Iinguqulelo ezinokuthi ziza kuxhomekeka ngokuxhomekeke apho Ufumana i-Intshurensi yakho
UDonald Trump wagxininisa ngesithembiso sokuthi uya kuphelisa ngokukhawuleza uMthetho woNonophelo ojongene noMnxeba (u-Obamacare), kwaye uyifake esikhundleni "ngoluhlu lweenguqulelo olulungele ukuphunyezwa olulandela imigaqo-mali yemakethe kwaye iya kubuyisa inkululeko yezoqoqosho kunye nokuqinisekiswa kwabo bonke abantu kweli lizwe. "U
AmaRiphabliki aseCongressal awazange achithe ixesha lokufumana ibhola ekugqibeleni kwi-ACA, ukugqithisa isisombululo sesabelomali phambi kokusungulwa kweTrump, ukuyalela iikomiti zendibano ukuba ziqale ukuqulunqa umthetho ukuphelisa iinkalo ezinxulumene nenkcitho ye-ACA.
Kwaye ngomhla wokuqala weTrump e-ofisi, wakhupha umyalelo olawulayo oyalela i-arhente ye-federal ukuba ibe yinyameko ekuthotyelweni kweentlawulo ze-ACA kunye nezohlwayo.
Kodwa i-ACA iboniswe ukuba yomelele kakhulu kwinkqubo yethu yokunakekelwa kwezempilo, kwaye kunzima ukuphelisa ngaphezu kobunkokheli be-GOP kulindeleke. Nangona kunjalo ukuba amaRiphabhliki alawula iNdlu, iNtloko, kunye neNdlu eNtshonalanga, ukuchithwa kwe-ACA kwahluleka ngo-2017. Iiphamlikhi zasekhaya zagqithisa ukuchithwa kwazo (uMthetho we- American Health Care Act ) ngo-Meyi 2017, kodwa i-Senate Republican yahluleka ukugqithisa iinguqu ezintathu zebhilikhi ngoJulayi 2017, kunye nomzamo wokugqibela we-September 2017 akazange afike kwivoti kwisiteti seSenate, ngenxa yokungabi ncedi.
Kodwa iCongress kunye neCandelo loLawulo lweTrump liye lisuka kumthetho wokuphucula ukunakekelwa kwempilo ngeendlela ezincinci, ezinye zazo ezinokuchaphazela ukukhutshwa kwezempilo abantu:
Isigwebo somntu ngamnye sasohlulwa ngo-2019
NgoDisemba ngo-2017, uMthetho wokuThuthwa kweRhafu kunye neMisebenzi usuphelile isigwebo se-ACA somntu ngamnye, ukususela ngo-2019.
Kukho isohlwayo sokungaqinisekiswa ngo-2018 , kodwa akuyi kubakho isohlwayo sokungaqinisekiswa ngo-2019 nangaphezulu, ngaphandle kokuba useMassachusetts okanye elinye ilizwe elisisebenzisa isigwebo sawo.
Ezinye zeerhafu ze-ACA, ezibandakanya irhafu yeCadillac , sele zilibalekile, phantsi kwemiqathango ye-HJ Res.125, umlinganiselo wokuchitha imali owenziwe ekuqaleni kwe-2018.
Ukupheliswa kwe-CSR inkxaso
Ulawulo lweTrump luphelile inkxaso-mali yenkxaso-mali yokunciphisa indleko (CSR) ngo-Oktobha 2017. Kodwa iinzuzo zokunciphisa indleko zisekhona kubhaliso abafanelekileyo, kwaye uninzi lwabafundi ababhalisayo alubi nakakhulu, okanye ngokubhetele ngakumbi, ngoku mali yapheliswa. Kungenxa yokuba i- insurers kwiinkoliso ezininzi zongeza nje iindleko ze-CSR kwisiqulatho sesilivere seplani ye-2018 , okubangela ukuxhaswa kweprayimenti ezinkulu kumntu wonke ofanelekileyo ukufumana inkxaso ye-premium.
