Uma kuziwa emayelana noMthetho Wokunakekelwa Onganakekelwayo, okunye okubizwa ngokuthi yi- Obamacare , ngezinye izikhathi kungase kube nzima ukuhlukanisa iqiniso neqiniso. I-Kaiser Family Foundation yakamuva ibike ukuthi ngamaphesenti angu-14 kuphela aseMelika abheka izingosi zomphakathi ezifana ne-Facebook ne-Twitter ukuze zibe imithombo yokwethenjelwa yokwaziswa mayelana ne-ACA.
Kodwa ulwazi mayelana ne-ACA luhlala luvela kuma-social media-futhi ngezinye izikhathi luphakamisa imibuzo eyenza abantu bazibuze. Uma uqala ukuthayipha "Ingabe iCongress ex ..." ku-Google, i-autofill yokuqala iqeda umbuzo ngokuthi "ukukhululwa ku-Obamacare?" Lokhu ngokucacile umbuzo abantu abaningi abanakho, ngokungangabazeki ngokuyingxenye ngenxa yenani elikhulu lezinhloko kulokhu okushiwo yizindaba ezenhlalo eminyakeni embalwa edlule.
I-Obamacare Empeleni Isebenza Kakhulu Kakhulu kwiCongress
Okokuqala, ukucacisa, iCongress ayikhululekile ku-Obamacare.
Kodwa ake sibheke indlela le nkohliso eqale ngayo, nemithetho-eqinisweni eqinile kakhulu kunendlela u-Obamacare esebenza ngayo sonke-esisebenza ngempela kwiCongress.
Emuva lapho i-ACA ingxoxwa ngeCongress ngo-2009, bekukhona imibuzo mayelana nokuthi abomthetho babephikisana yini nezinguquko ezihlukahlukene ze-ACA-kubandakanya ukushintshaniswa komshuwalense wezempilo-emphakathini waseMelika ngaphandle komthelela kumshuwalense wabo wezempilo.
Lokhu kwakukhathazeka okungaqondakali, ngoba, njengabaningi baseMelika, amalungu eCongress ayenomshuwalense wezempilo oxhaswe ngumqashi, ngakho abengebona abantu abadayiswa yomshuwalense wezempilo. Kodwa i-ACA ikhiqiza isiphepho esinjalo sezombangazwe ukuthi imininingwane enjengaleyo yalahleka emsindweni, futhi amahemuhemu aphikelela ukuthi iCongress ngandlela-thile "ikhululekile" evela ku-Obamacare.
Indaba Emuva
I-Obamacare ngumthetho. Isebenza cishe kuwo wonke amaMelika, futhi iyafinyelela kakhulu kunezingxoxo kuphela. Ihlinzeka ngokuvikela okuningi kwabathengi, futhi ihlanganisa usizo olunzulu lokwenza ukuthengwa okungabizi kakhulu kubantu baseMelika abangenayo imali engenayo futhi abaphakathi. Kodwa ngokuqondene nalokho umthetho okufunayo kumuntu ngamunye waseMelika, kuqondakala kakhulu: Abantu kufanele balondoloze ubuncane bokubambisana okubalulekile, noma ngabe babhekane nesigwebo sentela (ezinye izidingo zisebenza kubaqashi kanye nabathwali bomshwalense bempilo, kodwa imfuneko yabantu ngabanye iwukugcina ukuhlanganisa).
Ukuhlinzekwa okungenani okubalulekile kubandakanya izinhlelo ezixhaswe ngumqashi, i- Medicaid , i- Medicare , Uhlelo lwe-Insurance yezempilo lwezingane (CHIP) , kanye nezinhlelo zempilo ezinkulu zemakethe, kuhlanganise nalabo abathengwa ngokusebenzisa ukuhwebelana noma ukushintshaniswa , kanye nezinhlelo ezinkulu ezithintekayo. Kukhona nezinye izinhlobo zokuhlanganisa ezithintekayo ngaphansi kwesambulela esibalulekile sokubambisana-ngokuyisisekelo, noma yikuphi ukutholakala "kwangempela" kuzosebenza, kodwa izinto ezifana nomshuwalense wezempilo wesikhathi esifushane, izithako zengozi kanye nezinhlelo ezilinganiselwe zokuhlomula akuzona ukuhlinzekwa okungenani okubalulekile.
Njengoba abaningi baseMelika abangewona asebekhulile behlanganisa abaqashi babo, akudingeki benze izinguquko ngenxa yomthetho wokunakekelwa okunganakekelwayo.
Uma nje beqhubeka nokuba nomshuwalense wezempilo oxhaswe ngumqashi, baye baqhubeka behambisana nomthetho.
Lokho bekuyoba njalo neCongress, ngoba behlanganiswe ngaphansi kohlelo lwe-Federal Employee Health Benefits Programme (FEHBP), oluhlinzeka ngempilo yezempilo kwabasebenzi bombuso.
