Imizamo ye-GOP izokwandisa imikhawulo yokunikezela futhi ukwandise ukutholakala kweziKhwama
Akuyona imfihlo ukuthi abameli beRiphabhulikhi bafuna ukwandisa ukufinyelela kuma- akhawunti wokulondoloza impilo (HSAs) , ukwandisa ukusetshenziswa kwabo, bump inani lemali abantu abangayifaka kuma-HSA, futhi bavumele ukuguquguquka okukhulu ngokwendlela abantu abangasebenzisa ngayo imali abayitholayo ama-akhawunti. Akucacile kuleli phuzu uma noma ngabe bazokwenzani lokhu, kodwa kuyisimo abaye basichitha iminyaka.
Ingxabano yokuguqula impilo ye-GOP isuke yashaya iCongress ngo-2017. Nakuba iziqephu eziningi zomthetho zokuqeda futhi zishintshe uMthetho Wokunakekelwa Okunganakekelwa ziye zaqaliswa-ziqede ngoJulayi 28, 2017, ekulaleni kweSénate zonke izikweletu ababezicabangela-cishe konke kubo baye bathatha indlela efanayo yokushintsha i-HSAs.
Njengoba kuphelelwa yisikhathi-isikhathi sokuba-emizamweni yomthetho yokuqeda nokushintsha i-ACA, iziphakamiso ze-GOP zokuguqulwa kwe-HSA zingahle zifakwe emshini wokushisa ngemuva kwesikhathi. Kodwa kungenzeka ukuthi ukuguqulwa kwe-HSA kungaba yingxenye yokwehliswa kokubhekelwa kwezempilo ngokuqhubekayo, futhi kungenzeka ukuthi ukuguqulwa kwe-HSA kungenziwa njengomthetho wokuzimela ngasese ngesikhathi esithile, ozimele nezinguquko ezinkulu amaqembu ezombangazwe angathanda ukuzenza wenze ohlelweni lwezempilo lwaseMelika.
Ama-HSA athola Izinguquko Ezincane Nge-ACA
Ama-akhawunti wokulondolozwa kwempilo adalwe yi-Medicare Prescription Drug, uMthetho Wokuthuthukiswa Nokwenziwa Kwemisebenzi ka-2003, futhi waba khona kubathengi kusukela ngo-2004.
I-ACA yenza izinguquko ezithobekile kuma-HSA:
- Ama-HSA anenhlawulo uma uhoxisa izimali zokusetshenziswa okungezona ukwelashwa ngaphambi kokuba uneminyaka engama-65. Leyo nhlawulo yayisetshenziswa ngamaphesenti angu-10, kodwa i-ACA yenyuka ibe ngamaphesenti angu-20 (lokhu kuhlanganisa nezintela ezihlolwe uma imali esetshenziselwa izinhloso ezingezona ezokwelapha). Isijeziso senzelwe ukuqinisekisa ukuthi imali e-HSA isetshenziselwa ukuthi ihloselwe: ngezinhloso zezokwelapha (emva kweminyaka engu-65, i-HSA ingasebenza njenge-akhawunti yendabuko yomhlalaphansi, nezintela-kodwa akukho ukuhlawulwa-uma kukhishwa imali uma kukhishwa izindleko ezingezona ezokwelapha).
- Yonke imithi-ngaphandle kwe-insulini-kufanele ibe nomuthi kadokotela ukuze ithengwe nge-HSA izimali (ie, ukusebenzisa imali engenayo intela ku-HSA yakho ukuzithenga). Esikhathini esedlule, imithi engaphezu kwe-counter ingathengwa nge-HSA izimali, kodwa i-ACA ishintshe lokho.
I-Republican HSA Reform izokwandisa imikhawulo yokufinyelela nokunikela
Iningi lemithetho ekhokhwa yi-Congressional Republican esetshenziselwe ukuphinda futhi ichithe i-ACA ihlanganisa imibandela engashintsha eminye yemithetho esebenzayo kuma-HSA. Lesi sikhungo esiyinhloko sokuguqulwa kwezempilo kwe-GOP, ngakho-ke ukuguqulwa kwe-HSA kwafakwa ngisho nasesikhwameni se- "pepper" sokuphinda sekhasi eli-8 (i-Health Care Freedom Act) esenziwa yiSenate Republicans ngasekupheleni kukaJulayi 2017 (leso silinganiso asizange sidlule , njengoba amaRepublican amathathu ayiphikisa).
Nakuba iziphakamiso zokuguqula ziye zahlukahluka, kunezingxenye ezine eziyinhloko zezinguquko ze-HSA ukuthi abameli be-GOP bangathanda ukufeza:
- Phindela ukukhushulwa kwenhlawulo ye-ACA, futhi ubuyele emuva kwesigwebo se-10% sokuhoxiswa okungaphansi kuka-65 ngezinkokhelo ezingekho zezokwelapha.
- Ukuguqula ukuhlinzekwa kwe-ACA okuvimbela imithi engaphezu kwe-counter ekuthengweni ngezimali ze-HSA.