Ngethuba nje urhulumente wesigqeba uyaqhubeka evumela abaqinisekisi ukuba bangeze iindleko ze-CSR kwisicwangciso sesilivere seplani kwiminyaka ezayo, abaninzi abhalise baya kukhuselwa kwimpembelelo yokupheliswa kwezimali ze-CSR, kwaye abaninzi baya kuqhubeka bebhetele, ngenxa inkxaso ephakamileyo yeprayimenti.
Mi miselo
Kwaye ulawulo lweTrump luye lwaphakamisa imimiselo eya kuvumela izicwangciso zexesha elifutshane ukuba ziphinde zibe neentsuku ezingama-364 (umgaqo wokuba ulawulo lwe-Obama luqiniswe, ngenzame yokukhusela imarike rhoqo), kwaye uvumele Abantu abaqeshwe ngabanye kunye namashishini amancinci ukuba abhalise kwizicwangciso zempilo .
I-Leniency ngakumbi yeMedicaid Waivers
Ulawulo lweTrump liye laphawula ukuba baya kuba banomdla ngaphezu kolawulo luka-Obama lwaloo mvume yokuvuma ama-1115 aivers kumazwe afuna ukwenza utshintsho kwiiprogram zabo zeMedicaid.
Ngaphezulu kweminye iminqweno yesifiso somsebenzi ngumsebenzi we-Medicaid (owawusoloko unqatshelwe yi-Obama Administration), kwaye amazwe amathathu sele efumene imvume kwimisebenzi yomsebenzi ngo-2018: I-Arkansas, iKentucky, ne-Indiana, kunye nezinye ithi 'ukucinywa okucetywayo phantsi kokuqwalaselwa ngu rhu lumente.
Ngoko nangona i-ACA ngokwayo ihlala ingapheliyo, ikhona ikhona inguqulelo. Makhe sibone indlela ezo zinguqu ezinokuthi zitshintshe ngayo i-inshorensi yakho yezempilo, kuxhomekeke apho ufumana khona ukufumana ingxelo yakho ngoku. Siza kujonga kwiindawo ezine eziphambili zokubhengezwa ezibandakanya umthombo we-inshorensi yempilo:
- Izicwangciso ezixhaswe ngumqeshi (ama-49 ekhulwini aseMerika)
- Ukuthengwa kwemarike nganye (ama-7 ekhulwini aseMelika)
- I-Medicare (iipesenti ezili-14 zamaMerika)
- I-Medicaid (ama-19 ekhulwini aseMerika)
Umshuwalense wezeMpilo oyiNkxaso-mali
Amaqokobhe enathi:
- Ukuba ngaba umqeshi wakho unikezela ngokukhawuleza ngoku, baya kuqhubeka bekwenza njalo. Igunya lomqeshi, elifuna abaqeshi abaninzi ukuba banikeze i-coverage, alinakuguquka.
- Ii-premium zakho ziyakuthi zihlale zihlawula irhafu.
- Unokubona ukutshintshela kwizicwangciso zempilo ezidityanisiweyo (HDHPs) kunye neengxelo zokulondoloza impilo (ii-HSAs).
- Ukuba usebenzela ibhizinisi elincinci, umqeshi wakho unokugqitywa ekutshintsheni kwisicwangciso sezempilo.
Iinkcukacha:
Phantse isiqingatha seMerika bafumana i-inshurensi yempilo kumqeshi. Nangona ii-ACA zenzele utshintsho olubalulekileyo malunga nokuxhaswa ngumqeshi, inkxaso-mali eyayixhaswe ngumqeshi sele ilawulwa ngokubanzi, phantsi kwe-HIPAA, kunezicwangciso zorhwebo.
