Ngonyaka we-2017 wawungumnyaka wokukhathazeka wezinguquko zokunakekelwa kwempilo, kodwa cishe yonke imizamo ye-GOP-eholelekile yokuqeda uMthetho Wokunakekelwa Onganakekelwayo (ACA, ovame ukubizwa ngokuthi yi-Obamacare) awuphumelelanga. Akungabazeki ukuthi uhlobo lokuphinda futhi lushintshe izikweletu ezazisungulwa ngo-2017 kuzophinde zivele ngo-2018, kodwa ikusasa le-ACA kanye nokuguqulwa kwezempilo kuyaqhubeka kungaqiniseki ngaphansi kwe-Trump Administration kanye neRepublican Congress.
Enye yezinkinga eziye zangaphambili kanye nesikhungo yizimo ezandulele. I-ACA inqamule ukubhala phansi kwezokwelapha emakethe yempilo yomshuwalense wezempilo ngabanye nabancane, ngakho-ke izinhlelo zomuntu ngamunye nezincane manje zikhishwe kubo bonke abafakizicelo kungakhathaliseki umlando wezokwelapha, futhi kungekho ukuhluka kwezindleko ezisekelwe esimeni sezempilo.
Lokhu kuye kwaba yindoda kubantu abanezimo ezikhona ngaphambili namabhizinisi amancane anemininingwane emikhulu yezimangalo zempilo, futhi inikeza nokuthula kwengqondo kubantu abangenayo izimo ezikhona ngaphambili, njengoba izimo zezokwelapha zingavela nganoma yisiphi isikhathi, ngezinye izikhathi kungekho isixwayiso.
Kulula ukubona ukuthi kungani ukuthunyelwa kwezimo ezandulele kube esinye sezici ezithandwa kakhulu ze-ACA. Kodwa futhi yinye yezinhlinzeko eziye zaqhubekisela phambili izindleko zokuthengwa kwemakethe ngayinye. Izinsizakalo ze-Premium zithengisa lezo zindleko kubantu abaningi abanokungena ngezingxoxo, kodwa kulabo abangenayo imali (kubandakanya wonke umuntu othenga ukukhokhelwa ngaphandle kwezingxoxo), ama-premiums angaba ngumthwalo osindayo.
Ngakho-ke naphezu kokuthandwa kwemithetho ye-ACA okudinga ukuthi izinhlelo zezempilo zimboze izimo ezikhona ngaphambili, inkinga ihlala ingavumelani. Omunye wemithetho abaphathi be-GOP abaye bayiphakamisela kuyobuyisa emuva izici ezihlukahlukene zokuvikela izigqoko ze-ACA kubantu abanezimo ezandulele, futhi kubalulekile ukuqonda ukuthi lokhu kuzosebenza kanjani, ikakhulukazi uma kuthiwa izitatimende ezisemthethweni mayelana nalezi zingxenye zomthetho zivame ukunikela izimpikiswano mayelana nokuthi abantu abanezimo ezandulela kanjani bazobe bezovalwa.
I-AHCA neMibandela Ekhona Ngaphambili
NgoMeyi 4, 2017, izindlu zeRepublic Republican zidlulisela uMthetho weMpilo waseMelika (AHCA), futhi wawuthumela eSenate. I-AHCA yaba ngumphumela wokuxazulula isabelomali kaJanuwari 2017 owayala amakomidi aseCongress ukuba ahlele umthetho wokubuyisana ukuze aqede izici ezihlobene nokusetshenziswa kwemali ye-ACA (izinto ezifana nokusizwa , ukukhuliswa kwe-Medicaid , igunya lomuntu ngamunye kanye nomqashi ).
Izikweletu zokubuyisana ziyi-filibuster-proof, ngakho-ke zidinga iningi elilula eSenate. Kodwa zilinganiselwe emithethweni ethinta ngokuqondile imali yokusebenzisa imali, ngakho-ke ayikwazi ukubhekana nazo zonke izici zoMthetho Wokunakekelwa Onganakekelwayo. Izazi zezomthetho zazingabaza ukuthi ilungiselelo lokuphulukisa ukuvikelwa kwesimo esandulele isimo se-ACA sizovunyelwa ukuba kuqhubeke kwi-Senate njengesibambiso sokubuyisana.
Kodwa-ke, i- MacArthur Amendment ku-AHCA, eyongezwe eNdlini ngo-Ephreli ngomzamo wokunqoba abameleli abangenalutho, bekuyokwenza lokho nje. Ngenxa yalokho, kwakukhona ukucabanga ukuthi umthethosivivinywa uzoguqulwa kakhulu ukuze udlule iSénate. Ekugcineni, i-Senate Republican ihlongoze izinguqulo ezine ezihlukile zoMthethosivivinywa, konke okungazange kudlule (ukuchithwa kwe-"skinny", uMthetho we- Better Care Reconciliation Act , uMthetho we-Obamacare Repeal Reconciliation Act, kanye nesichibiyelo sikaGraham-Cassidy-Heller-Johnson).