- Ukwandisa imingcele ye-HSA, futhi uvumele abashade abaneminyaka engama-55 nangaphezulu ukuthi benze iminikelo yokubambisana kwi-HSA efanayo, kunokuba babe nama-HSA ahlukene, njengoba kunjalo njengamanje.
- Vumela izimali ze-HSA ukuthi zisetshenziselwe ukukhokhela izinkokhelo zomshuwalense wezempilo. Njengamanje, ungakhokha kuphela ama-premium ngezimali ze-HSA uma ngabe ku- COBRA , umshuwalense wesikhathi eside, ukunakekelwa kwe- Medicare Part B ( neNgxenye A uma ungayitholi mahhala), kanye nezinkokhelo zomshuwalense wezempilo ezitholakalayo ngenkathi uthola isinxephezelo sokungasebenzi. Iziphakamiso zokuguqulwa kwe-GOP zizovumela abantu abaningi ukuba basebenzise izimali ze-HSA ukukhokha imali yomshuwalense wezempilo.
Iningi lalo liyazichaza kahle, kepha ake sihlolisise imingcele yokunikela. Imali umuntu ayifaka kwi-HSA ayikho intela (noma idonswe ngaphambi kokuba intela ibalwe uma umnikelo okhokhwa ngamakhokhelo, noma owehliswa intela yentela).
Njengoba kunjalo nakwamanye ama-akhawunti ahlelwe intela, kunomkhawulo wokuthi ungabamba iqhaza kangakanani ku-HSA. Ngo-2017 , kungu-$ 3,400 uma unomsebenzi wokuzimela kuphela ngaphansi kwe-HSA-i-HDHP yezempilo ephakeme eqeqeshiwe, ne-$ 6,750 uma unomndeni wakho ngaphansi kwe-HSA-efanelekayo i-HDHP (inothi ukuthi ungafaka imali kuphela kwi-HSA uma njengamanje unesembozo ngaphansi kwe-HSA-efaneleka i-HDHP).
I-IRS iphinde ibeke izindleko ze-out-of-pocket ngezinhlelo zomshuwalense wezempilo ezibhekwa njenge-HSA-i-HDHP efanelekayo. Iningi lezincomo ze-GOP ukuguqula i-HSAs inxusa ukwandisa umkhawulo wenkambiso ye-HSA ukulingana nokuphuma ngaphandle kwephakethe ngaphansi kwe-HH-efanelekayo ye-HDHP (okungukuthi, ukuze imali ungayifaka kwi-akhawunti ehlelwe intela ukumboza ukwelashwa okungenzeka izindleko zizofana nesamba esiphezulu ozodingeka ukhokhe ezindleko ezingaphandle kwe-pocket ngaphansi kwe-plan yakho yomshuwalense wezempilo).
Ukuze kubhekiswe, ukuphuma kwephakethe okungaphansi kwe-HH-qualified HDHP ngo-2017 kungu- $ 6,550 kumuntu oyedwa kanye no-$ 13,100 emndenini (inothi lokuthi lokhu kuphansi kunezimiso ezingaphandle kwe-pocket ezisebenza kwezinye izinhlobo zokufakwa ). Ngakho uma izinguquko ezihlongozwayo zizosetshenziselwa, abantu bazokwazi ukunikela ngokuphindwe kabili kuma-HSA abo uma kuqhathaniswa nemithetho yamanje, eyenza abantu bakwazi ukufaka imali eningi kwi-akhawunti. Futhi kusiza ukuqinisekisa ukuthi abantu balungele kangcono ukubhekana nokubheja ngokwezimali kwesifo esibi noma ukulimala uma benayo imali ku-HSA. Kodwa-ke, lokho konke kuxhomeke kumuntu onomali okwanele wokufaka isandla kuqala.
Lesi siphakamiso asikho ngaphandle kokugxeka. Imikhawulo ephakeme yokunikela nge-HSA ayibasi usizo emakhaya aphansi engenayo, ngoba ngokuvamile akakwazi ukunikela ngisho nemali evumelekile yamanje. Futhi ngemindeni ehola imali ephezulu, imingcele ephezulu yokwenza imali yenza i-HSA ingaphezulu kwendawo yokukhokha yentela, evumela abantu ukuba babeke eceleni ngisho nangaphezulu kwemali yentela engakhulisa intela futhi ekugcineni isetshenziswe njenge-akhawunti eyengeziwe yokuthatha umhlalaphansi.
Nakuba cishe zonke iziphakamiso ze-GOP zokulungiswa kwe-HSA ziye zaphazamisa imikhawulo ehlongozwayo ye-HDHP ye-out-of-pocket maximums, kuyaphawuleka ukuthi iSenator Rand Paul (R, KY) wethule umthetho ekuqaleni kuka-2017 okwakungeke usususe yonke inqola ye-HSA , evumela abantu ukuba banikele imali engenamkhawulo ku-HSA. Lesi siphakamiso asihambanga noma yikuphi, kodwa kusobala ukuthi bekuyikhosi yokukhokha yocingo.
