.
I-MacArthur Uhlengahlengiso yayiya kwenza amazwe ukuba afune ukuxoshwa-phantsi kwezinto ezabonakala ngathi yinkqubo yokuvunywa kwemvume-eyayiya kubavumela ukuba batshintshe ubuninzi bokukhusela abathengi be-ACA:
- Abantu abaneemeko zangaphambi kokuba zibhalwe kwizicwangciso zeemarike ezizimeleyo kunye neengcambu ekujoliswe kuyo (ubuncinane iintsuku ezingama-63 kwiinyanga ezili-12 ezidlulileyo) ziya kuba ziphantsi kweeprayimari ezisekelwe kwimbali yabo yezonyango kwiinyanga ezili-12 zokuqala phantsi komgaqo-nkqubo omtsha. Kwakungekho mingeni ekuphakanyeni ukuba le mivuzo-mali ingaba yintoni, enokubangela ukuba kubekho abafaki izicelo, ngokuxhomekeke kwiimbali zabo zonyango. Olu hlobo luya kuba yindawo yokunyuswa kwama-premium engama-30 kunyaka omnye (kungakhathaliseki ukuba yintoni imbali yonyango) ukuba i-AHCA yayiza kuphunyezwa xa abafakizicelo beemarike abathile besetyenziselwa emva kwesithuba sokungena.
- I-AHCA ifuna ama-premium ayeza kuba ngamahlanu aphakamileyo kubantu abadala (iminyaka engama-50 ukuya kuma-64) kunabantu abadala abaselula. I-MacArthur Uhlengahlengiso yayiye yavumela amazwe ukuba ahlukane naloo mlinganiselo aze adale enye indawo ephakamileyo. Ngokombono, i-ACA ibeka umlinganiselo ukuya ku-3: 1, oku kuthetha ukuba abantu asebekhulile abanakho ukuhlawulwa ngokuphindwe kathathu kunabantu abancinci.
- I-MacArthur Uhlengahlengiso kwakhona yayiya kwenza amazwe afune ukuyeka ukutshintsha inkcazo yezibonelelo zezempilo ezibalulekileyo . Oku bekuya kuthetha ukuba ezinye iinkonzo ezifunekayo ukuba zifakwe phantsi kwe-ACA kungenzeka ukuba zingabandakanywa kwiindawo ezithile ukuba i-AHCA yenziwe. Kubantu abanemeko esele ikhona ngaphambili, ngokuqinisekileyo oku kwakuxhalaba kakhulu, njengoko unyango lwabo oluyimfuneko lugqityiwe lungazange lugqitywe yi-inshurensi. Ngaphantsi kwe-ACA, iimfuno zezempilo ezibalulekileyo zifunwa kuphela ukuba zikhutshwe zizicwangciso zeqela kunye namancinci, kunye neMedicaid. Izicwangciso zeqela elikhulu azidingeki ukuba zihlanganise nabo, nangona baninzi benza.
Yintoni Yonke Ukungavumelani Ngayo?
Ukuba ubukele amaRiphabhulikhi kunye namaDemokhrasi aphikisana ne-AHCA emva kokusungulwa kwe-MacArthur Amendment, mhlawumbi wabona amaDemokhrasi athi umthetho uya kubakhokelela ukukhusela kwangaphambili kweemeko, ngelixa amaRiphabhlikhi athi umthetho ukhusele abantu ngokubhekiselele kwiimeko ezikhoyo ngaphambili. Ngoko yintoni na?
Ngokwenene, i-MacArthur Amendment yathi abantu abanakuphikiswa ukuxhaswa ngokusekelwe kwimeko esele ikhona. Yiloo gatya lamaRiphablikhi awakhankanya xa bethetha ukuba umthetho wawuquka ukukhuselwa kweemeko zangaphambili. Ngamanye amaxesha baye baphawula ngxaki ngokuthi abantu abaneemeko zangaphambili babengeke babone nayiphi na impembelelo embi nje kuphela xa beqhubeka nokukhawuleza.
