Ngisho ne-ACA Isigaba 1557, kunzima
Amalungelo afanayo abakwa-transgender baseMelika belokhu efika isikhathi eside, kodwa uMthetho Wokunakekelwa Onganakekelwayo (ACA) wenza inqubekela phambili ekubhekaneni nokulingana empilweni yezempilo . Isigaba 1557 se-ACA sikwenqabela ukubandlululwa ngezizathu ezihlukahlukene zanoma yikuphi "uhlelo lwezempilo noma umsebenzi" othola noma yiluphi uhlobo losizo lwezezimali lwezezimali.
Kodwa lokho akusho ukuthi bonke abantu abathintekayo be-assender manje banokufinyeleleka okungabizi kunoma yiluphi uhlobo lwezokwelapha abadingayo.
Isigaba 1557 se-ACA
I-ACA Isigaba 1557 selokhu sisebenza kusukela ngo-2010, kodwa yizigaba ezimbalwa kuphela isikhathi eside, futhi zijwayelekile ngokwemvelo. Ukucacisa izidingo zokungabikho kokucwaswa, uMnyango wezeMpilo kanye noHulumeni lwabantu (HHS) kanye neHhovisi leMalungelo eLungelo (OCR) lanyathelisa umthetho wokugcina wamakhasi angu-362 wokuqalisa iSigaba 1557 ngoMeyi 2016.
Isigaba 1557 sikwenqabela ukubandlulula ngokusekelwe emibhalweni ekhona-uMthetho wamaLungelo oMphakathi, Isihloko IX, uMthetho wezeMinyaka, kanye neSigaba 504 soMthetho Wokuvuselela-esivele sijwayele kakhulu abantu baseMelika abaningi (okungukuthi, ubudala, ukukhubazeka, ubuhlanga, umbala, isizwe kanye nobulili). Isigaba 1557 se-ACA sisebenzisa leyo mithetho efanayo yokungabandlululo emisebenzini yezempilo kanye nemisebenzi etholwa yizimali zikahulumeni.
Ekubuseni kokugcina, i-HHS ne-OCR ichaza ukuthi ubunikazi "bungaba owesilisa, owesifazane, noma, noma inhlanganisela yesilisa nowesifazane." Futhi lo mthetho uvimbela ngokucacile izinhlelo zempilo nemisebenzi etholakele ngemali ye-federal kusuka ekubandlululweni kubantu ngabanye ngokusekelwe kobulili noma ukuhlukunyezwa ngokocansi.
Isigaba 1557 sisebenza kunoma iyiphi inhlangano ehlinzeka ngezinsizakalo zokunakekelwa kwezempilo noma umshuwalense wezempilo (kubandakanya izinhlangano ezinamabhiliyoni ezempilo ezizimele) uma zithola noma yiluphi usizo lwemali lwezezimali zomshuwalense wezempilo noma imisebenzi yezempilo.
Lokhu kuhlanganisa izibhedlela kanye nezinye izikhungo zezokwelapha, i- Medicaid , i- Medicare (ngaphandle kwe- Medicare Part B ), izinhlelo zezempilo zabafundi , Uhlelo lweMpilo Yomshuwalense Wezingane , kanye nabashuwalense abazimele abathola izinsizakalo zezimali (kufaka phakathi izinsizakalo ezithengiswaneni zabanye ababhalisile emakethe; Uma kunjalo, zonke izinhlelo zomshuwalense kufanele zihambisane neSigaba 1557, hhayi nje izinhlelo zabo zokushintshanisa).
Izinhlangano okufanele zihambisane neSigaba 1557 zibizwa ngokuthi "izinhlangano ezihlanganisiwe."
Iningi lezinhlinzeko zolawulo lokugcina lizoqala ukusebenza ngoJulayi 18, 2016, kepha uma izinguquko kufanele zenziwe kwisakhiwo sokuhlomula kwezempilo, lezo zingabambezeleka kuze kube sekuqaleni konyaka wokuqala wokuqala oqala noma emva kukaJanuwari 1, 2017 Ngakho-ke uhlelo lwezempilo olunomnyaka wokuhlela olusukela ngo-Agasti kuya kuJulayi aludingeki ukuthi luqalise izinguquko ezidingekayo emthethweni wokugcina kuze kube ngu-Agasti 2017.
I-OCR inomsebenzi wokuphoqelela iSigaba 1557, futhi yenze njalo kusukela ngo-2010. Izikhalazo nokuphoqelelwa kusetshenziselwa icala ngamacala, futhi abantu ngabanye bavunyelwe ukuletha izinsolo zokubandlulula enkantolo ngaphansi kwesigaba 1557.
Ingabe i-ACA idinga ama-inshurensi ukumboza ukuhlinzekwa kokusabalalisa ngokobulili?