I-ACA idinga abaqeshi abakhulu (abaqeshwa abangama-50 okanye ngaphezulu) ukuba banikeze ngokukhawuleza, ukufikelela ngokubanzi kwixesha elipheleleyo (iiyure ezingama-30 + ngeveki) abasebenzi. Kwaye nangona isigwebo somntu ngamnye se-ACA siya kupheliswa ngo-2019 (okt, akusayi kuphinda kubekho isohlwayo esisetyenziswe kubantu abangenayo inqaku), umyalelo wegunya lomqeshi uhlala endaweni, kwaye abaqeshi abaninzi kufuneka baqhubeke nokunika inkxaso .
Nangona igunya lomqeshi liza kupheliswa ngumthetho ozayo, abaninzi abaqeshi abaninzi bayaqhubeka nokunikela ngegalelo lokufihla. Phantse bonke abaqeshi abaninzi baye bafumana iinkonzo zezempilo ngaphambi kwe-ACA. Ulwazi lweKaiser Family Foundation lubonisa ukuba ama-96 ekhulwini yabaqeshi amakhulu (abasebenzi base-50 +) banikezela ngeenzuzo zempilo ngo-2015. Le nto yayingaphakamise ngaphezu kwama-95.7 ekhulwini yabaqeshi abakhulu ababonelela ngeenkonzo zezempilo ngo-2013, xa igunya lomqeshi kusekho.
Abaqeshi basebenzisa i-inshurensi yempilo-kunye nezinye iiphakheji zeenzuzo-ukutsala nokugcina abasebenzi abalungileyo. Kwaye basebenzisa iimali zangaphambili zerhafu ukuhlawula izibonelelo abazibonelayo ( njengabasebenzi ). Ukuthintela utshintsho olukhulu kwikhowudi yerhafu, mhlawumbi abaqeshi baya kuqhubeka nokubonelela ngeendleko zokuya phambili, ubuncinane kwixesha elisondeleyo.
Kungenzeka ukuba umthetho wexesha elizayo ungabangela utshintsho kwikhowudi yentlawulo esebenza kwizicwangciso ezixhaswe ngumqeshi. Indlu yeRiphabhlikhi yanyathelisa isilungiso sokwenziwa kwezempilo ngoncedo ngoJuni ka-2016 efuna ikhefu ngokukhutshwa kweenzuzo zezempilo kwimali engenayo engenayo. Isiphakamiso sichaza iindlela ezizahluka ngayo kwi- ACA ye-Cadillac Tax kodwa ukusuka kwindlela yomqeshwa, isiphumo siya kuba sesimo esifanayo: Abaqeshi baqala ukuhlazeka kwiiplani ezibiza iindleko eziphezulu, kuba isahlulo seprayimenti sinokupheliswa. Kodwa akukho njengaye yaqulunqwa ngo-2017, kwaye utshintsho olukhulu kumgaqo-nkqubo wezempilo awunakwenzeka ukuba lunikwe ingqalelo kunyaka lonyulo, ngoko oku kuya kuvela kwitafile ixesha.
Ukuba usebenzela umqeshi omncinci kwaye umqeshi wakho ufumene isicwangciso esincinane seqela ukususela ngo-2014, isicwangciso sakho siquka ukuxhaswa kweenzuzo zezempilo ze- ACA ezibalulekileyo . Ukuba iimfuno zezempilo ze-ACA ezifunekayo ziza kutshintshwa ziya phambili, iinkcukacha zakho zokubhengezwa zingashintsha. Kodwa umthetho oye wawushintsha iintlawulo zezempilo ezibalulekileyo awuzange udlule ngo-2017, ngoko akukho nto ishintshile ixesha. Kwaye nokuba ngaba yatshintshwa kwixesha elizayo, kwakukho utshintsho oluthile-olufana ne- HIPAA kunye noMthetho wokuNyulwa koBunqunu-oko sele sele isebenzayo kwimakethe yomshuwalense yempilo yenkxaso-mali ngaphambi kokuba i-ACA, kwaye abayi kuchatshazelwa nayiphi utshintsho olwenziwa kwi-ACA.
