Ngaba uya kubamba izibonelelo kunye nemingcele yecala yokulimaza i-Medicaid?
Ukuguqulwa kwezempilo kwindlela ekujoliswe ngayo kwingxoxo yezopolitiko yakutshanje. Ngaba i-GOP iya kususa uMthetho woNonophelo ongenakuncedo, u-Obamacare, okanye ngaba izaRiphablikhi ziza kufumana ezinye iindlela zokurhoxisa kwimigaqo yayo? Emva koMthetho weMpilo weMpilo yaseMelika (ACHA), aka-Trumpcare, akakwazanga ukufumana ivoti kwiNdlu ngo-Matshi 2017, kunzima ukwazi oko kulindeleke phantsi kolawulo lwangoku.
Ukulwa kukude. USomlomo weNdlu uPaul Ryan usalindele ukuba athathe inyathelo kwiinkonzo zempilo, nangona engazange azenzele ixesha elide. Ngethemba, isicwangciso sonyango sezempilo esicacileyo nesebenzayo siya kuboniswa egameni labantu baseMerika. Isicwangciso esinjalo sichaza ntoni kwi-Medicaid, inkqubo yezempilo ejongene nabahluphekileyo nabakhubazekile?
Indlela uRhulumente weSizwe ahlawulela ngayo iMedicaid
I-Medicaid yiprogram elawulwa ngumbuso karhulumente kunye noorhulumente. Urhulumente wezepolisi ubeka imigangatho yokuba ngubani kunye nento ekufuneka ikhutshwe ngayo, kwaye ngamnye urhulumente uthatha isigqibo sokuba okanye angenise iinkonzo ezongezelelweyo kwinkqubo. Abakwazi ukunikela ngaphantsi. Ngokumalunga nezimali, oorhulumente kunye noorhulumente babambene negalelo kwiinkqubo zabo zeMedicaid.
Ukuze siqonde ukutshintshwa kwezinto eziza kwenzeka, kufuneka siqonde indlela urhulumente wesifundazwe axhase ngayo iMedicaid ekuqaleni kolawulo lweTrump.
Zonke iifundo ziyafumana inkxaso yemali ngemithombo emithathu.
- Iintlawulo ze-Hospital (DSH) ezingabonakaliyo: Ngeentlawulo zeMedicaid ngokugqithiseleyo, izibhedlele ezikhathalele inani elingaphakamiseli labantu abakwi-Medicare okanye i-uninsured zingalwa nemali. Iintlawulo ze-DSH zihlawulwa kumazwe ukuba zisasazwe kwizibhedlele ezifuna.
- Amaphesenti e-Federal Aid Asscentages (FMAP): Urhulumente wezepolisi ufanisa imali yokusetyenziswa kwemali kwi-Medicaid dollar ye dollar kwaye inika amazinga aphezulu kumazwe anemivuzo engaphantsi nganye.
- Amanqanaba afanayo ahambelanayo: Urhulumente wephondo uhlawula ngaphaya nangaphezulu kwamaxabiso e-FMAP kwiinkonzo ezithile kuquka kodwa engaphelelanga kwonyango lomhlaza kunye nomhlaza wesibeleko , ukucwangcisa iintsapho, iinkonzo zempilo yasemakhaya kunye nokukhutshwa kwezikhuselo kubantu abadala .
Umbuzo wukuthi ezi ndlela zenkxaso-mali ziya kuqhubeka phantsi koMongameli uTrump okanye ukuba ziya kuthatyathwa ngenye indlela yokwenza imali.
Uxhasomali lwe-Federal for Medicaid Expansion
Ukwandiswa kweMedare kuqalise ukusebenza ngo-2014 kwaye bekuyinxalenye enkulu yeNqanaba loNonophelo loNcedo. Yatshintshe umyinge wokufumana imali oya kubafanelekela abantu kwiMedicaid kwaye avumele abantu abangabantwana abangenabantwana ukuba bafaneleke ukuba badibana nale miqathango.
Inqanaba lentlupheko elisemgangathweni (FPL), elichazwe kunyaka, kuxhomekeke ekubeni unomntu okanye kwintsapho, kunye nobukhulu bentsapho yakho. Amazwe amisela ukufaneleka kweMedicaid ngokusekelwe kwipesenti zeFPL. I-Obamacare ikwandisa i-criteria yokufaneleka yokufumana imali kwi-Medicaid ukuya kuma-133 ekhulwini kwi-FPL kumazwe akhethe ukuthatha inxaxheba, ngelixa kuthiwa ukunyusa ukunyuswa kweMedicaid kungagcina imilinganiselo yokufaneleka kwizinga langaphambili, i-44 ekhulwini ye-FPL.
Amazwe angathathi-nxaxheba angaqhubeka nokukhuphela abantu abadala abangabantwana abangabantwana.
Ngokuqhelekileyo, oku kuphazamise inkxaso ye-fédéral kwinkqubo. Amazwe kunye nokwandiswa kweMedicaid athole amanye ama-dollar federal ukubanceda, ukuya kuma-100 ekhulwini kwindleko zokwandisa ngo-2016 kunye neepesenti ezingama-90 zezo ndleko ngo-2022.