Kodwa ngonyaka ka-2009, uSenenja u-Chuck Grassley (R, Iowa) ucele ukuchitshiyelwa komthetho njengoba kuxoxwa ngazo, ngomzamo wokuqinisekisa ukuthi iCongress " izodinga ukushintshaniswa ukuze siphumelele i-tape ebomvu njengazo zonke ezinye izakhamizi . "
Khumbula, iningi lamaMelika akudingeki ukuthi lizothengiselana.
Ukuhwebelana kwaklanyelwe ukukhonza abantu abathengisa umshwalense wabo wezempilo ngoba abanakho ukufinyelela kumqashi womqashi, kanye nalabo ababengaqinisekisiwe ngokuphelele.
Abantu abanokuxhaswa ngokuxhaswe ngumqashi (okwakuhlanganisa iCongress emuva lapho uMthetho Wokunakekelwa Onganakekelwayo ubhalwa) akudingeki ukuthi ubhekane nokuhwebelana nhlobo, futhi akukho "tape obomvu" owengeziwe kubo ngaphansi kwe-ACA, ngaphandle kokuhlola ibhokisi ekukhokhiseni kwentela yabo ethi banempilo yomshuwalense wonyaka wonke (uma usebenzela ibhizinisi elincane, umqashi wakho angase athenge ukuthengwa ngokusebenzisa ukuhwebelana kwebhizinisi elincane (SHOP), noma kunjalo, ungathunyelwa ekushintsheni ukuze ukhethe i-plan yakho. Kodwa umqashi wakho uthenga ukufakwa kwaleso simo, futhi uxhase ingxenye ye-premium yakho).
I-Grassley Amendment
Kodwa ukuchitshiyelwa kukaGrassley kwenza kube ngumthetho. Isigaba 1312 (d) (3) (D) soMthetho Wokunakekelwa Onganakekelwayo sithi:
(D) AMALUNGU OKUQHUBEKA NGOKWESIKHATHI .- (i) UKUFUNA.-Ngaphandle kwanoma yikuphi omunye umthetho, emva kokusebenza komhlahlandlela, kuphela izinhlelo zezempilo uHulumeni waseHulumeni angase atholakale kumaLungu weCongress kanye nabasebenzi bebandla mayelana nenkonzo yabo njengeLungu leCongress noma abasebenzi be-congressional kuyoba izinhlelo zezempilo ezikhona
(I) wadala ngaphansi kwalo Mthetho (noma ukuchitshiyelwa okwenziwe yilo Mthetho); noma
(II) ehlinzekwa nge-Exchange esungulwe ngaphansi kwalo Mthetho (noma ukuchitshiyelwa okwenziwe yilo Mthetho).
Ngenxa yalokho, iCongress kanye nabasebenzi be-congressional baye bathengisa ukuthengiswa nge-DC Health Link sika-SHOP exchange kusukela ngo-2014. I-DC Health Link yindlela yokushintshanisa umshuwalense wezempilo esifundeni sase-Columbia.
Ukuhwebelana kwe-SHOP kwaklanyelwe abaqashi abancane ukuba basebenzise, kodwa ukushintshaniswa kwe-DC kuvulwe amalungu eCongress kanye nabasebenzi bawo, ukuze bahambisane nemfuneko ye-ACA ukuthi bathole ukukhokhelwa nge-exchange. Amalungu eCongress kanye nabasebenzi be-congressal kubhekene nokuningi kokubhaliswa kwe-SH Health Link sika-SHOP.
Kuthiwani Mayelana Nezinsizakalo?
I-ACA inikeza izinkxaso (izikweletu zentela) zokuqeda izindleko zama-premium kubantu abathengisa ukuthengiswa kwamakethe ngamanye ama-exchange. Kodwa kuma-SHOP ukuhwebelana, abaqashi banikeza izinsizakalo, ngendlela yokufaka umqashi ku-premium.
Lapho izinto zihlambalaza ukuthi amalungu eCongress ayezuza ngaphambili kuma-$ 5,000 kumqashi (okungukuthi, uhulumeni) iminikelo ekubhalweni kwabo kwe-FEHBP uma bebhaliswe ngabanye, futhi bangaba ngu-R10 000 uma bebhalisiwe emndenini. Qaphela ukuthi lokhu kusemthethweni, futhi ikakhulukazi ngokuhambisana neminikelo yomshuwalense wezempilo yomshuwalense owenza isilinganiso esisebenzela abasebenzi.
