Umgaqo omtsha unikezela ukuxolelwa ngokubanzi kwiMvume yokuLawula
UMthetho woNonophelo ongenakunqununu kunye nemimiselo yawo eyalandelayo yenzelwe ukwandisa ukufikelela kwendlela yokukhusela isondo. Kodwa abafazi ngoku bayazibuza ukuba ingaba i-inshorensi yokufumana i-contraceptive iya kulahleka, nokuba ingaba ifanele ifumane i-IUD kusasa elizayo, xa ibuye ibuyele kwiindleko ezilikhulu zamadola.
Kwaye ngokusekelwe ekuxolelweni kokuziphatha kunye nemithetho yokukhutshwa kwezenkolo epapashwe kwiRejista yeSithili ngo-Oktobha 6, kukho isizathu esibangela ukuba sikhathazeke.
Kodwa utshintsho olukhawuleza lujongene nemingeni yomthetho kwaye inani labaqeshi elilindeleke ukuba lisetyenziswe.
Makhe sijonge kwi-ACA igunya lokukhulelwa, umphumo onalo, kwaye sinokulindela ukuba sihambe phambili.
Ulwaphulo-mali phantsi kwe-ACA
Enye yeemfuno ezingenakuphikisana noMthetho woNonophelo ojongene noNyaka (i-Obamacare) yinkcazo yokukhulelwa. Ngaphantsi kwe-ACA, zonke izicwangciso zezempilo ezingabonakaliyo kufuneka zigubungele-kungabikho ukwabelana ngeendleko-ubuncinane enye ingongoma ye-18 eyahlukeneyo ye-FDA-avunyelwe ukukhulelwa kwezilwanyana (kubonakala ukuba izicwangciso ezinokuzala zisenza ipesenti yomqeshi Izicwangciso ezicwangcisiweyo; ngokwemigaqo-nkqubo ebhaliweyo, abantu abayizigidi ezingama-36.5 abanomvuzo oxhaswe ngumqeshi kwizicwangciso ezininzi, ezingafunwa ukuba zinikeze ukukhulelwa ngaphandle kokubelana ngeendleko).
Nangona amaninzi amalungiselelo e-ACA awazange asebenze ukususela ngo-2014, imfuno yokuba izicwangciso zibandakanya ukukhulelwa komzimba ziye zaqala ukususela ngo-Agasti 2012, kuzo zonke izicwangciso ezintsha nezivuselelayo.
Ngezicwangciso ezingazange zizalwe zivuselelwe emva kwelo nqanaba, ukukhutshwa komzimba kwongezwa ekuhlaziyweni kokuqala. Ngoko ngo-Agasti ka-2013, zonke izicwangciso ezingenabantwana zazibandakanya ukukhutshwa komzimba. Ngaphandle kweemfuno zezenkolo, ke kunjalo, kwaye kwandiswa ngo-2014 (ngenxa yesigqibo seNkundla ePhakamileyo kwiBurwell v. I-Lobby Hobby) ukubandakanya "imibutho ecwangcisiweyo" abanikazi babo abanenkcaso yenkolo kwigunya lokukhulelwa.
Ucwaningo lwezeMpilo luka-2015 lufumene ukuba igunya lika-ACA lokukhulelwa komzimba lalilondoloze umsebenzisi oqhelekileyo wokukhulelwa komntwana ongu-$ 255 ngonyaka, kunye nomyinge we-IUD umsebenzisi we-$ 248 ngonyaka (ngaphandle kwegunya le-ACA lokukhulelwa, i-IUD ixabisa imali engama-$ 500 ukuya kwii-1,000 zamawaka. kufuneka ihlawulwe ngaphambili, kodwa ukugcinwa kubalwa rhoqo ngonyaka, kwasasazeka kwiminyaka leyo ibhinqa inesixhobo).
