Phakathi nezinkulumo zokuvuselela i-AHCA, ukungabi nakhubazeka kungena ezimakethe zomshuwalense
Lapho uDonald Trump ethatha ukhetho lukaMengameli ngoNovemba 2016, ikusasa loMthetho Wokunakekelwa Ongenakusiza (aka Obamacare) ngokungazelelwe aliqiniseke kakhulu .
I-ACA ibhekene nezingqinamba zangaphambilini, kuhlanganise necala leNkantolo eNkulu yase-2012 eyathola igunya lomthetho elilodwa lokuba ngumthethosisekelo (kodwa hhayi isidingo esitshalayo sokwandisa iMedicaid ukuze kugcine imali ekhona ye-Medicaid ), necala leNkantolo eNkulu e-2015 lapho i- ACA ukuxhaswa kwe-premium kunqunywe ukuba kube ngokomthetho kuwo wonke amazwe.
Futhi-ke, sekube khona uchungechunge lokushaya okusemthethweni umthetho kusukela lapho usungulwa. Akekho kulawo maqhezu omthetho okwakungakaze kube khona ithuba langempela, kodwa ngenxa yesibalo se-veto sikaMengameli we-Obama.
Izinto zazibukeka zihluke kakhulu kusukela ngo-Novemba 9, 2016. Ngeningi lamaRiphabhuliki emaceleni omabili eCongress, naseRepublican e-White House abaye bakhankasela esiteji sokuqeda i-ACA ngaphandle kwamasango, kubonakala sengathi ukuma kancane i-GOP ekwenzeni okuhle eminyakeni eyisikhombisa yezithembiso zokuqeda i-ACA.
Kodwa i-ACA isiboshwe ngokuqinile kwisakhiwo somshuwalense wezempilo yethu, futhi inani labantu abanomshwalense wezempilo lenyuke cishe abangaba yizigidi ezingu-20 ngenxa ye-ACA (ikakhulukazi ngokukhushulwa kweMedicaid nokuthengiswa kwamakethe, nakuba abanye bebancane abantu abadala abaye bathola ukuhlolwa ngaphansi kwezinhlelo zezempilo zabazali babo). Ukuphinda futhi / noma ukushintsha i-ACA kuye kwafakazela ukuthi kuyinselele kunokuba ivele kuqala.
Kwenzekani Kude Kangaka?
NgoJanuwari, ngaphambi kokuthi uTrump asebenze, iCongress yadlula iSecon.Res.3, isixazululo sesabelomali esenza ibhola liguqulwe ngenqubo yokuqeda izici ezihlobene nokusetshenziswa kwe-ACA. Isixazululo sasiqondisa amakomidi ezinhlangano zokubamba iqhaza ukuze kulungiswe umthethosivivinywa wokubuyisana owawuzosetshenziselwa ukuchitha noma ukushintsha izingxenye ze-ACA ezithinta ngokuqondile isabelomali sesifundazwe (izindleko zokubuyisana ziyi-filibuster-proof, ngakho-ke zidinga kuphela iningi elilula ukuba lidlule; , noma kunjalo, kumalungiselelo okuthinta ngqo isabelomali).
Izicucu eziningana zomthetho ongelona ukubuyisana ezihlobene ne-ACA zatholwa ekuqaleni kuka-2017 , kodwa akekho oye waqhubeka nokuvotela. Ibhilidi yokubuyisana elabangelwa ukulungiswa kwesabelomali sika-Januwari-i-American Health Care Act, noma i-AHCA-yasungulwa ekuqaleni kuka-Mashi.
Kodwa ngemuva kwezinsuku ezingu-18 zokuxoxisana okusheshayo kanye nezinguquko zokugcina ngomzuzu wokugcina, uSomlomo weNdunankulu neNdlu uParry Ryan (R, Wisconsin) wadonsa imizuzu emibili ngaphambi kokuthi iNdlu ihlelwe ngoMashi 24. Ngokushesha ngemva kwalokho, uRyan unikeze inkomfa yabezindaba emfushane lapho ethi i-ACA ilapha ukuzohlala ikusasa elibikezelayo, nokuthi lawo maRiphabhuliki azoqhubeka nokunye okunye okwenziwe kwi-ajenda yabo.
Nokho, lokho kwakunesikhathi esifushane. Ngasekuqaleni kwesonto elilandelayo, uRyan wathi i-AHCA ibuyele etafuleni. I-House Freedom Caucus, iqembu elizimele lama-Representatives aseRiphabhuliki, kanye nabanye abomthetho ekupheleni komgogodla we-spectrum, bebegxile kakhulu emcimbini wokuqeda i-ACA, futhi bebengathandi ukuyeka ngokushesha.