Ngenxa yalokho, imizamo ye-2017 yokuqeda nokufaka izingxenye ezinkulu ze-ACA ayiphumelelanga. Abomthetho be-GOP baphumelele ekuqedeni isigwebo se-ACA somuntu ngamunye njengengxenye yentela yabo yentela eyenziwe ngoDisemba 2017, kodwa ukuchithwa akusebenzi kuze kufike ngo-2019 ( kusekhona isigwebo sokungaqinisekiswa ngo-2018 ).
Iningi le-ACA lonke lihlala lihlelekile ekuqaleni kuka-2018, kuhlanganise nokuhlinzekwa kwe-ACA okudinga ama-insurethi ukunciphisa izindleko ezingaphandle kwe-pocket kubhalisile abahola kancane. Lezi zinzuzo zokunciphisa izindleko (CSR) azisekelwa ngokuqondile nguhulumeni wesifundazwe, kodwa izinzuzo zisatholakala kubabhalisi abafanelekile.
Kodwa izingxabano zezinguquko zokunakekelwa kwempilo zide kakhulu, futhi akucaci ukuthi ngabe i-ACA ingaqedwa kanjani noma ishintshwe ezinyangeni ezizayo ngemithetho ehambisanayo kanye / noma imiyalo ephezulu. Ngakho kubalulekile ukuqonda imizamo yangaphambilini yokushintsha imithetho mayelana nemibandela ekhona ngaphambili, njengoba singabona imizamo efanayo esikhathini esizayo.
I-MacArthur Amendment
Ngo-Ephreli 2017, uMb. Tom MacArthur (R, eNew Jersey) wethule ukuchitshiyelwa ku-AHCA okuhloswe ukusekelwa yi-ultra-conservative House Freedom Caucus. Kwaphumelela, futhi ukusekelwa yi-Freedom Caucus ekugcineni kwabangela amavoti akwanele ukuba i-AHCA idlule eNdlu.
I-MacArthur Amendment yayizovumela amazwe ukuba afune ukuxoshwa-ngaphansi kwalokho okwakubonakala sengathi inqubo yokugunyazwa kwemvume-ezobavumela ukuba bashintshe ukuvikeleka kwabathengi abaningi ku-ACA:
- Abantu abanezimo ezikhona ngaphambili ababhalisela izinhlelo zamakethe ngamunye ngekhasi elikuyo (okungenani izinsuku ezingu-63 ezinyangeni ezingu-12 ezandulele) babeyobe bexhomeke kuma-premium asekelwe emlandweni wabo wezokwelapha ezinyangeni ezingu-12 zokuqala ngaphansi kwenqubomgomo entsha. Kwakungekho umkhawulo wokuthi lezi zinkokhelo zingaba ziphakeme kangakanani, okungahle kuholele ekusakazeni okungenakugwenywa kwabanye abafakizicelo, kuye ngemigomo yabo yezokwelapha. Lokhu kuhoxiswa bekuyobe sekukhona ukukhushulwa kwe-premium engamaphesenti angama-30 ngonyaka owodwa (kungakhathaliseki ukuthi umlando wezokwelapha) ukuthi i-AHCA izobe isebenzise lapho abafaki bezicelo abathile bezimakethe basebenzise emva kwegebe lokuhlanganisa.
- I-AHCA ifuna amaphrimiyamu okwakuzophindwa kasikhombisa kubantu abadala (iminyaka engama-50 kuya ku-64) kunabantu abadala abasebasha. I-MacArthur Amendment yayiyovumela izifunda ukuba zihlukane nalesi sikweletu futhi zenze indawo ephakeme kunalokho. Ngombono, i-ACA igxila isilinganiso esiya ku-3: 1, okusho ukuthi abantu asebekhulile abakwazi ukukhokhiswa izikhathi ezingaphezu kwesithathu kubantu abasha.
- I-MacArthur Amendment nayo yayizovumela amazwe ukuba afune ukuyeka ukushintsha incazelo yezinzuzo zezempilo ezibalulekile . Lokhu bekuyosho ukuthi ezinye izinsizakalo ezidingeka ukuba zihlanganiswe ngaphansi kwe-ACA zingase zingabhekwa emazweni athile uma ngabe i-AHCA yenziwe. Kubantu abanemibandela ekhona ngaphambili, lokhu bekuyikhathazeka enkulu, njengoba ukwelashwa kwabo okudingekile kungase kungabikho umshwalense. Ngaphansi kwe-ACA, izinzuzo zezempilo ezibalulekile zidingeka kuphela ukuba zihlanganiswe izinhlelo zeqembu ngalinye nezincane, kanye ne-Medicaid. Amacebo amakhulu weqembu akudingeki ukuba afake, nakuba iningi lenza.
Yini Yonke Ukungavumelani Ngayo?
Uma ubuke amaRiphabhulikhi kanye namaDemokhrasi bephikisana mayelana ne-AHCA ngemuva kokusungulwa kwe-MacArthur Amendment, cishe u-Democrats uthi umthetho uzovotela ukuvikeleka kwangaphambili kwemvelo, kuyilapho amaRepublicans athi umthetho uvikela ngokuqondile abantu abanezimo ezikhona ngaphambili. Ngakho bekuyini?
