Ngaba Inguqu Yokuguqulwa kwezeMpilo iya kutshintshwa, ibe nguLwesigqeba, okanye ngababili?
NgoJanuwari 20, iiyure emva kokuvulwa kwakhe, uMongameli uTrump wasayina umyalelo olawulayo ojoliswe "ekunciphiseni umthwalo wezoqoqosho we-Care Act." Amanqaku omyalelo olawulayo ukuba ulawulo lweTrump lifuna ukuchithwa kwe-ACA, kodwa okwangoku, i-Trump ifuna ukuba i-arhente yombuso ibe yinto eguquguqukayo kunye neyona nto ingenako ukunyanzelisa imiqathango ye-ACA.
Amaziko aseburhulumenteni ayalelwa ukuba "avuke, afuneke, afune ukukhutshwa, okanye aphuzise ukuphunyezwa" kwanoma yimuphi umbandela we-ACA oza kubeka umthwalo wezemali okanye olawulayo kwilizwe okanye kwi "abantu, iintsapho, ababoneleli bezempilo, abagulisi bempilo, izigulane, abaxhamli iinkonzo zonyango, abathengi be-inshorensi yempilo, okanye abenzi bezixhobo zonyango, iimveliso, okanye imishanguzo "-njalo nabani na ababandakanyekayo kwinkqubo yokunakekelwa kwempilo.
Ukongezelela, umyalelo olawulayo uyalela i-arhente yeeburhulumenteni ukuba "inikeze ukuguquguquka okukhulu" ukuchaza ukuba unqwenela ukuphumeza iinkqubo zabo zokunakekelwa kwempilo kunye neenkqubo zokunakekelwa kwempilo.
Kuthetha ntoni Lonke Oku?
Nangona i-ACA ngokwalo iphantse iphepha elinamawaka elide, kukho amaphepha amawaka amaninzi emimiselo yomgaqo-federal-ikakhulukazi esuka kwi-CMS / HHS kunye ne-IRS-eyayichaza kwaye icacisa amacandelo ahlukeneyo omthetho, kwaye yenza isikhokelo apho kwakufuneka khona.
Ezinye iindawo zeenkcukacha ze-ACA ezinjengeengxaki zokuxolelwa , kunye neenkcukacha zento ethathwa njengonyango lokukhusela- lugqitywe ngemimiselo eyongezelelweyo ye-federal yokusebenza iinkcukacha emva kwenyaniso (umzekelo, yimi kutheni ukunakekelwa okukhuselekileyo kwabasetyhini akulungiselelwanga kude kube ngo-2011, nangona i-ACA yenziwe ngo-2010).
Ukutshintsha i-ACA ngokwayo kudinga isenzo seCongress. Kodwa imimiselo eguqukayo eye yaphunyezwa yi-arhente yombuso idinga imithetho emitsha yombuso. Akunjalo nje njengokulula kwesipen, nangona kunjalo. UMthetho woLawulo lweNkqubo, oye waqhubeka ukususela ngowe-1940, ulawula indlela amaarhente aseburhulumenteni azisa ngayo imithetho.
Kwiimigaqo ze-HHS, umgaqo-nkqubo oshicilelweyo ushicilelwe, kwaye ke kukho ixesha lokunika izimvo zoluntu. Ekupheleni kwexesha lokubeka izimvo zikawonke-wonke, i-HHS yenza izigqibo ngokubhekiselele kumazwana karhulumente ize ishicilele imimiselo yokugqibela, kuquka iinkcukacha malunga namazwana afunyenwe kunye nezimpendulo zabo kulawo mazwana. Ngoko imimiselo emitsha ayenzeki ngobusuku (nangona kufanelekile ukuphawula ukuba indlela yokwenziwa komthetho ilawulwa ngayo ingatshintshwa phantsi koLawulo lweTrump).
Kodwa ngokusisiseko, ulawulo lweTrump lixelela ukuba i-arhente ye-federal ibe njengento enyanzelisayo ekuthotyelweni kwayo kwe-ACA enokubangela irhafu, izigwebo, okanye ezinye iintlawulo. Imiba ephambili eye yaqwalaselwa ngolu hlobo olulawulayo ngumyalelo ngamnye kunye nokulungelelaniswa kwamazwe ukujongana nokulungiswa kwempilo kwindlela ethile.
Umntu ngamnye
Igunya lomntu ngamnye lifuna abaninzi baseMerika ukuba bagcine i-inshurensi yezempilo okanye bajongane nesigwebo xa befake iirhafu zabo zerhafu.
