UMthetho weMpilo weMpilo yaseMerika: Ngubani oya kuLahla umyinge?

I-CBO ithi abantu abayizigidi ezingama-23 baya kulahleka ukukhutshwa phantsi kwe-AHCA. Ngobani?

NgoJanuwari 2017, iCongress yadlulisela isisombululo sesabelo-mali esiyalela iikomiti ze-congressional ukuba ziqulunqe umthetho wokuxolelana ukuze zichithwe iinkalo ezinxulumene nenkcitho ye-Care Affordable Act (ACA, ebizwa ngokuba yi-Obamacare). Le nkqubo yagqitywa ngo-Matshi 6, xa iikomiti ezimbini zeNdlu (iindlela kunye neendlela, kunye ne-Amandla kunye noRhwebi) -mithetho egqityiweyo ebizwa ngokuba yi-American Health Care Act (AHCA).

Umthetho-mali uqaliswe ngokusemthethweni kwiNdlu ngo-Matshi 20.

Emva kohambo olucebile ngokusebenzisa inkqubo yowiso-mthetho, i-AHCA yadlulela iNdlu ngo-Meyi 4, ngevoti ye-217 ukuya ku-213. Kwakudingeka ukuba i-216 idlule, ngoko ke kwakunomncinci kakhulu. Iidemokhrasi zahlanganisana ngokuchasene nomthetho-mali, kwaye abameleli abangama-20 baseRepublican bajoyina ngokuvota malunga nomlinganiselo.

I-AHCA yinkqutyana emfutshane, engqongqo komthetho ngaphandle kwe-ACA, kodwa kungenxa yokuba ityala lokuxolelana liyakwazi ukulungisa kuphela izinto ezichaphazela ngqo uhlahlo lwabiwo-mali. Iingxowa-mali zokuxolelana zi-filibuster-proof, ngoko banokudlulela kwi-Senate ngobuninzi obuninzi, kunokuba badinga amavoti angama-60. Kodwa zincinci kakhulu kunomthetho ophantsi kwe-filibuster.

I-Kaiser Family Foundation inesishwankathelo esihle kakhulu se-AHCA, kunye nesixhobo esiya kukuvumela ukuba uqhathanise i-AHCA ne-ACA, kunye neminye imithetho esanda kutshilwa .

I-Ofisi yeBhajethi yeCongressal iQala iBhili

Ngomhla ka-13 kuMatshi, i-Ofisi ye-Budget ye-Congressional (i-CBO) ikhuphe uhlalutyo lwayo lokuqala lwe-AHCA, iqikelela ukuba ukumiselwa komthetho kuya kukwandisa inani labantu abangaqinisekisiwe e-US ngezigidi ezingama-24 kwiminyaka elishumi ezayo.

I-CBO iyi-ofisi engabandakanyekanga ngokukhetha izibalo ezihamba kunye nemimiselo yomthetho.

Abameli beRiphabhlikhi basebenze ukuhlambalaza i-CBO kwiintsuku ezilandelayo ukufakwa kwe-AHCA, kodwa ngaphandle kwegalelo le-CBO, akukho ndlela efanelekileyo yokulinganisela ngokusemthethweni impembelelo yamanani ebhaliweyo, ekubeni uqikelelo lwabagwebi kunye nabasebenzi babo luya kuthathwa yizopolitiko ukunyaniseka.

Ngethuba ixesha le-CBO lifikeleleke, i-AHCA sele idlulile kwiKomiti yeNdlela kunye neNdlela yeNdlu kunye neKomishoni yamandla kunye neeNtengiso zeNdlu; zombini iikomiti ziye zadlula i-bhili-mali ngaphandle kolwazi oluvela kwi-CBO. Iindlebe zeKomiti yeBhajethi yeNdlu kwi-AHCA ifike emva kweentsuku ezimbini emva kokushicilelwa kwe-CBO, ngoko umcimbi wabantu abaninzi abaya kulahlekelwa ngumbandela wawuyingxenye yengxoxo kule komiti.

