I-AHCA, kanye namanye ama-Bill Gills anqunyelwe ukufaka esikhundleni se-Obamacare
Lapho uDonald Trump ethatha ukhetho lomongameli ngo-2016, ikusasa loMthetho Wokunakekelwa Ongenakusiza (i-ACA, eyaziwa ngokuthi i-Obamacare) ngokungazelelwe iphezulu emoyeni . I-oda lokuthoma lokuqala likaTrump, elikhishwe amahora ambalwa emva kokuvulwa kwakhe, ligxile ekunciphiseni umthwalo wezomnotho we-Care Affordable Act , futhi iqondisa izinhlangano ze-federal-njenge-IRS kanye ne-HHS-ukuba ibe mnandi ngangokunokwenzeka lapho kuphoqelela izinhlawulo ze-ACA neziqondiso .
Ekuqaleni, ngoNovemba noDisemba, ukubhekwa komthetho kubonakala kubonakala ekuqedeni i-ACA ngokushesha ngangokunokwenzeka esimisweni sika-2017, besebenzisa umthethosivivinywa wokubuyisana owawungeke uthathwe yi-filibuster futhi ungadlulela ngamavoti angu-51 kuphela eSenate (izikweletu zokubuyisana kunomkhawulo, noma kunjalo, ngokuthi bangakwazi ukubhekana nokusetshenziswa kwemali kahulumeni kuphela, ngakho-ke umthethosivivinywa wokubuyisana wokuqeda i-ACA ngempela uzokwazi ukukhipha kuphela izici ezihlobene nemali yomthetho).
Umthetho kulindeleke ukuthi ufanane no-HR3762 ka-2015, owavotelwa ekuqaleni kuka-2016 nguMongameli Obama, kodwa ngabe ngabe usuchithe izinhlinzeko eziningi ezihlobene nokuchitha imali kwe-ACA ngokulibaziseka kokusebenza kokusebenza kweminyaka emibili (ngamanye amazwi, umthetho wawuzobekwa ekuqaleni kuka-2016, kodwa iningi lezokuphinda lizosebenza kusukela ngo-2018). Umqondo wukuthi ukubambezeleka kokuqalisa ukusebenza kweminyaka emibili kunganika iCongress isikhathi sokumisa esikhundleni sokushintshwa okunamandla.
Ngokushesha lapho isimiso somthethosisekelo sika-2017 siqala, uSenator Mike Enzi (R, Wyoming) wethule isinqumo sesabelomali esiqondisa amakomidi amane e-congressional ukuba aqale ukuhlelwa kwebhilidi yokubuyisana ukuze aqede izingxenye ezihlobene nokuchitha imali ze-ACA. Isixazululo esingabophelanga, S.Con.Res.3, sidlulisele amakamelo amabili eCongress ngaphambi kokuvulwa kukaTrump, futhi amakomiti aqala ukusebenza kulo mthethosivivinywa.
I-AHCA Yadlulela Indlu NgoMeyi 4, 2017
Ngo-Mashi 20, iNdlu yabe isungula iMelika Health Care Act (AHCA), eyayiwumthetho owenziwe ngenxa yesinqumo sesabelomali sikaJanuwari (ukulungiswa komthetho kwafika ngo-Mashi 6, kodwa kwakungeniswa ngokomthetho kuze kube nguMashi 20 ). I-AHCA iyinkokhiso yokubuyisana, ngakho ayikwazi ukubhekana nezici eziningi ze-ACA. Kodwa kuhluke kakhulu ku-HR3762 ngezindlela eziningi. I-AHCA yabekwa emhlanganweni wekomidi ngesonto elifanayo laqala ngalo, futhi izilungiso eziningi zanezelwa phezu kwamasonto ayisithupha alandelayo, ngaphambi kokuba isilinganiso sidluliselwe eNdlu ngoMeyi 4, ngevoti lika 217 kuya ku-213.
