Akungabazeki ukuthi isikhundla sikaMongameli weDonald Trump-kanye neningi leRiphablikhi eqhubekayo e-Congress-liyoba nomthelela omkhulu eMnyangweni Wokunakekelwa Onganakekelwayo (i-Obamacare) nendlela umshuwalense wezempilo osebenza ngayo e-US
Kodwa ngemuva kokumemezela ngesithembiso sokuqeda u-Obamacare "ngosuku olulodwa," uTrump yaxosha leyo ndawo ezinsukwini ezilandelayo ukhetho, ngokuphawula ukuthi kunezingxenye ezithile zomthetho angathanda ukuzigcina, kufaka phakathi ukufakwa kokuphepha okuqinisekisiwe kungakhathaliseki ukuthi sekukhona izimo ezikhona ngaphambili, kanye nokuhlinzekwa okuvumela abantu abadala ukuba bahlale ohlelweni lwezempilo lomzali kuze kube iminyaka engu-26.
Ngempela, lezo zici zomthetho zithandwa kakhulu futhi zinokusekelwa okuqinile kwe-bipartisan, njengemithetho evimbela abahlinzeki bezempilo ukuba bangabe besenza amakhokheji wonyaka noma wokuphila .
Kodwa kunezinye izinhlinzeko ze-ACA ezingathandwa kakhulu, kuhlanganise nesidingo sokuba bonke abaseMelika-ngaphandle uma kufanelekile ukukhululwa- okutholakele umshuwalense wezempilo noma ukubhekana nesigwebo sentela .
Lezi zinhlinzeko ezingezona ezithandwa kakhulu yizona ezihloswe "zokuphinda futhi zithathele" imizamo eyenziwa yiCongressal Republicans ngosuku olulodwa lweseshini yomthetho ka-2017. Ngaphambi kokuba uMongameli uTrump asebenze, iCongress yayidlulisele isinqumo sesabelomali esiqondisa amakomidi ezomthetho ukuze kulungiswe umthetho ukuze kuqedwe izingxenye ezihlobene nokuchitha imali ze-ACA ngokubuyisana. Futhi ngosuku lokuqala lukaTrump ehhovisi, wasayina i- oda eliphezulu eliqondisa izinhlangano zikahulumeni ukuba zihloniphe ekusebenziseni izintela ze-ACA nezinhlawulo.
Inqubo yezomthetho yokuchithwa nokufaka esikhundleni se-ACA ingadonsela isikhathi esingaphezu kuka-2017, kepha uma idlula, ukuvumelanisa ngokujwayelekile ukuthi ukuqaliswa kwanoma yiziphi izinguquko kuzobe kubambezeleka kuze kube ngu-2018, futhi cishe 2019.
Ukuphinda
Uma iCongress idlula ibhilidi lokubuyisana (elidinga kuphela iningi elilula futhi liwubufakazi bokuthi yi-filibuster-proof), bangakwazi ukukhipha izinhlinzeko ezihlobene nokuchitha imali ku-ACA.
Lokhu kuzofaka izinto ezifana nokusizwa kwe- premium , ukuxhaswa ngezindleko , nokwandiswa kwe-Medicaid , kanye nezinhlawulo ezihambisana nomsebenzi womqashi kanye negunya ngalinye .
Kodwa umthethosivivinywa wokubuyisana ngeke ukwazi ukuchitha izici ze-ACA ezingahlobene nokusebenzisa imali-izinto ezifana nokuhlinzekwa ukuthi konke ukuhlinzekwa kuqinisekiswe-kungakhathaliseki umlando wezokwelapha, kanye nesidingo sokuthi wonke amapulani weqembu ngalinye namancane amboze izinzuzo zezempilo ezibalulekile .
Ukulungisa lezo zidingo kungenziwa ngomthetho ojwayelekile, futhi amaRiphabhuliki ahlinzekele iziphakamiso eziningana eminyakeni embalwa edlule, kufaka hlangana amaphuzu wombono wabo wokunakekelwa kwezempilo kanye nemithetho eminingi, kufaka phakathi ezinye izindleko ezithathwe emasontweni okuqala iseshini somthetho we-2017.
Futhi ngempela, kukhona izindlela eziningi zokwenza ngokuguqula umshwalense wezempilo kanye nezinhlelo zokunakekelwa kwezempilo e-US Akungabazeki ukuthi i-ACA ngokwalo idinga ukulungiswa eminyakeni embalwa edlule, kodwa kwakungamazambane ashisa ezombusazwe abenzi bomthetho ayikwazanga ukuthola indlela yokuthuthukisa ukuyekethisa okungase kuthathe amavoti akwanele.