Ukuba ulawulo lweTrump luqedela imimiselo ephakanyisiweyo yokucwangcisa izicwangciso zempilo , inokuvula ezo zicwangciso kwamashishini amancinane. Oku kungabangela iiproyamu zempilo ze-inshorensi ezantsi, kunye neenzuzo zempilo ezincinci, kumashishini amancinci ajoyina izicwangciso zempilo. Oko kuya kuthi, kubangelwa ukuba kukho iiproyamu zempilo ezincinci zamashishini amancinci aqhubeka nokuthenga i-ACA-efanelekileyo, ngenxa yokuba bekuya kuba nempilo, amaqela amancinci ahambela kwizicwangciso zempilo, eshiya umgulana, umthombo okhuselekileyo we-ACA zi cwangciso.
I-inshurensi yempilo yonyango
Amaqokobhe enathi:
- Isigunyazo somntu ngamnye sisesekuhlaleni, kwaye usadinga ukugcina ingcaciso ngo-2018. Ukuba awuzange ubhalise ngexesha lobhaliso oluvulekile, unako ukubhalisa phantsi kweemeko ezithile ukuba ufumana isiganeko esifanelekileyo (lungele ukubonelela ubungqina bokufaneleka ganeko).
- Inkxaso-mali yeeNkcazo kunye nokunciphisa iindleko ziyafumaneka kwiirejista ezifanelekileyo.
- Ubungakanani banobuhlobo obuqinisekileyo.
- Ii-Akhawunti ze-Savings Health (ii-HSAs) kunye nezicwangciso zezempilo ezidityanisiweyo (HDHPs) ziyakuthi zigxininiswe kwiminyaka ezayo.
- Izicwangciso zexesha elifutshane zingafumaneka ngezikhathi ezide kumazwe amaninzi.
- Izicwangciso zempilo zeManyano zingafumaneka kubantu abaqeshwe ngabanye.
Iinkcukacha:
Ukuba uthenge i-inshorensi yakho yempilo, mhlawumbi ngokutshintshiselana okanye ekutshintshiselwano , sele uyazi ukuba ii-ACA zenze utshintsho olukhulu kwiimarike zempilo yomshuwalense.
Zonke ezo zinguqu zisekhona, kwaye mhlawumbi ziya kuhlala kwindawo ezayo. Isigwebo segunya lomntu ngamnye sichithwe ngo-2019, kodwa sisesekuhlaleni ngo-2018, kwaye siya kuqokelelwa kwiimbuyekezo zerhafu zango-2018, zifakwe ekuqaleni kuka-2019.
Inkxaso-mali ye-premium kunye neendleko zokwabelana ngeendleko ziyaqhubeka zifumaneke kubhaliso olufanelekileyo, kwaye akukho nto malunga naloo nto inokutshintsha kwikamva elikufutshane. I-Congressional Democrats iye yaphakamisa umthetho oza kunciphisa inkxaso-mali, okwenza ibe namandla ngakumbi kwaye kufumaneke kubantu abaninzi, kodwa utshintsho olunjalo luya kwenzeka kuphela ukuba iiDemokhrasi zinkulu kwiCongress emva koonyulo luka-2018 lwangaphakathi.
Iimfuno ezicetywayo ze-2019, i-HHS iyaphawula ukuba iceba "ukukhuthaza abakhuphayo ukuba banike ii-HDHP [izicwangciso zezempilo ezidityanisiweyo] ezinokubambisana ne-HSA [i-akhawunti yokulondoloza impilo] njengendlela ekhethileyo yokubhalisa." Igosa liye laphawula ukuba "lihlola indlela yokusebenzisa iindlela zokubonisa izicwangciso kwi-HealthCare.gov ukukhuthaza ukufumaneka kwe-HDHP kubafake izicelo." Ngoko abathengi banokubona ezinye izicwangciso zempilo ezifanelekileyo ze-HSA ezifumaneka kwikarhwebo nganye ngo-2019 nangaphezulu. Kodwa izicwangciso ezingafanelekanga ze-HSA ziza kuqhubeka nokwenza ubuninzi bezinto ezikhoyo zorhwebo.
