Umthetho omusha unikeza ukuxoshwa okubanzi kumgomo wokukhulelwa
I-Care Affordable Act kanye nemithethonqubo yayo esilandelayo yathinteka ekufinyeleleni okufinyelelekile ekuhlinzekeni kokubeletha. Kodwa abesifazane manje bayazibuza ukuthi ngabe ukuhlinzekwa komshuwalense wezokwelapha kuzophela yini, nokuthi ngabe kufanele bathole i-IUD esikhathini esizayo esiseduze, uma bebuyela emuva bebiza izindleko zamakhulu ayizinkulungwane.
Futhi ngokusekelwe ekukhululweni kokuziphatha kanye nemithetho yokukhishwa kwezenkolo eyanyatheliswa kuyi-Federal Register ngo-Okthoba 6, ngokuqinisekile kunesizathu sokukhathazeka.
Kodwa izinguquko ngokushesha zibhekene nezinselele zomthetho futhi inani labaqashi abalindeleke ukusebenzisa lezi zizathu ziphansi kakhulu.
Ake sibheke igunya lokuvimbela ukukhulelwa kwe-ACA, umthelela onalo, nokuthi yini esingayilindela ukuqhubeka phambili.
Izinkinga Zokuvimbela Ngaphansi Kwe-ACA
Enye yezinhlinzeko ezingaphezu kokuphikisana noMthetho Wokunakekelwa Okungenakusiza (i-Obamacare) ukufakwa kokukhulelwa. Ngaphansi kwe-ACA, zonke izinhlelo zezempilo ezingezona ezithandwa kakhulu kumele zimboze-kungabikho ukwabelana ngezindleko - okungenani okuyinguqulo eyodwa yezinhlobo ezingu-18 zezinhlobo zokuvimbela izisu ezivunyiwe zakwa-FDA (kubonakala ukuthi izinhlelo ezibekwe kakhulu ziqhubeka zakha amaphesenti amakhulu omqashi -Izinhlelo ezixhasiwe, ngokwemigomo ebekiwe, abantu abayizigidi ezingama-36.5 abanokuxhaswa ngokuqashiwe ngumqashi basemapulani amakhulu, okudingekile ukuthi banikeze ukukhulelwa ngaphandle kokunikezwa izindleko).
Nakuba izinhlinzeko eziningi ze-ACA azizange zisebenze kuze kufike ngo-2014, isidingo sokuthi amapulani ahlanganisa ukukhulelwa komzimba kuye kwaba khona kusukela ngo-Agasti 2012, kuzo zonke izinhlelo ezintsha nokuvuselela.
Ngezinhlelo ezingenakubalwa ezavuselelwa ngemva kwalowo phuzu, ukufakwa kokubeletha kwanezelwa ekuvuselelweni kokuqala. Ngakho ngo-Agasti 2013, wonke amacebo angenalutho ayehlanganisa nokuhlanganisa ukukhulelwa. Ukunikezwa okuhlukile kunikezwa izinhlangano zenkolo, kodwa futhi kwandiswa ngo-2014 (ngenxa yesigwebo seNkantolo Ephakeme eBurwell v. Hobby Lobby) ukuze kufakwe izinhlangano "ezithintekayo" abanikazi babo abaphikisana nenkolo ngokugunyazwa kokukhulelwa.
Ucwaningo lwezeMpilo luka-2015 lwathola ukuthi igunya lika-ACA lokuvimbela ukuvimbela ukuvimbela ukuvimbela ukuvimbela ukuvimbela ukuvimbela ukuvimbela ukuvimbela ukuvimbela ukuvimbela ukuvimbela ukuvimbela ukuvimbela imithi. ukuba ikhokhwe phezulu-phambili, kodwa imali ibalwa minyaka yonke, isakazeka eminyakeni edlule owesifazane unedivaysi).