Kodwa kukho ukuxolelwa ezininzi kwigunya . Ezinye zazo zichazwe ngokucacileyo kwisicatshulwa se-ACA, kodwa abanye-ngokukodwa, iinkcukacha zezifundo ezifanelekayo njengemvume yokukhutshwa nzima-ziye zishiywa kwi-HHS.
Ngaphantsi kolawulo lweTrump, iSebe lezeMpilo kunye neenkonzo zoLuntu lingakhetha ukwandisa ukulungelelanisa ukuxolelwa kolukhuni, ukuvumela abantu abaninzi ukuba bahambe bengakhange baxhaswe ngaphandle kokujongana nesohlwayo serhafu ngokwenza njalo (ngokuqinisekileyo, ukungena kwi-uninsured ngumngcipheko omkhulu oya kude ngaphaya kwerhafu yerhafu; ukuba awuqinisekanga kwaye ufuna unonophelo lwonyango, wena ngokwakho uhlawula iindleko zonyango, kwaye ungenako ukufumana unonophelo kuzo zonke ngaphaya kovavanyo oluyisiseko / ukuzinzisa ukuba amagumbi okuphucula afunekayo ukubonelela ).
Ukuba isigunyaziso somntu ngamnye sichithwa ( nge-mthetho ) okanye sikhululekile (ngokusebenzisa isenzo sokulawula esivela kwinqanaba elilawulayo) kwixesha elisondeleyo, imakethe yempilo yomshuwalense yodwa ingabonakaliswa . IiRhafu ziya kukwenyuka ngokukhawuleza ngo-2018, kwaye ezinye iinkampani ziza kukhetha ukuphuma kumakethi nganye.
Kodwa ukuchithwa okanye ukuphucula isigunyaziso somntu ekuqaleni kwexesha likaTump liza kuzalisekisa inxalenye yesiphakamiso sokwenza isicelo sokukrazula i-ACA (i-Obamacare), kwaye iza kubhenela abantu abangathandanga igunya lomntu ngamnye. Ukucacisa, nangona isigunyaziso somntu ngokuqinisekileyo sisinye samalungiselelo athandwayo kangako kwi-ACA, yinxalenye ebalulekileyo ye-inshorensi yempilo ebonelela ngeendlela ezikhoyo ngaphambili, ezifunekayo yi-ACA. Awukwazi ukufumana ingxelo ngeemeko zangaphambi kokuba zikho ngaphandle kwendlela ethile yokuqinisekisa ukuba abantu bahlala bembalwa xa bephilile, kunokuba balinde baze bagule ukuba babhalise.
Ulungelelaniso lukaRhulumente kwiNkqubo yoLondolozo lwezeMpilo
I-States sele ikwazi ukuguquguquka phantsi kwe-ACA: i-1332 yaivers ivumela amazwe ukuba athathe indlela entsha yokuphumeza i-ACA, nje kuphela xa zihambisana nezikhokelo ezahlukeneyo ezibekwe kwi-ACA. IHawaii inikwe i-1332 waiver esandula ukuvumela ukuba urhulumente aphephe ukuba ne-inshurensi yoshishino lomshuwalense wezempilo, ekubeni iHawaii isele ine-inshorensi yempilo yonyanzeliso enempilo ebonelelwe ngumqeshi.
Kwaye amaqela amaninzi asetyenzise i-1115 waivers ukuphumeza ukwandiswa kweMedicaid kunye nokuguqulwa okungafani nokwandiswa kweMedicaid ku-ACA. Kodwa phantsi kwe-Obama Administration, i-CMS yenqwenela ukuvumela amanye amalungiselelo okulondoloza okulondoloziweyo afunyenwe kwiziphakamiso ezili-1115 zeiver.
Ngokomzekelo, amaqela amaninzi acebise imfuno yomsebenzi kubantu abadala abanokukwazi ukulungelelanisa iMedicaid (oku kuthetha ukuba baya kusebenza, bebandakanyeke ekufuneni umsebenzi, esikolweni / ekuqeqesheni umsebenzi, okanye ekunyamekeleni abantwana abaxhomekeke kuyo. ukuze ufumane iintlawulo zeMedicaid). Kuzo zonke iimeko, i-CMS ichithe iziphakamiso ezinje, kwaye ivumele kuphela iinkqubo zokuqeqeshelwa umsebenzi wokuzibandakanya ukuba zifakwe. Kodwa phantsi kolawulo lweTrump, sibona iimeko ezikhetha ukunyusa iMedicaid (ngaloo ndlela ifumana inkxaso-mali eyongezelelweyo yeprogram ye-Medicaid), kunye nemfuneko yomsebenzi evunyiwe yi-CMS.