Ukuba imimiselo ecetywayo yezicwangciso zexesha elifutshane igqityiwe, abantu kwiindawo ezininzi bangase baqale ukubona i-short-term options options kunye neentsuku ezingama-364. Kwiibhalisa eziphilileyo, ezi zicwangciso ziza kuba zizinto ezikhangayo kwizicwangciso ze-ACA ezifanelekileyo, kuba ziya kuba zibiza kakhulu. Kwaye ngo-2019, akusayi kuphinda kubekho isigwebo somntu ngamnye esivavanyelwe abantu abathengisa i-short-term coverage. Kodwa izicwangciso zangexesha elifutshane zikhawulelwe kumyinge wazo (ininzi ayifuni ukuzalisa umama, impilo yengqondo okanye izidakamizwa zamachiza), kwaye bavame ukuba neengubo ezingabikho kwiimeko ezikhoyo ngaphambili. Ukongezelela, izicwangciso zangexesha elifutshane zinama-maximums zonyaka kunye neenjongo zokuphila zingaphantsi ngokupheleleyo, kuxhomekeka kwisicwangciso.
Izicwangciso zexesha elifutshane ziza kubhenela abantu abanempilo, njengokuba iimeko ezingekaze zikhona. Ngokuxhomekeke ekubeni bangaphi abantu abathengisa izicwangciso zexesha elifutshane, i-pool yokubeka ingozi kwi-ACA-izicwangciso ezinyanzelisayo zingaba nempilo enempilo kubantu abagulayo, abathengi abadala, okubangelwa ukunyuswa kwama-premium. Kubantu abafumana inkxaso-mali ye-premium, ii-premium zonyuka ziya kunqunyulwa ngama-premium aphezulu. Kodwa kubantu abangafanelanga ukufumana inkxaso-mali ye-premium, ii-premiums ezikhulayo ziya kwenza ukuba i-coverage ibe yinto engenakulungiswa.
Into efanayo iya kwenzeka ngezicwangciso zezempilo kubantu abaqeshwe ngabanye. Ukuba imigaqo igqityiweyo evumela abantu abaqeshwe ngabanye ukuba bathenge intengiso yemibutho yempilo endaweni ye-ACA-efanelekileyo yokuxhaswa kwezonyango, abantu abaqeshwe ngokuzimeleyo banokutshintshela kwizicwangciso zentengiso ephantsi, beshiya abantu abadala, abagulayo kwi-ACA izicwangciso ezincedisayo, kunye neeprayimari ezinkulu.
Iimali-mali kwiimarike ezihambelana ne-ACA nazo ziyakuthi ziphakame ngenxa yokupheliswa kwesigwebo somntu ngamnye ngo-2019. I- Ofisi yeBhunga loBhankomali (i-CBO) ibonise ukuba izigidi ezi-3 zabantu abancinci ziya kubakho ukuthengiswa kwemarike nganye ngo-2019 ngenxa yoko lokutsalwa kwehlwayo, ukukhula kwezigidi ezi-5 ngo-2021. I-CBO iqikelela ukuba ii-premiums ziza kuba malunga neepesenti ezili-10 eziphezulu kunyaka kunokuba babeya kuba ngaba isigwebo senkundla sasihlala endaweni, kuba abantu abanokuthi bahlawule ngaphandle kwegunya Abantu abaphilileyo (abantu abagulayo baya kugcina ingxelo yabo, kungakhathaliseki ukuba kukho isohlwayo).