Ngomhla wama-23 Matshi, i-CBO yafaka i-AHCA kwakhona ukuba ibonise izilungiso ezongeziweyo, kodwa ezinye izilungiso ezongezelelweyo zongezelelweyo ngo-Ephreli no-Meyi (ezichazwe ngezantsi ngeenkcukacha ezingaphezulu). Ngenxa yokunyanzelisa ngokukhawuleza ukuza kuvota, iNdlu ayizange ilinde ukuba i-CBO ibambe iqela lokugqibela ngaphambi kokuvota kuyo.

Ekugqibeleni, amanqaku e-CBO kwiphepha lokugqibela leNdlu ye-AHCA yanyatheliswa ngoMeyi 24, malunga neveki ezintathu emva kokuba iNdlu idlulisele umthetho. Amanqaku amabini angaphambilini aye aqikelele ukuba inani lama-American uncedured liza kukhula ngabantu abayizigidi ezingama-24 ngaphezulu kwele minyaka elishumi ezayo.

Emva kokufaka izilungiso ezintathu eziye zongezwa ngo-Ephreli no-Meyi, i-CBO ibonise ukuba inani lama-American uninsuredyo liza kunyuka ngabantu abayizigidi ezingama-23 ngaphezulu kweminyaka elishumi ezayo.

Ngoko izilungiso ezongeziweyo ngo-Apreli no-Meyi zatshintshile ukuhlolwa okupheleleyo ngabantu abayizigidi ezi-1 (abantu abayizigidi ezingama-23 abambalwa abanomshuwalense ngo-2026, ngokuchasene nezigidi ezingama-24). Oku kubangelwa ukuqikelela ukuba abantu abangaphezu kwezigidi ezi-4 baya kuba negalelo elixhaswe ngumqeshi ngo-2026 phantsi kweenguqulelo zakutsha ze-AHCA (ngokuchasene nenguqulo yangaphambili yowiso-mthetho), kodwa ukuba izigidi ezi-3 zabantu abancinci ziya kuba nokuthengwa kwemakethe nganye.

Iiprojekthi ze-CBO ukuba abantu abaninzi baya kuba neenkcazo ezixhaswe ngumqeshi phantsi kweenguqu zakutshanje ze-AHCA ngokukodwa kuba bekulindele ukuba ukhetho lokuthenga kwiimarike ngamnye luyeke ukuncipha kumgangatho kumazwe afuna i-AHCA (iMacArthur Amendment) ekukhuselweni kwabaxhasi be-ACA. . Ngenxa yoko, bakholelwa ukuba abanye abaqeshi baya kunika igalelo leqela kubasebenzi babo, kuba iinketho zabasebenzi kwiimakethe ezingabandakanyeki ziya kuba ngamgangatho ombi (kwiimeko ezifuna ukukhutshwa, umzekelo, ukukhutshwa komama ongasayi kuba ngumgangatho inzuzo kwizicwangciso zentengiso nganye, kunye neeprojekthi ze-CBO ukuba umgibeli womama angabiza ngaphezu kwe-$ 1,000 / inyanga).

I-Million Yokulahleka Kwemillion: Ngubani na?

Uhlalutyo lokugqibela lwe-CBO lwama-AHCA lungama-41 amade ubude, kwaye luya kwiinkalo ezahlukeneyo, kubandakanya impembelelo enokuthi ibe nayo kwiimali-mali ze-inshorensi yempilo, ukuzinza kweemarike kunye nohlahlo lwabiwo-mali. Kodwa makhe sigxile kwi-projection yokuba abantu abayizigidi ezingama-23 baya kulahleka ukugqithiswa kwiminyaka elishumi ezayo. Ngoobani abo bantu, kwaye kutheni balahlekelwa ngumyinge?

Iingcali zepolisi yezeMpilo zithi ngokuphindaphindiweyo ukuba izigidi zabantu ziza kulahleka ukuxhaswa phantsi kwe-AHCA, kwaye ukuba izilungiso ezongeziweyo ukuphumelela inkxaso kwiNdlu aziyi kuphucula umphumo webhili-mali. Ephendula, iNdlu uSomlomo uParry Ryan (R, Wisconsin) yathi, abantu abayingcipheko baya kuba neenkcukacha xa kungekho myalelo karhulumente ofuna abantu bafumane ingxelo. Xa ucinezelwe ngokungabininzi abantu abangenasiphelo apho bekuya kuba phantsi kwe-AHCA, uRyan wachaza ukuba "kufikelela kubantu," okubonisa ukuba ukulahlekelwa ngendleko kuya kuba yinto yokuzithandela (okt, abantu baya kukhetha ukungena ngaphandle kokunika ingxelo xa kupheliswa).

