Ngaphandle kweCAA yeCandelo 1557, kunzima
Amalungelo alinganayo kubantu baseMelika base-transgender baye bafika ixesha elide, kodwa uMthetho woKhathalelo ongenakuncedo (ACA) wenza inkqubela ekubhekaneni nokulingana kwimpilo yononophelo . Icandelo 1557 le-ACA liyakwenqabela ukucalulwa kwimiba eyahlukahlukeneyo yeyiphi na "inkqubo yempilo okanye umsebenzi" ofumana naluphi na uhlobo lonyango lwezemali.
Kodwa oko akuthethi ukuba bonke abantu abakwizigqeba ze-transgender banokufikelela ngokufikelelekayo kwanaluphi na unyango oluyidingayo.
Icandelo 1557 le-ACA
I-ACA Icandelo 1557 liye laqala ukusebenza ukususela ngo-2010, kodwa yimihlathi emibini kuphela, kwaye ibonakala ngokubanzi kwimvelo. Ukucacisa iimfuneko zokungabonakali, iSebe lezeMpilo kunye neNkonzo zoLuntu (HHS) kunye ne-Ofisi yeeLungelo loLuntu (OCR) lipapashe umgaqo wokugqibela wama-362 wokuphunyezwa kweCandelo 1557 ngoMeyi 2016.
Icandelo 1557 lithintela ulwahlulo olusekelwe kwizikhokelo ezikhoyo-uMthetho wamaLungelo oLuntu, isiGaba se-IX, uMthetho woBudala, kunye neCandelo 504 loMthetho wokuBuyiselwa-oye waqhelana nabo abaninzi baseMelika (okt, ubudala, ukukhubazeka, uhlanga, umbala, isizwe kunye nesondo). Icandelo 1557 le-ACA lisebenzisa loo mithetho engeyiyo incatshulwa kwizicwangciso zempilo kunye nemisebenzi efumana inkxaso yemali.
Kumgaqo wokugqibela, i-HHS kunye ne-OCR icacisa ukuba ubume bendoda yesini "ingaba yindoda, isetyhini, akukho, okanye ukudibanisa kwindoda nowesifazana." Kwaye umgaqo wucacisa ngokucacileyo izicwangciso zempilo kunye nemisebenzi efumana inkxaso-mali ye-federal ekucalucaleni kubantu ngabanye ngokubhekiselele kwesazisi okanye kwizesini zobundlobongela.
Icandelo 1557 lisebenza kunoma yimuphi umbutho onika iinkonzo zonyango okanye i-inshurensi yempilo (kubandakanywa nemibutho enezicwangciso zezempilo ezizimeleyo) ukuba bayayifumana nayiphi na inkxaso yoncedo lwezemali kwi-inshurensi yempilo okanye kwimisebenzi yezempilo.
Oku kuquka izibhedlele kunye nezinye izibonelelo zonyango, iMedicaid , i- Medicare (ngaphandle kwe- Medicare Part B ), izicwangciso zempilo zabafundi , iNkqubo ye-Intshuwalense yezeNtlalo , kunye ne-insurers ezizimeleyo ezifumana inkxaso-mali yezemali (kuquka neenkxaso kwiintengo zengxubusho zabathengi ngabanye; Kwimeko enjalo, zonke izicwangciso ze-insurer kufuneka zihambelane neCandelo 1557, kungekhona nje kuphela izicwangciso zabo zokutshintshiselana).
Imibutho emele ihambelane neCandelo 1557 ibizwa ngokuba "ngamaziko agqityiweyo."
Uninzi lwemigqaliselo yomgaqo wokugqibela luqala ukusebenza ngoJulayi 18, 2016, kodwa ukuba utshintsho kufuneka lwenziwe kwisakhiwo soxanduva lwezempilo, loo nto inokulibaziseka kude kube kuqaliswe isicwangciso sokuqala sonyaka esiqala ngomhla okanye emva koJanuwari 1, 2017. Ngoko ke isicwangciso sempilo esinesicwangciso sonyaka esiphezulu ukususela ngo-Agasti ukuya kuJulayi asiyi kufezekisa utshintsho olufunekayo kumgaqo wokugqibela ukuya ku-Agasti 2017.
I-OCR inomsebenzi wokunyanzeliswa kweCandelo 1557, kwaye baye benza njalo ukususela ngo-2010. Izikhalazo nokunyanzeliswa zilawulwa kwimeko ngamacala, kwaye abantu ngabanye bayavunyelwa ukuzisa uxanduva lolwaphulo-mthetho kwinkundla yenkundla phantsi kweCandelo 1557.