Kwakhona, njengokunyuka kweprayimenti eziza kubangelwa izicwangciso zexesha elifutshane kunye nezicwangciso zempilo zentlangano, abantu abafumana inkxaso-mali ye-premium baya kufakwa kwizinga lokunyuka kwamaxabiso (nge-premium subsidies), ngelixa abo bangenelungelo lokufumana inkxaso ziya kuthotyelwa kwindlela yokhetho lokungafihli.
LweMida
Amaqokobhe enathi:
- Akukho nto itshintshayo ngoku. Iziphakamiso zokulungiswa kwe-GOP azikho phantsi kwengqwalasela yangoku, kwaye ukuba ekugqibeleni zenziwe, zibiza ukutshintshwa kwexesha elide, kunokuba utshintsho olukhawulezayo.
- Indlebe uSomlomo uPaul Ryan uye wazama ukulungiswa kwe-Medicare kubantu abangaphantsi kweminyaka engama-55 ubudala, kwaye amathuba akhe okwenza ukuba kwenzeke kakhulu ngaphantsi koLawulo lweTrump kunokuba bebengaphantsi koMongameli Obama. Kodwa i-ajenda yeRyan iya kuxhomekeka kumaRiphablikhi agcina ininzi kwiCongress emva kokhetho luka-2018.
- I-ACA iyaqhubeka ivala ingxowa ye-Medicare Part D, kwaye akukho nto itshintshile malunga nale nkqubela.
Iinkcukacha:
I-ACA ayizange ithathe utshintsho oluninzi kwi-Medicare. Kwakudinga ukuba i-Medicare iqale ukufihla ukuvakashelwa kweentengiso zonyaka, kwaye ngokukhawuleza ukuvala i- Medicare Part D donut hole , eza kuvalwa ngokupheleleyo ngo-2020. Nangona iyancishiswa ukubuyisela iRipare Benevantage izicwangciso, ukubhaliswa kwi-Medicare Benevantage kuye kwanda ngonyaka ukususela ekubeni i-ACA yenziwe.
Ukuguqulwa kwamagqirha kunye nokubaluleka kwexesha elide kube yinto ekuthethwa kuyo kwiingcebiso zezohlengahlengiso zezempilo ze-GOP. Indlu yeRiphabhuliki yashicilele isiluleko sokuphinda i-Medicare ngo-2016, kodwa ayizange iqhube phambili ngo-2018, kwaye umgaqo omkhulu awunakwenzeka ngoku, oya ehlotyeni kunyaka lonyulo.
Kodwa iPhalamende yeNdlu yeRiphabhlikhi 'ye-2016, esingaba setafileni kwiminyaka ezayo ukuba iRiphabliki igcina ii-Candelo zayo eziphambili ngexesha loLawulo lweTrump likhoyo, olubizwa ngokuba lutshintsho oluthile kwi-Medicare, kuquka ukuqinisa i- Medicare Benevantage , ukukhethwa kwangasese kwi-Medicare ba bhalise.
Ukususela ngowe-2020, isiphakamiso seNdlu yeRiphabliki siya kubiza ukuba iiplani zeMedigap zibekelwe umda. Okwangoku, kukho iiplani zeMedigap ezifihla zonke okanye ziphantse zonke iindleko ezingaphezulu kwee-Registered under Medicare yase-Original. Isiphakamiso seNdlu siyakunciphisa ukuba i-Out-of-pocket ihlawulise kangakanani iiplani zeMigigap, ekuzame ukukhusela ukusetyenziswa ngokweqile (ingcamango yokuba xa ababhalisile bengenazo iindleko zokuphuma ngaphandle kwezinto, banako ukuphucula iinkonzo, kubangele iindleko eziphezulu). I-HR2, i-Medicare Access kunye ne-CHIP yokuVunyelwa koMthetho, okanye i-MACRA, isayinwe ngumthetho ngo-2015, isele ifake ukuthengiswa kweMigodi ye-Medigap F kunye no-C ukuphela ekupheleni kwe-2019, njengoko ezo zicwangciso zifihla ngokupheleleyo i-Medicare Part B.