Ngaphansi kwe-ACA, abesifazane ababheke nge-insured abangenazo izindleko ezingabonwayo akudingeki bakhokhe noma nini ngesikhathi bethola ukulawulwa kokuzalwa kwabo, becabanga ukuthi bakhetha izinzalo zokubeletha ukuthi abahlinzeki babo bezempilo baphekele ngokugcwele (i-ACA idinga ukuthi izinhlelo zezempilo zimboze okungenani enye yohlobo ngalunye; aludingi ukuba limboze zonke izinguqulo zohlobo ngalunye).
Nakuba lokhu kuvame ukubizwa ngokuthi "mahhala" ukulawulwa kokuzalwa, abagxeki banothi akukho lutho olukhululekile. Eqinisweni, izindleko zokuvimbela ukukhulelwa zihlanganiswe kuma-premium abesimame nabaqashi babo bakhokhela ukukhokhelwa. Ngakho-ke ngenhloso yokucaca, ingxoxo mayelana nokulawulwa kokuzalwa kwamahhala kulesi sihloko ibhekisela ekulawulweni kokuzalwa okuhlinzekiwe ngaphandle kokuthola izindleko ngenkathi itholakala.
Ukufinyelela Okunwetshiwe Kubeletha Kunciphisa Ukukhipha Isisu & Ukuzalwa Kwezingane
Ngo-November 2016, i-CDC yashicilela idatha ebonisa ukuthi ngo-2013, izinga lokukhipha isisu lalihle kakhulu eNingizimu Afrika
Ukukhipha isisu abaphikisanayo bayiqaphele ukuthi lokhu kungase kube ngenxa yemithetho eminingi eyadluliselwa emazweni ahlukene ukukhawulela ukufinyelela kokukhipha isisu eminyakeni yamuva. Kodwa ubufakazi obuvela eColorado-engekho phakathi kwezizwe eziye zadlulisela imithetho ekuvimbeleni ukufinyelela kokukhipha isisu-kubonisa ukuthi ukutholakala kwezinzalo zokubeletha kudlala ngempela indima ebalulekile: I-Colorado Family Planning Initiative yaqala ukuhlinzeka ngezinqubo zokuvimbela ukukhulelwa okuqhubekayo isikhathi eside (IUDs kanye nezimpande) ukuze intsha kanye nabesifazane abahola kancane ngo-2009, ngaphambi kokumiswa kuka-ACA. Ngonyaka ka-2014, izinga lokuzalwa nokukhipha isisu liye lahla ngamaphesenti angu-48.
Ama-IUDs kanye nezimpendulo zithola Ukubaluleka ngaphansi kwe-ACA Imithetho
I-CDC iphinda ibike ukuthi ukusetshenziswa okusebenzayo okusebenza isikhathi eside isikhathi sokubeletha kokubeletha (LARC) kuphezulu isikhathi sonke phakathi kwabesifazane baseMelika.
Lokhu kungenzeka ngenxa yokuhlanganiswa kwemfundo engcono mayelana ne-LARC nokuthi iqiniso lokuthi i-ACA ithathe umkhawulo wokungabi namandla okwezinye izikhathi owavimbela abesifazane ukuba bathole i-LARC ngaphambi kokusebenza kwezidingo ze-ACA.
Imizamo yesigungu sokuphinda i-ACA ihlulekile
Ukuphathwa kweTrump kanye neCongress of GOP elawulwa yi-GOP yaqala ngo-2017 ngamathemba aphezulu ekuqedeni i-ACA, kodwa lokho akuzange kwenzeke ngo-2017. AbaseRepublic Republic House badlulisela uMthetho wezeMpilo waseMelika ngoMeyi 2017, kodwa iSénate ayizange idlule noma yiziphi izinguqulo zalo zomthetho, futhi ukuphela kuka-Septhemba 30 wonyaka wezimali kwakuyisikhathi sokugcina ukubuyisana ukuze sikwazi ukuphinda i-ACA ngamavoti angu-50 kuphela (kanye nokuvota kwe-tie-breaker evela kumengameli we-vice).