Ngaba i-ACA ifuna ama-Insurers ukuGubungela ukuBulawa kwaBafazi beSini?
Nangona umgaqo wokugqibela weCandelo 1557 ucaciswe ngokucacileyo kwaye ngokukhawuleza ukuthintela ulwahlulo olusekelwe kubume bobulili, alufunanga imigaqo-nkqubo ye-inshorensi yempilo "ukuba ifake nayiphi na inkqubo okanye inyango ethile yokunakekelwa ngononophelo."
Imithetho ayinakuyithintela iqumrhu elikhuselekileyo "ekusebenziseni imigangatho yokungathathi hlangothi elawula imeko apho iya kubonelela ngokubhengezwa kubo bonke ababhalise kuyo ngendlela engacacisiyo." Ngamanye amazwi, iinkqubo zonyango kunye nocwangco kufuneka zinikezelwe ngendlela engacaluliyo, kodwa akukho mfuneko ethile yokuba abo baqinisekisayo bahlanganisa nayiphi na inkqubo yokunakekelwa kwempilo enxulumene ne-transgender, nangona baqwalaselwa njengemfuneko yempilo.
I-OCR icacise ukuba xa iqumrhu elikhuselekileyo lenza okanye lihlawulela inkqubo ethile ethile yamalungu ayo, ayikwazi ukusebenzisa ubume bobulili okanye ukutshatyalaliswa ngokwesini ukuze kugweme ukunikezela loo nkqubo kumntu ophula umthetho. Ngokomzekelo, ukuba umgcini-inshurensi ubandakanya ukunyanzeliswa kokukhusela okanye ukunyanga umdlavuza kumabhinqa e- cisgender , kuya kufuneka kusebenze imigaqo-nkqubo yokungathathi hlangothi, engenakubandlulula ukuze kuqinisekiswe ukuba ngaba iya kubandakanya ukungahambisani nokuziphatha ngendlela yokuphatha i- dysphoria .
Ubume bolwahlulo alukwazi ukusetyenziswa ukukhanyela unyango oluyimfuneko yonyango, kungakhathaliseki ukuba uhambelana nobuntu obukhethiweyo.
Ngokomzekelo, inkunzi ye-transgender ayinakuphikiswa unyango lwe-ovarian umdlalo ngokusekelwe kwinto ayichaza njengendoda.
Kodwa umcimbi uhleli nzima. Ngaphambi kolawulo olukhutshwe kwisiGaba esingu-1557 sokugqibela, kwakukho ama-17 amabandla awayekhusela abakhuseli bezempilo ngokubandakanya iingubo ezingabandakanywanga ngononophelo oluthile, kunye ne-10 zithi zithintela iingubo ezingenanto kwiinkqubo zabo zeMedicaid. Ngaphantsi kolawulo lokugqibela, amaziko afakwe kuwo onke amazwe awavunyelwe ukusebenzisa iingubo ezingenanto zokukhanyela ukunyamekela isini-dysphoria, kwaye kufuneka basebenzise iindlela ezingabalulekanga xa kuchongwa ukuba inkqubo iya kugqitywa.
Nangona iCandelo 1557 liyinyathelo elikhulu ekubhekiselelaneni nokulingana kwezempilo kwi-transgender yaseMerika, ayifuni ukuxhaswa kwenkqubo yokuhlinzwa ngokwesini kunye nokunyangwa kwezokwelapha.
Ngaba iinjongo zeIntshurensi zeMpilo zeCandelo leeNgcaciso zeGender Reassignment?
Nangona iCandelo 1557 liye lahlala khona ukususela ngo-2010, umgaqo wokugqibela awuzange ufike emva kweminyaka emithandathu kamva, kwaye abagcini bomshuwalense kunye nabahlinzeki bezempilo baqhubeka bezama ukulungisa iinkcukacha. Inikwe ngokukodwa ukuba umgaqo wokugqibela kwiCandelo 1557 ayifuni ukuba abagcini besikhokhelo bahlawule nayiphi na inkqubo-nangona kuthathwa njengemfuneko yempilo-kusekho indawo eninzi yegrey.
I-Healthcare.gov inikeza ulwazi malunga nendlela yokunika isini ngesini sokubhalisa kwisicelo sokufumana inzuzo kwintengiso ye-inshurensi yezempilo kwimeko ethi ukusebenzisa i-Healthcare.gov, kwaye ichaza indlela yokwenza ingxelo malunga nocalucalulo.