Ihhovisi le-Congressional Budget libike ukuthi i-AHCA izokwehlisa ukulahlekelwa kwezimali ngama-dollar ayi-337 billion, kodwa kungabangela ukuthi abantu abangaqinisekisiwe bekhula ngamamiliyoni angu-24 kule minyaka eyishumi ezayo. I-CBO yakhipha ukuhlaziywa okusha komthetho ngemuva kokuthi kulungiswe ngo-Mashi 20, ukulinganisa ukuthi umthetho oshintshiwe unganciphisa kuphela ukulahlekelwa kwezimali ngo-$ 150 billion, kodwa kungabangela ukuthi abantu abangaqinisekisiwe bekhuliswe ngabantu abayizigidi ezingu-24. Izilungiso eziningana ezengeziwe zanezelwa ngo-Ephreli noMeyi, kodwa iNdlu yavotela ngesilinganiso ngaphambi kokuba i-CBO inesikhathi sokuqedela ukuhlaziywa kwabo komthelela walezo zichibiyelo.
I-AHCA iqalile ukuvotela ngoMashi 24, kodwa yadonswa ngemuva kwamahora amaningi ephikisana ngalolo suku, lapho kubonakala ukuthi kwakungekho ukwesekwa okwanele ukuyidlulisa. Ukuchitshiyelwa okwethulwa kwamasonto alandelayo kwakuwumzamo wokunciphisa ukusekelwa komthetho, futhi ekugcineni kwaphumela ekungenikeni kwawo ngamancele amancane, ngoMeyi 4.
I-AHCA ithunyelwe eSenate ngemuva kokuthi idlulele iNdlu, kodwa iSenate ithe izobe zibhale umthetho wabo siqu, zibandakanya okuningi kwe-AHCA ngangokunokwenzeka. Amakamelo amabili azobe esebenzela ukubuyisana nanoma yikuphi ukungafani emithwalweni yabo ngaphambi kokuba athumele umengameli wokugcina ngesiginesha sakhe.
Nakhu okuku-AHCA, njengokungathi lapho kudlule iNdlu:
- Iphinda izikweletu zentela ze-premium ze-premium ngemuva kuka-2019, futhi zishintsha izikweletu zentela ze-premium ezilungiselelwe ngokususelwa eminyakeni yobudala, futhi ezandisa kubantu abanemali ephezulu. Izikweletu ze-ACA zentela zikhulu kubantu abanemali encane, futhi bakhulile ezindaweni lapho umshuwalense wezempilo ubiza kakhulu. Izimali zokukhokha intela ze-AHCA zizofana nomuntu ohola i-$ 20,000 noma i-$ 70,000, futhi uzohluka ngokususelwa eminyakeni yobudala. Umthelela jikelele uzoba amaphrimiyamu aphansi amancane. Futhi imali engenayo ephansi kanye nabantu abampofu bayoba ngaphansi kokuthola ngaphansi kwe-ACA, kuyilapho abantu abancane nalabo abanemali ephakeme beyozuza ngaphezulu.
- Ukunwetshwa kwe-Medicaid kuzohlala kuqhubeka ngo-2019, kodwa kuzobe sekuqhwaqile ngemuva kwalokho. Ababhalisile abasha ngeke bakwazi ukujoyina, futhi abantu abalahlekelwe ukufaneleka ngeke bakwazi ukubhalisa kamuva. Izizwe ezingakaze zandiswe iMedicaid ngo-Mashi 1, 2017, zazingeke zifanelekele ukwandisa iMedicaid ngemali eyengeziwe ekhululwayo eyamanje okwakhulunywa ngayo (ngokuyisisekelo, lezi zingu-19 ezingakaze zandiswe i-Medicaid ngeke zisekho ukugqugquzela imali ukwenza kanjalo uma i-AHCA isungulwa njenge-is). I-medicaid nayo izoshintshwa kusukela kumanje ehambisana ne-federal ehambisanayo nesabelo somuntu ngamunye noma ukuvimba izibonelelo ezivela kuhulumeni wesifundazwe.
- Isijeziso somuntu ngamunye sizoqedwa, ngokuphindaphindiwe ekuqaleni kuka-2016. Esikhundleni salokho, i-AHCA incike ekutheni "ukuhlanganiswa okuqhubekayo" okuhlinzekwayo: Ngemuva kwesikhathi sokubhalisa okuvuliwe ngo-2018 (okuhlongozwayo ngoNovemba 1, 2017, ngoDisemba 15, 2017), noma ubani ngubani obhalisa ohlelweni lomakethe ngalunye emva kwekhasi lokubanjwa okungenani izinsuku ezingu-63 ngabe bekhokhiswa ama-premium angu-30 ephakeme kunamazinga ajwayelekile, izinyanga ezingu-12. Ngaphandle kwalokho, njengengxenye ye- MacArthur Amendment eyongezwe ku-AHCA, ithi kuzokwazi ukufuna ukuxoshwa okuzovumela abakwa-insurer ukuba bakhulise amaphrimiyamu asekelwe emlandweni wezokwelapha (ngokuphambene namaphesenti angama-30 aphathekayo kungakhathaliseki isimo sezempilo) kubafaki bezicelo ngabanye bemakethe owayephethe igebe ekufundeni. Njengokukhula kwezinga lamaphesenti angu-30, amaphrimiyamu aphezulu asekelwe emlandweni wezokwelapha uzohlala endaweni yonyaka.