Oku kuyinyaniso, kwabanye abantu. Kodwa ezininzi zokulahlekelwa phantsi kwe-AHCA ziza kwenzeka xa i-inshorensi ingenakulungiswa.

Nantsi ukuphazamiseka kolukhuni kwabanikezelwa ukuba bangaqinisekanga, kwaye kutheni:

Ngo-2017, abantu abane-Million ngenxa yokuqheliswa kweNkundla yeMatyala yoMntu ngamnye

I-AHCA iya kuphelisa isigwebo somntu ngamnye, sibuyele emva kokuqala ngo-2016. Ngenxa yoko, iiprojekthi ze-CBO ezi-1 zabantu zabantu (zonke ezibandakanyekayo kwimarike nganye, kubandakanya ukutshintshiselana) ziza kuhlawulela u-2017 umyinge weminyaka-mali, ukuba kwaye xa umthetho wenziwe.

Ngo-2018, ii-Million ezili-14 ngenxa yeeNkulumbuso eziPhakamileyo kunye neNkundla yokuLawula

Ngo-2018, ukwanda kwenani labantu abangaxhaswanga (malunga nokuqhubeka kwe-ACA) kuya kukhula ukuya kwizigidi ezili-14, kwaye ngo-2012, kuya kufikelela kwizigidi ezili-19. I-CBO iyaphawula ukuba uninzi lwaba bantu luya kuncipha ngenxa yokubakho kungekho myalelo ofuna ukuba babe nayo, kodwa kwiimeko ezininzi, ukutshintsha kwabo "ngokuzithandela" ukungaqiniseki kuya kuvela ngenxa yokunyuswa kweprayimenti.

Oku kuya kuba yinyaniso ngo-2020 nangaphezulu, xa iingxelo ze-AHCA zerhafu ziza kuthatha indawo yerhafu ye-ACA (ii-AHCA zerhafu ziza kubancinci kubantu abaninzi), ingakumbi kubhaliso abafumana imali encinane abangenako ukunyamezela kwenyuka kwentlawulo ye-premium net).

I-CBO iyaxela ukuba kumazwe afuna ukuyeka ukuvumela izicwangciso ukuba zithengiswe ngaphandle kokumboza zonke ii-ACA ezibalulekileyo zezempilo, kunye nokuvumela abaqinisekisi bemarike ngabanye ukuba babeke iiprayimari kwimbali yonyango xa abafakizicelo benesithuba sokubhengezwa, iiprayimenti zingaba zilungele ngokupheleleyo kubantu abanemeko esele ikhona kunye nesithuba esikwi-coverage.

Ngama-2021, abantu abayizigidi ezili-21: Ukunyuswa kweMedicaid Ukukhulisa iFreeze idlala indima enkulu

Ukususela ngo-2021, inani labantu abalahlekelwa nguMedicaid ligqithise ukunciphisa inani labantu abanokubhengeza ngemarike nganye. Ukususela kuloo ngongoma ukuya phambili, ukunciphisa inani labantu abaneMedicaid lide liyinxalenye enkulu kunazo zonke ekuhlaleni ngokubanzi kwinani labantu abanezempilo.

Kungenxa yokuba i-AHCA ikhuphula i-ACA's Medicaid ukwandisa ukususela ngo-2020. Ukususela ngalelo xesha, ukubhaliswa kwabakwaMedicaid kuzophela, oku kuthetha ukuba abantu abangenamntwana abangenayo imali engenayo ukuya kuma-138 ekhulwini lobuhlwempu abayi kuphinda babhalise kwiMedicaid exhaswa ngemali ngokubanzi rhu lumente.

Abantu abaye babhalisa kwi-Medicaid kwandiswa ngaloo ndlela baza kuhlala bekhutshwe, kodwa ukuba ingeniso yabo yanda ngaphezu kwe-138 ekhulwini yezinga lehlwempu, edala ukulahlekelwa kwemvume yokuxhaswa kweMedicaid, abayi kukwazi ukubhalisa kwiMedicaid kamva, nokuba ngaba imali yabo engenayo iyancipha kwakhona.