Ukususela ngo-2014, u- Medicare uye wagqithisa ukuhlinzwa ngokutsha ngokwesondo ngokufanelekileyo , kunye nokuthatha isigqibo sokwenza isigqibo ngokubhekiselele kwimeko yeemeko ngokuxhomekeke kwimfuno yonyango. ISebe leMantshi e-Veterans (VA) liye lacetyiswa ukuba lisuse ukuvinjelwa kwexesha elide ekuhlawuleleni ukuphinda kwenzelwa ulwabiwo ngokwesini kwiimpi zaseMerika.
Kwale mfutshane u-Aetna ngumzekelo omhle wendlela abaqinisekisi bempilo yabucala abanokuthi bahlanganise ngayo iinkalo ezithile kwinkqubo yokuguquka kwesini, kodwa kungekhona.
Njengoko umgaqo wokugqibela kwiCandelo 1557 uphunyezwa, kuya kubakho izicwangciso zempilo ezikhethileyo ukukhetha ukuphambuka kwicala lokugubungula ngokutsha. IYunivesithi yaseVanderbilt yamemezela ngoJuni 2016 ukuba baya kuqalisa ukugqithisela ukuguqulwa kwezesini kwisicwangciso sezempilo sabo, kwaye isixeko sasePortland, iMaine siya kuqwalasela unyango oluthile lwe-transgender ngoJanuwari 2017.
Kodwa ngoJuni ka-2016, ibhodi yeThala leNcwadi yeLuntu yaseCincinnati livotelanise ukuba lingabangeli nabani na abagibeli kwi-inshurensi yangoku ye-inshurensi yangoku. Abaqhankqalazi abacatshangelwayo babandakanya ukunakekelwa kwezempilo, ukuphathwa ngonyango kunye nokunyangwa kwabantwana. Ilayibrari ine-cover nge-Anthem, kwaye umphathiswa unika umkhwele okhethiweyo ukuba ithala linokuthenga ukulungiselela ukunakekelwa kwezempilo lwe-transgender.
Kodwa ilayibrari ayithathwa njengeziko eliphantsi kweCandelo 1557 le-ACA, kuba ishishini labo eliphambili alinikezeli ngononophelo lwempilo, i-inshurensi yezempilo okanye iinkonzo ezinxulumene nempilo. Ngaloo ndlela, ngumzekelo wentlangano engenakufuneka ihambelane neemfuno ze-Section 1557 ezingabandlulululwayo kwiinshorensi zabo zempilo zomshuwalense.
Umongikazi wesigqirha osisigxina osebenzela iSan Francisco-based Based Dignity Health ummangalele umqeshi wakhe ngo-Juni 2016 kwiindawo zokuchaswa, kuba isicwangciso sezempilo esibhedlele asifumani unyango lwe-dysphoria. Phantse zonke izibhedlele zihlanganiswe phantsi kweCandelo 1557, kodwa isibhedlele sichaza ukuba isicwangciso sayo sempilo singacalucaluli ngoba singabandakanyi "ukuphazamiseka komntu" ngokubanzi (ngokuchasene nokucwaswa kwabasebenzi be-transgender).
Icala lichaza ukuba ubulili be-dysphoria akuyiyo ingxaki yomntu, kodwa ityala ligxininisa ukuba iCandelo 1557 livumelekile ukuba lichazwe ngokuthe ngqo, ngokubhekiselele kwimeko.
Le ngxaki iyakwazi ukujongana nombhikano wezomthetho osisigxina kwiminyaka emininzi elandelayo, ngokukodwa inikwe ukuba iinkonzo zezempilo ze-ACA ezingundoqo azibandakanyi ngokukodwa ukunakekelwa kwempilo ye-transgender, kwaye ukuba umgaqo wokugqibela weCandelo 1557 awuchazi ngokucacileyo ukuba izicwangciso zezempilo zijolise ngqo iinkqubo zonyango ezinxulumene nokubuyiswa kwesini, kungakhathaliseki ukuba kuyimfuneko yonyango.
> Imithombo:
ISebe lezeMpilo kunye neeNkonzo zoLuntu, iNondlululo kwiNkqubo zezeMpilo kunye neMisebenzi , ukusebenza ngoJulayi 18, 2016. Kufumaneka ngomhla we-6/22/6.
Iziko leSizwe loLingana kweTransgender, Yazi amaLungelo akho: i-Medicare. Fi kelele 6/22/16.
I-United States Isebe loLungisa, ngokuPhezulu kwesiGaba se-IX seMihlabiso yeMfundo ka-1972, ifikeleleke ngomhla we-6/22/6.
Indlu yabaBameli be-US, Ukuhlanganiswa koKhuseleko lweMonde kunye noMthetho woNonophelo ojongene noNgcono, njengoko ulungiswe ngoMeyi 1, 2010 . Fi kelele 6/22/16.