Ngaphantsi kwe-ACA, amabhinqa angama-insured angenayo i-coverage ayifuni ukuhlawula nayiphi na into ngexesha bafumana ukulawulwa kwabo kokuzalwa, becinga ukuba bakhetha i-contraceptives ukuba i-insurers yabo yempilo igxile ngokupheleleyo (i-ACA idinga ukuba izicwangciso zezempilo zigubungele ubuncinane enye yolu hlobo; ayifuni ukuba iguqulwe zonke iinguqu zolu hlobo).
Nangona oku kudla ngokuba kuthiwa "ukukhululeka" kolawulo lokuzalwa, abagxeki bathi akukho nto ikhululekile. Enyanisweni, iindleko zokukhulelwa komzimba zihlanganiswe kwiiprayimari ukuba abafazi nabaqashi babo bahlawula umvuzo. Ngoko ngenxa yokucaca, ingxoxo malunga nokulawulwa kokuzalwa kwamahhala kweli nqaku ibhekisela kulawulo lokuzalwa olunikezwa kungekho sabelo-mali ngexesha elifunyenweyo.
Ufikeleleko olwandisiweyo kwiNzalo yokuNyunyanisa kunciphisa ukuKhutshwa kweMisukelo kunye nokuzalwa komntwana
NgoNovemba ka-2016, i-CDC yashicilele idatha ebonisa ukuba ngo-2013, amazinga okukhipha isisu ayephantsi kwexesha lonke e-US
Ukukhupha isisu isicatshulwa sokuchazela ukuba oku kungakho ngenxa yemithetho emiselweyo kwiindawo ezahlukeneyo ukunciphisa ukufikelela kokukhipha isisu kwiminyaka yamuva. Kodwa ubungqina obuvela kwiColorado-engekho phakathi kwamazwe adlulisele imithetho yokuthintela ukufikelela ekukhutsheni isisu-ibonisa ukuba ukufikelela kwi-contraceptive ngokwenene kudlala indima ephambili: I-Colorado Inkqubo yoCwangciso lweNkqubo yoLondolozo lweNzululwazi yaqala ukubonelela nge-contraceptive (iUDs and implants) ekusebenziseni ixesha elide. abasetyhini kunye nabasetyhini abanomvuzo ophantsi ngo-2009, ngaphambi kokumiswa kwe-ACA. Ngo-2014, amazinga okuzalwa kunye nokukhupha isisu ayehlile ngama-48 ekhulwini.
IUDs kunye neziphumo zokufumana ukuBaluleka phantsi kweMigaqo ye-ACA
I-CDC ikwaxela ukuba ukusebenzisa okusebenzayo kwexesha elide lokubuyisela ukukhulelwa (LARC) kuphakamileyo ixesha eliphakathi kwamabhinqa aseMerika.
Oku kwenzeka ngenxa yokudibanisa imfundo engcono malunga ne-LARC kunye nokuba i-ACA ithathe umqobo wokungabi nakwazi okuthintela ngamanye amaxesha abesifazane ukuba bafumane i-LARC ngaphambi kokuphunyezwa kweemfuno ze-ACA.
Imizamo yokuLawulwa kweMithetho yokuPhepha i-ACA ayizange iphumelele
Ulawulo lweTrump kunye neCommittee-controlled GC yaqala ngo-2017 ngethemba elikhulu lokuphelisa i-ACA, kodwa oko akuzange kwenzeke ngo-2017. Iiphabhuliki zasekhaya zadlulisela uMthetho we-American Health Care Act (AHCA) ngoMeyi 2017, kodwa i-Senate ayizange idlule naziphi na iinguqulelo zalo zomthetho, kwaye ukuphela kuka-Septemba 30 kunyaka-mali kwakuyimfuneko yokusebenzisa ukuxolelana ukuze ukwazi ukuphelisa i-ACA ngamavoti angama-50 kuphela (kunye nevoti yokuphumula i-vice-president).