Ngaphansi kwemigaqo ekhoyo ye-ACA, abantu abafanelekayo kwiMedicaid banokubhalisa nanini na, kwaye kukho inani elincinane "le-churn" kwisixa sokunyuka kwamaMediicaid. Umzekelo, umqeshwa onyaka-mali onomvuzo oguquka kakhulu ngexesha lonyaka unokuba nguMdinga-mvume-unokufanelekela inxalenye yonyaka. Olu hlobo lokutshintsha ngaphaya nangaphandle ukusuka kwi-Medicaid eyandisiweyo ukuya kumxhasi oxhaswe ngumqeshi okanye ukuthengwa kwemakethi nganye akuyi kuvunyelwa phantsi kwe-AHCA ngowe-2020.

Ngexesha elide, ukunciphisa inani labantu abanokuxhaswa ngemali abaxhaswe ngumqeshi luya kukhula, ngenxa yokuba abantu bakhetha ukungabhalisi (kuba bekungekho isigwebo somntu ngamnye) nangenxa yokuba abaqeshi bakhetha ukungabaniki-mali (kuba kwakungeke kubekho isigwebo somqeshwa). Uninzi lwabaqeshi luya kuqhubeka lunikela ukunika ingxelo, nangona kunjalo, ukwenza njalo kuyindlela efanelekileyo yokutsala kunye nokugcina abasebenzi abaphezulu. Kwaye umlinganiselo we-May CBO ubonisa ukuhla kweabantu abayizigidi ezi-3 kuphela ezigqitywe ngamalungiselelo axhaswe ngumqeshi ngo-2026-ngokuchasene nokuhla kwezigidi ezi-7 eziye zacetywa kuhlalutyo lwazo lwangaphambili kwilwayo.

Ngo-2025, ii-Million ezingama-23, ukuhlala kwilo nqanaba ngo-2026

Iiprojekthi ze-CBO eza kuthi ngo-2025, kwakuza kuba nezigidi ezingama-23 ezingabikho abantu abancediweyo kwi-US kunokuba bekungekho ukuba i-ACA ihlale isendaweni. Oku kusekho ngethuba ngo-2026, okuyiyona nto ekupheleni kwenkqubo ekhoyo.

Ukongeza kwimiba echazwe ngasentla, i-AHCA nayo iya guqula imali ye-Medicaid ye-federal kwisabelo ngasinye okanye i-block grant, ukususela ngo-2020. Isiphumo siya kuba yindleko yokugcina imali kurhulumente wesigqeba, kodwa imali engaphantsi yeMedicaid yelizwe ithi ixesha lihamba. Ukuhlawulela, uthi uya kuba nenketho yokuchitha imali eyongezelelweyo kwiMedicaid, kodwa abaninzi baya kunyanzeliswa ukuba banciphise ukufaneleka ukuze banciphise iindleko.

I-AHCA Ekuqaleni yayiphumelelanga, kodwa yabuyiselwa kwaye yagqitywa yiNdlu

Bonke abameli bezomthetho beDemocratic bachasene ne-AHCA ekuqaleni, kwaye abameli abaninzi beRiphabhlikhi baye bavakalisa uxhalabo malunga nomthetho. Oku kuquka amaRiphabhliki aphakathi aphethwe yi-Medicaid atshintsha ukushiya abahlali bawo ngaphandle kokufikeleleka kwimiba yokuthenga, kwaye iquka neRiphabhuliki ekude, kuquka ne-House Freedom Caucus, abaya kukhetha ibhaso-mthetho ekhuphe ngokupheleleyo i-ACA.

Ngexesha leNkundla yeBhajethi yeNdlu ye-AHCA, okwenzeka emva kokuba umqulu we-CBO ushicilelwe, uMmeli uTom McClintock (R, California) waphawula ukuba utshintsho lufuneka lwenziwa kwiirhafu ze-AHCA ukwenzela ukuba kugcinwe i-coverage enokubakho kwi-registered-income tax register (okwangoku i-bilo ibiza iingxowa-zerhafu zeplati kubantu abanemali engenayo ukuya kwii-75,000 zamawaka, oko kuthetha ukuba umntu ofumana i-20,000 $ uza kufumana uncedo olufanayo njengomntu ofumana i-$ 70,000).