I-House House ye-AHCA kanye nezindleko ezehlukene ezenziwe eSenate ngeke ziqede igunya lokuvikela ukuvimbela i-ACA, kodwa iningi lazo lingavumela izifunda ukuthi zifune ukuxoshwa ukuze zihlenge izinzuzo ezibalulekile zezempilo. Ukunakekelwa kokuvimbela, okubandakanya ukukhulelwa ngokweqile, kungenye yezinzuzo zezempilo ezibalulekile ze- ACA . Uma ngabe umthetho ungasungulwa ovumela izifunda ukuthi zithole izimali zokuhlenga izinzuzo ezibalulekile zezempilo, ukutholakala kokukhulelwa kungase kungadingeki.
Izindleko ezihlukahlukene zokuqeda i-ACA ezacatshangwa ngabameli beRiphabhliki ngo-2017 nazo zizophelisa ukuxhasa ngezimali zika-Planned Parenthood unyaka owodwa, ukunciphisa ukufinyelela kokukhulelwa kwababelethi phakathi kwabesifazane abathembele ku-Planned Parenthood ekunakekeleni kwabo.
Kodwa ayikho enye yalezi zindleko ezidlule, kanti u-Okthoba ubonisa ukuphela kwesithuba esisheshayo sokumisa umthetho wokuqeda i-ACA. Abameli beRiphabhlikhi bathembisa ukuthi bazoqhubeka nokulwa nokuqeda umthetho, kodwa i-Trump Administration ibuye isebenze ukwenza izinguquko nge-oda eziphezulu kanye nemithetho emisha.
Yini emithethweni emisha?
Ngo-May 4, 2017-ngosuku olufanayo I-House Republican idlulise i-AHCA-President Trump Isungulwe umyalelo olawulayo oqondisa abaNobhala beMgcinimafa, Abasebenzi, kanye neHHS, ukuba " bacabangele ukukhipha imithetho echitshiyelwe, ehambisana nomthetho osebenzayo, ukuphikisana okubhekiswe ekugunyazweni kokuvikela. " Lokhu kubeka isiteji semithetho emisha, okusho, ngokusho kweNew York Times, ukuPhathwa kweTrump bekucatshangelwa ngasekupheleni kukaMeyi.
Ngomhlaka-31 Meyi, i-Vox ithole uhlaka olunembile lomthetho omusha we-HHS kanye ne-IRS, okwakungabhubhisa kakhulu igunya lokukhulelwa kwamanje. Akukho okwenzekile ezinyangeni ezimbalwa ezilandelayo, futhi ukugxila kulo lonke ihlobo ngokuvamile kulomzamo wokushaya umthetho we-ACA.
Kodwa ngo-Okthoba 6, imithetho emisha emibili yashicilelwa kwi-Register Federal evumela abaqashi ukufinyelela okubanzi ekukhululweni kwegunya lokukhulelwa: ukukhululeka kokuziphatha nokukhululwa kwezenkolo .
Imithethonqubo iyasebenza ngokushesha, ngaphandle kwesaziso esivamile kanye nesikhathi sokuphawula. Amazwana ayamukelwa ngezinsuku ezingama-60 (ngoDisemba 5), kodwa imithetho yaqala ukusebenza ngo-Okthoba 6. I-HHS ivame ukwamukela ukuphawula komphakathi emithethweni ehlongozwayo, iyababheka, futhi ichaza indlela imibono yomphakathi eyakhe ngayo umgomo wokugcina.
Kodwa kulokhu, bathi "banezizathu ezinhle " zokusebenzisa le mithetho ngokushesha nokuthi "ngeke kube yinto engenakuqhathaniswa nokuphikisana nentshisekelo yomphakathi ukulibaziseka ukubeka lezi zinhlinzeko endaweni kuze kufike inqubo egcwele yokuphawula umphakathi kuphelile. "Ngokuvikela ukweqa isaziso kanye nesikhathi sokuphawula, i-HHS iphinde ithi akudingeki ukuthi iphinde iphinde ihambisane nenqubo yokuphawula, njengoba isivele ithole imibono mayelana nokukhishwa kwegunya lokukhulelwa lapho imithetho ishicilelwe eminyakeni eyedlule. Kumele kuqaphele ukuthi lezi ziqondiso ezintsha zifinyelele kakhulu kunalokho okukhulunywe khona kwe-HHS ngaphambilini, futhi lokho okushiwo yiyo kungase kuhluke kakhulu.