Kodwa umtyholi usezi nkcukacha. Ngaphantsi kwe-MacArthur Uhlengahlengiso, kuyinyaniso ukuba isicelo asikwazanga ukuchithwa ngokupheleleyo (esasetyenziswa kuzo zonke iinkalo phambi kwe-ACA, xa abantu babeneemeko ezinzulu ezenzeka ngaphambili kwaye bafaka isicelo sokuthengiswa kwemarike nganye). Kodwa oomatshini bamashurensi babeya kuba nako ukuhlawulisa iiprayimari eziphakamileyo kwiimarike ngamnye kwilizwe ngokuxhomekeka, ukuba ngabafaki-sicelo babenemeko esele ikhona kwaye befumene igalelo ekuhambeni kweenyanga ezili-12.
Oko kwakungenokuba yenze i-coverage engabonakaliyo. Ngoko nangona isicelo singenakuphikiswa, ukufikelela komthengi kufikeleleko kwakungeke kwenzeke. Sonke sinokufikelela "kwi-Lamborghinis. Kodwa oko akuthethi sinawo onke ama-Lamborghinis.
I-MacArthur Amendment iphinde ivelise inkxalabo ngokubhekiselele kwizibonelelo zempilo ezibalulekileyo. Ukuba urhulumente ukhetha ukukhipha imithetho esebenzayo kwimithi yonyango, umzekelo (enye yeenzuzo zezempilo ze-ACA), sinokubona izicwangciso ezingazange zifake uluhlu olupheleleyo lwegama lomenzi kunye namachiza okhethekileyo. Le yingxaki ebalulekileyo kubantu abaneemeko esele ikhona efuna imithi ebiza.
Ngokufanayo, ukuba urhulumente ukhetha ukukhetha ukhetho lokubeleka (yenye yezona zibonelelo zezempilo eziyimfuneko kwaye ngoko kunyanzelekile phantsi kwe-ACA), ininzi i-inshurensi kwimarike nganye ayiyi kuphinda iphinde ibenike, njengokuba kunjalo phambi kwe-ACA .
Nangona iRiphabhliki ichanekile ngokuchanekileyo ekutshilo ukuba i-AHCA ayilungiswanga i-AHCA ayingayi kubavumela abo baso-inshorensi ukuba baphikise izicelo ngokusekelwe kwiimeko ezikhoyo ngaphambili, i-MacArthur Amendment yayinganciphisa ukukhuselwa kumashishini ngamnye kubantu abaneemeko ezikhoyo. Kwaye ngenxa yeenguqu ezinokuthi zenze inkcazo yeemfuno zezempilo eziyimfuneko, igalelo lingaye longezwa kumakethi axhaswe ngumqeshi ngokunjalo.
Yintoni enye i-AHCA eya kwenza yona?
I-AHCA yayiya kuphelisa isigwebo somntu ngamnye se-ACA ekuqaleni konyaka we-2016, ukususa enye yezinto ezikhuthazayo okwangoku ezigcina abantu abasempilweni kwiziko le-inshurensi (i-inshurensi isebenza kuphela xa kukho abantu abanempilo elaneleyo echibini ukuze balinganise amabango abantu abafuna unyango lwempilo). Kodwa i-coverage iya kuqinisekiswa-kungakhathaliseki ukuba imbali yonyango yomfaki sicelo.
[Qaphela ukuba isigwebo somntu ngamnye sachithwa kwi-BOP yebhili yerhafu eyenziwe ngasekupheleni konyaka we-2017, kodwa ukutshitshiswa akuyi kusebenza ukususela ngo-2019. Zonke iinzame zomthetho zokuphelisa nokubuyisela i-ACA ngo-2017 ziquka ukuchithwa ngokutsha isigunyaziso somntu ngamnye, kodwa umrhumo werhafu uphunyelelwa ngaphandle kokutshitshiswa kwikamva.]
Ukuze kukhuthazwe abantu ukuba bagcine ukuxhaswa, kwiindawo ezingakhange zifune ukuxoshwa phantsi kwe-MacArthur Amendment, i-AHCA yayiza kunokuba ixhomekeke kwi-premium yereferensi kubantu abangagcinanga ukugcinwa kwengxelo. Kubhaliso emva kobhaliso oluvulekileyo lwe-2018 (okt, nabani na ababhalisa ngexesha lokubhalisa okhethekileyo ngo-2018, okanye ngexesha lokubhalisa okuvulekileyo ngo-2019 nangaphezulu), abafaki zicelo baza kuhlolwa iiprayimari ezingama-30 eziphezulu ngaphezu kwezinga eliqhelekileyo ukuba ngaba isithuba ekuhambiseni iintsuku ezingama-63 okanye ngaphezulu kwiinyanga ezili-12 ngaphambi kokubhalisa. Iiprayimari eziphezulu ziza kuhlala zihlala kwindawo esisele kwisicwangciso sonyaka.
