Ukubheka izinhlelo zokuguqula i-Medicaid ne-Medicare
UMongameli uDonald Trump wenza izithembiso kubantu baseMelika emkhankasweni womkhankaso. Ukuphinda u-Obamacare nokulondoloza i-Medicare kwakungaphezulu kwelolu hlu. Ingabe uMongameli wethu uphila kulowo mkhankaso?
Ukubuka Izithembiso Zomkhankaso We-Trump
Njengesikhumbuzo, uMongameli Trump umkhankaso ohlelweni lwezempilo oluyingxenye eyisikhombisa. Ngezinguquko ezilandelayo, wathembisa ukuthi uzophinde avuselele impilo.
- Ukuphinda uphethwe uMthetho Wokunakekelwa Onganakekelwa, i- Obamacare
- Vumela ukuthengiswa kwezinhlelo zezempilo kuzo zonke imigqa yombuso uma nje izinhlelo zezempilo zilandela imihlahlandlela yombuso
- Vumela abantu ukuba banqume ama-premium yomshuwalense wezempilo ezinkambisweni zabo zentela
- Vumela abantu ukuba basebenzise ama- Akhawunti Wokulondoloza Impilo (HSA)
- Kudinga intengo ebonakalayo kulo lonke uhlelo lwezempilo
- Yeka izinsizakalo zombuso ukuthi zisho i-Medicaid
- Vumela ukunyuka zibe izimakethe zamahhala, kuhlanganise nokuthenga izidakamizwa ezishibhile ngaphandle kwezilwandle, ukunciphisa izindleko zemithi yokudokotela
Ingabe uMongameli Trump uhambisa izithembiso zakhe zomkhankaso?
I-Trump ithatha ngokucubungula
Kungakhathaliseki ukuthi uyibheka kanjani, uxhasomali lwe- Medicaid lusebhokisi lokuchofoza. Lokhu kungathinta ukuthi bangaki abantu abakwazi ukuthola ukunakekelwa kwezempilo ngohlelo.
Ukuphinda ukuphinda kutholakale
Ngenkathi uMthetho Wokunakekelwa Okungenakusiza wawusungulwa ngo-2010, kwakunabantu abaningi baseMelika abangaba yizigidi ezingu-48, abangaba ngu-15.7% wabantu.
Ngokusho kwamaCenter for Medicare and Medicaid Services, ukuhamba komthetho kunciphise leyo namba ibe ngamaphesenti angu-9.2 ngo-2015.
U-Obamacare wavumela abantu abasha ukuba bahlale ezinqoleni zabazali isikhathi eside, bavimbele izinkampani zomshuwalense ekukhuleni amaphrimiyamu asekelwe ezimweni zangaphambili , ezivunyelwe ukwandiswa kwezinhlelo ze-Medicaid ezikhona futhi zakha i-Health Insurance Marketplace njengendlela engabizi kakhulu kulabo abangazange bahlangane criteria for Medicaid.
Kulula nje, izindleko zemisebenzi yomshuwalense wangasese ngaleso sikhathi zaziphakeme kakhulu kubantu abaningi ukuphatha.
Abaningi bathi u-Obamacare waqhubeka nokushiya izinhlelo zezempilo ngaphandle kokufinyelela kwezezimali. Ama-deductibles kumacebo amaningi aphakeme kakhulu kangangokuthi abantu abaningi abakwazi ukuwuthola. Ingabe kungcono kunokungabikho ukunakekelwa kwezempilo nhlobo?
Ngokudlulisa umthetho we-American Health Care Act (AHCA), uMongameli Trump uhlose ukuguqula izinqubomgomo eziningi ezivezwe yi-Obamacare. Ngokwenza kanjalo, iHhovisi likaBongameli be-Congressional lilinganisela ukuthi abantu abayizigidi eziyi-14 bazolahlekelwa ukufinyelela kumshuwalense wezempilo ngonyaka ozayo kanye nabantu abayizigidi ezingu-23 eminyakeni eyishumi. Ukuze sichaze ngokuqondile, uma silandela umkhondo wamanje ngaphansi kwe-Obamacare, abantu abayizigidi ezingu-28 abangaphansi kweminyaka engama-65 ubudala bebengavunyelwe ngo-2026 kodwa nge-AHCA, lelo nani lalizofinyelela ezinkulungwaneni ezingu-51.