- Iningi lezokuvikela kwabathengi be-ACA lizoguqulwa, ngoba i-AHCA iyinkokhiso yokubuyisana ekhuluma ngamanyathelo ahlobene nokusebenzisa imali (abaphathi be-GOP bathi ezinye izinhlinzeko zizobhekana nezigaba zakamuva zokuhlelwa kwezinhlelo zokunakekelwa kwezempilo, kodwa izikweletu ezingekho ukubuyisana angadinga amavoti angama-60 eSenate ukuba abe ubufakazi be-filibuster). Kodwa-ke, i-MacArthur Amendment iphinde ivumele ukuthi izimo eziguquguqukayo zokufuna ukuxoshwa ukuguqula ububanzi bezinto ezibhekwa njengezidingo zezempilo ezibalulekile , nokwandisa imithetho yobudala beminyaka yobudala engaphezu kwenani le-5: 1 elibizwa ku-AHCA (i-ACA ivumela kuphela Ukukala okungu-3: 1 kwababhalisile abadala noma abasebancane).
- Ukuphepha bekuzobe kuqinisekisiwe ngokuqinisekisiwe-kungakhathaliseki ukuthi kunjani izimo zezokwelapha, kodwa njengoba kuboniswe ngenhla, abantu bakwamanye amazwe bathi bathengi uhlelo emakethe ngayinye emva kokuba igebe elikuyo likwazi ukubona ama-premium aphakeme kakhulu ngenxa yemibandela yabo ekhona ngaphambili . Isimo esivele sikhona isikhathi sokulinda kanye nezizathu zokulinda ngeke kuvunyelwe, noma kunjalo. Ama-maximum wokuphila okuqhubekayo kanye nonyaka azoqhubeka enqatshelwe izinzuzo ezibalulekile zezempilo, futhi ama-maximums angaphandle kwe-pocket ayadingeka ukuba athole izinzuzo zezempilo ezibalulekile. Kodwa njengoba kuphawuliwe ngenhla, uthi kuzoba nenketho yokunciphisa ububanzi bezinzuzo zezempilo ezibalulekile, okuzokwenza buthakathaka ukuvikelwa okusebenzayo kumingcele engaphandle kwe-pocket kanye nama-maximums wokuzuza ngonyaka.
May 2017: I-Senate izocabangela i-AHCA
I-AHCA yadlula iNdlu ngoMeyi 4 futhi yafika eSenate. Kodwa kusukela ekuqaleni, umthetho awuzange ube nokusekelwa okubanzi kwabathintekayo noma ngisho nesigungu esiphelele sezomthetho we-GOP. I-American Medical Association, i-AARP, ne-American Hospital Association, kanye nezinye izinhlangano eziningi, zikhulume ngokumelene ne-AHCA. AmaDemokhrasi e-Congress aphikisana ne-AHCA, kodwa ngisho namaRiphabhulikhi ahlukaniswa. Amanye ama-Senate Republican ahloniphekile akholelwa ukuthi i-AHCA ayifuni okwanele ekuphonseni ngokushesha izingxenye ze-ACA ukuthi zicabangela ukungathandwa kwabathelisi esikubona (izikweletu ezikhokhiswayo zentela kanye nokukhuliswa kwe-Medicaid, isibonelo).
Futhi ngakolunye uhlangothi lwesigubhu, amaRepublican Senators athile abonise ukubhuka noma ukungathandi ukuqeda ukukhuliswa kwe-ACA's Medicaid nokusebenzisa umthetho ozokwenza ukubiza kube kubi kakhulu kwabaseMelika basebekhulile nabangaphansi.