Kwaye ngo-Matshi 19, uSomlomo uRyan wathi iirhafu ze-AHCA zifuneka zihlengahlengiswe ukwenzela ukuba igalelo likwazi ukuhlawulela abantu abaneminyaka engama-50 no-60. I-AHCA sele ifuna ukuba iikhredithi ezinkulu zerhafu kubhalisile abadala, kodwa umthetho uvumela abaqinisekisayo ukuba bahlawulise abhalise abadala abaphindaphindi amahlanu kubhaliso abancinci (ngokuchasene nomyinge we-3: 1 okhoyo), kwaye iikhredithi zerhafu ezicetywayo kwangoku aziyi kuba okwaneleyo ukugcina ukufihlakeleka kubantu abaneminyaka engama-50 kunye nee-60 kunye nemali ephantsi nephakathi.

Ukulungiswa koMphathi oye wongezwa kwi-AHCA ngo-Matshi 20 kwakungumzamo wokufumana abenzi bomthetho ngaphezulu, kwaye kwenziwe utshintsho olongezelelweyo kumzuzu wokugqibela ekukhokeleleni kuvotelwe ekuqaleni ngoMatshi 23 waza wachazwa Ngomhla wama-24. Kwakungekho ngokwaneleyo, nangona emva kweeyure ezine zeengxoxo kumgangatho weNdlu ngo-Matshi 24, umqulu-mali uthathe imizuzu ngaphambi kokuvota.

Kungekudala emva koko, uSomlomo uRyan wanikela inkomfa yenkomfa apho wathi i-ACA iya kuhlala isasebenza kwixesha elizayo eliza kubonakala, kwaye abavoki beRiphabhuliki baya kuhamba kwezinye izinto kwi-ajenda yabo.

Kodwa loo nto yayimfutshane, nangona kunjalo ngeveki yokuqala ngo-Ephreli, umthetho wawubuyele etafileni kunye naphantsi kwengxoxo. Kodwa kwakukho umda omkhulu phakathi kwe-House Freedom Caucus kunye namaRiphabhulikhi athatywayo.

I-Freedom Caucus ifuna ukuvumela amazwe ukuba aphelise iimfuneko zezempilo ze-ACA ezibalulekileyo, kwaye avumela abaqinisekisi ukuba bahlawule ababhalisayo abagulayo abangaphezu kwezibhaliso zempilo (ezaziqhelekileyo ngaphambi kokuba i-ACA, kodwa i-ACA ivimbele ukusebenza, ukuvumela ukuba amazinga ahluke kuphela ngokusekelwe kwiminyaka yobudala , i-zip code kunye nokusetyenziswa kwecuba). Ngakolunye uhlangothi, ukhathazeka ukuba ukuvumela abatshutshisi ukuba bahlawulise ngaphezulu abafakizicelo abagulayo baya kubangela ukukhuselwa kwe-ACA yabantu abaneemeko ezandulelekileyo, enye yezona zibonelelo ezidume kakhulu ze-ACA.

Izilungiso ezintathu ezibandakanyiweyo kwi-Third Score CBO

Ngo-Apreli 6, iiRephablikhi zeNdlu zazisa isilungiso kwi-AHCA (ichazwe ngcaciso engaphezulu apha). Isilungiso siya kufumana i-$ 15 billion kwiimali zenkxaso-mali ngaphezu kweminyaka engama-9 (2018 ukuya ku-2026) "kwinkqubo yokwabelana ngengozi engabonakaliyo." Isilungiso samaphepha amane kuphela ubude kwaye ishiya ezininzi iinkcukacha zifike kwiimigaqo zeCMS eza kupapashwa ngomhla ozayo.