Ingabe i-HSA Reform Stall Nge-ACA Ukuzama Ukunciphisa?
Ukuguqulwa kwe-HSA kuye kwaba ukuhlinzekwa okuyisisekelo kwemizamo yokulungisa ukunakekelwa kwempilo yaseRiphablikhi iminyaka eminingi, futhi kucacile ukuthi abaholi beRiphabhuliki bafuna ukubona abantu abaningi basebenzisa ama-HSA, imingcele ephezulu yokunikela, nokunye okuguquguqukayo ngokwezimali.
Abamengameli be-GOP benza ukucindezela kanzima ekuqedeni kwe-ACA engxenyeni yokuqala ka-2017, kodwa lowo mzamo wancipha ngasekupheleni kukaJulayi. Akucaci ukuthi kuzoba ne-bipartisan indlela yokwenza ushintsho lwezempilo, noma ukungabi nalutho kule mizamo ngenkathi abameli bekhuluma nezinye izinkinga.
Kodwa ukuguqulwa kwe-HSA yinto engayithola ukwesekwa kwe-bipartisan eCongress, futhi futhi into engase ibe yedwa ngokwayo, ngaphandle kwemithetho ephelele yezempilo yase-US.
I-Democrats cishe ifuna ukugcina isigwebo esiphezulu se-ACA ekuhoxisweni okungaphansi kuka-65 ku-HSAs ngezinyathelo ezingekho zezokwelapha, ngenxa yenhloso ye-HSA ukuqinisekisa ukuthi izimali zitholakala uma futhi kuvela izindleko zezokwelapha.
I-Democrats (kanye namaRephabhuliki amaningi) ngokusobala angeke ahambe ngesiphakamiso ngokweqile njengoba umbono weSenator Paul ungenamkhawulo, kodwa ukunyuka okuncane kwemikhawulo yemikhawulo kuyinto engayithola ukwesekwa kwe-bipartisan. Kungabiza uhulumeni wesifundazwe, noma kunjalo ngenxa yemali engenayo yentela-njengokungathi kunoma yikuphi ukukhipha intela, lokho kuyisithiyo okufanele sibhekiswe.
Ukuvumela abantu ukuba bakhokhe imali ye-premium yomshuwalense ngemali ye-HSA kuyisimo esingahle sithole ukusekelwa kwe-bipartisan, ngomzamo wokwenza kube lula ngabantu ukuba bakhokhe imali (kubalulekile ukuthi kuqaphele ukuthi, isilinganiso sokulinganisela kwe-HSA sincane kakhulu ; kufanele banikele ngaphezulu kuma-HSA ukuze benze umthombo wemali okhokhelwayo okhokhelwa ama-premium).
Izwi elivela
Kungakhathaliseki ukuthi i-HSAs ishintshelwa kanjani, ayilona i-panacea yezinkinga ezibhekene nesistimu yokunakekelwa kwezempilo yase-US. Abasizi abantu abathola imali engenayo ukuze bathole umshwalense noma banakekele ukunakekelwa, kanti nakuba izinhlelo eziphezulu zokunakekelwa kwempilo zinciphisa ukusetshenziswa kwezempilo (ngaleyo ndlela ziletha izindleko), ukusetshenziswa okunciphile kungokubili kokudingekayo kanye nezinsizakalo ezingadingekile. Ukusetshenziswa okuncishisiwe kwezinsizakalo ezidingekile (isb., Umuntu owehlukanisa amaphilisi ukuze ahlale isikhathi eside ukuze asindise imali, kodwa ngaleyo ndlela angathobeli ukwelashwa okwenziwe) ngokuvamile akulungile emiphumeleni yezempilo yesikhathi eside.
Ngakho-ke, nakuba indlela yokubhekela ezempilo ye-bipartisan ingase ihlanganise izinguquko ezinesizotha emithethweni ye-HSA, indlela ephelele ye-HSA-centric yokulungiswa kwempilo yezempilo ayinakukwazi ukugcina ukuxhaswa kwabaseDemocrats eCongress, noma kubagqugquzeli besiguli.
> Imithombo:
> I-Employee Benefit Research Institute. I-Akhawunti Yokulondoloza Impilo Ukulinganisa, Iminikelo, Ukunikezwa Kwezimali, nezinye Izibalo Ezibalulekile, 2015: Kulinganiselwa ku-EBRI HSA Database . Nov. 29, > 2016 > • No. 42.
> Insizakalo yangaphakathi yeNgeniso, Ukushicilelwa 969: Ama-Akhawunti Wokulondoloza Impilo kanye nezinye izinhlelo Zempilo Zentela. 2016
> Insizakalo yangaphakathi yeNgeniso, Inqubo Yokuthola Imali Yonyaka 2016-28 .
> Paul, Rand MD, S.222, uMthetho Wokuguqulwa Kwama-Obamacare, Isigaba Sokufinyelelwa Kwesigaba.
> Senate.gov. Ukuchitshiyelwa 667 ku-HR1628. Umthetho Wokunakekelwa KwezeMpilo ka-2017 . Ngo-July 27, 2017.