Kubalulekile ukuba uqaphele ukuba iiprayimari eziphezulu ziya kufaka isicelo kubani ababhalisa kumgaqo-nkqubo weemarike ngamnye emva kwesithuba esikwi-coverage. Akukho nto ingaba umenzi wesicelo unempilweni okanye uyagula. Ngendlela, oku kubangela ukuba abantu banempilo bangabhaliswa emva kokungena kwi-gap, kwaye bangaphinda baqhube amaziko e-inshurensi kumabhalane abagulayo.
Ngaba i-ACA yokuBuleka kwemizamo iya kubangela Ukubuyela kwiMimiselo ye-AAA yangaphambili?
Idatha yeKaiser Family Foundation yakutshanje ibonisa ukuba i-27 ekhulwini yabantu abadala asebekhulile e-US baneemeko zangaphambili eziza kubangela ukuba zingenakunceda kwimarike nganye xa sabuyela kwimigangatho yokubhala phantsi kwezokwelapha eyayisendaweni ecaleni phantse kuwo onke amazwe phambi ko-2014 .
I-AHCA ekugqibeleni ayiphumelelanga ngo-2017, kuba zonke iinguqu zeSenate zahluleka ukudlula. Kodwa nangona i-AHCA idlulile, ayizange ibuyele ekubuyiseleni izinto ngendlela ababeyi-ACA ngaphambili. Nangona kukho abameli abathile abanomdla abaye bacetyiswa ukuba benze njalo , ukubuyela ekugqibeleni ngokugcwele kwonyango kwiimarike ngamnye kukucebisa okungekho mgaqo-nkqubo.
Kodwa nangona ii-ACA zangaphambili ezikhuselekileyo zokhuseleko ziya kupheliswa, abaninzi abantu baseMerika babeya kukhuselwa, ngenxa yemigaqo ebeyi-date ye-ACA. Makhe sijonge indlela abasebenza ngayo:
I-ACA yangaphambili: Imithetho eyahlukileyo ngokusekelwe kuhlobo lwe-Inshorensi
Kukho iindlela ezine eziphambili abantu baseMelika abafumana i-inshurensi yezempilo: Inkxaso-mboleko exhaswa ngumqeshi, i-Medicare, i-Medicaid, kunye nemarike nganye. Unokulindela izinto ezahlukeneyo ngamnye ngamnye phantsi kolawulo lweTrump .
Ukuba i-ACA yangaphambili ekhuselekileyo imeko yokukhusela iyakucinywa, impembelelo ayiyi kufanana phakathi kwala maqela amane. Utshintsho olusisiseko olwenziwa ngu-ACA ngokwemimiselo yexesha elide lisekho kwikarhwebo nganye, apho ama-7 ekhulwini labantu base-US bafumana i-inshurensi yezempilo.
I-HIPAA iyakuthi ikhusele iCandelo lamaRejista
I-HIPAA (uMthetho we-Inshurensi yokuPhathwa kwe-Intshuwalense kunye nokuPhatha kweMpilo) ibuyele kwiminyaka engama-90, kwaye sele idala ukukhusela okubalulekileyo kubantu abafumana ukufumana ingxelo evela kumqeshi (malunga nama-49 ekhulwini labantu base-US abanokuxhaswa ngabaxhasi). Kuphela ukuphonswa ngokupheleleyo kwe-ACA-ngokuchasene ne-bill ye-reconciliation njenge-AHCA-ayiyi kuphelisa imimiselo ye-HIPAA, ngoko ke abantu abafumana inkxaso evela kubaqeshi babo baya kuba neengxelo zeemeko zangaphambili.