Ukuguqulwa Kweqiniso
Uma kufika phansi kumantongomane namabolts okufaka esikhundleni se-Obamacare, kunezinselele ezizovela uma ukugxila ekugcineni izici ezithandwayo zomthetho ngenkathi kuqeda izinhlinzeko ezingathandwa kakhulu.
Ngaphansi kwezokuphathwa kweTrump kanye neningi leRiphablikhi eNkongweni, cishe sekuqinisekiswe ukuthi uhlelo lwethu lwamanje lomshuwalense wezempilo wangasese luzohlala lukhona, kunokushintshelwa kumkhokheli oyedwa. Ngalokho engqondweni, kuzomele kube nokugxila ekuqinisekiseni ukuthi izinkampani zomshuwalense zinezikhuthazo zokuqhubeka nokuhlinzeka ngemali emakethe yomshuwalense wezempilo.
Iningi lomshuwalense wezempilo wangasese uhlinzekwa ngokuxhaswa ngumqashi, futhi lokho kuzoqhubeka kube yilokho okwenzeka esikhathini esizayo: Iningi lezinkampani ezinkulu linikeze umshuwalense kubasebenzi babo isikhathi eside ngaphambi kokuthi i-ACA ibenze ukuba benze kanjalo, futhi iningi lizokwenza Qhubeka nokwenza kanjalo noma ngabe igunya lika-ACA lomqashi lichithwa; umshuwalense wezempilo uyingxenye yephakheji yokuncintisana abaqashi abasebenzisa ukuheha nokugcina abasebenzi.
Yize i-ACA yashintsha izici ezithile zomshuwalense oxhaswe ngumqashi, iningi lezinguquko zalo lihloselwe emakethe yomshuwalense wezempilo. Kukhona abantu abangaba yizigidi ezingu-22 base-US abanomshwalense wezempilo ngamunye (okusho ukuthi bazithengi ngokwabo, kunokuba bathole umqashi noma uhulumeni). Kusukela ngo-2016, cishe ingxenye yabo yayinezinkolelo ezithengiswaneni ezakhiwe ngaphansi kwe-ACA. Lesinye isigamu sithengile ukutholakala kwabo ngokuqondile emithwaleni yomshuwalense wezempilo, noma ngabe kunomsebenzi wokuqashwa ngaphansi kwamalungiselelo amakhulu noma amakhulu.
Yile makethe-yedwa umshuwalense wezempilo-oye waba nezinguquko ezinkulu kakhulu ngaphansi kwe-ACA. Futhi kunezici ezine ezisemqoka zomthetho ezenzelwe ukusebenza ndawonye ukuqinisekisa ukuthi ukutholakala komshuwalense wezempilo ngamunye kufinyeleleka kuwo wonke umuntu owudinga:
- Izinsizakalo ze-Premium zokwenza ukukhokhelwa okungabizi kubantu abangenakukwazi ukukhokha ama-premium. Izinsizakalo ze-premium ngaphansi kwe-ACA ziyatholakala ukuze zibhalise ngemali engenayo kuze kube ngu-400 amaphesenti wezinga lobuphofu, elingama-$ 97,200 emndenini wabantwana ngo-2017.
- Ukusabalalisa okuqinisekisiwe , okusho ukubhalwa phansi kwezokwelapha akusetshenziselwa ukucacisa ukuthi abantu bangathola yini ukuthengiswa emakethe ngayinye, noma ukubeka amaphrimiyamu abo. Ngaphambi kuka-2013, zonke izinhlangano eziyisihlanu zomshuwalense zivumela izinkampanini zempilo yomshuwalense ukuba zenze umsebenzi obhaliwe wezokwelapha ukuze zithole ukuthi ngabe umfakisicelo angazithola yini, futhi yikuphi ukukhokhelwa okuzokhokhiswa. Izinkokhelo eziphakeme-noma ukuphika ukukhokhelwa konke-zazivame ukuhlolwa konke kusukela ekukhulelwe kuya emlandweni womdlavuza wokuqhathaniswa nokuphefumula.
- Izikhathi zokubhalisa ezinqunyelwe . I-ACA yasungula izikhathi zokubhalisa zonyaka ezivulekile (ezisebenzisana ngokuthengiselana kanye ngaphandle kokuhwebelana), okuyinto i-HHS eyayikelwe ukuhlela. Isikhathi sokuqala sokubhalisa (sokwaziswa kuka-2014) sinezinyanga eziyisithupha. Kusukela ngaleso sikhathi, isikhathi ngasinye sokubhalisa sonyaka esivulekile sinezinyanga ezintathu ubude, futhi lokho kuhlelwe ukuthi kube yinto yokubhalwa kuka-2018.