Ngokomthetho, i-MacArthur Amendment ithi abantu abakwazi ukuphikiswa ukuxhaswa ngokusekelwe esimweni esandulele. Yilesi sigatshana amaRephablikhi asho uma ethi umthetho wawuhlanganisa nokuvikeleka kwesimo esandulele. Ngesinye isikhathi nabo bahlezi phezu kwenkinga ngokuthi abantu abanezimo ezandulela ngaphambili babengeke babone umthelela omubi uma nje begcina ukufakwa okuqhubekayo.
Kodwa uDeveli usemininingwane. Ngaphansi kokuchitshiyelwa kwe-MacArthur, kuyiqiniso ukuthi isicelo asikwazanga ukunqatshwa ngokuphelele (esasetshenziswa njalo emazweni amaningi ngaphambi kwe-ACA, lapho abantu benemibandela engakafiki ekhona futhi bafake isicelo sokuthengiswa kwamakethe). Kodwa izinkampani zomshuwalense ziyokwazi ukukhokhisa amaphrimiyamu aphakeme kakhulu emakethe ngayinye kulesi sikhungo ngokushiya imali, uma abafakizicelo benemibandela ekhona ngaphambili futhi bebe ne-gap ekubhekaneni nezinyanga ezingu-12 zangaphambili.
Lokho kungase kube nokwenza okungeke kwenzeke. Ngakho-ke noma ngabe isicelo singenqatshelwe, ukungena komthengi ukufinyeleleka bekungeke kwenzeke. Sonke sine "ukufinyelela" kwi-Lamborghinis. Kodwa lokho akusho ukuthi sonke singaba neWalorghinis.
I-MacArthur Amendment iphinde yafaka ingqinamba ngokuphathelene nezinzuzo ezibalulekile zezempilo. Uma ngabe izwe likhethe ukukhipha imithetho esebenzayo emithini yemithi kadokotela, isibonelo (enye yezinzuzo zezempilo ze-ACA), kungenzeka sibone izinhlelo ezingazange zihlanganise uhla olugcwele lwegama lomkhiqizo nezidakamizwa ezikhethekile. Leyinkinga enkulu kubantu abanezimo ezikhona ngaphambili ezidinga imithi ebiza kakhulu.
Ngokufanayo, uma ngabe izwe lithatha ukhetho lokubeletha ngokubeletha (kungenye yezinzuzo zezempilo ezibalulekile futhi ngaleyo ndlela kudingekile ngaphansi kwe-ACA), iningi lezinkampani zomshuwalense emakethe ngayinye ngeke liphinde linikeze, njengoba kunjalo ngaphambi kwe-ACA .
Ngakho-ke ngenkathi amaRiphablikhi asebenza kahle ngokusho ukuthi i-AHCA ehlongozwayo ngeke ivumele abanikezeli bomshuwalense ukuba baphikise izicelo ngokusekelwe ezimweni zangaphambili, iMacArthur Amendment yayinganciphisa ukuvikelwa emakethe ngayinye kubantu abanezimo ezikhona ngaphambili. Futhi ngenxa yezinguquko ezingase zibe khona ekuchazeni izinzuzo zezempilo ezibalulekile, umthelela ungadluliselwa emakethe exhaswe ngumqashi futhi.
Yini enye i-AHCA eyayingayenza?
I-AHCA izobe isuliwe isigwebo somuntu ngamunye we-ACA emuva ekuqaleni kuka-2016, isusa esinye sezikhuthazo ezigcina abantu abanempilo eqenjini lomshuwalense (umshuwalense usebenza kuphela uma kukhona abantu abanempilo ephelele echibini ukuze balinganise izimangalo abantu abadinga usizo lwezempilo). Kodwa ukusabalalisa bekuzobe kuqinisekisiwe-kungakhathaliseki ukuthi umlando wezokwelapha umfakisicelo.
[Phawula ukuthi isigwebo somuntu ngamunye sichitshiyelwe kumthethosivivinywa wezezimali we-GOP owasungulwa ngasekupheleni kuka-2017, kodwa ukuchithwa akusebenzi ukusebenza kuze kube ngo-2019. Yonke imizamo yomthetho yokuqeda nokushintsha i-ACA ngo-2017 yayihlanganisa ukuchithwa okuphindaphindiwe ukugunyazwa ngabanye, kodwa umthethosivivinywa wentela uphonsela ukuphonswa esikhathini esizayo esikhundleni.]
Ukuze kuvuselele abantu ukuthi balondoloze ukwaziswa, ekuthiwa abazange bafune ukuxoshwa ngaphansi kweMacArthur Amendment, i-AHCA ingabe isethembele ngokukhokhwa kwemali ekhokhelwa abantu abangekho ukugcinwa okuqhubekayo. Ukubhalisa emva kwesikhathi sokubhalisa okuvuliwe ngo-2018 (okungukuthi, noma ubani obhalisa ngesikhathi sokubhalisa esikhethekile ngo-2018, noma ngesikhathi sokubhalisa okuvulekile ngo-2019 nangaphambilini), abafakizicelo bazobe behlolwe amaphesenti angu-30 ephakeme kunezinga elijwayelekile uma benalo igebe ekukhunjweni kwezinsuku ezingu-63 noma ngaphezulu phakathi nezinyanga ezingu-12 ngaphambi kokubhalisa. Amaprimiyamu aphezulu ayeyohlala ekhona kulo nyaka osele wepulani.