Ingqungquthela yeNdlu ye-AHCA kunye neendidi ezahlukahlukeneyo ezifakwe kwi-Senate zazingayi kuphelisa igunya lika-ACA lokukhusela ukukhusela, kodwa uninzi lwabo luye lwavumela amazwe ukuba afune ukuxoshwa ukuze ahlaziye iinjongo zezempilo ezibalulekileyo. Ukunakekelwa kokukhusela, okubandakanya ukukhulelwa komzimba, ngenye yeenzuzo zezempilo ze- ACA ezibalulekileyo . Ukuba umthetho wawulungelelwa ukuba amazwe afumane iimfuno zokuhlaziya izibonelelo zezempilo eziyimfuneko, ukukhuselwa kwezokhuseleko kungekufuneka kwenziwe.
Iimpazamo ezahlukahlukeneyo ze-ACA zokuphinda eziye zaqwalaselwa ngabagwebi baseRiphabhlikhi ngo-2017 nazo zagqitywa ngemali yenkxaso-mali ye-Planned Parenthood kunyaka owodwa, ukunciphisa ukufikeleleka kokukhulelwa kwabantwana abaxhomekeke kwi-Planned Parenthood ekunakekeleni kwabo.
Kodwa ayikho enye yee bhili ezigqityiweyo, kwaye ngo-Oktobha ibonisa ukuphela kwithuba elikhawulezayo lokumisela umthetho ukuphelisa i-ACA. Abameli beRiphabhulikhi bathembisa ukuba baqhubeke nokulwa ukutshitshisa umthetho, kodwa ulawulo lweTrump lusebenzela ukwenza utshintsho ngokusebenzisa imiyalelo yolawulo kunye nemimiselo emitsha.
Yintoni kwiMimiselo emitsha?
Ngomhla we-4 kuMeyi, ngo-2017-ngaloo mini iRephabliki yeNdlu idlulisele i-AHCA-uMongameli weTonga Ekhutshiwe umyalelo olawulayo olawula abaNobhala be-Nondyebo, uMsebenzi kunye ne-HHS, ukuba " bacinge ngokukhupha imimiselo echitshiyelweyo, ngokuhambelana nomthetho osebenzayo, izichaso ezisekelwe kwisigunyaziso sokukhusela. " Oku kubeka isigaba semimiselo emitsha, leyo, ngokutsho kweNew York Times, ulawulo lweTrump luqwalasela ngasekupheleni kukaMeyi.
Ngomhla we-Meyi 31, iVox ifumene iqulunqo elichaziweyo lomgaqo-nkqubo omtsha we-HHS kunye ne-IRS, eyayiza kunciphisa kakhulu igunya lokukhulelwa kwangoku. Akukho nto eyenzeka kwiinyanga ezimbalwa ezizayo, kwaye kugxininiswe kulo lonke ihlobo kwimizamo yokumisa i-ACA.
Kodwa ngo-Oktobha 6, imithetho emitsha emibini yapapashwa kwiRejista ye-Federal evumela ukuba abaqeshi bafumane ukufikelela okukhulu ekukhutshweni kwegunya lokukhulelwa: ukuxolelwa kokuziphatha kunye nokuxolelwa ngokwenkolo .
Imimiselo ithatha ukusebenza ngokukhawuleza, ngaphandle kwesaziso esivamile kunye nexesha lokuphawula. Amazwana ayamkelwe kwiintsuku ezingama-60 (ngo-Disemba 5), kodwa imimiselo yaqala ukusebenza ngo-Oktobha 6. I-HHS ivame ukufumana izimvo zikawonkewonke kwimimiselo ecetywayo, iyayiqwalasela, kwaye ichaze indlela izimvo zoluntu ezifake ngayo umgaqo wokugqibela.
Kodwa kulo mzekelo, bathi " banezizathu ezilungileyo " zokuphumeza imimiselo ngokukhawuleza kwaye "kuya kuba yinto engenakwenzeka kwaye iyaphikisana nomdla woluntu ukulibaziseka ukubeka amalungiselelo enziwe kwithuba de i-public notice-and-comment comment Kugqityiwe ukukhupha isaziso kunye nexesha lokuphawula, i-HHS nayo ithi ayifuni ukuhamba kwakhona kwinkqubo yokuphawula, kuba sele sele ifumene imibono malunga nokukhutshwa komyalelo wokukhulelwa komthetho xa imigaqo ipapashwe kwiminyaka edlulileyo. Kuyafaneleka ukuba uqaphele, nangona kunjalo, ukuba le migaqo emitsha ifikelela kude kakhulu kunemvume yokukhulelwa komthetho i-HHS eyapapashwa ngaphambili, kwaye loo mpendulo iya kuba yinto eyahlukileyo.