Ukushintshela kumakethe okuthengisa emakethe ngamunye kuzoqeda ukutholakala kweminikelo yomqashi, njengoba i-ACA inqabela abaqashi ukuba bakhokhele ukuthengwa kwemakethe ngabasebenzi babo. Kodwa futhi kusho ukuthi iningi lalabo bantu-kuhlanganise wonke amalungu eCongress kanye nabasebenzi babo abaningi-ngabe belahlekelwe ukufinyelela kokuthola usizo ngokugcwele, ngoba izinsizakalo ezishintshaniswayo zisekelwe emalini engenayo, futhi imali engenayo ye-Congressional iphezulu kakhulu ukuze ivumeleke ukuxhaswa ngaphandle uma umndeni ukhulu kakhulu.
Gcina Iminikelo Yabasebenzi, kodwa Bhalisa nge-Exchange
Ngakho i-Office of Personnel Management (OPM), eqhuba i-FEHBP, yangena. Yabusa ngo-2013 ukuthi abasebenzi beCongress and Congressional bazokwazi ukubhalisa kwi-DC Health Link ye-SHOP exchange futhi bazokwazi ukugcina iminikelo yabaqashi babo ukuhlanganisa.
Lokhu kubonakala kuphikisana, nabanye abantu bethi iCongress kanye nabasebenzi bayo kufanele bayeke ukunikela ngemali yabo yomqashi we-FEHBP futhi babhalisele ukuhwebelana ngamakethe, ngokuthola imali etholakala kuphela uma befanelekile ngokusekelwe kwimali engenayo. Kumele kuqashelwe ukuthi uGrssley ngokwakhe wathi ngo-2013 ukuthi injongo yokuqala yokuchitshiyelwa kwakuwukuvumela iCongress kanye nabasebenzi ukuba bagcine iminikelo yomqashi eyayenziwa emishwalenimpilo yabo yomshuwalense wezempilo, naphezu kwemfuneko yokuba babhalise ngokuhwebelana . UGrssley uphikelele ukuthi ukuchitshiyelwa kwakungabhalwanga ngemuva kokuthi imininingwane ithunyelwe kuSenate Majority Leader, uHarry Reid (D, Nevada).
Ngenxa yesinqumo sika-OPM, iCongress kanye nabasebenzi bayo banomthelela wokuqashwa kumaphrimiyamu omshwalense wabo wezempilo, kodwa bathola ukutholakala kwabo ngokusebenzisa i-DC Health Link SHOP exchange. Lokhu kuyinkinga yokuzama ukufeza izidingo ze-ACA, kodwa ngaphandle kokonakalisa iCongress kanye nabasebenzi bayo ngokwezinzuzo zezisebenzi ngokuphathelene neminye imisebenzi efana nayo.
Isimo samanje senziwa ngenxa yelwimi ku-ACA ngokwayo ekhuluma ngokuqondile ngezinzuzo zezempilo zeCongress nabasebenzi bayo. Ngaphandle kwalolu limi, bekungeke kube khona umbuzo-iCongress ngeke idingeke ukuthi ithengise ukushintshaniswa, ngoba yayinezinkokhelo ezixhaswe ngumqashi. Lokho kwakungasho ukuthi "bekhululekile" kusuka ku-Obamacare. Besazobe befanele balondoloze umshuwalense wezempilo noma babhekane nesigwebo, njengawo wonke amanye amaMelika.
Ukuhwebelana kwasungulwa kubantu ababengenayo ukuxhaswa okuxhaswe ngumqashi (kanye namabhizinisi amancane afisa ukuthenga ukukhokhela abasebenzi babo). Kodwa ngenxa ye-Grassley Amendment ku-ACA, iCongress kwadingeka ukuba ishintshe kusuka ezinhlanganweni zezempilo ezixhaswe ngumqashi ku-FEHBP, futhi ushintshe esikhundleni se-DC Health Link sika-SHOP exchange. Lesi yisidingo esingafakwa kunoma yimuphi omunye umkhakha wabasebenzi ngaphansi kwe-ACA, kuhlanganise nabanye abasebenzi bakahulumeni abasebenzisa i-FEHBP.
Ngakho-ke i-Congress ayikona nje kuphela ukukhululwa ku-ACA, umthetho empeleni waphuma endleleni ukuze uwafake engxenyeni yabantu (okungukuthi, labo okwenzelwe ukuhwebelana) lapho bengenakufaka khona.
> Imithombo:
> Healthcare.gov. Funda uMthetho Wokunakekelwa Onganakekelwayo.
> Kaiser Family Foundation, Izinzuzo zezeMisebenzi zabaSebenzi, 2016 Ukufingqa kokuthola .
> Kaiser Family Foundation, Ukuphepha Kwempilo Yomphakathi Yonke Inani labantu. 2015.
> Kaiser Family Foundation, Kaiser Health Tracking Poll, Okthoba 2016.
> Ihhovisi lezokuPhathwa kwabasebenzi. Imibuzo evame ukubuzwa: Umshuwalense.