Kubalulekile ukuqaphela ukuthi amaphrimiyamu aphezulu ayeyofaka isicelo kunoma ubani obhalisa kwinqubomgomo yamakethe ngayinye elandela igebe elikuyo. Akungakhathazeki ukuthi lowo ofake isicelo unempilo noma uyagula. Ngandlela-thile, lokhu kubangela ukuba abantu abanempilo bangabhaliswa ngemuva kokungena kwegebe, futhi bangaphinde bahlasele amachibi omshwalense kubhalisa abagulayo.
Ingabe i-ACA Imizamo Yokunciphisa Inhloso Yokubuyisela Emithethweni Yomshuwalense we-Pre-ACA?
Idatha ye-Kaiser Family Foundation yakamuva ibonisa ukuthi amaphesenti angu-27 abantu abadala asebekhulile ase-US abanemibandela ekhona ngaphambili ezobenza bangenakulinganiswa emakethe ngayinye uma sibuyela emazingeni obhaliswa ngaphansi kwezokwelapha ezazikhona cishe kuwo wonke amazwe ngaphambi kuka-2014 .
I-AHCA ekugcineni ayiphumelelanga ngo-2017, ngoba zonke izinguqulo ze-Senate zahluleka ukudlula. Kodwa noma ngabe i-AHCA idlulile, ayizange ibuyele emuva ekubuyiseleni izinto ngendlela ababeyi-AC-preA. Nakuba kunabamemezeli abathile abaqaphele kakhulu abaye bahlongoza ukwenza kanjalo , ukubuyela ekubhalweni okugcwele kwezokwelapha emakethe ngayinye yisiphakamiso esingenakulinganiswa kwezombusazwe.
Kodwa noma ngabe izivikelo ze-ACA zangaphambi kwesikhathi ezikhona zizoqedwa, iningi labantu baseMelika lizobe livikelwe, ngenxa yemithetho eyandulela i-ACA. Ake sibheke ukuthi basebenza kanjani:
I-Pre-ACA: Imithetho ehlukene ngokususelwa kuhlobo lomshwalense
Kunezindlela ezine ezisemqoka abantu baseMelika abazithola umshuwalense wezempilo: Ukunikezelwa okuxhaswe ngabasebenzi, Medicare, Medicaid, kanye nemakethe ngayinye. Ungalindela izinto ezihlukile kuzo zonke zazo ngaphansi kwe-Trump Administration .
Uma ukuvikeleka kwesimo se-ACA esandulele kwakuzocinywa, umthelela awunakufana nawo wonke amaqembu amane. Izinguquko eziyinhloko ezenziwe yi-ACA ngokwemibandela yangaphambili ekhona emakethe ngayinye, lapho amaphesenti angaba ngu-7 e-US athola umshuwalense wezempilo.
I-HIPAA izobe isalokhu ivikela i-Group Plan Enrollees
I-HIPAA (uMthetho Wokubheka Umshuwalense Wezempilo kanye Nokuziphendulela Kwezempilo) ibuyele phakathi neminyaka engama-90, futhi isikhathi eside inikeze ukuvikelwa okuphawulekayo kubantu abathola ukutholakala kumqashi (cishe amaphesenti angu-49 abantu base-US abanomsebenzi oxhaswe ngumqashi). Ngisho nokuchithwa okugcwele kwe-ACA-ngokuphambene nomthethosivivinywa wokubuyisana njengo-AHCA-ngeke uqede ukuhlinzekwa kwe-HIPAA, ngakho-ke abantu abathola ukuqashelwa kubaqashi babo bazobe benesimo semibandela ekhona ngaphambili.
Kodwa ngaphambi kokuba i-ACA, ngaphansi kwemithethonqubo ye-HIPAA, izinhlelo ezixhaswe ngumqashi zingenza izinkathi zokulinda zesikhangiso se-pre-existing (ngaphandle kokubeletha, ukucabanga ukuthi lolu hlelo luhlinzekelwe ngezinzuzo zokubeletha) uma obhalisile engagcinanga ukufakwa kokugcina ngaphambi kokubhalisa kuhlelo.
Uma nje lowo muntu egcine ukugcinwa okuqhubekayo okungenani izinyanga eziyi-12 ngaphandle kwegebe lezinsuku ezingu-63 noma ngaphezulu, izimo ezandulele zivele zenziwa ngokushesha nje uma ukufakwa kokusebenza konke kusebenza kahle. Kodwa uma obhalisile abe nekhasi lokubanjwa kwezinsuku ezingaba ngu-63 ngaphambi kokubhalisa ohlelweni oluxhaswe ngumqashi, lolu hlelo lungabeka isikhathi sokulinda kuze kube yizinyanga ezingu-12 ngezimo ezandulele.