Kodwa phambi kwe-ACA, phantsi kwemimiselo ye-HIPAA, izicwangciso ezixhaswe ngumqeshi zinokubangela ukuba kubekho ixesha lokulinda kwi-postage ekhoyo ngaphambili (ngaphandle kokubeleka, ukucinga ukuba isicwangciso sinikezele ngeenzuzo zokubeletha) ukuba umntu obhalisile wayengagcinanga ukukhutshwa kwangaphambili phambi kokubhalisa kwisicwangciso.
Ngethuba nje loo mntu egcine ukugcinwa kokuqhubekayo okungenani iinyanga ezili-12 ngaphandle kwekhefu leentsuku ezingama-63 okanye ngaphezulu, iziganeko ezenzeka ngaphambili zafunyaniswa ngokukhawuleza xa kufikeleleka ngokubanzi. Kodwa ukuba lowo ubhalisile unesithuba sokubhengezwa kweentsuku ezili-63 ngaphambi kokubhalisa kwisicwangciso esixhaswe ngumqeshi, isicwangciso sinokumisela ixesha lokulinda kwiinyanga ezili-12 kwiimeko ezikhoyo ngaphambili.
I-ACA iphelile loo mbandela. Ngaphantsi kwe-ACA, iimeko eziphambili zikhokelelwe kuyo yonke icebo elixhaswe ngumqeshi, kunye nazo zonke izicwangciso zeemarike ezingabonakaliyo (non- grandmathered ), ngokukhawuleza xa ukufakwa komntu phantsi kwesicwangciso kusebenza.
I-ACA iyanqabela nabatshutshisi ukuba bahlawule amaqela amancinci angaphezulu kweeprayimari ezisekelwe kwimbali yabo yezonyango. Inkcazo yeqela elincinci yayisele iqinisekisiwe-phantsi kwe-HIPAA, kodwa abathwali banokuhlawulisa iiprayimari eziphezulu kumaqela anempilo ebuthakathaka. Xa i-ACA iqalile ukusebenza, le nto yayivalwe, kwaye iiprayimari zeqela elincinci kuphela zinokusekelwe kwiminyaka yabhalisile, indawo yokuhlala, ubungakanani bentsapho kunye nokusetyenziswa kwecuba.
Ukuba i-ACA yatshitshiswa kwaye ukufakwa endaweni ayizange ifake ilungiselelo lokunqanda ixesha lokulinda kwiimeko eziphambili, imigaqo yayiya kubuyela kwindlela ababeyiyo phambi kuka-2014. Abantu abagcina ukugcinwa kwekharityhulam bekungekho ixesha lokulinda elide likhona imeko xa ujoyina isicwangciso sezempilo somqeshi. Kodwa abantu abanesiphakamiso kwi-coverage babeya kuba phantsi kwexesha lokulinda kwiimeko ezikhoyo ngaphambili. Kwaye amaqela amancinci kunye nabasebenzi abakwiimpilo ezihluphekileyo banokujamelana neeprayimari eziphezulu eziphezulu kunamaqela amancinci nabasebenzi bezempilo.
Kodwa i-AHCA ayingayi kuphelisa loo migaqo ye-ACA (ukugcina engqondweni ukuba yayiyi-bill ye-reconciliation, kwaye ke yayinganiselwe ngokwale nto ingatshintsha). Ngaphantsi kwe-AHCA, ukuvinjelwa kwimiqathango yokulinda kwangaphambili kwimiqathango yokulinda iiplani ezixhaswe ngumqeshi kuya kuhlala isasebenza, kwaye iiprayimari kwiimakethe ezincinci zeqela azizange zixhomekeke kwiimeko zempilo zecandelo lomqeshi.
I-Medicare kunye neMedicaid iya kuqhubeka ikhupha iziganeko zangaphambili
I-Medicaid kunye ne-Medicare zibandakanya iimeko ezikhoyo ngaphambili. Kukho ezinye izicathulo kunye ne-Medicare, nangona kunjalo, ezingenanto nantoni na i-ACA:
- Kwiinkoliso ezininzi, abantu ababhalisa kwisicwangciso seMedigap emva kw window yabo yokuqala yokubhalisa (kwaye ngaphandle kokufikelela kwenye yexesha elide kakhulu lokubhalisa i-Medigap) ziphantsi kobhaliso lwezokwelapha. Izicelo zabo zinganqatshwa, zinganikezelwa isicwangciso nge-premium ephezulu kune-standard, okanye umphathiswa unokumisela ixesha elilindelekileyo lokulinda imeko.