Lo ngumzekelo omnye; kukho imiba emininzi yokuguqulwa kwezempilo kwimiphakathi yamaRiphabhliki karhulumente aphikisana nolawulo lwe-Obama, kwaye umyalelo wokulawula weTrump ubapha indlela ecacileyo yokuphumeza ukulungiswa ngendlela yabo. Indlu yabameli beMinnesota yadlulisa umthetho ngoJanuwari 2017 oya kubavumela abathwali bee-inshurensi zempilo ukuba bathengise izicwangciso ngaphandle kweenzuzo ezahlukeneyo ezithe zawa phantsi kwe-ambulula yeemfuneko zezempilo ezibalulekileyo. I-Minnesota Senate yamenqaba ukuba inxalenye yomthetho, nangona kunjalo, kwaye ayizange ifakwe. Kodwa ukuba imithetho efana nayo yayingamiselwa ngamanye amazwe ahamba phambili (kuthathwa ukuba i-ACA ngokwayo ayichithwanga) loo mazwe aya kufuna i-1332 waiver ukuyisebenzisa. Ulawulo luka-Obama aluzange lunikeze ukukhutshwa okunjalo, kodwa ulawulo lweTrump lukwazi ukwenza njalo.
Kuyafaneleka ukuba uqaphele apha ukuba isakhiwo seMedicaid ngokwayo sinokutshintsha phantsi koLawulo lweTrump ngokugqitywa komthetho we-ACA. Abameli beRiphabhliki bayasichukumisa ukutshintsha inkqubo yokukhusela izibonelelo okanye izabelo ze-per capita, kunokuba ukuzinikezela okukhoyo ngokugqityiweyo okugqityiweyo ukuba urhulumente wephondo usetyenzise ukuxhasa i-Medicaid.
Kwenzeka ntoni emva koko?
Phantse yonke into isenyuka emoyeni ngokwexesha elizayo lokuguqulwa kwezempilo. Umthetho wokuchithwa kwe-ACA okwangoku uqulunqwe ngamakomiti amane ebandla. Abenzi bomthetho abangekho coalesced malunga nokutshintshwa, nangona kukho iziphakamiso ezininzi kwitafile (kubandakanya ezinye ezandululwe kwiseshoni somthetho we-2017, njenge-bill yeCassidy-Collins).
Ulwazi oluvela kwiCandelo loLawulo lweTrump lugqithise kakhulu kwaye lucatshulwa ngokukodwa ngokulandelelana komyalelo olawulayo, kodwa ngoku ngoku ininzi yee-khabhinethi zezonyulo ziqinisekisiwe, isenzo sokulawula ngokuphathelele umyalelo wokulawula singasondela.
Amanye amazwe aya kuthatha izinto ezandleni zabo, edlulisela imithetho yokugcina iinkalo ezithile ze-ACA endaweni ngaphandle kwazo zonke iinguqu kwi-federal level. Ngokomzekelo, ngosuku emva kokuba uTrump isayine umyalelo olawulayo, iNew York imemezele imimiselo yomgaqo-nkqubo yokukhusela ukungena kwiindleko zokukhulelwa ngaphandle kweendleko kunye nokukhupha izisu eziyimfuneko kwizicwangciso zempilo ezilawulwa nguRhulumente.
Ngexesha, akukho nto ishintshile malunga ne-inshorensi yakho yempilo okanye imithetho elawula i-inshurensi yezempilo. I-ACA isesekhona, ufanele ugcine ukuxhaswa, izicwangciso zempilo azikwazi ukusebenzisa ukubhala phantsi kwezokwelapha okanye ukukhuphela ukukhutshwa kweemeko zangaphambili ezikhoyo, kunye nenkxaso-mali ye-premium (okt iikhredithi zerhafu ye-premium) ziyafumaneka kwishintshiselwano kukukunceda ukuthenga.
> Imithombo:
> Amasebe e-Medicare kunye neeNkonzo zeMedicaid, iZiko loLwazi loThengi kunye noLawulo lweNtshuwalense. Icandelo 1332: i-State Innovation Waivers.
> I-Cornell University School Law, i-Legal Information Institute. Inkqubo ye-US Code Administrative Procedure.
> HealthCare.gov. Funda uMthetho woNonophelo ongenakunceda. Itheksthi epheleleyo yoMthetho woNonophelo ongenakunyanzeliswa kunye noMthetho woXhumano.
> Medicaid.gov. Malunga neSigaba 1115.
> I-White House, i-Ofisi yoNobhala woLondolozo. IsiGqeba esiLawulayo Ukunciphisa Umthwalo wezoQoqosho weMpilo yoNonophelo ongenakunciphisa.