Kuyinkimbinkimbi kakhudlwana kunokuba ukuchithwa nokushintshwa kugcine kuhambisane
Lapho uDonald Trump ethatha ukhetho lukaMengameli ngoNovemba 2016, ikusasa lomshuwalense wezempilo e-US ngokungazelelwe likhulu kakhulu emalini-lapho abantu beqala ukujwayela uMnyango Wokunakekelwa Ongabizi kahle (aka, Obamacare).
Akungabazeki ukuthi ukusetjenziswa kwe-ACA kunezinto eziningi ezinengi eminyakeni edlulileko, kodwana bekusekelwe ekupheleni kwe-2016.
Isikhathi sesine sokubhalisa esivulekile emakethe ngayinye (ekuphumeni nasekushintsheni ) kwakuqhubeka. Abaqashi bebangena ngonyaka wabo wesibili noma wesithathu (kuye ngokuthi usayizi wabo) ukuhambisana nobunikazi bomqashi we-ACA . Abantu babejwayele ukubuza imibuzo mayelana nokubhekwa kwe-inshuwalense yezempilo ezinkambisweni zabo zentela, kanye nesigwebo esingenzeka kubantu abangazange baqinisekiswe phakathi nonyaka.
Abantu base bezitholile ukuthi izimo zangaphambili azikho isithiyo lapho befaka isicelo somshuwalense wezempilo, nokuthi iqiniso lokuthi abantu abathenga ukuthengiswa emakethe ngayinye, ukuxhaswa kuyatholakala ukuze kuqedwe izindleko, kuye ngokwemali engenayo ( lokhu kwasiza ukulinganisa inkundla yokudlala kubantu abathengisa umshwalense wabo wezempilo , ngoba abantu abanomshwalense wezempilo oxhaswe ngumqashi bebelokhu benemali eyinzuzo).
Khona-ke ngokuzumayo, konke kwakusenyakatho emoyeni. UMongameli uTrump wamemezela ngesithembiso sokuthi uzoqeda i-ACA; i-website yakhe yomkhankaso ithi, "Ngosuku olulodwa lwezokuPhatha kweTrump, sizocela iCongress ukuthi ihambise ngokushesha i-Obamacare."
AmaRephablikhi agcina izikhulu zawo eNdlu naseSénate, futhi bebelokhu bezama ukususa i-ACA kusukela ngo-2010. Imizamo yabo yangaphambilini yayinqotshwe yi-veto ipeni likaMongameli Obama, kodwa lokho akusisona isithiyo ngaphansi kwe-Trump Administration.
Ukuphinda i-ACA Akuyona into elula njengoba izwakala
Ngokushesha lapho isimiso somthethosisekelo sika-2017 siqhubeka, uSenator Mike Enzi (R, Wyoming), uSihlalo weKomiti Yezezimali zeSénate, wethule isinqumo (SCRes 3) ukuqala inqubo yokuqeda i-ACA ngokusebenzisa ukubuyisana kwesabelomali.
Isinqumo sika-Enzi sinikeza iziqondiso zamakomidi amane ukwenza umthetho, kuhlanganise nokunciphisa ukulahlekelwa, okuzokwaziswa kwiKomidi Lesabelomali. Zombili izingxenye zeCongress zadlulile ama-SCR 3 phakathi no-Januwari, futhi amakomidi ezinhlangano ezihlangene ayelokhu esebenza ngemininingwane yokuqeda umthetho kusukela ngaleso sikhathi.
AmaRiphabhliki aseCongress ahlela ngaleso sikhathi kwakuzodlulisela ibhilidi yokubuyisana ngokushesha. Okulindelwe ukuthi bekuyofana no-HR3762, eyadlula ekuqaleni kuka-2016 kodwa yavotelwa nguMongameli Obama.
Ukuze kucace, abanalo amavoti adingekayo ukuze kudlule ukupheliswa okugcwele kwe-ACA, njengoba lokho kungadinga okungenani amavoti angu-60 eSenate ukuze kunqobe i-filibuster. Kodwa ibhilidi yokubuyisana-elibhekisa kuphela ukusetshenziswa kwemali-lingadlulela ngeningi nje elilula, futhi alikho ngaphansi kwe-filibuster. Isimali sokubuyisana sokubuyisela imali ku-ACA singadlula nabakwa-Senators abangu-51, ngakho-ke kukhona ama-Republican Senators angu-52 ngo-2017.