Manje ukuthi lesi sinani siseSenate, sibhekene nenselele enkulu kunokwakho eNdlu. Ngisho nokusebenzisa ukubuyisana (okuyinto idinga ukuthi amavoti angu-51 adlule, kunama-60), iSenate ingakwazi ukulahlekelwa yiRiphabliki ezimbili kuphela uma umthethosivivinywa udlula. Ngokushesha nje lapho i-AHCA idlulela iNdlu, iSenate yabonisa ukuthi kungenzeka ukuthi babhale isilinganiso sabo, bathathe isiqondiso ku-AHCA, kunokuba nje bachibiyele i-AHCA. Ngakho-ke kungase kube khona inqubo ebalulekile yokushaya umthetho ngalesi sikweletu, futhi ikusasa likude nakwezinye zeSenate.
Okunye Umthetho Wokuguqulwa Kwezempilo
Nakuba ukunakekelwa kugxile kwi-AHCA kusukela ekuqaleni kuka-Mashi, ezinye izikweletu eziningana ziye zafakwa ngesikhathi sokuqala ka-2017, konke okuhloswe ukushintsha noma ukushintsha i-ACA noma izingxenye zayo (ungasebenzisa leli thuluzi ku-Kaiser Family Foundation ukuqhathanisa ezinye zazo eceleni)
Ake sibheke ezinye zezikweletu ezazisetshenziswe ngo-2017 ngaphambi kwe-AHCA, futhi ziyoba nomthelela onjani. Uma i-Senate ingadluli i-AHCA-noma enye inyathelo iNdlu iyavumelana ngayo-enye yalezi zimali zingaphetha ukubukwa kabusha ngo-2018, njengoba abameli beRiphabhulikhi bengenakukwazi ukuyeka imizamo yabo yokuqeda i-ACA, noma ngabe umzamo wabo we-2017 ayiphumelelanga.
Izindleko zeSenate
Umthetho Wezokwelapha Patient
UMthetho WezeMpilo Ophulukisiwe wasungulwa ngoJanuwari 23, 2017, yiSenators Bill Cassidy (R, Louisiana) noSusan Collins (R, Maine).
Umthethosivivinywa ukwedlula ukwedlula ezinye iziphakamiso zeRiphabhulikhi eziye zanyuka eminyakeni embalwa edlule, njengoba unikeza inqubo yokugcina i-ACA njenge-noma, ukushintshela ohlelweni olusha ngokuguquguquka kombuso okwengeziwe. Kodwa umthethosivivinywa we-compromise ungase ungapheli ukuthola ukwesekwa okwanele kusuka ngakunye uhlangothi lwesiteleka, kanti umthetho wokufaka esikhundleni uzodinga okungenani amavoti angu-60 eSenate ukuze unqobe i-filibuster.
Umthetho we-Patient Freedom Act uzodlulisela inqubo enkulu yokwenza izinqumo ezizweni futhi uzobanikeza izinketho ezintathu (ngokukwazi ukushintsha unyaka ngamunye kusuka kwesinye inketho kuya kwesinye):
- Gcina i-ACA njengenhla.
- Izinhlinzeko eziningi ze-ACA zizochithwa, kodwa amaphesenti angama-95 emali ezobe isetshenziselwa ukukhokhela izinsizakalo ze-premium, ukuxhaswa ngezindleko zemali, nokukhuliswa kwe-Medicaid esifundazweni kuzosetshenziselwa ukuxhasa amaRoth Health Savings Accounts (Roth HSAs) ukuze izakhamuzi zendawo ezifanelekile. Izakhamuzi ezingaqinisekisiwe zizobhaliswa ngokuzenzekelayo ezinhlelweni zempilo eziphakeme ezidonswayo (ukubhaliswa ngokuzenzekelayo kuzothatha isikhundla somuntu ngamunye).
- Izinhlinzeko eziningi ze-ACA zizochithwa, futhi umbuso uzobe ulawula ukuklama nokugcina uhlelo olusha (ngaphandle kwezidingo ezichazwe ku-Option 2). Kodwa uhulumeni ngeke athole noma yiziphi izinsizakalo zezimali.
Kungakhathaliseki ukuthi yikuphi okukhethwa nguhulumeni, uMthetho WezeMpilo Uzoqhubeka nokuvikeleka kwabathengi be-ACA: Umkhawulo wesikhathi esizayo nomhlomulo uzobe uvunyelwe, njengoba kungavunyelwa isimo esingekho ngaphambili. Ukuphepha kuzoqhubeka nokuqinisekisiwe, futhi abadala abasha bazoqhubeka nokuvunyelwa ukuhlala ohlelweni lwezempilo lomzali kuze kube iminyaka engu-26 . Umthetho WezeMpilo Ophulukisayo awungadingeki ukuthi izinhlelo zezempilo zihlanganise zonke izinzuzo ezibalulekile zezempilo ze- ACA , kodwa kuzodinga ukuhlinzeka ngempilo yengqondo nokuphathwa kabi kwezidakamizwa.
