Ukuguqulwa kokunakekelwa kwezempilo sekuyisihloko sezombusazwe ephikisanayo e-US iminyaka eminingi, kanti kanye nokuphathwa kweTrump esikhundleni, ikusasa loMthetho Wokunakekelwa Ongenakusiza awuqinisekisiwe. Yini iqembu ngalinye elifunayo? Ake sibheke ukuthi iziplathi ezisemthethweni zeDemocratic Party neRepublican Party zingathinta kanjani umshuwalense wakho wezempilo.
I-Framework yoMthetho Wokunakekelwa Okunganakekelwa
Amademokhrasi ngokuvamile asekela i-ACA, kodwa angathanda ukulungisa amaphutha ayo futhi ngokujwayelekile athuthukise umthetho.
I-Democrats iphakamise ukuthi kungenzeka ukuthi ikhulise i-ACA emazweni ase-US, futhi ifuna ukunika amandla amandla okusebenzisa ama-waivers amasha (1332 waivers) ukudala izindlela zabo zokulungisa izinguquko zezempilo ezihle kakhulu-noma ezingcono kune-system yamanje. AmaDemokhrasi amaningi asekela futhi ukulungisa "i- glitch " yomndeni ka-ACA ngokusebenzisa ukubalwa kokukwazi ukukhokhelwa kokuqashwa okuqashiwe ngumqashi kumaphrimiyamu omndeni kunokuba i-premium yempesheni kuphela.
I-Trump namaRephablikhi amaningi afuna ukuphinda i-ACA bese iqala ngeendlela ezintsha. Kukhona okungenzeka kube nokuguquguquka lapha lapha; Amalungu amabili aseRepublican Senators enza umthetho ngoJanuwari 2017 ozobe usinikeze ithuba lokugcina i-ACA noma ukushintshela ohlelweni olusha.
Ukwandiswa kwezidakamizwa
Ukwandiswa kwe-Medicaid kuyigumbi lekhonkco le-ACA futhi lilandisa ngengxenye ebalulekile yokwanda kwenani labantu baseMelika abanomshwalense wezempilo.
I-ACA idinga i-Medicaid ukuba yande kuwo wonke umbuso, ukuhlinzeka ngokubheka kubantu abanemali yasemakhaya kuze kube ngu-138% wezinga lobuphofu.
Kodwa iNkantolo Ephakeme yabusa ngo-2012 ukuthi ukwandiswa kwe-Medicaid kungaba yindlela yokuzikhethela ngenxa yezifundazwe, futhi kusukela ekuqaleni kuka-2017, kwakunamanje angu-19 athi ayengamukeli imali yokuxhasa i-Medicaid.
Ezingu-18 kulawo mazwe (konke kodwa i-Wisconsin), kukhona igebe lokubheka i-Medicaid; cishe abantu abayizigidi ezingu-2.6 banamathele ngaphandle kokufinyelela ku-Medicaid noma izibonelelo ze-premium kulawo mazwe.
I-Democrats ifuna ukunyusa ukukhuliswa kwe-ACA's Medicaid emazweni angu-19 angakaze akhulise ukuxilongwa, futhi aphikisana neziphakamiso zokuvimbela izimali zezibonelelo zeMedicaid emazweni (iziphakamiso zesibonelelo se-block zibandakanya ukuqeda uhlelo lwamanje lwemali ehambisana ne-federal ngokusekelwe ku-State Medicaid ukuxhaswa ngemali, futhi kunalokho ukunikeza kusho inani elibekiwe lezimali zikahulumeni okufanele zizisebenzise njengoba zibona kufanelekile ohlelweni lwabo lweMedicaid).
AmaRephablikhi afuna ukucima i-ACA, okuzofaka phakathi ukuphinda ukwandiswa kweMedicaid. Indlela abayithandayo eya eMedicaid ivimbela ukunikezela, futhi amapulatifomu eqembu athi bayonikeza izwe ngesandla samahhala sokuvuselela iMedicaid ngokuvimba-ukunikeza uhlelo ngaphandle kwemicu. AmaRephabhuliki nawo ahlongoze ama-Medicaid ama-Medicaid.