Ngaphantsi kwemimiselo emitsha, nayiphi na umqeshi, iyunivesithi, okanye umshwalense wempilo unokucela ukuxolelwa kumyalelo wokukhulelwa, kunye nayiphi na isizathu senkolo okanye yokuziphatha njengesizathu sokuxolelwa. Ukuxolelwa akufuneki ukuba kuvunywe nguRhulumente-abaqashi abangafisi ukukhusela ukukhulelwa ngokweqhinga kwiiplani zabo zezempilo kufuneka baxelele abasebenzi babo utshintsho kwiintlawulo.
Imithetho emitsha ichaza ukuba " Ukwandisa ukuxolelwa kususa izithintelo zonqulo / zokuziphatha ezichaphazelekayo kunye nabantu abathile abanokufuna ukuba bathathe inxaxheba kwiimarike zonyango. banokufikelela ngokukhawuleza kwiinkqubo zokukhusela i-contraceptive (iUDs and implants) ezithatha ixesha elide ezithatha ukufumana iindleko eziphezulu xa zingabhekwanga yinshuwalense yezempilo.
Xa iqulunqo yemimiselo yachithwa ngoMeyi, i-ACLU ithembise " ukubona ulawulo lweTrint enkundleni ukuba bazama ukulandelelana kwezi zicwangciso. " Kwaye, i-ACLU ifake isambatho ngokukhawuleza ngo-Oktobha 6, njengokuba uMmeli weMassy Maura Healey.
Ukucaca, ulawulo lwe-Obama luthe lathatha amanyathelo okuqinisekisa ukuba abaqeshi benkolo abazange bahlawule ngokukhawuleza inzuzo yezokhusela, kodwa umsebenzi wokuqinisekisa umsebenzi uyaqinisekisa ukuba abafazi abafakwe kwiiplani zempilo zabaqashi bayaqhubeka nokufikelela kwiinkcukacha zokukhusela izithintelo (leyo ayisoloko iqhutyelwa ngokufanayo, nangona kunjalo, kunye nabanye abafazi nabaqeshi benkolo abanakho ukufikelela kwiinkqubo zokukhusela ngaphandle kweendleko ngokusebenzisa isicwangciso sezempilo esixhaswe ngumqeshi). Kodwa esi sisisombululo sokuba abanye abaqeshi benkolo bakholelwa ukuba basaphulaphula inkululeko yabo yonqulo.
Kwenzeka ntoni emva koko?
Imimiselo emitsha ibhekane nemingeni esemthethweni yomngeni, kwaye kungekudala ukuxelela ukuba baya kubamba enkundleni. Kwintetho malunga nemithetho, i-HHS yathi imithetho emitsha "ayiyi kuphazamisa ngaphezu kweepesenti ezingama-99.9 zabasetyhini abangama-165 baseUnited States" kuba balindele kuphela amaziko angama-200-abo babesele bafaka amacala okugweba malunga nesigunyaziso sokukhusela isiseko esekelwe ukuchasa ngokwenkolo okanye ukuziphatha-kuya kucela ukuxolelwa phantsi kwemithetho emitsha.
Kodwa abathengi abathengi banenkxalabo yokuba imithetho iya kugqiba ekubeni yinto eninzi kakhulu, kwaye ukuba imigaqo emitsha ibonakala yinto enkulu kwigunya lokukhulelwa.
Amaqela amaninzi azalisekise izigunyazo zabo zokukhulelwa, kodwa ezo zisebenza kuphela kwizicwangciso ezilawulwa nguRhulumente. Izicwangciso ezizimeleyo ezizimeleyo (okuyizona zinto abasebenzisi abaninzi kakhulu abazisebenzisayo) zilawulwa phantsi kwe-federal, kunokuba zizwe, umthetho. Izigunyazo ze-ACA zokukhulelwa komzimba ziyasebenza kulo lonke ibhodi, kodwa imimiselo esekelwe kwisigqeba ayisebenzisi kwizicwangciso ezizimeleyo.