Kungani i-AHCA ihluleka isikhathi sokuqala?
AmaRephablikhi aneningi eNdlu, kodwa uma amaRepublican angaphezu kwezingu-22 ephula izinkampani zawo, lesi silinganiso ngeke sidlule.
Ngesikhathi sokubukwa kukaMashi phezu kwe-AHCA, kwakukhona okungenani ama-Republican angama-33 awazange asekele umthetho (amaDemocrats ayephikisana nomhlaba wonke).
Kodwa lawo maRepublican angu-33 ayengabumbene emibonweni yabo; babe nezizathu ezihluke kakhulu zokuphikisa i-AHCA. Ngesikhathi sokuphela kwesigameko, amalungu e-Freedom Caucus akholelwa ukuthi umthetho awuzange uhambe ngokugcwele ekuqedeni i-ACA, engathanda ukuyiqeda ngokuphelele (umthetho wokubuyisana ngeke ukwazi ukuwuqeda ngokuphelele i-ACA, kodwa i-Freedom Caucus Amalungu afuna umthethosivivinywa okungenani unamandla njengo-HR3762, owavotelwa nguMongameli Obama ngo-2016).
Futhi ekupheleni kokulinganisela kombono, abomthetho babekhathazekile ngokubheka kwe-CBO ukuthi abantu abangaqinisekisiwe bazokhula ngabantu abayizigidi ezingu-24 kule minyaka eyishumi ezayo ngaphansi kwe-AHCA, futhi mayelana nezinguquko ze-AHCA ekunwetsheni kweMedicaid kanye nezimali zikaMedicaid.
Kwenzekani Ngesibili Sonke?
Ngasekuqaleni kuka-Ephreli, iNdlu yamaRephabliki, ngokubandakanyeka ngokuqinile nguMongameli uMike Pence, noNobhala weHHS uTom Price, kubonakala sengathi bayakhipha umthetho wabo wokuguqulwa, kodwa basengxoxweni mayelana nezinguquko ezizofakwa.
Inkinga ibangelwa ukuthi ukungqubuzana kweRiphablikhi kokuqala kuzokuvela ezilinganisweni kanye nabantu abasemuva ekugcineni kwesokudla kwezepolitiki. Izinguquko ezisetshenziselwe ukuheha amalungu e-Freedom Caucus aqiniseke ukuthi ahlukanise amaRephabhulikhi ajwayelekile, futhi ngokufanayo.
Ekuqaleni, abaholi bePeni kanye neRiphabhuliki babenikeza isiphakamiso sokufaka uhlelo lokuxoshwa oluthi luzokwazi ukusebenzisa ukuguqula izidingo zezempilo ze -ACA ezibalulekile kanye nokuvinjelwa kwe-ACA ngokusekela izinkokhelo zomshuwalense wezempilo emlandweni wezobuchwepheshe. Amalungu e-Freedom Caucus afuna ukuthi izifunda zikwazi ukuchaza izinzuzo zabo ezibalulekile zezempilo, ukuze kunciphise ububanzi balokho okumele kutholakale umshuwalense wezempilo. Bafuna ukuqeda umkhuba wamanje wabhalisile abanempilo nabagulayo bakhokhela amaprimiyamu afanayo.
Ngaphansi kwe-ACA, ama-premium angashintsha ngokususelwa eminyakeni yobudala (ngenani le-3: 1 lababhalisile abadala nakwababhalisile abancane), ukusebenzisa ugwayi (isilinganiso sokufinyelela ku-1.5: 1 isilinganiso), nekhodi ye-zip. Kodwa umlando wezokwelapha womfakisicelo awuyona ingxenye ye-equation.
Ngaphambi kuka-2014, izinkampani zomshuwalense wezempilo ezizweni eziningi zingahle zibuyekeze umlando wezokwelapha zabafaki futhi zisebenzise lolo lwazi ukunquma amaphrimiyamu. Bangase banqabe izicelo ngokuqondile uma izimo ezandulele zikhona ngokwanele. Ukuguqulwa okuhlongozwayo kwe-AHCA ngeke kuvumele ukuthi abakwa-inshurenti banqabe abenzi bezicelo ngokusekelwe emlandweni wezokwelapha, kodwa abagxeki bathi uma ama-premiums angakhuphuka kakhulu kubafakizicelo abagulayo, kuzokwenza ukuthi kuqinisekiswe ukuvikela kwama-ACA kubantu abanezimo ezikhona ngaphambili. Lokhu kuyiqiniso ikakhulukazi uma isimo sizophinde sishintshe izidingo zezempilo ze-ACA ezibalulekile, njengoba umfakisicelo engase athole ukuthi izimo zabo ezikhona ngaphambili "zimbozwe" kodwa uhlelo aluhlinzeki ngezinzuzo endaweni edingekayo yokunakekelwa.