- Kwiimeko ezininzi, ukuba unesifo se-renal (ESRD) sokugqibela, awukwazi ukubhalisa kwi- Medicare Benevantage .
Nangona i-ACA ayitshintshi nantoni na malunga ne-post-existing coverage phantsi kwe-Medicare ne-Medicaid, yenza kakhulu ukwandisa ukufikelela kwiMedicaid. Ubhaliso lwabonke kwi-Medicaid / CHIP lwandisiwe ngabantu abangaphezu kwezigidi ezili-17 ukususela ekupheleni konyaka ka-2013, sibonga kakhulu kwinxalenye enkulu ye-ACA yokwandiswa kwemigaqo yokufaneleka yeMedicaid.
Ngaphambi kwe-ACA, i-Medicaid (ebandakanya ukuhanjiswa kweemeko zangaphambili) ifumaneke kwiindawo ezininzi kuphela kubafazi abancinane abakhulelweyo nabantwana, abanye abazali abanomvuzo ophantsi kakhulu, kunye nabahlali abanomvuzo ophantsi abakhubazekile kunye / okanye badala.
Ngaphantsi kwe-ACA, i-31 kwaye iSithili sase-Columbia sandise iMedicaid kubo bonke abantu abadala abanomvuzo wekhaya ukuya kuma-138 ekhulwini kwinqanaba lehlwempu, elingaphantsi kwama-16,700 ama-dollar kwimali engenayo yonyaka omnye ngo-2018.
Ukuba i-ACA igqityiwe ngokutsha kwaye ukutshintshwa akuyiyo njengeziqinileyo, izigidi zabantu abaye babe neMediicaid bangahle balahlekelwe ukufikeleleka kokufikelela kwi-coverage. Baya kuba nako ukuthenga ukuthengwa kwemarike nganye (mhlawumbi inomnye uhlobo lwenkxaso-mali yerhafu), kodwa loo nto ingenokuba yinkxaso-mali kubantu abanemali ephantsi. Ukuba bekungayi kuqinisekiswa, izimo zabo zangaphambi zikhoyo zazingasayi kugqitywa, kwaye akukho naluphi unyango olungalindelekanga olungalindelekanga.
I-AHCA ifuna ukubhalisa ngokukhenkcela kwi-Medicaid kwandiswe ngowe-2020, kwaye uguqule iMedicaid kwisabelo ngasinye okanye isibonelelo sebhloko kunokuba isistim sokunxibelelana esipheleleyo se-federal esebenzayo namhlanje.
Oko akuzange kwenzeke, kodwa ulawulo lweTrump liqalise ukuthatha indlela eyahlukileyo yokunciphisa ukubhaliswa kwabakwaMedicaid ngokuziphucula imithetho ekukhutshweni kwabo bathi banokufuna iiprogram zabo zeMedicaid (i-Medicaid ixhaswa ngemali kunye nekarhulumente kunye nekarhulumente, ngoko ke isandla ekuqulunqeni eminye yemithetho). Izinto ezinjengeemfuno zomsebenzi kunye neengubo zokufihla ubomi azivunyelwe phantsi koLawulo lwe-Obama, kodwa ziyavunywa okanye ziqwalaselwa yiCandelo loLawulo lweTrump. Ekugqibeleni, injongo yeCandelo loLawulo lweTrump kunye nabaphathi be-GOP kukuba babe nabantu abambalwa abagqitywe nguMedicaid. Ngelishwa, akukho mfanekiso ocacileyo wendlela abo bantu kufuneka bafumane ngayo enye inkcazo, kwaye abaninzi baya kuba baxhaswanga ngaphandle kokufikelela kwiMedicaid.
Iimeko eziPhambi kweMarike kunye neMarike yoMntu
Njengoko kuchazwe ngasentla, i-AHCA-kunye ne-MacArthur Amendment-yayiza kubuyisa enye yezinto ezikhuselekileyo ezikhuselekileyo ezidalwe yi-ACA.