Nakuba umthetho wokugcina weSigaba 1557 ucacise kakhulu futhi uvimbela ngokucacile ukucwaswa ngokusekelwe kobulili, akudingi izinqubomgomo zemishuwalense yezempilo "ukumboza noma iyiphi inqubo ethile noma ukwelashwa ukunakekelwa okuhlobene noguquko."
Imithetho futhi ayivimbeli inkampani ehlanganisiwe "ngokusebenzisa amazinga angathathi hlangothi alawula izimo lapho ezohlinzeka khona ukufakaza kubo bonke ababhalisile ngendlela engacacile." Ngamanye amazwi, izinqubo zezokwelapha nezokuhlinzekwa kumele zinikezwe ngendlela engeyona inbandlululo, kodwa akukho mfuneko ecacile ukuthi abanikazi besikhwama sezimali bahlanganisa noma yiziphi izinqubo ezithile zokunakekelwa kwezempilo eziphathelene ne-transgender, ngisho noma zibhekwa njengezidingekile zempilo.
I-OCR ichaze ukuthi uma inhlangano ehlanganisiwe yenza noma ikhokhela inqubo ethize yamanye amalungu ayo, ayikwazi ukusebenzisa ubunikazi noma ukuhlukunyezwa ngokocansi ukuze kugweme ukuhlinzeka ngaleyo ndlela kumuntu owephula umthetho. Ngakho-ke, uma umshuwalense ehlanganisa ama-hysterectomies ukuvimbela noma ukwelapha umdlavuza kubesifazane be-cisgender , kuzodingeka ukuthi basebenzise izindlela ezingathathi hlangothi, ezingenabandlululo ukucacisa ukuthi zizobe zihlanganisa ukungahambisani nokuziphatha ngendlela yokuphatha i- dysphoria .
Futhi ubunikazi bobulili abukwazi ukusetshenziselwa ukuphika ukwelashwa okudingekayo ngokwezempilo, kungakhathaliseki ukuthi kufanelana nobulili obukhethwe ngabanye.
Isibonelo, owesilisa we-transgender akanakwenqatshelwa ukwelashwa ngomdlavuza we-ovarian esekelwe eqinisweni lokuthi ubonisa njengowesilisa.
Kodwa le nkinga ihlala ilukhuni. Ngaphambi kokuqondiswa okukhishwe ngaphansi kwesigaba se-Section 1557 sokugcina, kunezifunda ezingu-17 ezivimbela ngokuqondile abaqinisekisi bezempilo ukuba bangabandakanyi izibopho zokubhekelela ukunakekelwa okwehlukile, futhi kuthiwa ezingu-10 zivimbela ukungabikho kokugqoka okunjalo kwizinhlelo zabo ze-Medicaid. Ngaphansi kokubusa kokugcina, izinhlangano ezihlanganisiwe kuzo zonke izimo zivinjelwe ekusebenziseni izibopho zokugqoka ukukhanyela ukunakekelwa kwesifo sobulili, futhi kumele zisebenzise izindlela ezingezona ukubandlulula uma kunquma ukuthi inqubo izokwenziwa yini.
Kodwa ngenkathi iSigaba 1557 isinyathelo esikhulu ekubhekaneni nokulingana ekunakekelweni kwezempilo kwabakwa-transgender baseMelika, akudingi ukuhlinzekwa kokuhlinzekwa kabusha ngokobulili nokunakekelwa kwezokwelapha okuhlobene.
Ngabe Imiphakamiso Yomshuwalense Wezempilo Iphelisa Ukuphindaphinda Kwesini?
Nakuba iSigaba 1557 sisekhona kusukela ngo-2010, umthetho wokugcina awuzange uze kuze kube yiminyaka eyisithupha kamuva, futhi abahlinzeki bezempilo nabanikezeli bezempilo beqhubeka nokusebenza ukuze balungise imininingwane. Ikakhulukazi yanikezwa ukuthi umthetho wokugcina eSigabeni 1557 awudingi inshuwalense ukumboza noma yiziphi izinqubo ezithile-ngisho noma kubhekwa ukuthi kunesidingo sempilo-kusekhona izindawo eziningi ezimpunga.
I-Healthcare.gov inikeza ulwazi mayelana nendlela yokubika ubulili obhalisile ngesicelo sokuthola imali kwimishwalense yomshuwalense wezempilo lapho uthi usebenzisa i-Healthcare.gov, futhi uchaza ukuthi ungahamba kanjani ngokubika ukubandlululwa.