Ngaphansi kwemithetho emisha, noma yimuphi umqashi, inyuvesi, noma umshwalense wezempilo angakhipha ukukhululwa komthetho wokukhulelwa, nganoma yisiphi isizathu sezenkolo noma sokuziphatha njengesizathu sokukhululwa. Ukukhululwa akudingeki kuvunywe nguhulumeni-abaqashi abangafisi ukuvimbela ukukhulelwa ngokweqile emaqenjini abo ezempilo kumele bazise abasebenzi babo ushintsho ezinzuzweni.
Imithetho emisha ichaza ukuthi " Ukwandisa ukukhululwa kuzosusa izithiyo zenkolo / zokuziphatha ukuthi izinhlangano nabantu abathile bangabhekana nabani abafisa ukuzibandakanya emakethe yezokunakekelwa kwempilo. " Kodwa ukugqugquzela inothi lokuthola inzalo etholakalayo emhlabeni jikelele ukuthi umthelela womthethonqubo uzoba ukuthi abesifazane abambalwa ukutholakala ngokuqondile kwemithi yokukhulelwa, ikakhulukazi ukuvimbela ukukhulelwa kokubeletha isikhathi eside (ama-IUD kanye nezimpande) ezivame ukuba nezindleko eziphezulu uma zingekho emshuwalense wezempilo.
Ngesikhathi uhlaka lwemithetho lubekwe ngoMeyi, i-ACLU ithembise ukuthi " izobona ukuphathwa kwe-Trump enkantolo uma bezama ukulandela ngalezi zinhlelo. " Ngempela, i-ACLU yafaka isambatho ngokushesha ngo-Okthoba 6, njengoba kwenza iMatthew Attorney General UMaura Healey.
Ukucaca, i-Obama Administration isivele ithathe izinyathelo zokuqinisekisa ukuthi abaqashi bezenkolo abadingeki ukuba bakhokhe ngokuqondile izinzuzo zokukhulelwa, kepha umsebenzi wokuqinisekisa umsebenzi uqinisekisa ukuthi abesifazane abahlanganiswe nezinhlelo zezempilo zabaqashi bayaqhubeka nokufinyelela kokungabikho kwemali yokukhulelwa kokukhulelwa (lokho akusiyo njalo ukuqiniswa ngokufanayo, kepha abanye besifazane abanabankolo abangenayo imali yokuthola izindleko zokubeletha ngokusebenzisa uhlelo lwabo lwezempilo oluxhaswe ngumqashi). Kodwa lesi yisisombululo abanye abaqashi benkolo abakholelwa ukuthi basaphula amalungelo abo enkolo.
Kwenzekani Okulandelayo?
Imithethonqubo emisha ibhekene nezinselele ezisemthethweni zomthetho, futhi maduzane ukutshela ukuthi bazobe benamacala enkantolo. Esitatimendeni mayelana nemithetho, i-HHS yathi imithetho emisha "ngeke ithinte ngaphezu kwamaphesenti angu-99,9 wabesifazane abayizigidi ezingu-165 e-United States" ngoba balindele kuphela izinhlangano ezingaba ngu-200-lezo ezivele zafaka amacala ngokugunyazwa kokukhulelwa ngokusekelwe ukuphikisa okungokwenkolo noma ukuziphatha-kuyodala ukukhululwa ngaphansi kwemithetho emisha.
Kodwa abathengi bamathengi bakhathazeka ngokuthi imithetho ingaqeda ukuba yiyona enkulu kakhulu, nokuthi imithetho emisha ibhekene nomsebenzi omkhulu ekugunyazweni kokukhulelwa.