Ukusika Uxhaso Lwase-Federal ukuze Uxilongwe
U-Obamacare wanikeza izikhuthazo zokuthi ukhethe ukuqhubeka nokwandiswa kwe-Medicaid . Lawo mazwe athole ama-dollar asebusheni ukuze abasize, izindleko zokukhulisa ezingamaphesenti angu-100 iminyaka engama-30 bese kuthi amaphesenti angama-90 wezindleko ngo-2020. Ukwandiswa kwe-Medicaid kuzoqeda ngaphansi kwe-AHCA, nakuba ukuphathwa kwe-Trump kuzoqhubeka nokuxhasa ngezimali ngo-2020 .
Ngaphandle kokuphinda u-Obamacare, i-AHCA ihlose ukunciphisa ezinye izinsizakalo zezimali eziseMedicaid izinhlelo. Liye lahlongoza ukukhawulela imali ekuvimbeleni izibonelelo . Kusukela ngo-1965, amazwe athole ama-dollar aseMelika nge-Medicaid esekelwe kwinani labantu abafanelekele uhlelo. Vimba izibonelelo zizoshintsha konke lokho, ukunikeza imali ehleliwe ye-Medicaid kungakhathaliseki isidingo sombuso. Izinguquko zoxhaso zingathinta wonke amazwe, hhayi kuphela labo ababambe iqhaza ekwandiseni iMedicaid.
Ukunciphisa ukusekelwa kwe-federal kwe-Medicaid kwenza umthwalo onzima emazweni ukuba uzuze izidingo. Izifunda eziningi zinenkinga yokulahlekelwa kwesabelomali njengoba kunjalo.
Ngo-2016, abangaphezu kwesigamu sezwe bathola inzuzo encane kunebhajethi yabo ehlongozwayo futhi abangu-19 kubo kwakudingeka benze isabelomali sichitha phakathi nonyaka ukuze baqhubeke behamba.
Ihhovisi le-Congressional Budget lilinganisela ukuthi i-AHCA izokwehlisa imali ye-Medicaid nge $ 800 billion eminyakeni eyishumi ezayo. Ngokubeka umthwalo owengeziwe kumazwe ukuhlinzeka ngemali, ngubani nokuthi yini i-Medicaid ehlanganisa ngayo ingashintsha. Amanye amazwe angakhetha ukusetha izinhlamvu zokubhalisa noma ahlele izinhlu zokulinda izinzuzo ze-Medicaid kubantu abahlangabezana nezidingo zokufaneleka. Amanye amazwe angaphoqeleka ukusika izinzuzo zokugcina izindleko zokuhlola. Abanye bangenza kokubili.
I-Trump ithatha ku-Medicare
Emgwaqweni womkhankaso, uMongameli Trump wathembisa ukuthi angeke anqume ama-Medicare, kodwa i-AHCA izoba nomthelela omkhulu kumalusi abahlomulayo. Wenza izithembiso eziningana kubantu abadala baseMelika ukuthi usazobhekana naso.
Ukuxoxisana Nezindleko Zezidakamizwa
Imithi efanayo esetshenziswa e-United States ivame ukubiza kancane emazweni angaphandle. Isibonelo, i-Advair, imithi ejwayelekile esetshenziselwa ukwelapha isifo sofuba , ibiza u-R9,9.60 ngenyanga e-United States kanti ibiza kuphela amaRandi 74,12 eCanada nase $ 46.99 e-United Kingdom. Ngesikhathi samanje, i-Medicare ayivumeli ababhalisile ukuba bathenge imithi yabo ngaphandle kwezwe ukuze basebenzise izidakamizwa ezishibhile. UMongameli Trump ufuna ukushintsha lokho. Kodwa-ke imboni yezokwelapha ihlelwe ngokumelene nayo.
UMongameli uTrump ufuna nokuxoxisana nezinkampani zokwelapha zaseMelika ngamanani angcono. Amapulani e- Medicare Part D odokotela njengamanje alawulwa yizinkampani zomshuwalense wangasese, futhi imithetho isendaweni evimbela uhulumeni wesifundazwe ukuba angene ezindlini. Nakulokhu, kukhona ukubandakanya okuphawulekayo izinkampani zokwelapha ukuqhubeka lomthetho.