Ukuze kunconywe amaRephabhuliki alinganisiwe, esinye isinqumo siphakanyisiwe. Kungavumela ukuthi amazwe athole ukuxoshwa ukuguqula izinzuzo ezibalulekile zezempilo kanye nenani le-ACA's premium age (ngakho-ke abafakizicelo abadala bazokhokhiswa kuze kube izikhathi eziphindwe kabili abafake izicelo, kunokuba kathathu), kodwa ngeke kuvumele amaprimiyamu ukuba asekelwe umlando wezokwelapha zabafakizicelo.
Ngo-Ephreli 5, ukungafani phakathi kweziphakamiso ezimbili kwakwenze ukuba izinkulumo zihlehle, okungenani okwesikhashana. Amalungu e-House Freedom Caucus afuna ukuqhubeka ngaphandle kwesiqinisekiso sokuthi uzokwazi ukuvumela abanikezeli besikhwama ukuba babuyele ekusebenziseni ukubhaliswa kwezokwelapha ukubeka ama-premium, njengoba bakholelwa ukuthi lokhu kuyisihluthulelo sokunciphisa amaphrimiyamu eningi labantu (okungukuthi, labo abangenayo izimo zangaphambili).
Futhi ngakolunye uhlangothi lwama-republic, amaRephabhulikhi alinganisiwe akholelwa ukuthi ukubuyiselwa kwama-premium okusekelwe emlandweni wezokwelapha kuzokwenqabela ukuvimbela kwe-ACA kubantu abanezimo ezikhona ngaphambili, okunye okuhlinzekwa okuthandwa kakhulu komthetho.
Abomthetho bahlongoze ukusebenzisa imali eyabelwe ku-AHCA ukuze izimboni ziqiniseke izimakethe zabo zomshuwalense, futhi esikhundleni salokhu zibeke ekuzijabuliseni kwamachibi aphezulu . Lezi zikhukhula ezinobungozi obuphezulu zizofihla abantu abanezimo ezandulele ezithengiswa emakethe yangasese uma amaprimiyamu encike esimeni sezempilo sabhalisile. Izifunda ezingu-35 zazinamachibi aphezulu kakhulu ngaphambi kwe-ACA, futhi zazijwayele ukukhokhelwa imali. Ukubuyela emachibini aphezulu kakhulu njengesixazululo kuyinkinga futhi kuzodinga imali engaphezulu kakhulu kulawo madamu athola esikhathini esedlule.
Sikuvelaphi Kulapha?
Nakuba uTrump noPence baye baveza ukuthi isivumelwano siyeza maduzane, izingxoxo zibonakala zide kakhulu, futhi azikho izichibiyelo ezitholakala esidlangalaleni ezitholakala kumbhalo we-AHCA. Izingxoxo zingaqhubeka ngemuva kokupheka kwentwasahlobo, kodwa kungenzeka ukuthi akwanele nje emkhakheni ophakathi kokubili kokuphela kwesigungu seRiphabhulikhi sokuvumelana endleleni.
Uma umthetho ungadluli ukuphinda noma ukuguqula i-ACA, uzohlala umthetho wezwe. Noma kunjalo, ikusasa layo lixhomeke kakhulu ezintweni ezithathwa yi-Administration Trump.
Ababheki besikhwama baye baqaphela izinyanga abadinga ukubona ezinye izindlela zokuqiniswa kwemakethe ezibekiwe ukuze baqhubeke nokuhlinzeka ngo-2018. Abakwa-Insurers ababili-Humana, ne-Wellmark ye-Iowa-kakade bamemezele ukuthi ngeke bahlanganyele ku-ACA- imakethe ngayinye ehambisanayo ngonyaka ozayo, kanti abanye bangalandela ukulandela uma bezwa ukuthi kunokungaqiniseki okukhulu ngokwenzekayo ngokulandelayo.