Ama-Akhawunti Wokulondoloza Impilo
Ama-Akhawunti Wokulondoloza Impilo (ama-HSA) ama- akhawunti ahlelwe intela abantu abangasebenzisa ukulondoloza imali yokukhokha izindleko zezempilo ezizayo. Ziba yi-trifecta yokulondoloza intela:
- Imali oyifaka ku-akhawunti iyadonswa ekubuyiselweni kwentela yakho (noma ngokuphelele ngaphambi kwentela uma unikela kwi-HSA yakho ngokukhishwa kweholo).
- Imali ku-akhawunti ikhula mahhala intela.
- Usengakhokhiswa intela ngemali uma uyikhipha, uma nje uyisebenzisa ukuze ukhokhe izindleko zezokwelapha ezifanele (abanye abantu basebenzisa la ma-akhawunti njenge-IRA yendabuko, njengoba imali ingasuswa ngaphandle kwezindleko zezokwelapha ngaphandle isigwebo ngemuva kweminyaka engama-65. Kodwa uma kunjalo, ukuhoxiswa kuzoba ngaphansi kwentela ejwayelekile engenayo).
Imithethonqubo ye-IRS yamanje ivumela kuphela abantu abanezinhlelo zezempilo eziphakeme ezifanelekayo ze-HSA-HDHPs (HDHPs) ukufaka isandla kwi-HSA, futhi kukhona nemingcele yemiklomelo: Ngo-2017, inani elingaphezulu ongayifaka kwi-HSA liyi $ 3,400 umuntu ngamunye, noma i-$ 6,750 uma ukufakwa kwe-HDHP yakho kumndeni.
Nakuba i-HSA ngokuqinisekile iyithuluzi eliwusizo lokuxhasa izimali zokunakekelwa kwezempilo esikhathini esizayo-futhi izinzuzo zabo zentela zibalulekile-kufanele sihlale sikhumbula ukuthi ukusebenziseka kwabo kuphela kufinyelela kumakhono omuntu nokuzimisela ukukhokhela i-akhawunti. Ngenxa yalokho, bathambekele ekuthandweni nalabo abanemali ephakeme.
Amademokhrasi awazange aphakamise noma yiziphi izinguquko eziphawulekayo emithethweni yamanje elawula ama-Akhawunti Yokulondoloza Impilo.
AmaRephabliki, ngakolunye uhlangothi, acabangela ama-HSA ukuthi abe yisisombululo sokwenza ngcono ukunakekelwa kwempilo. Umzila wokuqala wekhasi lokunakekelwa kwezempilo likaTrump ngesikhathi somkhankaso uthe " Phindela futhi ubeke esikhundleni se-Obamacare ngama-Akhawunti Wokulondoloza Impilo ." Baye bahlongoza izinguquko ezihlukahlukene, kufaka phakathi imingcele emikhulu yokunikela (mhlawumbe ihambisana neHDHP ekhishwe), imingcele emincane yokuthi ubani ongakwazi ukufaka isandla kwi-HSA, nemithetho ekhululekile ngokuqondene nokuthi izimali ze-HSA zingasetshenziswa kanjani ngaphandle kwentela noma izinhlawulo.
Imithetho emibili eyaboniswa yiRepublican Senators ngoJanuwari 2017 idinga ushintsho olubandakanya ama-HSAs: Umthetho we-Patient Freedom Act uzoshintsha ama-HSA ku-Roth HSAs (iminikelo ayengeke idonswe, kodwa ukukhula ngeke kube intela, futhi ukuhoxiswa kwezindleko zezokwelapha kungaba intela -free), futhi izokwandisa umkhawulo wokunikela. Umthetho Wokuguqulwa Kwe-Obamacare uzoqeda imingcele yemiklomelo ngokuphelele, futhi izovumela futhi i-HSA ukuthi isetshenziswe ngabantu abangenawo ama-HDHP.
Ukuxhaswa kwe-premium nokungabi nabathengi
Ukukhathazeka okuyinhloko esikhathini esizayo ngokwemishwalense yomshuwalense wezempilo kanye nokuthengwa kwemali kuye kwaba semakethe ngayinye , lapho amazinga akhuphuka ngokuphazamiseka ngo-2017. Imakethe ngayinye yingxenye encane kakhulu yabantu, kodwa, futhi izinga lokunyuka liye lalinywa kakhulu inani eligcwele.