Izinsizakalo ze-Premium, ukuxhaswa ngezindleko, nokwandiswa kwe-Medicaid kungaqedwa konke nge-bill reconciliation. Ngakho-ke intela ye-ACA ingathi umqashi ugunyaze isigwebo, isigwebo somuntu ngamunye, nezinto ezifana nentela yezokwelapha kanye ne-Cadillac Tax yentela.
Isikhwama sokubuyisana ngeke sikwazi ukucubungula izingxenye ezihlobene ne-ACA ezihlobene nokungahambisani nokuchitha imali, njengokungenwa okuqinisekisiwe okukhishwayo (kungakhathaliseki ukuthi umlando wezokwelapha), izinzuzo ezibalulekile zezempilo , futhi uvumela abantu abadala ukuba bahlale ezinhlelweni zezempilo zabazali babo kuze kube yilapho beneminyaka engu-26 Kodwa uma i-ACA ibolekwa, izingxenye ezisele zazingeke zisinde ngaphandle kokuba kwenziwe isenzo somthetho esengeziwe sokwenza imakethe yomshuwalense iqiniswe.
Yini Ezayo Okulandelayo?
AmaRiphabhuliki aseCongress asebenze ngokushesha ukuqala inqubo yokucima i-ACA ngokuyidlulisela, kodwa angakaboni ngokuvumelana nokuphakanyiswa esikhundleni. Iziphakamiso eziningi ze-GOP ezithatha isikhundla se-ACA ziye zafakwa eminyakeni embalwa edlule, kuhlanganise nesiphakamiso sikaPhalamende sikaPaul Ryan esithi " Indlela Engcono," kanye no-Tom Price's Empowering Patient First Act ka-2015 (HR2300) -ukubaluleke kakhulu lapho inani liphakanyiswa ukuhola i-HHS ngaphansi kwezokuphathwa kwe-Trump (iSenate yaqinisekisa ukuphakanyiswa kwakhe ngoFebhuwari 2017).
Iziphakamiso zivame ukuba nezindawo eziningi ezifanayo, ngakho-ke sinombono omuhle wendlela abaCreat Republical bafuna ngayo ukuqhubeka.
Izindleko eziningana ezishaye zafakwa emasontweni okuqala esimisweni somthethosisekelo ka-2017, ngokulandela imigomo eminingi efanayo echazwe kuzincomo zokulungisa ukunakekelwa kwempilo yaseRepublican. Kodwa akekho oye wazuza ukwesekwa kwe-bipartisan noma ngisho nokusekelwa okugcwele ukusuka ohlangothini lweRiphablikhi ye-aisle.
Ngamafuphi, imininingwane ecacile yalokho engayenza esikhundleni se-ACA ayitholakali. Abanye baseMelika bangcono ngaphansi kwe-ACA, kanti ezinye zibi kakhulu, kodwa akekho noyedwa wabo oye waba nethuba lokubona kahle ukuthi ukushintshwa kuzobukeka kanjani. Futhi mhlawumbe okubaluleke kakhulu kukho konke, umshuwalense wezempilo kanye nezimboni zokunakekelwa kwezempilo aziqiniseki ukuthi yini elandelayo.
Abaholi beCongress bathi kusukela ekuqaleni bekungeke kube khona i-gap ekusakazeni. Nakuba bephindaphindiwe bathi uhlelo lwabo lokuqeda i-ACA ngokushesha ngangokunokwenzeka, abanenhloso yokuba ukuchithwa kuthathe umphumela ngokushesha. Ukubambezeleka kweminyaka emibili kuya kwemibili ukuphinda kusetshenziswe kungenzeka, okusho ukuthi bangavotela ukuqeda i-ACA ekuqaleni kuka-2017, kepha ukuchithwa kuthathe isikhathi esithile phakathi kuka-2019 no-2021.