Kodwa kusukela ngo-2019, ukubhaliswa okuvulekile kuzoba mfushane , kusebenza kusukela ngoNovemba 1 kuya kuDisemba 15 ngonyaka (HHS icubungula isiphakamiso sokunciphisa isikhathi sokubhalisa sika-2018, okwenza ushintsho lufinyelele izikhathi ezincane ngaphambi kokuhlelwa ngaphambilini). I-ACA ibuye ivumele isikhathi sokubhalisa esikhethekile esinika abantu ithuba lokufinyelela emakethe ngamunye ngaphandle kokubhalisa okuvulekile, uma benomcimbi wokuphila ofanelekayo owenza isikhathi sokubhalisa esikhethekile .
Izibonelo ziyashada, zinezingane, noma zilahlekelwe ukufinyelela kuhlelo lomshuwalense wezempilo olukhona. Kodwa ngaphandle komcimbi ofanelekile, umshuwalense wezempilo awukwazi ukuthengwa ngaphandle kokubhaliswa okuvulekile, kungaba ngokushintshaniswa noma ngokuqondile kumthwali womshuwalense wezempilo. Iphuzu lamafasitela okubhaliswa okulinganiselwe ukuvimbela abantu ekuhlehliseni ukubhaliswa kuze kube yilapho beswele ukunakekelwa. - Isigunyazo esithile esidinga ukuthi wonke umuntu abe nomshuwalense wezempilo noma akhokhe intela yentela. Isijeziso esiphezulu esihlolwe abantu abangazange baqinisekiswe ngo-2014 sasingama-dollar ayi-210 nje kuphela, kodwa senyukele ku-$ 470 kubantu abangazange baqinisekiswe ngo-2015, futhi kuzoba ngaphezulu uma izinhlawulo zika-2016 zihlolwa ekubuyiselweni kwentela efakwe ngo-2017.
Ukusakazwa okukhishwe okuqinisekisiwe kuye kwande kakhulu. Izinsizakalo ze-premium zinezinga elithile lokuthandwa, nakuba iziphakamiso eziningana zokufaka esikhundleni se-ACA zithembele emalini amaningi okukhokhwa kwentela angahlanganiswa nemali engenayo, kodwa futhi angeke ibe yi-indexed kwizindleko zangempela zomshuwalense wezempilo. Izinkolelo zentela ezinjalo zingase zingenele njengoba isikhathi sihamba uma izindleko zempilo yezempilo ziqhubeka zikhula ngokushesha kunomnotho jikelele.
Kodwa ukugunyazwa ngabanye ngokuvamile akuyona into engathandeki, futhi iziphakamiso zokulungisa ukunakekelwa kwezempilo eRepublican zihlale zibiza ukuthi ziqedwe (naphezu kokuthi umqondo wecala lomuntu ngamunye wawuthandwa kakhulu ngamathangi angacabangi nabomthetho emuva kwama-80 no-90).
Ungaba Yini Okuqinisekisiwe-Ukukhishwa Kwenkinga Ngaphandle Kwemigomo?
Uma ugcina ukuhlinzekwa okuqinisekisiwe kwe-ACA kodwa ukhiphe isinqumo somuntu ngamunye, ugijima ngokumelene nenkinga ebalulekile: Abantu bangakwazi ukungaqiniseki uma bephilile, bese babhalisela umshwalense uma bedinga ukwelashwa. Amakhomishana omshwalense we-skyrocketing amahle alula kakhulu ukubikezela kuleso simo.
I-New York isebenzise ukuqinisekiswa okuqinisekisiwe eminyakeni engamashumi amabili ngaphambi kokuba i-ACA ifake umqondo kuwo wonke amazwe, kodwa ayinalo igunya elilodwa. Umphumela waba yizinkokhelo eziphakeme kakhulu kunezwe lonke (ngisho naku-2017, amaphrimiyamu omshwalense wempilo yamakethe angaphezu kwamaphesenti angama-50 aphansi eNew York kunabo bonke ngo-2013).
Ngempela, lokho bekuyingxenye yenkinga eyenziwa yi-ACA eminyakeni embalwa edlule: ababhalisile ngamakethe bebekhulile futhi begula kakhulu kunalindelekile (ngoba abanele abancane, abantu abanempilo baye babhalisela ukulinganisa ibhulogi eliyingozi), kanye nama-premiums hhayi okwanele ukumboza izindleko ababheki besikhwama abazenzayo emakethe ngayinye. Kunezizathu ezihlukahlukene zalokhu, kufaka phakathi nokuthi i-ACA's penalty ngayinye yokugunyazwa ayigxilile ngokukhethekile, nokuthi iqiniso lokuthi ukufaneleka kwesikhathi sokubhalisa okukhethekile kuye kwakunzima kakhulu; Asikho isizathu esisodwa senani elingaphansi kunalindelekile lababhalisi abanempilo.