Ukuqonda indlela iimeko eziphambili ezazisetyenziswa ngayo ngaphambi kokuba i-ACA yiyona nto ebalulekileyo yokuqonda ukuba kungani i-ACA ifunekayo kwindawo yokuqala, kwaye yintoni enokubangela ukuba ukukhuselwa kwimeko esele ikhona kushintshiwe.
Ubungakanani kwimarike nganye kwiintlobo ezihlanu kuphela zibhalwe ngonyango phambi ko-2014, xa i-ACA ivinjelwe ukuba kusebenza (ukuthengwa kwemarike nganye yintlobo oyithengayo kuwe-ngokutshintshiselana okanye ukutshintshana- ngaphandle kokukufumana kumqeshi ).
Kukho abantu abangaphezu kwezigidi ezili-17 abanomsebenzi kwiimarike nganye. Abaninzi babo sele benomsebenzi wokuthengisa nge-ACA ngaphambili, kodwa abanye babekwazi ukufumana ingxelo xa imithetho ye-ACA iqalisa ukusebenza kwaye abaphathi bebenakho ukukhanyela izicelo ngokusekelwe kwimbali yezonyango zabafaki-sicelo.
Ukubhalwa kwezonyango kwakuthetha ukuba iinkqubo zomshuwalense zempilo zentengiso nganye ziquka uluhlu olude lwemibuzo malunga nembali yezobugqirha. Ubungakanani bokufaneleka buxhomekeke kwiimpendulo, kwaye kubantu abavunyelwe ukubhalisa ngaphandle kweemeko zabo zangaphambili, ii-premiums zivame ukuphakama kunezinga eliqhelekileyo.
Iimeko eziphambili ezikhoyo zibandakanyiweyo naluphi na uphando lwezokwelapha. Ukugqithisa, ukuphakamisa i-cholesterol okanye uxinzelelo lwegazi, imbali yokutyelela kwi-chiropractor ... yonke into yahlaziywa ngabagqirha bezonyango ukuze baqinisekise ukuba umfaki-sicelo unelungelo lokufumana ingxelo, kwaye ukuba kunjalo, ngeliphi inani.
I-ACA yatshintshe yonke loo nto. Kwimarike nganye, imigaqo ye-ACA yangaphambili ekhoyo iguqule umdlalo. Izicelo ezilahliwe kunye neeprimiyamu ezikhulayo ngenxa yembali yezonyango zaba yinto edlulileyo, njengoko kwakunjalo ixesha lokulinda.
Ukongeza kwi-AHCA, ezinye iinqununu ze-ACA zokutshintshwa / ukuthatha indawo yomthetho zaziswa ngabagwebi be-GOP kwiseshoni ka-2017. Abaninzi babo babiza ukuba bahlale bekhusele i-ACA yokukhusela kwangoku kubantu abanemeko ekhoyo ngaphambili.
Kodwa ukuba iimfuno eziqinisekisiwe ze-ACA zigcinwe, zikho iindlela ezimbini eziphambili zokubambisa iimeko ezikhoyo ngaphambili ezifakiwe kwiinkoliso zeziphakamiso ezivezwe kwiminyaka embalwa edlulileyo: imithombo yamanzi enobungozi okanye "imfuno yokuqhubekayo" , okanye zombini.
Bobabini babandakanywa kuMthetho wokuQala abaPhezulu abaPhezulu, owethulwa nguT. Tom Price (R, Georgia), owamiselwa yiSenethi ngoFebruwari 2017 ukuba abe nguNobhala wezeMpilo kunye neeNtlalontle zeNtlalo (Ixabiso liye lasula emva ko-2017, phakathi kweengxelo wasebenzisa ii-jets ezizimeleyo endaweni yeenqwelo zokurhweba ezithengisayo. Bobabini bahlanganiswe kwiNdlela Eyona ndlela, isilungiso sokwenziwa kohlengahlengiso lwezempilo oluvezwe yiRephablikhi yeeNdlu ngoJuni 2016.