Amademokhrasi asehlongoze amasu ahlukahlukene okwenza ukuhlinzekwa nokukhathazeka okungabizi. Zibandakanya izikweletu zentela kubantu abachitha imali engaphezu kwezingu-5 ezingeniso zabo, nokwandisa izinsizakalo ze-premium ukuqinisekisa ukuthi akekho okufanele akhokhe amaphesenti angaba ngu-8.5 wemali engenayo, okuzoqeda "umcibisholo wenkxaso" okwamanje ikhona kwabanye ababhalisile.
I-Democrats iphinde ihlongoze uhlelo lwezempilo oluzokwazi ukuncintisana nabathwali bomshuwalense wezempilo yangasese ngenhloso yokwehliswa kwamanani, kanye nekhono labantu abaneminyaka engama-55 nangaphezulu ukuthenga eMedare, okwamanje inikeza ukuhlinzekwa okuqala lapho abantu beba ngu-65 .
I-Democrats nayo ifuna ukunikeza igunya likahulumeni ukuvimbela ukunyuka kwamazinga okubhekwa njengabulungisa. Njengamanje, ukuba nehlelo "lokubuyekezwa kwezinga eliphumelelayo", uhulumeni-noma uhulumeni wesifundazwe-kufanele nje ubuyekeze amazinga ahlongozwayo futhi anqume ukuthi alungile yini noma cha. Kodwa ngaphandle kokuthi umbuso usungulwe imithetho evumela ukuba bavimbele amanani angalungile, akukho ukuhlinzekwa okwakhelwe kulokho. Kufanele kuphawulwe, kepha-ke, ukuthi imithetho yamanje yokulahlekelwa kwezidakamizwa ezidinga ukwelashwa idinga ama-insurers ukuthumela izikhwama kumalungu uma izindleko zabo zokuphatha zidla amaphesenti angaphezulu kuka-20; lokhu kudala ukuvikelwa okwakhiwe ngaphakathi kokunciphisa intengo ngenhloso yokushayela inzuzo noma isinxephezelo esiphezulu.
AmaRephabliki ahlongoze ukuvumela abantu ukuba bathathe ngokugcwele imishanguzo yabo yomshuwalense wezempilo ngezintela zabo, okuyokwenza ukuthi izindleko zangempela zenzeke. Imishanguzo yomshuwalense wezempilo oxhaswe ngumqashi njengamanje ikhokhelwe intela ngaphambi kokukhokha intela, futhi abantu abaziqashile bangakwazi ukukhipha ama-premiums abo.
Kodwa abantu abangaqashile abazithenga umshuwalense wabo wezempilo abakwazi ukukhipha amaphrimiyamu akho okwamanje ngaphandle uma bekhipha imali yabo. Uma benza itemize, bavunyelwe kuphela ukukhipha izindleko zezokwelapha-kufaka phakathi ama-premiums- okudlulele amaphesenti ayishumi emali engenayo . Lokhu akuzuzisa kakhulu abantu kunamithetho yamanje yomshuwalense oxhaswe ngumqashi kanye nabantu abaziqashile.
AmaRephabliki afuna ukuvumela abantu ukuthi bathenge umshwalense wezempilo emigqeni yombuso ukuze ukwandise ukuncintisana futhi wehlise izintengo. Kodwa-ke, akucaci ukuthi ngabe ama-insurers angaba nesithakazelo sokwandisa izindawo zabo ezikhona manje, ngenxa yezingqinamba ezihilelekile ekwakheni inethiwekhi endaweni entsha.
Kukhona futhi imibuzo mayelana nokulawula okulawulwayo, njengoba ukusethwa kwamanje kuvumela uKhomishane Womshuwalense wombuso ngamunye ukuba alawule wonke amapulani athengiswa kuleso simo (nakuba izinkampani zomshuwalense ngokuvamile zihlala kwelinye izwe), okusho ukuthi abathwali kumele baguqule ukuhanjiswa okunikezwayo isimo ngasinye sihambisana neziqondiso ezithile zombuso. Uma lolawulo lokulawula luqedile izinhlelo ezingaphandle kwezwe futhi i-ACA yaxoshwa ngesikhathi esifanayo, ukuvikelwa kwabathengi kungase kunciphise njengababambisensi abangakhetha ukuhlala emazweni ngemitheshonqubo ye-lax.