Kodwa ukulahlekelwa kwezimali emakethe ngayinye kungenxa yokuthi inani elibalulekile lababheki bomshuwalense bakhetha ukuphuma emakethe noma yonke imakethe ngayinye ngowezi-2017. Akuzange nje kube yiyona ingxenye yamakethe enenzuzo kubo, futhi yingxenye encane yamakethe noma kunjalo, ngakho-ke ama-insurers abashiya emakethe ngayinye angakwazi ukugxila emaceleni amakhulu amakhulu emakethe, kuhlanganise nomshuwalense oxhaswe ngumqashi, i- Medicare Advantage , nokunakekelwa okuphethwe yi-Medicaid.
Ngamafuphi, ama-insurers ngeke anikeze ukuthengiswa emakethe ngayinye ngaphandle uma kungenakuqinisekiswa ukuthi imakethe izohlala isimeme, futhi abantu abanempilo enempilo bayobhalisela ukukhokha izindleko zokubhalisa abadinga ukunakekelwa kwezokwelapha.
Kunezindlela ezihlukahlukene zokwenza lokhu, kodwa zonke zihilela uhlobo oluthile lwezinto zokwenza kube nzima noma akunakwenzeka ukuba abantu bahambe ngaphandle kokuvota lapho bephilile. Kungaba yindunyazo yomuntu ngamunye, noma kungaba amaphrimiyamu aphakeme kakhulu kubantu abangabhalisi uma beqala ukufaneleka (yilokho uMnyango wezeMpilo u-Medicare Part B no-D). Noma kungaba amaphrimiyamu aphezulu asekelwe ekubhalweni kwezokwelapha kubantu abangagcinanga ukufakwa okuqhubekayo (lokhu kuyincenye yesiphakamiso esakhishwa yi-House Republicans ngo-2016).
Kodwa ngenye indlela, kuzomele kube nokugqugquzela abantu ukuba babhalise, uma nje sincike ohlelweni olusebenzisa umshuwalense wezempilo wangasese kanye nokubhalisa okuzithandela. Ngaphambi kuka-2013, leso sikhuthazo sasiwukuthi ukuhlinzekwa kwakungavumelekile ukushicilelwa emazweni amaningi, ngakho-ke abantu kwakudingeka babhalise ngenkathi bephilile-futhi bahlale babhalisile-ukuze bavikele ukungenakulinganiswa uma futhi bakhulisa isimo esivele sikhona.
Singabuyela emuva kuleso simiso, kodwa ukubuyiselwa kwezimo ezandulele kanye nokubhalwe phansi kwezokwelapha ezikuzo yonke indawo ngeke kuvezwe kwezombangazwe. Kungenzeka ukuthi, ukuhlinzekwa okuqinisekisiwe okukhona ukuhlala, ngesimo esithile. Futhi lokho kusho ukuthi uhlobo oluthile lwesigwebo sokungabhalisi luphinde luhlale lapha, ngolunye uhlobo. Kungaba amaphrimiyamu aphezulu kubantu ababhalisa kamuva noma uhlobo oluthile lokubhala phansi kwezokwelapha kubantu abangagcinanga ukufakwa okuqhubekayo. Kodwa ayikho indlela yokugcina ukuhlinzekwa okuqinisekisiwe kwe-ACA ngaphandle kokuqinisekisa ukuthi abantu abanempilo ngokwanele bayobhalisa ukuze bakwazi ukulinganisa ibhuloho eliyingozi.
> Imithombo:
> Amasevisi we-Medicare ne-Medicaid Services, ngo-Mashi 31, 2016, Isitoreji sokubhalisa esenziwe kahle.
> Indlu yabaMamele, Isiphakamiso sezempilo se-GOP. Indlela Engcono, Umbono Wethu Wokuqinisekisa I-America . NgoJuni 22, 2016.
> Kaiser Family Foundation, Ukuphepha Kwempilo Yomphakathi Yonke Abantu, 2015.
> Koskinen, uJohn, Insizakalo Yengeniso Yangaphakathi, Incwadi Yongqungquthela ngemiphumela yangaphambili kusukela ngonyaka ka-2015 wokubhalisa ohlobene noMthetho Wokunakekelwa Onganakekelwa Okwenziwe ngo-Okthoba 2015 . NgoJanuwari 8, 2016.
> Koskinen, uJohn, Insizakalo Yengeniso Yangaphakathi, Incwadi eya eNkomfeni mayelana nezimali zentela ka-2016 ezihlobene noMthetho Wokunakekelwa Kwezintela ezinganakekelwa. NgoJanuwari 9, 2017.