Ixesha elidlulileyo iT Tom Price (ngoko ummeli waseRephabliki waseGeorgia, owaba nguNobhala weHHS ngokukhawuleza phantsi koLawulo lweTrump ngaphambi kokuba ahlawule ngoSeptemba 2017) wathi ngo-2012 ukuba "akukho mfazi" ongenakukwazi ukufumana izibonelelo zokuzalela ngaphambi kokuba Igunya lika ACA. Kodwa uphando olwenziwa ngo-2010 olwenziwe ngu-Planned Parenthood luboniswe ukuba ama-34 ekhulwini kwabasetyhini "bekunzima neendleko zokulawulwa kokuzalwa komzimba ngexesha elithile ebomini babo."
Ngo-2012, umfundi we-University of Georgetown, uSandra Fluke, wangqina phambi kwepaneli yenkampani ngokubhekiselele kwi-ACA. Wafaka ubungqina ukuba ama-40 ekhulwini kwabafundi besigqeba sase-Georgetown besigqeba sase-University babika ukuba ukungabikho komsebenzi we-yunivesithi yokunqongophala kwemithi kwipyunivesiti kwabangele bahlukane ngokwezimali.
Ukubuyela kwiindleko zokwabelana okanye ukungabikho kwempilo ye-inshorensi yempilo yokukhulelwa kwe-contraceptives kungenzeka ukuba ingabonakali inkathazo ebomini kubasetyhini abaneemali ezibafaka ubuncinci kumgangatho ophakathi. Kodwa ingabonakalisa ingxaki ebalulekileyo kubafazi abancinane abafumana imali. Kwaye ukufikelela kwii-IUD kunye neemplantshi eziyimpumelelo kunokuba nefuthe ngokuphawulekayo xa iindleko zabo eziphambili ziphelile ukugqitywa ngokupheleleyo ngomshuwalense wezempilo.
> Imithombo:
> Iziko loLawulo lweZifo kunye nokukhusela, ukuKhulelwa kwesisu-iMelika, ngo-2013. NgoNovemba 25, 2016.
> Iziko loLawulo lweNtsholongwane kunye nokuKhusela, iZiko leSizwe leMatriki yeeMpilo. Imiba ekusebenziseni ukuNyelwa kweNkqubo yokuLawulwa kwexesha elide eliphakathi kwe-US Abasetyhini abadala 15-44. Fe bruwari 2015 .
> Isebe le-Colorado yeSebe lezeMpilo kunye neNgqongileyo, iNqanaba leNzala yokuzalwa yaseColorado liyaqhubeka nokuPhumela. Oktobha 21, 2016.
> Isebe Lempilo Neenkonzo Zoluntu, Izibonelelo zezeMpilo kunye noLawulo lweeNkonzo, Ukuhlaziya iikhokelo zeeNkxaso zeeNkxaso zaBasetyhini, ngo-2011.
> I-Register Register. Isebe leNondyebo; ISebe lezeMpilo kunye neNkonzo zoLuntu. Ukuxoxwa koMoya kunye nokuHlala koNcedo lweeNkonzo ezithile zokuVala phantsi koMthetho wokuNakekelwa ongenakuncedo . > Oktobha 6, 2017.
> I-Register Register. Isebe leNondyebo; ISebe lezeMpilo kunye neNkonzo zoLuntu. Ukukhutshwa kwezenkolo kunye neendawo zokuHlala koNcedo lweeNqobo zoKhuseleko phantsi koMthetho wokuNakekelwa ongenakuncedo . > Oktobha 6, 2017.
> HealthAffairs. Abafazi babona ukwehla okukhulu kwi-Out-of-Pocket Spending for Contraceptives Emva kokuba i-ACA Inqununu ikwahlulelane ngeendleko. I-Vol 34, uNgo-7, Julayi 2015.