I-ACA yaqeda lelo lungiselelo. Ngaphansi kwe-ACA, izimo ezandulele zikhona kuzo zonke izinhlelo ezixhaswe ngumqashi, nakuzo zonke izinhlelo ezingakabonakali kakhulu (futhi ezingenabo amakhulu) ezimakethe, ngokushesha nje lapho ukufakwa komuntu ngaphansi kohlelo kusebenza.
I-ACA iphinde inqabe ama-insurers ekushaja amaqembu amancane ama-premium engeziwe ngokusekelwe emlandweni wezokwelapha zabasebenzi. Ukufakwa kweqembu elincane kwase kuqinisekisiwe kakade ngaphansi kwe-HIPAA, kodwa abathwali bangakwazi ukukhokhisa amaphrimiyamu aphezulu kumaqembu anempilo enhle kakhulu. Uma i-ACA iqale ukusebenza, lokhu kuvinjelwe, futhi amaphrimiamu amancane amaqembu angase asekelwe kuphela kubhalisile, indawo, ubukhulu bomndeni, nokusetshenziswa kogwayi.
Uma i-ACA ichithwe futhi ukufaka esikhundleni akuzange kubandakanye ukuhlinzekwa kokuvinjelwa isikhathi sokulinda kwezimo ezandulele, imithetho yayizobuyela emuva ngendlela eyaba ngayo ngaphambi kuka-2014. Abantu abagcina ukugcinwa okuqhubekayo ngeke babe nezinkathi zokulinda zangaphambili izimo lapho ujoyina uhlelo lwezempilo lomqashi. Kodwa abantu abanesiphakamiso sokubheka kungenzeka babe ngaphansi kwezikhathi zokulinda kwezimo ezandulele. Futhi amaqembu amancane anabasebenzi abasempilo engafanele angabhekana nezinkokhelo eziphakeme kakhulu kunamaqembu amancane anezisebenzi ezinempilo.
Kodwa i-AHCA ayingayikuqeda lezo zinhlinzeko ze-ACA (ekhumbula ukuthi kwakungumthethosivivinywa wokubuyisana, ngakho-ke wawuncane ngokwalokho okungashintsha). Ngaphansi kwe-AHCA, ukuvinjelwa kwezimo zangaphambili ezikhona zokulinda izinhlelo ezixhaswe ngumqashi bekuyohlala kusebenza, futhi ama-premium emakethe amancane ahluleka ukuxhomeke esimweni sezempilo seqembu labaqashi.
I-Medicare ne-Medicaid izoqhubeka nokumboza izimo zangaphambili ezikhona
I-medicaid ne-Medicare ikhava izimo ezikhona ngaphambili. Kukhona ezinye izigqoko ezibhekene neMedare, noma kunjalo, ezingenakho lutho nge-ACA:
- Ezingxenyeni eziningi, abantu ababhalisa ohlelweni lweMedigap ngemuva kwewindi lokuqala lokubhalisa (futhi ngaphandle kokufinyelela kwelinye lezinkathi zokubhalisa ezikhethekile kakhulu eMedigap) kuncike ekubhalweni kwezokwelapha. Izicelo zabo zinganqatshwa, zinganikezwa uhlelo nge-premium ephakeme kune-standard, noma othwalayo angabeka isikhathi sokulinda sesimo esandulele.
- Ezimweni eziningi, uma unesifo se-renal esiphezulu (ESRD), awukwazi ukubhalisa ku- Medicare Advantage .
Yize i-ACA ingashintshi lutho mayelana nokuhlinzekwa kwesimo esandulele esikhona ngaphansi kwe-Medicare ne-Medicaid, yenza kakhulu ukwandisa ukufinyelela kuMedicaid. Ukubhaliswa okuphelele ku-Medicaid / CHIP kuye kwanda ngabantu abangaphezu kwezigidi ezingu-17 kusukela ekupheleni kuka-2013, kubonga kakhulu ekukhuleni kwe-ACA kwemigomo yokufaneleka ye-Medicaid.
Ngaphambi kwe-ACA, i-Medicaid (okubandakanya ukufakwa kwezimo ezikhona ngaphambili) yayitholakala kakhulu kulabo besifazane abakhulelwe abahola kancane, nabanye abazali abangenayo imali kakhulu, kanye nabakhileyo abahola kancane abakhubazekile kanye / noma asebekhulile.
Ngaphansi kwe-ACA, i-31 ithi nesifunda sase-Columbia sandeze i-Medicaid kubo bonke abantu abadala abanezinkokhelo zasemakhaya kuze kube ngu-138% wezinga lobuphofu, elingamaphesenti angama-16,700 ngemali engenayo yonyaka umuntu ongashadile ngo-2018.