Njengoba kunamaphesenti ayishumi kuphela okusetshenziswa kwempilo ebikwe ngemithi, i-Congressional Budget Office (CBO) ithi ngeke ilindele ukunciphisa izindleko ezinkulu ngokungenelela kombuso. Ezinye izinkulumo zemigomo ziphakamisa ukuthi i-Medicare ingasindisa imali engaba ngu-R16 billion ngonyaka ngokuxoxisana nokunciphisa izindleko zemithi yegama lomkhiqizo kumazinga uhulumeni wesifundazwe oye waxoxisana kakade ngeMedicaid ne-Veterans Administration .
Kuze kube manje, akukho sinyathelo somthetho esithathwe ukubhekana namanani okusetshenziswa kwezidakamizwa.
Ukulondoloza intela
UMongameli uTrump anganikeza amathuba aseMelika ukusindisa ngezintela zabo. Ngesikhathi samanje, abahlomuli beMedare abavunyelwe ukusebenzisa ama-akhawunti wokulondoloza impilo. Ngokushintsha komthetho, abahlomuli beMedricare bangabeka eceleni imali yentela ngenhloso yokukhokha izindleko zezempilo.
Ngokwenzela izindleko zama-premium tax deductible (imali esukela ku-$ 1,608 kuya ku-$ 5,143 ku-Medicare Part B ngo-2017) , abadala bangakwazi ukulondoloza imali eyengeziwe yokuhola umhlalaphansi.
Nakulokhu, akukho mzamo owenziwe ukufaka lokhu emthethweni ngokomthetho.
Ukuphindaphinda okufakwe ku- Obamacare kuthinta i-Medicare
Nakuba ukunakekelwa kugxile kwi-Medicaid kanye nokungavunyelwanga, ukususwa ngokugcwele kwe-Care Affordable Act kungaba nemiphumela ebalulekile kubantu baseMedare . U-Obamacare wasiza ukusungula izinhlelo zokuthuthukisa ukunakekelwa esibhedlela, ukwehlisa ukukhwabanisa kweMedare, nokuvuselela izindlela ezintsha zokukhokha ezingasindisa imali kulolu hlelo. Futhi kwandiswe ekuhlinzekeni kwe-Medicare, okwenza izinsizakalo zokuvimbela ezifana ne- colonoscopies kanye nama- mammograms mahhala uma uthola ukunakekelwa kusuka kumhlinzeki obambe iqhaza . Okubaluleke kakhulu, kuye kwasiza ukunciphisa izindleko zemithi kadokotela kubantu abahlelweni lwe-Part D.
Ekuqaleni, kwakungaqondakali ukuthi i-AHCA izobhekana kanjani nalezi zinkinga, kodwa kubonakala sengathi akuwona wonke imizamo ye-Obamacare esebenzayo. I-AHCA ngeke ishintshe ukutholakala kwezinzuzo zamanje, futhi izovumela ukuthi imbobo yokuxhuma ivalwe ngo-2020 njengoba kuhlelwe.
Okushiwo yizintela. I-AHCA izosusa i-surtax ye-Medicare yokukhokhela abakhokheli abahola imali ephezulu, okusho ukuthi imali encane izotholakala kwi-Medicare Trust Fund ngokuhamba kwesikhathi. Eqinisweni, kulinganiselwa ukuthi i-Medicare Trust Fund izolahlekelwa i-solvency ngo-2025, eminyakeni emithathu ngaphambili ngaphambi kokubikezelwa ngo-2016, uma i-AHCA idlula.
Sizokwenzenjani uma i-Medicare iphelelwa yimali ?
Iqiniso lezokuphatha kweTrump
UMongameli Trump waya emsebenzini wabe esayina i-oda eliphezulu ngoJanuwari 20, 2017, ngosuku lokuvulwa kwakhe. Lo myalelo uqondise ama-ejensi e-federal ukuba abuyele emuva ku-Obamacare "kuze kube sezingeni eliphezulu evunyelwe umthetho". Kodwa-ke, umyalelo awuzange uchithe uMthetho Wokunakekelwa Ongenakusiza futhi awuzange ucacise ukuthi ama-ejensi ayezoqhubeka kanjani kulolu daba.