Iinguqulelo zenkxaso-mali zoTshintsho lweMedicaid
UMthetho wezeMpilo waseMelika wawubandakanya amalungiselelo amaninzi anqumla inkxaso ye-Medicaid. Nangona isicwangciso esiqinileyo sandisa ukunyuselwa kweMedicaid, sichaza ukuba siya kubonelela ngemali eyongezelelweyo ekuchazeni oko kwakuthembisiwe ngo-2022.
NgokweNgcaciso yeNkcazo yeMpilo kaZwelonke, ukusetyenziswa kweMedicaid kudlule i-$ 545 yezigidigidi ngo-2015, kubalwa iipesenti ezili-17 zonke iindleko zonyango.
Ngaloo nani ekukhuphukeni, amaRiphabhuliki afuna indlela yokunciphisa loo mali. Iziphakamiso ezibini eziphambili zokuguqulwa kweMedicaid zitshintsho kwimida ye-per capita okanye i-block grants.
Imingcele ye-Per capita yimali echanekileyo yemali eya kuhlawulwa kwilizwe ngalinye ngonyaka. Ixabiso li sekelwe ukuba bangaphi abantu abakwiProgram yeMedicaid. Oku kuya kuvumela ukuba i-dollar federal isamba sinyuka kwiminyaka esilandelayo ukuba abantu abaninzi bafanelekile kwaye babhaliswa kule nkqubo. Imingcele ye-Per capita kwi-Medicaid yacetyiswa kunye nesilathisi sokuqala se-American Health Care Act.
AmaRephabliki amaninzi, ngokukhethekileyo iCaucus Freedom, ayekholelwa kwimingcele ye-capita ayizange ihambe ngokukhawuleza ukunciphisa iindleko zemali kwi-Medicaid. UMthetho wezeMpilo weMelika waseMelika uguqule ekunikeni imingcele yemida nganye ekusebenziseni izibonelelo zebhloko kwiMedicaid. Ngokungafani nemingcele ye-capita, iiblokhwe zebhloko aziqwalaselanga inani labantu kwiMedicaid. Iintlawulo ze-Federal ziyahlakazeka kwisixa esicwangcisiweyo esiya kunyuka ngomlinganiselo ngamnye ngonyaka ukwenzela ukuba ilandele ixabiso lokunyuka kwamaxabiso. Ingxaki kukuba ukunyuka kwamaxabiso kungakhuphuka kunokunyuka kweendleko zonyango.
Uhlalutyo olwenziwa ngu-Avalere, oluqiniweyo lokunakekelwa kwezempilo, luqikelela ukuba ngaphezu kweminyaka emihlanu urhulumente wombuso uza kusindisa imali engama-R10 000 billion ukuba basebenzise imingcele nganye okanye i-150 million yezigidi ukuba basebenzise izibonelelo zebloki zeMedicaid.
IiNkqubo zeMedicaid ziyakulungiswa njani?
Umbuzo uhleli ukuba ngaba ezinye zeziphakamiso ziya kufakwa njengenxalenye yexesha elizayo lokunakekelwa kwezempilo kwiRyan. Ukuba imingcele yecala okanye i-grants grant isetyenziswe, iya kuthi ilahlekelwe yimali ebalulekileyo. Ukujongana nalahleko, kufuneka ukuba benze utshintsho olwenza iinkqubo zabo zeMedicaid ziphumelele.
Amazwe angafuneka afake iindleko zabo zeMedicaid, atyunde iiphi iinkonzo ezigqitywe nguMedicaid, okanye ufake imida malunga nokuba bangaphi abantu abanokubhalisa, nangona abo bantu bahlangabezana neenqobo zokufaneleka. Ukukhutshwa kwezibonelelo kuya kuba kunqanda kakhulu ukuthetha ngenxa yokuba beya kuphelisa kokubili ukuchitha nokubhalisa.
> Imithombo:
> HR1628 - UMthetho wezeMpilo waseMelika ka-2017. Iwebsite yeCongress.gov. https://www.congress.gov/bill/115th-congress/house-bill/1628. Ukuhlaziywa kwe-Matshi 24, 2017.
> I-National Health Expenditure Data Sheet Sheet. Amasebe e-Medicare ne-Medicaid Services website. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html. Ukuhlaziywa kweDisemba 2, 2016.
> Pearson CF. Ukuxhaswa kweMali eNgxowa-mali kwiMedicaid ingabonakalisa ngokukhawuleza ukunciphisa imali. Avalere.com. http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-city-development-rederal-spending. Ipapashwe ngoFebruwari 6, 2017.
> Rosenbaum S, Schmucker S, Rothenberg S, Gunsalus R. Yintoni eya Kuvimba iiNkxaso okanye iMida kwiCape Capita Spending Pure for Medicaid? Inkcazo emfutshane (i-Commonw Fund). 2016 Nov; 39: 1-10. https://www.ncbi.nlm.nih.gov/pubmed/27959479.
> Izikhokelo zeNtsholongwane zase-US ezisetyenziselwa ukuchonga ukufaneleka kwezeMali kwiiNkqubo ezithile zeSithili. I-Ofisi yoNcedisi uNobhala weCwangciso noVavanyo, iSebe lezeMpilo leSebe lezeMpilo yase-US. https://aspe.hhs.gov/poverty-guidelines. Ukuhlaziywa kweJanuwari 31, 2017.