Uma i-ACA ekugcineni isuliwe futhi ukushintshwa akukona okunamandla, izigidi zabantu okwamanje zineMedicaid zingahle zilahlekelwe ukufinyelela okufinyeleleka kokufinyelela. Bazokwazi ukuthenga ukuthengiswa emakethe ngayinye (mhlawumbe banezinhlobo ezithile zempesheni yentela), kodwa lokho kungase kungabi yimali ebonakalayo kulabo abanemali ephansi kakhulu. Uma bekungabikho abaqinisekisiwe, izimo zabo ezikhona ngaphambili zazingasakwazi ukumbozwa, futhi noma ngabe kunjani ukunakekelwa kwezempilo okungalindelekile okungadingeka.
I-AHCA idinga ukubhaliswa kwamahhala ekudleni i-Medicaid kusukela ngo-2020, futhi kushintshela i-Medicaid kwisabelo somuntu ngamunye noma kuvimba isibonelelo kunokuba isistimu yamanje ehambisana nephephandaba evulekile esetshenziswa namuhla.
Lokhu akuzange kwenzeke, kodwa ukuLawula iTrump sekuqalile ukuthatha indlela ehlukile yokunciphisa ukubhaliswa kwe-Medicaid ngokuphumula imithetho ekuhambeni kwemithetho echaza ukuthi ingafuna izinhlelo zabo ze-Medicaid (i-Medicaid ixhaswe ngokuhlanganyela nguhulumeni wesifundazwe nesifundazwe, ngakho-ke kuthiwa isandla ekudaleni ezinye zezimiso). Izinto ezinjengezidingo zomsebenzi kanye nama-caps wokubhalwa kwesikhathi sokuphila azange avunyelwe ngaphansi kwe-Obama Administration, kodwa zivunyiwe noma zicutshungulwa ngu-Trump Administration. Ekugcineni, umgomo we-Trump Administration kanye nabomthetho be-GOP kufanele babe nabantu abambalwa abahlanganiswe yi-Medicaid. Ngeshwa, asikho isithombe esicacile sokuthi labo bantu kufanele bathole kanjani ukwaziswa okunye, futhi abaningi bayobe bengabanikezwa ngaphandle kokufinyelela ku-Medicaid.
Izimo zangaphambili ezikhona kanye noMakethe ngamunye
Njengoba kuchazwe ngenhla, i-AHCA-ne-MacArthur Amendment-yayizobuyisela emuva ezinye zezivikelo zangaphambili ezikhona ezidalwe yi-ACA.
Ukuqonda ukuthi izimo zangaphambili ezikhona ezazisetshenziswa kanjani ngaphambi kokuba i-ACA iyingxenye ebalulekile yokuqonda ukuthi kungani i-ACA yayidingeka kuqala, futhi yini okumele ikhokhwe uma ukuvikelwa kwesimo esandulele kushintshiwe.
Ukubheka emakethe ngayinye kuzo zonke izifundazwe eziyisihlanu kodwa kubhalwe phansi ngokwemithi ngaphambi kuka-2014, ngenkathi i-ACA ivimbela lo mkhuba (ukuthengwa kwemakethe ngayinye uhlobo oluthengela wena-ngokusebenzisa ukushintshaniswa noma ukushintshana- ngaphandle kokukuthola kumqashi ).
Kukhona abantu abangaphezu kwezigidi ezingu-17 abanomsebenzi kumakethe ngamunye. Abaningi babo bebelokhu benomsebenzi wokuthengisa emakethe ngaphambi kwe-ACA, kodwa abanye bakwazi ukuthola kuphela ukutholakala lapho imithetho ye-ACA iqale ukusebenza futhi abathwali babengasakwazi ukuphika izicelo ngokusekelwe emlandweni wezokwelapha zabafakizicelo.
Ukubhaliswa kwezokwelapha kwakusho ukuthi izicelo zomshuwalense wezempilo emakethe ngamunye zihlanganisa uhlu olude lwemibuzo mayelana nomlando wezokwelapha zabafakizicelo. Ukufaneleka kokufaneleka kuxhomeke kwizimpendulo, futhi kubantu abavunyelwe ukubhalisa naphezu kwezimo zabo zangaphambili, ama-premium ayevame ukuphakama kunamazinga ajwayelekile.
Izimo ezandulele zifakiwe ngokuyinhloko noma yikuphi ukuxilongwa kwezokwelapha. Ukuqhathanisa ngokweqile, ukuphakamisa i-cholesterol noma ukucindezelwa kwegazi, umlando wokuvakashelwa kwe-chiropractor ... konke kwahlaziywa ngabanyathelisi bezokwelapha ukuze banqume ukuthi ngabe umfakisicelo ufanelekile yini ukukhokhelwa, futhi uma kunjalo, ngentengo ngayiphi indlela.
I-ACA ishintshe konke lokho. Ngokwemakethe ngayinye, imithetho ye-ACA yangaphambili ekhona yimiguquli yemidlalo. Izicelo ezinqatshelwe kanye nama-premiums akhule ngenxa yomlando wezokwelapha zaba yinto esedlule, njengokwenziwe isikhathi esiluvele sesikhathi sokulinda.
Ngaphandle kwe-AHCA, ezinye izicucu ze-ACA zokuchithwa / ukufaka esikhundleni somthetho zenziwa ngabomthetho be-GOP kusikhathi sika-2017. Abaningi babo bacela ukugcina ukuvikeleka kwamanje kwe-ACA kubantu abanezimo ezandulele.