Isizathu sokubambezeleka kokuqeda ukuqaliswa ukunikeza abameli ithuba lokwenza imininingwane yesikweletu esithatha indawo, bayidlulise, futhi banesikhathi sokuthola zonke izingcezu ukuze ziqaliswe ngesikhathi esifanayo ukuze kusetshenziswe i-ACA. Ummeli uChris Collins (R, New York), oyilungu lethimba leTrans Transform, uthe ekuqaleni kukaJanuwari 2017 ukuthi umthetho wokubuyisela uzobe usungulwa ngoJuni noma ngoJulayi 2017. Wakhulume ukuthi akukho lutho olungashintsha mayelana nempilo uhlela ngo-2017 noma ngo-2018, kodwa wathi ukususwa ngokushesha kwe-ACA kwakudingeka ngoba abameli behlela ukuchitha ngokushesha izinto ezifana "nentela yedivayisi yezokwelapha, intela yomshuwalense wezempilo ezinkampanini zomshuwalense, igunya lomqashi, igunya lomsebenzi [ngokubhekiselele igunya lomuntu ngamunye]. "
Indlu yePhalamende uParry Ryan (R, Wisconsin) uthe uthe ulindele ukuvota ukuthi kwenzeke ngo-Mashi noma ngo-Ephreli, kodwa uMongameli Trump, owayeqale ukukhuluma ngevoti yokuphinda ngasekupheleni kukaJanuwari, okukhulunywe ngawo ekuqaleni kukaFebruwari ukuthi ukuchithwa ukuvota kungenzeka kwenzeke kuze kufike ngo-2018.
Yiziphi izigameko ezitshengiswayo
Umlayezo wokuthi i-Congressional Republican isibekezelele ngokuqinisekile iheha abantu abaningi baseMelika:
- Phindela i-ACA, kodwa ngesikhatsi esingeziwe ukuze abantu bangalahlekelwa ukufakwa kwabo ngenkathi balinde ukushintshwa.
- Isu esiphezulu esenziwa abamemezeli siyoba ngcono kune-ACA (nakuba singaboni umthetho wangempela, abantu kufanele bawuthathe izwi labo), futhi okuzohlelwa ukuthi kusebenze ngesikhathi esifanayo nokuqedwa kwe-Obamacare, kungekho gap Iphakathi.
- Ukuchithwa ngokushesha kwezintela ze-ACA, kuhlanganise nokugunyazwa komqashi nokugunyazwa ngabanye, kokubili okwakungavunyelwe neze.
Lokho Okushiwo Ngempela
Ngokuqinisekile kuzwakala kuhle. Kodwa uma sibheka ngaphansi kwe-hood, kunezicucu ezimbalwa ezingekho. Ihhovisi le-Congressional Budget libikezele ukuthi igunya lika-ACA lomqashi kanye nezigwegwe zomuntu ngamunye, kanye ne-Cadillac Tax, izoletha u-R7 297 billion emali evela ku-2016 kuya ku-2025. Lezo zimali zisetshenziselwa ukulungisa izindleko ze-ACA, okubandakanya izindleko zomphakathi ekusizeni kwe-premium nokukhuliswa kwe-Medicaid.
Uma lezo zakhi ezikhiqiza imali ezivela ku-ACA ziqedwa esikhathini esizayo esiseduze, zingagcina ziba yinselele ngokwezezimali ukuze ziqhubeke nokuhlinzeka ngemali nokukhuliswa kwe-Medicaid.
Kodwa kunezinye izinkinga ezinkulu ezingase ziphakame uma amavoti aseCongress maduze aqede i-ACA (ngisho nokuqaliswa kokulibaziseka) bese ulinda izinyanga ezimbalwa ukwethula umthetho wokufaka esikhundleni. Okubili okubaluleke kunazo zonke ukuhlaselwa kwemakethe yomshuwalense wempilo ngayinye futhi kungenzeka ukuthi ibheyili ekhokhelwa indawo ingase ingadluli.
Usho ukuthini, "Ukubhujiswa kweMshwalense Womshuwalense WezeMpilo"?