I-Cassidy no-Collins balindele ukuthi amazwe amaningi angakhetha ukukhetha 2. Ivumela ukuguquguquka kombuso okwengeziwe ngokwemigomo yokuhlolwa kwepulani kanye nezidingo zokubheka, kodwa futhi inikeza ngemali ebalulekile yezimali ezobekwa kwizakhamuzi zaseRoth HSAs.
Umthetho WezeMpilo Uphilile uzoqeda ukusebenzisa ama-HSA wendabuko futhi uzowafaka esikhundleni samaRoth HSAs. Njengamanje, iminikelo ye-HSA itholakala intela, kodwa inqunyelwe ( ngo-2017 ) engabi ngaphezu kwamaRandi angu-3,400 kumuntu oyedwa, noma i-$ 6,750 yomndeni.
Iminikelo yamaRoth HSA ayengeke itholwe intela kodwa abantu bazokwazi ukufaka imali engama-$ 5,000 ngomuntu ngamunye (ngakho umndeni wezingane ezine uzokwazi ukufaka imali engu-$ 20,000 ngonyaka, okungekho ngaphezu kwama $ 6,750 abangabanikela namhlanje i-HSA yendabuko).
Iminikelo ingakhula intela phezu kwesikhathi, futhi ihoxiswe intela mahhala ukukhokhela izindleko zezokwelapha (lezi zici zeRoth HSAs zizofana nezamaHSA wendabuko).
UMthetho WezeMpilo WezeMpilo awusho ukuthi uhulumeni uzoba nomthelela kangakanani kumuntu ngamunye weRoth HSA. Babelindele ukuthi kuyoba inani elikhulu, kodwa ukufaneleka kwemali kahulumeni kuyokwandisa ngisho nabantu abanemali ephakeme kakhulu, ekusakazeni izimali kubantu abaningi kunokuba i-ACA iyenze.
Imali emaRoth HSAs (kufaka phakathi iminikelo kahulumeni kanye nomnikelo ngamunye) ingasetshenziselwa ukukhokhela izinkokhelo zomshuwalense wezempilo kanye nezindleko zangaphandle.
Umthetho Wokuguqulwa Kwe-Obamacare
USenator Rand Paul (R, eKentucky) wethule uMthetho Wokuguqula Umthetho (S.222) ngosuku olulandela uCassidy noCollins bavule umthethosivivinywa wabo.
USeninkulu uPaul ubelokhu ekhuluma ngokukholelwa ukuthi ngeke kube necala lokuba iCongress idlulisele umthetho ukuqeda i-ACA ngaphandle kwemithetho ehambisanayo ukuze isuse esikhundleni sayo (nguye kuphela uSenate Republican ongavota ku-S.Con.Res.3; naphezu kokholo lwakhe ukuthi i-ACA kufanele isuswe, akafuni ukuqhubeka nokuqeda umthetho ongafaki umthetho wokufaka esikhundleni).
UPawulu wayephikisana nabalingani bakhe beRiphabhuliki ezinsukwini eziholela ekukhululweni kwe-AHCA, echaza ukuthi umthethosivivinywa uhlelwa ngasese (izikweletu azisobala zomphakathi kuze zingeniswe ekomidini, kodwa uPawulu wayefuna bheka umthetho owawubhala phansi amaRephabliki aseNdlu).
Ngokuphikisana okuqhubekayo ne-AHCA, uPaul ubize ngokuthi "Obamacare-Lite" futhi uphinde washo isifiso sakhe sokuqedwa ngokugcwele kwe-ACA esikhundleni.