Kodwa uma izidingo eziqinisekisiwe zokukhishwa kwe-ACA zingagcinwa, kunezindlela ezimbili eziyinhloko zokufaka izimo ezikhona ngaphambili ezifakwe kuzo eziningi zeziphakamiso ezivezwe eminyakeni embalwa edlule: amachibi angaphezu kwengozi noma "imfuneko yokuqhubekayo" , noma kokubili.
Zombili zifakwe kuMthetho WokuQala AbaPhezulu Abanamandla, owethulwa nguTh. Tom Price (R, Georgia), owaqinisekiswa yiSenate ngoFebruwari 2017 ukuba abe uNobhala WezeMpilo NezeNkonzo Zabantu (Intengo ishicilelwe emuva ngo-2017, phakathi kwemibiko ethi wasebenzisa ama-jets akhethekile esikhundleni sezindiza zezokuhweba ekuhambeni kwakhe kwebhizinisi). Zombili zifakwe ku-A Way Better, isiphakamiso sokulungisa isimo sezempilo esivezwa yi-House Republican ngoJuni 2016.
Amachibi aphezulu
Iningi leziphakamiso zokuguqulwa kwempilo yeRiphabhuliki zifake ukubuyisela emachibini aphezulu okubeka amathuba okuqinisekisa abantu abangakwazi ukuthola ukuthengiswa emakethe ngayinye (ngeziphakamiso ezibandakanya ukuhlinzekwa okuqhubekayo, amachibi aphezulu okumele abhekele ukumboza abantu abangagcinanga ukugcinwa okuqhubekayo, nokuthi izimo zabo ezikhona ngaphambili zibalulekile ngokwanele kangangokuthi abakwazi ukuthola ukutholakala kokubhalwe ngokomuthi).
Amapulazi aphezulu kakhulu asungulwa emazweni angu-35 phakathi nama-90 no-00. Kodwa ukwehluleka okuphelele kwesimodeli esikhulu samanzi echibi kwakuyingxenye yesizathu sokuthi i-ACA iyadingeka kuqala. Amalungiselelo ayevame ukuba abizayo, futhi ngokuvamile ayenokuphakanyiswa okuphezulu kwe-pocket kanye nezinzuzo ezilinganiselwe zokuphila esikhathini esizayo. Ukwengeza, amanye amachibi aphezulu okumele aphephe ukubhaliswa eminyakeni edlule ngenxa yenkinga yebhajethi.
Amachibi aphezulu kakhulu aphelile ukusebenza lapho kuqinisekiswa ukuthi ukuthengiswa kwemakethe ngamunye kutholakala ngo-2014. Kodwa amanye amanje asenamachibi aphezulu asebenzayo. Ngenkxaso yezimali eyaneleyo, amachibi aphezulu angase abe yisisombululo esisebenzayo esiqhubeka phambili. Kodwa ngaphandle kokuthola imali eyanele, cishe akunakwenzeka ukuthi bayobe baphumelela kakhulu kunayo yonke iminyaka eyaholela ekusebenzeni kwe-ACA.
I-AHCA izobe ihlinzekele ngemali yezemali ukuze amazwe asetshenziselwe ukusebenzisa amachibi aphezulu, kodwa futhi ayengayisebenzisa ukuze kube neminye imizamo yokuqiniswa kwemakethe. Futhi ochwepheshe ngokuvamile bathi ukuxhaswa kwamachibi aphezulu e-AHCA bekungeke kube ngokwanele ukuvumela amachibi aphakeme kakhulu ukuba asebenze kahle.
Ukuqhubeka okuqhubekayo
Ngaphansi kwe-ACA, ukuhanjiswa kuyinkinga eqinisekisiwe, isikhathi. Akubalulekile ukuthi uke waqinisekiswa isikhathi esingakanani uma ubhalisa, futhi akunandaba ukuthi yiziphi izimo ezikhona ngaphambili (kodwa ungakwazi ukubhalisa ngesikhathi sokubhalisa ngonyaka ovulekile, noma ngesikhathi sokubhalisa esikhethekile uma uhlangabezana nesenzakalo esifanelekayo).
Ngaphansi kweziphakamiso ezihlukile zokuguqulwa kwe-GOP ezibiza ukufakwa okuqhubekayo, umqondo wukuthi ukwandisa ngokuyinhloko ukuvikela kwe-HIPAA emakethe ngayinye. Abantu abagcina ukugcinwa okuqhubekayo (kungaba ohlelweni lweqembu noma uhlelo olulodwa) bazokwazi ukubhalisa ohlelweni olusha kwi-premium ejwayelekile, kungakhathaliseki ukuthi kukhona izimo ezikhona ngaphambili (okungukuthi, ngaphandle kokubhaliswa kwezokwelapha).
Kodwa abantu abahlangabezana negebe ekubambeni bazoba ngaphansi kwezijeziso. Umqondo uwukugqugquzela abantu ukuthi balondoloze ukufakwa okuqhubekayo ngaphandle kokusebenzisa igunya lika-ACA elingavunyelwe ngabanye.