Isiphakamiso se-2016 siza kudibanisa i-Medicare Part A kunye neCandelo B , kunye nexabiso elilodwa elidibeneyo kunye ne-coinsurance. Kwakhona kuya kwandula ukunyusa i-Medicare yobudala bokufaneleka ukuhamba ngokuhambelana nobudala bemihlala-phantsi yomhlalaphansi.
Isiphakamiso seNdlu yamaRiphabhulikhi sicelela i-Medicare "inkxaso yenkxaso ye-premium" ekufuneka iphunyezwe malunga neminyaka elishumi phantsi komgwaqo, kwaye iya kubakho inani elixhomekeke ngakumbi kwi-Medicare Advantage-style coverage. Ekubeni kunokubambezeleka kweminyaka elishumi, abantu abaneminyaka engama-55 okanye ngaphezulu baya kuba ne-Medicare ngendlela ekhoyo ngayo namhlanje. Kodwa abaseMelika abancinci babeya kukhetha-xa befika kwi-Medicare ukufaneleka-ukubhalisa kwisicwangciso sabucala, esikhundleni se-Medicare premium inkxaso yokuhlawulwa eyenziwa egameni labo kwi-inshurensi.
Ukuba loo ntlawulo iya kubakho konke okanye inxalenye ye-premium, iya kutshintshwa phezulu kubantu abagulayo abajongene neeprayimari eziphezulu, kwaye babeza kuba bancinci kubadala abakhulileyo abangakwazi ukuhlawula isabelo esikhulu seprayimari zabo. Kuya kubakho uncedo lwezezimali olongezelelweyo kubantu abadala abafumana ingeniso elincinci abafuna uncedo olujongene neendleko zabo zangaphandle.
Uxilongo
Amaqokobhe enathi:
- Ukuba urhulumente wakho ukwandise iMedicaid phantsi kwe-ACA, ezo zikhokelo ezifanelekayo zisasebenza, kwaye amaninzi amazwe anenjongo yokuzigcina zisebenza, nangona mhlawumbi zifuna iimfuneko zokufaneleka.
- I-Kentucky, Arkansas, ne-Indiana zizalisekisa iimfuno zomsebenzi kubantu abadala abangakhubazekanga, kwaye ezinye iindibano ezininzi zilindele imvume yomgaqo-mvume yokuphumeza iimfuno ezifanayo.
- Amazwe angakhange awandise iMedicaid ayenokwenza njalo, kunye nenkxaso-mali efanayo yemali eyenziwa kwezinye iindawo eziye zandisa i-Medicaid phantsi kwe-ACA.
Iinkcukacha:
Inkqubo nganye yelizwe iM Medicaid ixhaswa ngemali kunye ne-state kunye nemali yomthetho. Amazwe anemali engenayo ephezulu afumana imali encinci yemali ehambelanayo neye-federal, ngelixa abo abanemali engaphantsi nganye bayayifumana imali ehambelanayo yemali. Kwizifundo eziye zandisa i-Medicaid (iziganeko ezingama-31 kunye neSithili sase-Columbia), urhulumente wephondo uhlawula ipesenti ezingama-94 zeendleko zokumboza abantu abesandula ukufumana ngo-2018. Oku kuya kwehla kuma-90 ekhulwini ngo-2020, kwaye uhlale kuloo nqanaba phambili.
Ezinye iingu-19 ziyakwazi ukukhetha ukwandisa iMedicaid. Umthetho owawucingwa ngawo ngo-2017 ukuphelisa i-ACA yayiye yavala amatye angaphezulu ekuwandiseni iMedicaid, kodwa loo mthetho awuzange wenziwe. Abavoti baseMaine bavumile ukwandiswa kweMedicaid ngoNovemba 2017, ngoko i-Maine ilungiselelwe ukukhulisa iMedicaid ngehlobo le-2018.