Ukukhulelwa Nokukhipha Isisu
Igama lokukhipha isisu lisetshenziswe izikhathi ezingu-35 kwiRiphablikhi yamaRiphabliki, kodwa kuphela izikhathi eziyisithupha eDemocratic Party Platform. I-GOP yenza kucacise ukuthi bafuna ukuqeda zonke izinsizakalo zombuso wezinhlangano ezifana ne-Planned Parenthood ezinikezela ngezinsizakalo zokukhipha isisu. Futhi ngenkathi iDemocratic Party ikholelwa ukuthi "ukukhipha isisu okuphephile kufanele kube yingxenye yokunakekelwa kwezempilo kokubeletha kwababelethi nabesifazane," i-GOP "iqine ngokumelene" nokukhipha isisu. I-Trump yamukele izimo ezifanayo ngokukhipha isisu .
I-Hyde Amendment ibilokhu isendaweni kusukela ngo-1976, futhi ivimbela ukusetshenziswa kwezimali zikahulumeni ukukhokhela ukukhipha isisu ezimweni eziningi. Ngenkathi iDemocratic Party Platform idinga ukuchithwa kwe-Hyde Amendment, i-Republican Party Platform idinga ukuba i-codification yayo "nesicelo kulo lonke uhulumeni, kuhlanganise ne-Obamacare."
Amademokhrasi ngokuvamile asekela ukuhlinzekwa kwe-ACA ukuthi wonke amaphuzu omshuwalense wezempilo kumele ahlinzekele ukuvimbela imithi ngaphandle kokubiza izindleko, futhi abaholi beDemocratic bawusizo ekwenzeni ukwelashwa kokuphuthumayo kuyatholakala ngaphezu kwe-counter.
I-Republican Party Platform iphikisana nemitholampilo esekelwe esikoleni ehlinzeka ngemithi yokuvimbela imithi, futhi ilahla umqondo wokuvumela "ukukhulelwa kwezikhukhula ezinamandla" ukuba kuthengiswe phezu kwe-counter. Kodwa i-Trump ibike ukuthi uthanda ukuvumela ukudayiswa kwezizalo zokubeletha ngaphandle kwemithi.
Izimo zangaphambili ezikhona
I-ACA ishintshe ubuso bomshuwalense wezempilo ngamunye ngokwenza kube nokuqinisekiswa okuqinisekisiwe kuzo zonke izimo, kungakhathaliseki ukuthi zikhona izimo ezikhona. Amacebo omshwalense wezempilo weqembu asevele afanele ukumboza izimo ezikhona ngaphambili, kodwa angafaka izinkathi zokulinda ngaphambi kwesikhathi ngo-2014 (ukuze kucace, abanikezeli besikhwama bavunyelwe ukukhokhisa abaqashi amaphrimiyamu aphakeme emazweni amaningi asekelwe emlandweni wesimangalo seqembu, kodwa izisebenzi ngabanye azikwazanga ukunqatshwa kusukela ohlelweni lweqembu ngenxa yezimo zangaphambili).
Njengoba manje i-ACA isetshenzisiwe, izimo ezandulele zikhona kuwo wonke amapulani (ngaphandle kwamakethe amakhomikhali ahlukene) ngaphandle kwezinkathi zokulinda. Abaqashi bangakwazi ukuhlala isikhathi sokulinda ezinsukwini ezingu-90 ngaphambi kokuba kutholakale ukukhishwa, kepha uma kwenzeka, izimo ezandulele zihlanganisiwe kungekho sikhathi esengeziwe sokulinda.
Amademokhrasi afuna ukulondoloza i-ACA, kuhlanganise nemigomo evikela abantu abanezimo ezikhona ngaphambili.
Ezinye iziphakamiso zeRiphabhulikhi zibiza ukuchithwa ngokugcwele kwe-ACA, okusho ukuthi izimo ezandulele ziphinde zivumele ukuthi umshwalense akwehlise ukuthengiswa emakethe ngayinye, noma enze izikhathi zokulinda emakethe yeqembu. Ezinye iziphakamiso zeRiphabhulikhi zibiza ukugcina ukuvikela kwabantu abanezimo ezikhona ngaphambili.