Isikhathi sokubhalisa okuvulekile sokuvalwa kwe-2017 siphelile, kodwa abathwali bomshuwalense wezempilo kakade bagxile kakhulu ekuhleleni ngo-2018. Abathwali abafisa ukuhlinzeka ngamalungiselelo emakethe ye-federally-facilitated (ie, HealthCare.gov) ngo-2018, amazinga nezakhiwo zokuhlela kumele kuhanjiswe ngoMeyi 3, 2017 lapho kusho ukuthi uhulumeni wesifundazwe uqhuba inqubo yokubuyekeza izinga (Missouri, Oklahoma, Texas, naseWyoming), futhi ngo-Julayi 17 emazweni asele.
Uma umthetho we-ACA wokuphinda usuvele udlulisile ngaleyo phuzu, kodwa ukushintshwa kungakaze kwenziwe futhi / noma kudluliwe, abathwali bomshuwalense wezempilo bazobhekana nokungaqiniseki okukhulu ngokwezinga lokuhlela kwabo okude.
Kufana ngokuqondene nabathwali uma kungenakwenzeka nhlobo ngokuya komthetho-kubandakanya ukuchithwa komthetho-ngamazinga okusebenza kanye namacebo okumele afakwe. Abathwali bayazi ukuthi konke kuphelile emoyeni, lokho kuphezu kusetafuleni, futhi lokho kuthunyelwa akuqinisekisiwe.
Abanye abathwali bangase baqhubeke futhi bafake amazinga namapulani ka-2018 (okungenzeka ukuthi banamanani aphezulu abengayifaka ngaphandle kokungaqiniseki okwamanje azungeze imakethe ngayinye). Kodwa abanye bangase banqume ukuthi ukungaqiniseki kuyingozi kakhulu, bese nje ukhetha ukuphuma ukuhwebelana noma yonke imakethe ekupheleni kuka-2017.
Uma igunya lomuntu ngamunye liqedwa kodwa ukusabalalisa kusazobe kuqinisekisiwe-ngo-2018, kulula ukubona ukuthi kungani ama-insurer angase ahlasele umqondo wokuqhubeka nokuhlanganyela ekukhulumisaneni. Uma kunjalo, kuzoba lula kunanini ngaphambili ukuthi abantu abanempilo bahambe ngaphandle kokufakaza, futhi amachibi amabi azobe esengenelela kubhalisa abagulayo, okusho ukuthi inshuwalense kuzodinga ukungabambi iqhaza nhlobo, noma ukubamba iqhaza ngamaprimiyamu aphakeme kakhulu.
I-Trump Administration ikhulume ukuthi izokhipha imithetho ehlose ukuzinzisa imakethe yomshuwalense wempilo yomuntu ngamunye, kodwa ihlala ibonakala ukuthi imithethonqubo izokwanela ukugcina inshuwalense ezimakethe ngo-2018, nokuvimbela ama-premium kusuka ekuphambeni ngokumangalisayo.
Kwabaningi bomshuwalense wezempilo, imakethe ngayinye iyisiqeshana esincane kakhulu sebhizinisi labo jikelele. Iningi lebhizinisi labo livame ukufaka izinhlelo zeqembu (noma ukwenza njengabaphathi bezinhlelo zeqembu elizimele), amahlelo we-Medicare Advantage, kanye nezinhlelo zokunakekela ezilawulwa yi-Medicaid. Ukuphuma emakethe ngayinye akuyona isinqumo abayithatha kalula, kodwa futhi akusona isinqumo esingawuthinta ukusebenza kwabo bonke ngokuhamba kwesikhathi.
Uma ukushintshwa kungakaze kudlule
Enye inkinga ngokuphinda manje (ngokuqaliswa kokulibaziseka) bese isebenza ukuthuthukisa indawo yukuthi ukushintshwa kungase kungabikho phansi. Mhlawumbe iCongress ngeke ivumelane ngokuklama kwendawo, noma mhlawumbe ayikwazi ukwenza izinombolo zisebenze ngokwemali yokusetshenziswa kukahulumeni ohlelweni lokubuyisela.
Njengoba kuboniswa inqubo eyinde, inselelo yokuphikisana nokudlulisa i-ACA emuva ngo-2009/2010, kucacile ukuthi ukuthola isivumelwano mayelana nomthethosivivinywa wokulungisa ukunakekelwa kwempilo entsha ngeke kube lula.