Nakhu ukuthi uMthetho ka-Paul Obamacare Replacement Act uzosebenza kanjani:
- Amandla amaningi e-ACA azosuswa, kufaka phakathi izigunyazo zomuntu ngamunye kanye nomqashi, inkinga eqinisekisiwe nokuhlinzekwa kokulinganisa umphakathi, kanye nemfuneko yezidingo zezempilo . Ngenxa yalokho, abantu abayodinga ukuthenga umshwalense, abaqashi ngeke badingeke banikeze umshuwalense, izinkampani zomshuwalense wezempilo zizokwazi ukuphika izicelo noma ukwandisa amaphrimiyamu asekelwe emlandweni wezokwelapha, kanti nezinhlelo ezingenakho ukukhokhelwa ngezinzuzo ezihlukahlukene ezibalulekile zezempilo zitholakale zithengwa (lezo zinhlelo zingabizi kakhulu, kodwa zizoshiya abathengi ngaphandle kokuthola imali uma ziphela zifuna ukwelashwa okungakahlanganiswa necebo).
- Kuyoba khona isikhathi sokuqala sokubhalisa sokuqala seminyaka emibili lapho abantu abanezimo ezandulela khona bazokwazi ukuthenga ukuthengiswa emakethe ngayinye. Ngemuva kwalokho, ukuhanjiswa kungaba kuphela ukukhishwa okuqinisekisiwe (okungenakho ukubhala phansi kwezokwelapha) kubantu abagcina ukufakwa okuqhubekayo. Kubantu abathola umshwalense kusuka kumqashi, imithetho ye-HIPAA izosebenza, okusho ukuthi izinhlelo zingabeka isikhathi sokulinda esimweni sokulinda kubhalisile abasha ababengazange baqhubeke nokubika ngaphambi kokubhalisa ohlelweni lomqashi.
- Abantu abazithenga umshuwalense wabo wezempilo bazovunyelwa ukukhipha izindleko zemali ekhokhwayo emalini yabo engenayo kanye nezintela zomholo (njengamanje, imithetho iyancipha kakhulu kulabo abathengisa umshuwalense wezempilo ngamunye , kanti labo abanamalungiselelo ezempilo axhaswe ngumqashi bangasebenzisa ngaphambi kwentela izimali zokukhokha amaphrimiyamu abo).
- Kuyoba nomklamo wentela ongabuyiselwa imali efinyelela ku-$ 5,000 ukuze kukhuthazwe iminikelo kuma- Akhawunti Wokulondoloza Impilo (HSAs) . Ukungabuyiselwa kwemali kusho ukuthi isikweletu sizobe sitholakale ukuze sikhokhe intela yentela umuntu ayenayo, futhi ayikwazi ukukhudlwana kunezintela umuntu okhokhelwa unyaka. Lokhu kuqhathaniswa nokuxhaswa kwe-premium ye-ACA , okuyikhredithi yentela ebuyiswayo; uma isikweletu se-ACA sentela singaphezu kokukhokhwa intela, i-IRS izokunika umehluko.
- Ngeke kube khona umkhawulo ongaphezulu mayelana nokuthi ungangenisa kanjani i-HSA. Iminikelo ye-HSA ingenziwa ngisho nabantu abangahlanganiswa nezinhlelo zezempilo eziphezulu ezidonswayo, kanti izimali ze-HSA zingasetshenziselwa ukukhokhela izinkokhelo zomshuwalense wezempilo.
- Ababheki bezempilo bazokwazi ukuthengisa izinhlelo kumigwaqo kahulumeni. Umthethosivivinywa ubeka ukuthi imithetho yezwe elawula imikhiqizo yomshuwalense wezempilo izobe ikhishwa, ngakho-ke izifunda ngeke zivunyelwe ukuvimbela izinhlelo ezingaphansi kwezwe ezivela ekuthengiseni ukuthengiswa ngaphakathi kombuso.
Umthetho wokuphinda u-ObamaCare
NgoJanuwari 12, USeninkulu uTed Cruz (R, Texas) wethula iS.106, uMthetho we-ObamaCare wokuphinda. Yimali ekhishwa ngamakhasi owodwa efuna ukuthi uMthetho Wokunakekelwa Ongabizi kahle uphonswe ngokugcwele ngoJanuwari 1, 2018, nakho konke okubuyela endleleni okwakuyoba ngayo uma i-ACA ingakaze yenziwe.
Lo mthethosivivinywa awusoze wathola izinga lokusekela kwe-bipartisan okudinga ukudlula, kodwa kuyithuba lokuba uSenator Cruz ahambe ekurekhodweni njengoba eveze isilinganiso sokuqeda ngokuphelele umthetho, ngaleyo ndlela ekhangisa labo abakhe abafuna ukubona i-ACA isusiwe.