Ezizweni ezingazange zifune ukuxoshwa ngaphansi kwe-MacArthur Amendment, i-AHCA yayiyofaka inkokhelo yokukhokhela imali yezinkokhelo kubantu abangekho ukugcinwa okuqhubekayo. Amaphrimiyamu engeziwe ayesebenza ngendlela efanayo, kokubili abafakizicelo abanempilo nabagulayo.
Lokhu kuhluke nokuhlinzekwa okuqhubekayo okuzovumela abakwa-insurer ukuba basebenzise ukubhala phansi kwezokwelapha lapho abafakizicelo bebhalisa ukulandela igebe ekufundeni. Yileyo ndlela eyayizosetshenziswa ngaphansi kwe-AHCA emazweni athi afuna ukuyeka ukwenza kanjalo. Kulawo mazwe, abantu abanempilo enesiphakamiso sokubambisana bazokwazi ukubhalisa ekuthengeni kwamakethe ngamanani ajwayelekile. Kodwa abantu abanezimo ezandulele (okuluhlu olubanzi kakhulu) bebeyobekwa ngaphansi kwama-premium aphakeme kakhulu uma befaka isicelo sokuthengiswa kwamakethe ngaphandle komlando wokuqashwa okuqhubekayo phakathi nonyaka odlule.
Ingabe Ngidinga Ukukhathazeka?
Mhlawumbe, nakuba kuxhomeke ekuqondiseni ukuthi izinguquko zokunakekelwa kwezempilo esikhathini esizayo zithatha. I-AHCA ayisekho ngaphansi kokucatshangelwa, kepha okunye okungahle kuvele ngo-2018 noma ngonyaka ozayo, ikakhulukazi uma amaRiphabhuliki egcina izikhulu zawo eCongress ngemuva kokukhethwa kuka-2018 phakathi nonyaka.
I-version ye-AHCA eyadlulela iNdlu yayiyoba yingozi kakhulu kubantu abanezimo ezikhona ngaphambili ezazifuna ukukhishwa emakethe ngayinye. Kwakunenkinga futhi ngokuthi kungenzeka ukuthi izinzuzo zezempilo ezibalulekile kungenzeka zaphuziswa, okwenza kube nzima ukuthi abantu abaneqembu elincane bahlele ukuthola ukutholakala kwezimo zabo ezikhona ngaphambili.
Futhi ngisho nasemakethe amakhulu amaqembu, izinhlinzeko ze-ACA zokuvimbela ama-maximum wokuphila kanye nezinzuzo zonyaka zemihlomulo kanye nokunciphisa izindleko ze-out-of-pocket zisebenza kuphela ezintweni ezibalulekile zezempilo (ezingadingeki ukuba zihlanganiswe ngaphansi kwamaqembu amakhulu amaqembu, kodwa uma zikhona-futhi zivame uku-ukuvinjelwa kwemali yokuphila / yenzuzo yonyaka kanye nezindleko ezithathwa ngaphandle kwezindleko). Ngakho-ke uma izinzuzo zezempilo ezidingekayo zibuyiselwe emuva, abantu abanezidingo eziqhubekayo zezokwelapha abanezinhlelo ezixhaswe ngumqashi nabo bangathinteka futhi .
Ngo-2017, abameli beRiphabhulikhi bathi ngokuphindaphindiwe i-AHCA izoqhubeka nokuvikela abantu abanezimo ezandulele, nakuba lokho kwakungelona iqiniso ngempela. Ikusasa lokuguqulwa kwempilo yezempilo lizobonakala, futhi ukukhathazeka mayelana nemibandela ekhona ngaphambili kuyasebenza. Kodwa okwamanje, akukho lutho olushintshile mayelana nezinzuzo zezempilo ezibalulekile kanye nokubhalwa kwezimo zangaphambili.
> Imithombo:
> Ihhovisi le-Congressional Budget, uMthetho wezeMpilo waseMelika, ngo-Mashi 13, 2017.
> HealthCare.gov, Izinhlelo ze-Assurance Health Grandfathered.
> Kaiser Family Foundation, Ukuphepha Kwempilo Yomphakathi Yonke Inani labantu. 2016.
> Kaiser Family Foundation, Imibandela Ekhona Ngaphambi Kokubhaliswa Kwezokwelapha Emakethe Yomshwalense Ngamunye Ngaphambi kwe-ACA. NgoDisemba 12, 2016.
> Kaiser Family Foundation, i-Kaiser Health Tracking Poll-Juni 2017: I-ACA, i-Replacement Plan, ne-Medicaid. NgoJuni 23, 2017.
> I-United States uMnyango Wezabasebenzi, Ukuhlomula Kwezempilo Ngaphansi Komthetho we-Federal. September 2014.
> UMnyango Wezabasebenzi waseMelika, Umthetho Wempilo Yokwethenjelwa Kwempilo Nokuthenjelwa (HIPAA) Ukuhamba Kwempilo Nokuzikhethela Ukuzikhethela Imibuzo FAQ.