Kusukela ngo-2014, i- Medicare iye yahlinzeka ngokuhlinzwa kwezokwelapha okudingekayo ngokokwelapha ngokomzimba , kanye nezinqumo ezithintekayo ezenzelwe icala ngokweqhinga ngokwezidingo zezokwelapha. UMnyango Wezombusazwe (VA) uphinde uhlongoze ukuqeda ukuvinjelwa kwaso isikhathi eside ekukhokheni ukuhlinzekwa kocansi ngokuphindaphindiwe kwama-veterans aseMelika.
Futhi lesi sifushane esivela ku-Aetna sibonelo esihle sendlela abathintekayo bezempilo abangasese abangase bahlanganise ngayo ezinye izici zenqubo yokuguqula ubulili, kodwa hhayi bonke.
Njengoba umthetho wokugcina eSigabeni 1557 usuqalisiwe, cishe kuzoba nezinhlelo eziningi zempilo ezikhetha ukuphambukisa eceleni kocansi lokuhlinzekwa kokuhlinzwa kwesondo. I-Vanderbilt University yamemezela ngo-June 2016 ukuthi izoqala ukuhlinzekela ukuguqulwa kobulili ohlelweni lwezempilo lwabafundi, kanti idolobha lasePortland, iMaine lizoqala ukuhlinzeka ngempilo eqondene ne-transgender kusukela ngoJanuwari 2017.
Kodwa futhi ngoJuni 2016, ibhodi le-Public Library yaseCincinnati livotelwe ngokungafani ukuze lingeze noma yiliphi abagibeli kulolu hlelo lomshwalense wamanje welabhulali. Abagibeli abacatshangelwayo bahlanganisa ukunakekelwa kwezempilo ngokwe-transgender, ukuhlinzwa kwe-bariatric, nokuphathwa kokwelashwa. Umtapo wezincwadi uhlinzeka nge-Anthem, futhi umphathi wenkampani unikeza umgibeli ozithandayo ukuthi umtapo wezincwadi angathenga ukuze agcine ukunakekelwa kwempilo ye-transgender.
Kodwa umtapo wezincwadi awubhekwa njengento ehlanganisiwe ngaphansi kweSigaba 1557 se-ACA, ngoba ibhizinisi labo eliyinhloko akulona ukuhlinzekwa kwezempilo, umshuwalense wezempilo, noma izinsizakalo ezihlobene nempilo. Njengalokhu, ziyisibonelo senhlangano engadingeki ihambisane nezidingo zeSigaba 1557 ezingabandlululo emisebenzini yabo yomshuwalense wezempilo.
Umhlengikazi wesilisa wase-transgender osebenzela uSan Francisco-based Dignity Health wamangalela umqashi wakhe ngo-June 2016 ngezizathu zokubandlulula, ngoba uhlelo lwezempilo lwezempilo aluhambisani nokuphathwa kwesifo sobulili. Cishe zonke izibhedlela zihlanganiswe ngaphansi kweSigaba 1557, kodwa isibhedlela sisho ukuthi isisebenzi saso sezempilo asibandlululo ngoba asihlanganisi "ukukhathazeka komuntu" ngokujwayelekile (ngokungafani nokubandlulula ngokuqondile abasebenzi be-transgender).
Icala lichaza ukuthi ubulili besifo sobulili akuyona inkinga yobuntu, kodwa icala lifakazela ukuthi iSigaba 1557 sisavumela ukuchazwa kwamacala okuthiwa yi-subjective, case-by-case.
Loludaba luzobhekana nokuphikisana komthetho okwesikhashana eminyakeni eminingana elandelayo, ikakhulukazi kunikezwe ukuthi izinzuzo zezempilo ze-ACA azibandakanyi ngokukhethekile ukunakekelwa kwempilo ye-transgender, futhi ukuthi ukubusa kokugcina kweSigaba 1557 akudingi ngokucacile ukuthi izinhlelo zezempilo zihlanganisa ngqo izinqubo zezokwelapha ezihlobene nokubuyiswa kobulili, kungakhathaliseki isidingo sezokwelapha.
> Imithombo:
UMnyango wezeMpilo kanye nezinsizakalo zabantu, ukucwaswa kweziNhlelo zoMpilo kanye nemisebenzi , ukusebenza kahle ngoJulayi 18, 2016. Ukutholakala ngo 6/22/16.
Isikhungo Sikazwelonke Sokulingana Kwe-Transgender, Yazi Amalungelo Wakho: Medicare. Kufinyelelwe ngo 6/22/16.
UMnyango Wezobulungiswa wase-United States, Uhlolojikelele kweSihloko IX se-Amendments Yezemfundo ka-1972, Ukufinyelelwa ngo-6/22/6.
I-House of Representatives yase-US, Ukuhlanganisa Ukuvikelwa Kweziguli Nokwethenjelwa Kwezomthetho, njengoba kulungisiwe ngo-Meyi 1, 2010 . Kufinyelelwe ngo 6/22/16.