Eziphakamisweni zeRiphabliki ezizoqeda ukuhlinzekwa okuqinisekisiwe kwe-ACA, kube khona izingcingo zokuvuselela amachibi aphezulu asezingeni elibheke emphakathini ukukhonza abathengi ngezimo ezandulele. U-Trump uye wathi izixazululo zakhe ezisekelwe emakethe (njengokuvumela ukuthengiswa kwamapulani kuwo wonke imigqa yombuso) zingavumela abathwali ukuba baqhubeke bemboza izimo ezikhona ngaphambili ngaphandle kwemithetho efuna, kodwa kukhona ubufakazi obuncane obuyobe buba khona.
Izindleko Zezidakamizwa Zesidakamizwa
Ama-democrats afuna ukunciphisa izindleko ezingaphandle kwezindleko zemithi yokwelapha (ukukhathazeka lapha yizidakamizwa ezibiza izindleko eziphezulu, ezivame ukumbozwa nge-coinsurance-iphesenti yezindleko-kunokuba i-copays flat; ezinye izifunda sezivele zikhishwe -pocket izindleko kwemigomo).
Amademokhrasi nawo afuna ukuqeda " ukukhokhela ukubambezeleka ," (umkhuba ogcina izidakamizwa ezibiza izindleko ezingekho emakethe). Ipulatifomu yenkampani ihlanganisa nokuvumela ukungenisa okuthengiswayo kwemigomo evela kwamanye amazwe, nokuphakamisa ukuvinjelwa kwamanje kweMedarera ukuxoxa ngezintengo zemithi nabakhiqizi bemithi.
I-Republican Party Platform ayibhekisisani nemigomo ngaphandle kwesimo se-opioid kanye nemizamo yokubhekana nokusetshenziswa kabi kwezidakamizwa. Ngesikhathi somkhankaso, uTrump uthe ufuna ukuxoxisana nezindleko ngembonini yezokwelapha, nokuvumela ukungenisa izidakamizwa eziphansi kwamanye amazwe. Kodwa-ke, isikhundla sakhe ekuxoxiseni izintengo zezidakamizwa sasishintshe ngasekupheleni kukaJanuwari.
Isimiso somuntu ngamunye
Igunya lomuntu ngamunye we-ACA (ukunikezwa komthwalo ngamunye okwabelwana ngawo) kudinga abaningi baseMelika ukuthi balondoloze umshwalense wezempilo noma babhekane nesigwebo sentela. Abashuwalense baphikisana ngokuthi lokhu kuyindlela ewukuphela komshwalense wezempilo oqinisekisiwe, futhi isipiliyoni sangaphambili sivame ukusekela leso simangalo.
Amademokhrasi ngokuvamile asekela igunya lomuntu ngamunye.
AmaRephabliki aphikisana nalo, nakuba ekuqaleni kuka-2016, uTrump wabonakala ethanda. Washintsha ngokushesha isikhundla sakhe, ebona ukuthi usekela ngokugcwele ukukhishwa kwe-ACA, kuhlanganise nomsebenzi ngamunye.
Isibopho somuntu singenye yezinto eziphikisana kakhulu ze-ACA, futhi inhlawulo ehambisana nayo ingasuswa nge-billbus-proof proof reconciliation. Lokhu kungabangela ukungazinzi emakethe yomshuwalense wezempilo, kodwa-ke, futhi inkinga isacatshangwa ngabamengameli, kanye nokufaka embonini yomshuwalense nabameli bezimpahla.
> Imithombo:
> Barnett JC, Vornovitsky MS. I-United States Census Bureau, I- Health Insurance Coverage e-United States: 2015 . Ikhishwe ngo-September 2016
> Blumberg LJ. I-Urban Institute. Ukuthengiswa Kwomshuwalense Kuzozonke Zomhlaba, June 2016.
> Amasevisi e-Medicare naseMedicaid Services, Isikhungo Sokwaziswa Komthengi kanye Nokuqapha Umshwalense. Isigaba 1332: I-State Innovation Waivers
> Garfield R, iDamico A. Kaiser Family Foundation, i-Gap Coverage: Abadala Abangenalutho Emiphakathini Engabandlulanga I-Medicaid - Isibuyekezo. NgoJanuwari 21, 2016.