Kodwa ngokuqinisekileyo, ulawulo lombuso luza kuthatha amabango aphakamileyo kakhulu kwizame zokunciphisa ama-premiums. Abantu abanamabango aphezulu baya kuhlala behlanganiswa zicwangciso zomshuwalense njengawo wonke umntu (ngokuchasene nokuxhatshazwa kwamachibi aphezulu), kodwa urhulumente wephondo uza kuthatha i-strain kwi-insurance providers xa amalungu adinga unyango. Ngenxa yoko, "inxalenye engabonakali" inxalenye, njengoko amalungu angayi kubona nayiphi na ingqinani ngokubhekiselele kwenkcazo yabo okanye ukuba amabango abo aqhutyelwa njani.

Kamva ngo-Ephreli, i- MacArthur Amendment yaziswa ngenzame yokufumana amavoti avela kwi-House Freedom Caucus. Eli qhinga lasebenza, kwaye i-Freedom Caucus isekela i-AHCA emva kokuba i-MacArther Amendment yongezwa. Uhlengahlengiso lunikeza inketho yokukhupha ezinye ze-ACA zokukhusela abathengi. Kwiindawo ezifuna ukukhutshwa,

Olunye uhlengahlengiso, u- Upton Uhlengahlengiso , lwafakwa kwi-AHCA ngoMeyi 3, ngokuhlwa ngaphambi kokuvota kwiNdlu. I-Upton Uhlengahlengiso yayiyimpendulo kwiinkxalabo ukuba i-MacArthur Uhlengahlengiso yayiza kubakhusela abantu abanemeko ekhoyo ngaphambili.

Inika iibhiliyoni eziyi-8 ezidlulileyo kwiiminyaka emihlanu ukukhutshwa kwemali ekusebenziseni ukukhupha iindleko eziphezulu eziza kuthwala abantu abaneemeko ezikhoyo ngaphambili abafumana i-gap ekujoliswe kuyo kwaye badinga ukuthenga isicwangciso kwimarike nganye. Ezi ziRiphabliki ezilungelelanisiweyo zanele ukuba i-AHCA idlulele kwiNdlu, kodwa kukho ukukhathazeka okuqhubekayo ukuba inani lemali liphantsi kakhulu ukubonelela ukukhusela okufanelekileyo kubantu abanemeko esele ikhona (i-CBO iqinisekisile ukuhlalutya kwabo ngoMeyi i-$ 8 billion) kuya kuba nezimali ezinganeleyo).

I-CBO yayingazange iqedele ukufaka izilungiso ezi zintathu ngethuba leNdlu evotelwe kwi-AHCA. Oku akuzange kumangalise, kunikwa ukuba i-Upton isilungiso yongezwa kwiiyure nje ngaphambi kwevoti. Kodwa kulindeleke ukuba i-AHCA ihlaziywe iya kubangela ukuba kubekho i-spike ephawulekayo kwisantya esingenakuncediswa, ukususela kwixesha layo eliphantsi lonke ixesha.

Ngokuqinisekileyo, iiprojekthi ze-CBO ukuba inguqu echitshiyelweyo ye-AHCA iya kubangela abantu abayizigidi ezingama-51 abangaqinisekanga ngo-2026, ngokuchasene nezigidi ezingama-28 ukuba siqhubeka ne-ACA.

> Imithombo:

> I-Ofisi yeBhajethi ye-Congressional, uMthetho we-American Health Care Act, ngoMatshi 13, 2017.

> I-Ofisi ye-Budget ye-Congressional, uMthetho we-American Health Care Act kunye noMlungiso woMlawuli , ngoMatshi 23, 2017.

> I-Ofisi yeBhajethi ye-Congressional, i- HR1628, uMthetho we-American Health Care Act, uqikelelo lweendleko , wam wama-24, 2017.

> I-C-Span, iKomiti yoHlahlo lwabiwo-mali loNcedo loNcedo olungabonakaliyo, uMthetho weBhili-16, 2017.

> I-GOP yeNdlu, uMthetho weMpilo weMpilo yaseMelika (iqulethe itekisi ekhutshweyo ye-bill).

> I-House.gov Ulungiso loMlawuli kuMthetho wezeMpilo waseMelika, iiNguqulelo zoMgaqo-nkqubo , ngoMatshi 20, 2017.

> I-House.gov Ulungiso loMlawuli kuMthetho wezeMpilo weMelika waseMelika, iiNguqulo zoBuchule , ngoMatshi 20, 2017.