Amachibi aphezulu
Uninzi lweziphakamiso zokulungiswa kwempilo yeRiphabhliki zibandakanya ukubuyela kwiindawo ezinobungozi obuphezulu ekuqinisekiseni abantu abangenako ukufumana ingxelo kwiimarike nganye (kwiziphakamiso ezibandakanya amalungiselelo okubhengezwa okuqhubekayo, amachibi amaninzi afunekayo ukuze afake abantu abangagcinanga ukugcinwa kwenkcazo eqhubekayo, kunye neemeko zabo ezisekhona ngaphambili zibalulekile ngokwaneleyo ukuba abanako ukufumana ukukhutshwa kwezigulana ezisezantsi).
Amachibi aphakamileyo emngciphekweni asungulwe kumazwe angama-35 ngexesha le-90 ne-00. Kodwa iingxaki ezingapheliyo ze-pool ye-pool eyingcipheko yayiyingxenye yesizathu sokuba i-ACA ifunekayo kwindawo yokuqala. Izicwangciso zazihlala zibiza, kwaye zineziphumo eziphezulu zokukhutshwa kweepokotho kunye nokunciphisa ixesha elide lokuphila. Ukongezelela, amanye amachibi aphezulu ekukhuselekeni ayenomlinganiselo wokubhalisa kwiminyaka ngenxa yemithintelo yebhajethi.
Amanxweme amaninzi aphelile ukusebenza xa kuqinisekiswe ukukhutshwa kweemarike eziza kutholakala ngo-2014. Kodwa ezinye iindawo zinezixhobo ezinobungozi obuphezulu. Ngenkxaso-mali eyaneleyo yezemfundo, izibonda ezinobungozi obuphezulu zingaba isisombululo esinokuqhubekayo. Kodwa ngaphandle kwemali eyaneleyo, akunakwenzeka ukuba baya kuba nempumelelo ngakumbi kunokuba babekho kwiminyaka ekhokelela ekuphunyezweni kwe-ACA.
I-AHCA yayiza kubelwa inkxaso ye-federal ukuze amazwe asetyenzise amaziko asemngciphekweni ophezulu, kodwa ayenokuyisebenzisa nakwezinye iinzame zokuzinzisa imarike. Kwaye iingcali ziqaphele ukuba inkxaso-mali yamachibi aphezulu kwi-AHCA ayinakukwazi ukuvumela amachibi aphezulu ukuba asebenze ngokufanelekileyo.
Umgangatho oqhubekayo
Ngaphantsi kwe-ACA, ukukhutshwa kwesiqinisekiso kuqinisekiswa, ixesha. Akunandaba nokuba ungakhange uqinisekiswe kangakanani ixesha lokubhalisa, kwaye akunandaba nokuba yiyiphi imeko ekhoyo ngaphambili (kodwa ungabhalisa ngexesha lokubhalisa lonyaka, okanye ngexesha lokubhalisa okhethekileyo ukuba ukufumana isiganeko esifanelekileyo).
Ngaphantsi kweziphakamiso ezahlukahlukeneyo ze-GOP ezibiza umnxeba ngokuqhubekayo, le ngcamango kukuxhomekeka kwezinye ze-HIPAA zokukhusela kumashishini ngamnye. Abantu abagcina isigxina esiqhubekayo (mhlawumbi kwisicwangciso seqela okanye isicwangciso ngasinye) baya kukwazi ukubhalisa kwisicwangciso esitsha kwi-premium ye-standard, kungakhathaliseki ukuba iimeko ezikho ngaphambili (okt, kungabikho phantsi kwonyango).
Kodwa abantu abafumana isithuba kwi-coverage baya kuba phantsi kwezohlwayo. Iingcamango kukukhuthaza abantu ukuba baqhubeke nokufikelela ngaphandle kokusebenzisa i-ACA ingavunyelwe umntu.
Kwimihlaba engazange ifune ukukhishwa phantsi kwe-MacArthur Amendment, i-AHCA yayiza kubandakanya ukuhlawulwa kweprayimenti kubantu abangazange balondoloze ukukhutshwa okuqhubekayo. Iiprayimari ezongezelelweyo ziza kufaka isicelo ngokufanayo, kubafakizicelo abanempilo kunye nabagulayo.