Nakuba ethi angeke asebenze ohlelweni lweMedricare, uMongameli Trump ogama lakhe lingummeli uTom Price njengoNobhala WezeMpilo kanye Nezisebenzi Zomuntu okwaqinisekiswa ngoFebhuwari 10 ngemuva kokulalelwa kweSenate. Intengo kuye kwaba ngaphezu kokuzwakala ngokufuna ukukhishwa okukhulu kweMedare. Uye wavumela ukuzikhethela okuyingxenye ye-Medicare ngecebo elithi "Better Way" elivezwe yi-GOP ngo-2016. Ngaphezu kwalokhu, uye wakhuthaza ukusikeka okukhulu ohlelweni lweMedicaid.
UMongameli uphinde wathinta iSema Verma ukuqhuba amaCenter for Medicare neMedicaid Services (CMS). Umcebisi wezempilo kanye nomsunguli we-SVC. Inc., umsebenzi wakhe e-Indiana uholele ekudingeni ukuthi abantu baseMedicaid bakhokhele imali yonke ngenyanga noma balahlekelwe ukukhokhelwa izinyanga eziyisithupha. Kwezinye izifundazwe, usebenze ngeziphakamiso ezidinga abantu ku-Medicaid ukuthi bakhokhele ingxenye yokunakekelwa kwabo noma okudinga ukuba basebenze noma bafune umsebenzi. Kuze kube yimanje, uye wabamba iqhaza ezingeni likahulumeni, kodwa endimeni yezinhlangano, angashintsha izindinganiso ezweni lonke.
Ziningi izithembiso ezenziwe futhi ngokuqinisekile akuyona iningi labantu abazobhekana nalo. UMongameli Trump uthumele izimpawu ezixubile kubantu baseMelika. Lokho akuthembisile emgwaqeni womkhankaso akuzange kube njalo ekuhambisaneni nezenzo zakhe njengoMengameli. Ukuchithwa kwe-Obamacare kungenzeka kwenzeke, okungenani kancane, uma i-AHCA idlula. Ukunqunywa kwe-Medicaid kuyaqiniseka ukuthi kulandela. Kuzokwenzekani ku-Medicare, noma kunjalo, umdlalo wokuqagela.
Izwi kusuka
I-AHCA ehlongozwayo idlulisela iNdlu Yezimele Zase-United States, kepha kuze kube yilapho ivunyiwe yiSenate, uMthetho Wokunakekelwa Ongenakusiza unomthetho wezwe. UMongameli Trump wathembisa ukuchitha u-Obamacare, kodwa i-AHCA njengoba ibhaliwe izokwenqabela izingxenye zomthetho kuphela. Wathembisa ukugcina uM Medicare engakhulumi, kodwa i-AHCA izokwehlisa imali kuMedare. Kusengaphambili ekuphathweni koMengameli, futhi yisikhathi kuphela esizokwazisa ukuthi uMengameli uzophila ngokuvumelana nezithembiso azenzile kubantu abamvotela emkhankasweni womkhankaso.
> Imithombo:
> Ukunakekelwa kwezempilo kweMelika: Ukulinganisa Izindleko. Ihhovisi le-Budget ye-Congressional. https://www.cbo.gov/publication/52486. Ishicilelwe ngo-Mashi 24, 2017.
> Indlela Engcono: Umbono Wethu Wokuqinisekisa I-America - Ukunakekelwa Kwezempilo. Better.GOP. http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf. Ishicilelwe ngo-June 22, 2016.
> Ukulimala kweBalimi L. I-Budget Kulindeleke kakhulu emazweni amaningi Kusukela Ukuqeda. Iwebhusayithi ye-Govern.com. http://www.governing.com/topics/finance/gov-nasbo-state-spending-survey-2017.html. Ishicilelwe ngo-December 13, 2016.
> Ukuxoxisana ngezindleko zemithi engaphansi kwe Medicare Part D. IKomidi likazwelonke lokugcina iwebhusayithi yezokuphepha kanye newebhusayithi yeMedare. http://www.ncpssm.org/EntitledtoKnow/entryid/2061/negotiating-for-lower-drug-costs-in-medicare-part-d.
> Izinombolo zokubhalisa zakwa-Obamacare. I-Obamacare Facts iwebhusayithi. http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/. Ifinyelele ngo-Ephreli 18, 2016.