Futhi kwenzekani uma bengenakukwazi ukuthola noma yini edluliselwe ngokuya esikhundleni? Uma kunjalo, ibhilidi yokuphinda izobe isendaweni, ngokuqaliswa okuphelele okubekiwe ngo-2019 noma kamuva. Futhi uma kungekho lutho oluzoyifaka esikhundleni, ukukhubazeka kwemakethe okuchazwe ngenhla kuzoba okuphawuleka nakakhulu, ngoba ezinye izici ze-ACA (njengokufana nokuqinisekiswa kokukhishwa okuqinisekisiwe) zizobe zisekhona, kanti ezinye (njengezigunyazo ngabanye kanye nezinsizakalo ze-premium) kwakuzoqedwa.
Kuphakathi kwabantu abayizigidi ezingu-20 kanye nezigidi ezingu-30 kungenzeka ukuthi balahlekelwa umshwalense wabo uma i-ACA ichithwa futhi ingasetshenzisiwe ngenye into eqinile. Ihhovisi le- Congressional Budget lilinganiselwa ngoJanuwari 2017 ukuthi abantu abayizigidi ezingu-18 bazolahlekelwa ukukhokhelwa ngonyaka wokuqala emva kokukhokhwa kwemali efana ne-HR3762, nokuthi inani labantu abalahlekelwe ukukhokhelwa lizokhula libe yizigidi ezingu-32 ngaphezu kweminyaka eyishumi.
I-Trump Isho Umthetho Iyoba Ngesikhathi Sonke
Phakathi nomsindo mayelana nalezi ziqeshana ezimbili zomthetho ezethulwa izinyanga ezimbalwa ngaphandle, ama-Republican senators amaningi aqala ukuveza ukungabaza ngaleli qhinga. U-Rand Paul (Kentucky) uLamar Alexander (Tennessee), noTom Cotton (Arkansas) bonke bathi kungcono ukulibazisa ivoti lokuphinda kuze kutholakale uhlelo lokubuyisela. Kukhona ithuba elincanyana kodwa elikhulayo lokuthi ibhilidi lokuphinda ngokushesha lingase lingadluli uma umthetho wokufaka esikhundleni ungakulungeli ukuya ngesikhathi esifanayo.
Ngenkomfa yabezindaba kaJanuwari 10, uTrump uthe izindleko zokuqeda nokushintsha i-ACA zizothunyelwa "ngokuyisisekelo ngesikhathi esisodwa" emva koku-P. Inani liqinisekisiwe ukuhola i-HHS (Inani liqinisekisiwe ngoFebhuwari 10). I-Trump yacacisa kancane, ithi "Kuyoba izingxenye ezihlukahlukene, uyaqonda, kodwa cishe kuzoba ngosuku olufanayo noma ngesonto elifanayo, kodwa mhlawumbe usuku olufanayo." Kungaba yihora elifanayo. "
Lokho kubeka ingcindezi enkulu kubomthetho ukuba bahlangane ngokuzungeze uhlelo lokufaka esikhundleni ngokushesha, kodwa lokho kungase kube lula kunokuba kwenziwe. Okwamanje, ikusasa le-ACA lihlala phezulu emoyeni. Kodwa lapho ukhuluma ngokukhuluma ukuthi akunakho inkinga ngoku "ukuphinda nokulibazisa" ngoba uhlelo olusha luzogcina lukhahle njengoba nje i-ACA iphuma, khumbula ukuthi kunzima kakhulu kunalokho.
> Imithombo:
> Congress of the United States, i-Congressional Budget Office. Ama-Projections abuyekeziwe we-Budget, ngo-2015 kuya ku-2025 . Mashi 2015.
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. I-2018 Incwadi Yabasusa Emkhakheni Wemakethe Wenzelwe Federally. NgoDisemba 16, 2016.
> DonaldJTrump.com. Ukuguqulwa kwezeMpilo. Umkhankaso we-2016.
> Intengo, Tom, US House of Representatives. Umthetho Wokunika Isiguli Wokuqala Oka-2015. May 11, 2015.
> Ikomidi le-Senate lase-United States le-Budget. I-Senate Ukuqala Ingxabano Ngokuxazululwa Kokuphelelwa Komzimba. NgoJanuwari 3, 2017.