Oku kwahluke kwindlela yokubonelela ngokukhawuleza okuya kubangela ukuba abaqinisekisi basebenzise ukubhala phantsi kwezonyango xa abafakizicelo bebhalela ukulandela isithuba kwi-coverage. Yile ndlela eya kuyenziwa phantsi kwe-AHCA kwimibandela eyafuna ukuyeka ukukwenza. Kuloo ndawo, abantu abanempilo enesiphakamiso ekukhuselweni babeya kuba nako ukubhalisa kwiimveliso zentengiso nganye ngamanani aqhelekileyo. Kodwa abantu abaneemeko zangaphambi (eziluhlu olubanzi kakhulu) bebeya kuba phantsi kweprayimari eziphakamileyo ngokukhawuleza ukuba zifake isicelo somntu ngamnye wokuthengisa ngaphandle kwembali yokubhengezwa okuqhubekayo kunyaka odlulileyo.
Ngaba Ndifuna Ukukhathazeka?
Mhlawumbi, nangona kuxhomekeke kwinqanaba eliza kutshintsha utshintsho lwempilo lwexesha elizayo. I-AHCA ayisayi kuqwalaselwa, kodwa into efana nayo ingeniswa ngo-2018 okanye kunyaka ozayo, ngokukodwa ukuba amaRiphabliki agcina amaninzi awo kwiCongress emva koonyulo lwe-2018 phakathi kwexesha elide.
Inguqu ye-AHCA eyadlulela iNdlu yayiya kuba yingozi kuba bantu abaneemeko zangaphambili eziye zafuna ukukhutshwa kwintengiso. Kwakhona kunengxaki ngokubhekiselele kwimeko yokuba iimfuno zezempilo ezifunekayo zazinganisela, zenza kube nzima kubantu abaneqela elincinci ukufumana ukufumana ingxelo ngeemeko zabo zangaphambili.
Kwaye nakwiimarike ezinkulu zeqela, iimfuno ze-ACA zokunqanda amaxesha okuphila kunye namaxesha angamaxabiso angaphandle kwindleko zisebenza kuphela kwizibonelelo zempilo ezibalulekileyo (ezingenakufuneka ukuba zifakwe phantsi kweeplani zeqela elikhulu, kodwa ukuba kwaye-kwaye ngokuqhelekileyo yiyo-yokunciphisa umvuzo wonyaka-mali kunye nekhefu kwiindleko ezingaphandle kweefowuni ziyasebenza). Ngoko ukuba iingeniso zempilo ezibalulekileyo zibuyiselwe emuva, abantu abaneemfuno zonyango eziqhubekayo abanezicwangciso ezixhaswe ngumqeshi banokuchaphazeleka .
Ngo-2017, abameli beRiphabhliki bathi ngokuphindaphindiweyo i-AHCA iya kuqhubeka ikhusela abantu abaneemeko zangaphambili, nangona oko kwakungekho kwenene. Ixesha elizayo lokuguqulwa kwempilo yolondolozo lwezempilo liyabonakala, kwaye ukuxhalabisa malunga neemeko ezikhoyo ngaphambili kusemthethweni. Kodwa ngeli xesha, akukho nto ishintshile malunga neemfuno zezempilo ezibalulekileyo kunye neenkcazo zeemeko zangaphambili.
> Imithombo:
> I-Ofisi yeBhanjethi yeCongress, uMthetho we-American Health Care Act, ngoMatshi 13, 2017.
> I-HealthCare.gov, iiNtshumo zeNtsholongwane yeNtsholongwane.
> I-Kaiser Family Foundation, iNgcaciso yoMshuwalense wezeMpilo yoBonke abantu. 2016.
> I-Kaiser Family Foundation, Iimeko eziPhambi kweeNkcazo kunye neNgxelo yokuThengiswa kwezoNyango kwi-Individual Market Market phambi kwe-ACA. Disemba 12, 2016.
> Kaiser Family Foundation, iKaiser Health Tracking Poll-Juni 20117: I-ACA, iSicwangciso seNguqulelo, kunye neMedicaid. NgoJuni 23, 2017.
> I-United States Isebe lezabasebenzi, uMgangatho woNcedo lwezeMpilo phantsi koMthetho weSizwe. Septemba 2014.
> I-United States Isebe lezabasebenzi, uMthetho we-Intsholongwane yokuPhatha nokuXanduva lokuPhatha (i-HIPAA) UkuPhathwa koMgangatho wezeMpilo kunye neNkcitho yeNondiscriment requirements.