Amaqembu amaningana asebenzise izibopho zabo zokuvimbela ukukhulelwa, kepha lokho kusebenza kuphela ezinhlelweni ezilawulwa nguhulumeni. Izinhlelo zokuzikhokhela (okungukuthi abaqashi abaningi kakhulu abazisebenzisayo) zilawulwa ngaphansi kwesifundazwe, kunokuba isimo, umthetho. Izigunyazo zokuvimbela ukukhulelwa kwe-ACA ziyasebenza kulo lonke ibhodi, kodwa imithetho yesisekelo esivela kuhulumeni ayisebenzisi izinhlelo ezizimele.
Owake waphendula uTom Price (khona-ke uMmeli waseRephabhulikhi waseGeorgia, owaba uNobhala weHHS kamuva okwesikhashana ngaphansi koMnyango wezokuPhatha ngaphambi kokusula ngoSepthemba 2017) wathi ngonyaka ka-2012 ukuthi "owesifazane oyedwa" wayengenakukwazi ukukhokhela ukubeletha ngaphambi kokuba Imisebenzi ye-ACA. Kodwa inhlolovo ka-2010 eyenziwe ngu-Planned Parenthood itholakala ukuthi amaphesenti angu-34 abesifazane "ayebhekene nezindleko zokulawulwa kokubeletha esikhathini esithile empilweni yabo."
Ngo-2012, umfundi we-University of Georgetown, uSandra Fluke, ufakaze ngaphambi kwephaneli yebandla ngokuphathelene nokuhlinzekwa kokukhulelwa ngaphansi kwe-ACA. Ufakaze ukuthi abafundi abangamaphesenti angama-40 abafundi bomthetho we-University Georgetown babika ukuthi ukungabi nesandulela ngculaza yocwaningo lwezempilo eyunivesithi kwakubangele ukuba bahlukane ngokwezimali.
Ukubuyiselwa kokwabelana ngezindleko noma ukungabi khona kwempilo yomshuwalense wempilo yezinzalo zokubeletha kungase kungabonakali inkinga enkulu yabesifazane abanemali abafaka okungenani ekilasini eliphakathi. Kodwa kungabonisa inkinga enkulu kubesifazane abangenayo imali encane. Futhi ukufinyeleleka kuma-IUDs nama-implants asebenzayo kungahle kuthinteke kakhulu uma izindleko zabo eziphezulu eziphezulu ziphela ukugcwala ngokugcwele umshwalense wezempilo.
> Imithombo:
> Isikhungo Sokulawulwa Nokuvimbela Izifo, Ukukhipha Isisu-I-United States, 2013. Ngo-Novemba 25, 2016.
> Isikhungo Sokulawulwa Nokuvimbela Izifo, Isikhungo Sikazwelonke Sezibalo Zempilo. Amathrendi Ekusebenziseni Ukuvimbela Ukukhulelwa Okudala Okusebenzayo Phakathi Kwase-US Abesifazane Abakhulile 15-44. February 2015 .
> I-Colorado Department of Health Public & Environment, I-Colorado's Teen Birth Rate iyaqhubeka nokuguqula. Ngo-Okthoba 21, 2016.
> UMnyango WezeMpilo Nezinsizakalo Zabantu, Imithombo Yezempilo Nezokuphathwa Kwezinsizakalo, Ukuvuselela Imihlahlandlela Yezinsizakalo Zokuvikela Abesifazane, ngo-2011.
> I-Federal Register. UMnyango Wezezimali; UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. Ukuzikhethela Kokuziphatha Nezindlu Zokuhlinzekwa Kwezinsizakalo Ezithize Zokuvimbela Ngaphansi Komthetho Wokunakekelwa Onganakekelwayo . > Okthoba 6, 2017.
> I-Federal Register. UMnyango Wezezimali; UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. Ukuxoshwa Kwezenkolo Nezivakashi Zokuhlinzekwa Kweminye Imisebenzi Yokuvimbela Ngaphansi Komthetho Wokunakekelwa Onganakekelwayo . > Okthoba 6, 2017.
> HealthAffairs. Abesifazane babona ukunciphisa okukhulu ngaphakathi kwePokhethi Ukuchitha imali yezinkinga zokuvimbela emva kokumiswa kwezindleko ze-ACA. I-Vol 34, uNgo-7, Julayi 2015.