Ulawulo lweTrump luye lwacaca ukuba baya kuba banomdla ngaphezu kolawulo luka-Obama lwaloo mvume yokuvuma ii-1115 zokushiya amazwe afuna ukwenza utshintsho kwiinkqubo zabo zeMedicaid. Ngo-2018, eKentucky, e-Indiana nase-Arkansas sele sele ifumene imvume yokumisela ukuphumeza iimfuno zomsebenzi kwi-Medicaid enrollees. Ezinye iindawo ezisixhenxe zinezicelo zokulindela, kwaye ezinye ezininzi ziqwalasela iziphakamiso zokuyeka. Ngoko abantu abadala abangabadala aseMedicaid ababhalisa kwamanye amazwe banokufumanisa ukuba bafanele banikele ubungqina beeyure zomsebenzi (okanye ukuzithandela, isikolo, ukuqeqeshwa komsebenzi, njl. Iiyure) ukuze kugcinwe i-Medicaid.
Amaqela ambalwa, kuquka i-Arizona, iKansas, iMaine, i-Utah, ne-Wisconsin, sele ecetywe ukufaka iingeniso zexesha lokuphila eMedicaid kwiminyaka emihlanu kubafundi abangabikho abakhubazekileyo, nangona kungekho zizwe zifumene imvume kuye kwangaphambili ngo-2018.
Nangona iikhokelo jikelele zeMediicaid ukufaneleka zihlala zingatshintshi, ababhalisi banokuthi banyuke kwimigaqo engaphezulu yokufaneleka, njengemfuneko yomsebenzi okanye iiprayimamu ezincinci, kunye nokuqinisekiswa okuthe rhoqo kokufaneleka.
ILizwi
Nangona i-ACA iqhutyelwe iminyaka eyisibhozo, isoloko ibe ngumgaqo-mthetho wezopolitiko. AmaRiphabhliki eC Congressional akakwazanga ukuwususa ngo-2017, kodwa iinzame zomthetho kunye nokulawula ukuphuma kwi-ACA ziyaqhubeka.
Ngokwenxalenye enkulu, ukukhuselwa kwabathengi kunye nemimiselo ye-inshorensi ayiguqukanga ngo-2018, kwaye umgaqo omkhulu awunakwenzeka njengoko siya kwixesha lokhetho lonyulo. Kodwa utshintsho lwezempilo luya kuqhubeka luba ngxaki enkulu kumgangatho welizwe kunye neyezemfundo kwiminyaka embalwa ezayo, kwaye i-2020 iqonga lomongameli linokuthi libandakanye iziphakamiso ezinkulu zokunakekelwa kwezempilo.
> Imithombo:
> Isebe leSebe lezeMali, iSebe lezeMisebenzi, iSebe lezeMpilo kunye neNkonzo zoLuntu. Inqununu yexesha elifutshane, eliNcinci (imiqathango ecetywayo). Fe bruwari 2018.
> I-Register Register. Ukhuseleko loMonde kunye noMthetho woNonophelo ojongene noThathaka, iSaziso esikhombululo seNzuzo kunye neParameters Payment ka-2019. Novemba 2, 2017.
> Indlu yabameli, I-GOP Proposal Healthcare. Eyona ndlela ilungileyo, Umbono wethu wokuqinisekisa i-America . NgoJuni 22, 2016.
> Kaiser Family Foundation. UmNyango weNtsholongwane wezeMpilo yoBonke abaLuntu 2016.
> Kaiser Family Foundation. Uqwalaselo lweMedicaid I-Cap Cap Cap Proposals, ngo-Juni 22, 2016.
> IKasier Family Foundation. Ipesenti zeeNdawo eziNgcaciso zeeNdawo eziNgcacisayo ezinikezela iAshurensi yezeMpilo kubaSebenzi, ngoFirm Size. 2012-2015.