Izindleko zendlu
Izikweletu eziningana ezengeziwe zafakwa eNdlu Yezimele ngoJanuwari, ngayinye ehloswe ngokuchithwa noma ekushintsheni izici ezithile ze-ACA noma ukuthi isebenza kanjani:
I-HR708 , uMthetho we-"Age Age Rating Flexibility Act ka-2017," owasungulwa ngu-Rep. Larry Bucshon (R, Indiana, esifundeni sesishiyagalombili). Lo mthethosivivinywa uzoqala ukusebenza ngoJanuwari 2018, futhi uzovumela abathwali bomshuwalense wezempilo ukuthi basebenzise isilinganiso esiyisihlanu kuya kwesinye uma izinhlelo zamanani ezibhalisiwe abadala. Ngamanye amazwi, umfakisicelo oneminyaka engu-64 ubudala angahlawuliswa izikhathi eziphindwe kasikhombisa njengomfakisicelo oneminyaka engu-21 ubudala. I-ACA ibeka isilinganiso sokulinganisa okungaphezu kweyesithathu kuya kwesinye.
I-HR628 , i- "Ukuphepha Kwezempilo Okuqinisekisiwe Yomthetho Wokusebenza Okwenzeka Ngonyaka ka-2017," owasungulwa nguRem. Rodney Davis (R, Illinois, esifundeni seshumi nesishiyagalolunye). Lo mthethosivivinywa uklanyelwe ukuvikela abantu kusukela ekuphikisweni kokukhishwa noma okungafunwa ngenxa yemibandela ekhona ngaphambili. Kuzosebenza uma ngabe i-ACA isusiwe nokuthi nini. Kungadinga izinhlelo zezempilo neqembu ngabanye ukwamukela bonke abafakizicelo, ngaphandle kwemibandela yangaphambili ekhona. Njenge-ACA, izovumela abakwa-insurer ukuba babe nezikhathi zokubhalisa ezivulekile zonyaka kanye nezinkathi zokubhalisa ezikhethekile ezibangelwa izenzakalo ezifanelekayo.
I-HR710 , uMthetho we-"Health Couverture State Flexibility Act ka-2017," owasungulwa nguRep. Bill Flores (R, Texas, esifundeni se-17). Lo mthethosivivinywa uzoqala ukusebenza ngoJanuwari 2018, futhi unganciphisa isikhathi somusa ngezinkokhelo zempilo yomshuwalense wezempilo. Ngaphansi kwe-ACA, abantu abamukela izinsizakalo ze-premium banezinyanga ezintathu zomusa uma bewa ngemuva kumakhokheyamu abo (kumele bazuze ngokugcwele ekupheleni kwezinyanga ezintathu; ngeke bakwazi ukuhlala njalo ngemva kwezinyanga ezintathu). I-HR710 izofinyeza isikhathi somusa ezinsukwini ezingama-30, ngaphandle uma umthetho wezwe unenkathi ehlukile yomusa. Ngokuyinhloko, isikhathi somusa siyofana nabantu bonke, kungakhathaliseki ukuthi bathola izinsizakalo (njengamanje, isikhathi somusa ezindaweni eziningi kubantu abangatholi izinsizakalo cishe izinsuku ezingu-30).
I-HR706 , uMthetho wokuQinisekisa nokuPhathwa koMthetho ka-2017, owasungulwa nguMe. Marsha Blackburn (R, Tennessee, esifundeni sesi-7). Lo mthethosivivinywa uzodinga ukuthi abantu babhalise ngezingxoxo ngaphandle kokubhaliswa okuvulekile (okungukuthi, ngesikhathi sokubhalisa esikhethekile esabangelwa umcimbi ofanelekayo ) ukunikeza ubufakazi bokuthi kwenzeke yini. Lokhu kube yinkinga yokuphikisana eminyakeni embalwa edlule, futhi uhulumeni wesifundazwe waqinisa ukuqinisekiswa kwezenzakalo ezifanelekayo ngo-2016 phakathi kokukhathazeka abantu abangase babe "ukudlala uhlelo" uma ukuqinisekiswa kungadingeki.
I-HR184 , i- "Vikela uMthetho Wokuvuselela Imithi Ka-2017," owasungulwa ngu-Rep. Erik Paulsen (R, Minnesota, esifundeni sesithathu). Lo mthethosivivinywa uzosusa intela yedivayisi yezokwelapha ye-ACA, kuwo wonke amasheya ezenziwe ngemuva kukaDisemba 31, 2017.
I-HR173 , "uMthetho wokuPhelelwa kwentela kaHulumeni wase-Middle Class Benefits of the Year of 2017," owasungulwa nguMike Mike Kelly (R, Pennsylvania, esifundeni sesithathu). Lo mthethosivivinywa uzosusa intela ye-ACA ye-Cadillac . Kuzoqala ukusebenza ngo-2018, nakuba intela yeCadillac ngokwayo ingakapheli ukufaka isicelo kuze kube ngu-2020.
I-HR 247 , "uMthetho Wokukhulisa I-Akhawunti Yokulondolozwa Kwempilo ka-2017," owasungulwa ngu-Rep. Dave Brad (R, Virginia, District 7). Lo mthethosivivinywa uzokwenyusa inani lemali ephezulu lama-HSA, futhi uzovumela abantu ukuba banikele kwi-HSA ngisho noma bengenalo uhlelo oluphezulu lokudonswa kwempilo. Kuzovumela futhi abantu ukuthi basebenzise izimali ze-HSA ukukhokha imali yomshuwalense wezempilo, bavumele izimali ze-HSA ukuthi ziphinde zisetshenziselwe imithi engaphezulu, futhi inciphise inhlawulo ekhokhiswayo lapho abantu basebenzisa izimali ze-HSA ngezinkokhelo ezingekho zezokwelapha (okwamanje Amaphesenti angu-20, futhi ubuyele emuva kumaphesenti angu-10, ngendlela ayeyiyo ngaphambi kwe-ACA).
I-HR285 , i- "Health Care Tax Relief Act and Repeal Act," eyethulwa uMp. Michael R. Turner (R, Ohio, Distrit 10). Lo mthethosivivinywa uzosusa igunya le-ACA ngabanye kanye negunya lomqashi. Ngakho-ke abantu ngeke badingeke ukuba balondoloze umshuwalense wezempilo, futhi abaqashi ngeke badingeke ukuba bayinikeze.
Yonke yalezi zinkokhelo zihloswe ngamalungiselelo athile we-ACA, noma izindlela umthetho oye wazisebenzisa ngayo ngemithethonqubo elandelayo (isibonelo, i-HHS inikwe umsebenzi wokusungula izidingo ezithile kanye nemininingwane yezikhathi ezikhethekile zokubhalisa, futhi ekuqaleni ukukhetha ukusebenzisa uhlelo lokuhlonipha esikhundleni sokudinga ubufakazi bokuthi izenzakalo ezifanelekayo).
Izwi elivela
I-AHCA manje ineSenate, futhi asazi ukuthi ikusasa layo liyoba yini. Asikwazi ukusho ngokuqinisekile ukuthi i-ACA izoke isuswe noma ishintshwe, nakuba leyo mgomo jikelele kubamemezeli abaningi baseRiphabhulikhi futhi ibamba iningi kulawo maqembu amabili eCongress.
Kodwa iqembu alihambisani nesisombululo, futhi kukhona ukungavumelani okukhulu phakathi kwamaRepublican Senators ngokulandela indlela. Ababambe iqhaza beDemocratic Alliance bafungise ukuvimbela i-ACA ukuchithwa nganoma iyiphi indlela abangayenza ngayo, futhi uma nje bengathola ama-Republican Senators amathathu ukuba avumelane nawo, ukuchitha umthetho ngeke ukwazi ukudlula.
Kuyisikhathi, akukho lutho olushintshile, kanti i-ACA namanje ngumthetho wezwe.
> Imithombo:
> Cassidy.Senate.gov. Umthetho Wezokwelapha Patient. UMthethosivivinywa wokuthuthukisa ukukhetha kwesiguli ngokuvumela amazwe ukuba athathe izindlela ezisekelwe ezimakethe kuMthetho Wokunakekelwa Okungenakusiza okwandisa ukufinyelela kumshuwalense wezempilo ongabizi futhi ukunciphisa izindleko ngenkathi kuqinisekiswa ukuvikela okubalulekile komthengi nokuthuthukisa ukunakekelwa kwesiguli . Kuthulwe ngoJanuwari 23, 2017.
> Congress.gov. S.106. I-ObamaCare Ukuphinda Umthetho. Kuthulwe ngoJanuwari 12, 2017.
> Congress.gov. S.222, Umthetho Wokuguqulwa Kwe-Obamacare. Kuthiwe ngoJanuwari 24, 3017.