Indlu v. Intengo: Inkokhelo Yokwabiwa Kwezindleko Zokwabelana Ngezindleko
Ama- ACA's-sharing-sharing subsidies njengamanje abekwe icala (iNdlu v. Intengo, eyayiyiNdlu v. Burwell) eyabekwa yi-House Republican ngo-2014. Abamengameli (okuyinto ehlanganisa uTom Price, owayengamele iSifunda sase-Georgia e-House ngaphambi ukuphakanyiswa nguTrump ukuholela i-HHS, lapho manje engummangalele kulokho) kuthiwa izinsizakalo zokwabelana ngezindleko zixhaswe ngokungemthetho, njengoba imali ingabelwe umthetho. I-suit yabo yayifanelekile, kanti ijaji lesigodi lesifunda lathola ilungelo ngoMeyi 2016.
Ukuphatha kuka-Obama kwancenga, okwakubambelela ukuxhaphazwa kwezindleko ezigijimela kubanini besikhwama sezimali okwamanje. Ngemva kokuthi uTrump inqobe ukhetho, i-House Republican icele ukuthi icala lizobanjwa ngenkathi lihlehlisa ikusasa le-ACA. Umbiko wesimo uzovela enkantolo ngoMeyi 22.
Uma izindlu zaseRepublic Republic zibeka phansi icala, noma uma iCongress inquma ukudlulisa umthetho ukuze kutholakale izimali ezifanelekayo zokwabelana ngezindleko, iNdlu v. Ukukhishwa kwentengo kuzophela. Ngakolunye uhlangothi, uma i-Trump Administration kufanele ilahle isikhalazo sokuthi uhulumeni we-Obama uqalise, imakethe ngayinye izobhekana nokuwa kokubanzi (abatshengisi banomshwana wokuphunyuka kwezivumelwano zabo nge-HealthCare.gov abavumela ukuba baphume ekushintsheni uma izindleko -nokuthi izinsizakalo ziqedwa).
Imizamo Yokuqiniswa Kwemakethe
Ngo-February 2017, i-HHS ihlongoze izinguquko ezihlukahlukene zolawulo ezihloswe ekuqiniseni imakethe ngayinye. Kodwa ngesikhathi esifanayo, usuku olulodwa lwe-Trump olulodwa oluhle oluqondisa ama-ejensi e-federal ukuba abe oqotho ekusebenziseni kwabo i-ACA kunomphumela ohlukile.
Isibonelo, i-IRS ihlose ukuqina ngokwengeziwe ngendlela yokucubungula ngayo ukubuyiswa kwentela ngo-2016 ngokuqondene nomsebenzi ngamunye we-ACA. Kodwa ngokulandela umyalelo wokuphatha, baphendulela inkambo kulokho, futhi baqhutshwa ngokuphindaphindiwe ngendlela efanayo nangokwakhe eminyakeni engaphambili . Noma yini ekhonza ukwehlisa amandla okugunyazwa ngabanye ekugcineni iyanciphisa ukuzinza kwemakethe yomshuwalense, njengoba abantu abanobuchopho bangabhalisiwe ekubhaleni.
Yini Okulandelayo?
Ngalesi sikhathi, ikusasa le-ACA kanye nemakethe yomshuwalense wezempilo yempilo ka-2018 kakhulu kakhulu emoyeni. Abameli bamaRephabliki ne-White House bazama ukuvuselela i-AHCA, kodwa akucaci ukuthi bazokwazi yini ukwenza kanjalo. Ngisho noma i-ACA ihlala ingalungile, noma kunjalo, izimakethe zomshuwarensi eziphumelelayo zidinga imithetho ezinzile, izimali ezanele, kanye nedamu elingahlelekile lokubeka ingozi. Asisazi ukuthi konke lokho kuzozamazama kanjani ezinyangeni ezimbalwa ezilandelayo.
> Imithombo:
> Congress.gov, HR1628 - UMthetho wezeMpilo waseMelika ka-2017. I-Congress ye-115 (2017-2018).
> Congress.gov. S.Con.Res.3. I-Congress ye-115 (2017-2018)
> I-Congressional Budget Office Esindleko Esilinganisiwe, Umthetho Wezempilo waseMelika , ka- Mashi 13, 2017. ( nokuhlelwa kokuhlelwa okulungisiwe kuMashi 23, 2017)
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi , ukuvikelwa kwabagulayo kanye nomthetho wokunakekelwa kwempahla ongenakunyaka, ukuqiniswa kwemakethe , isaziso se-rulemaking ehlongozwayo. February 2017.
> Garrett, Bowen; I-Gangopadhyaya, Anuj; I-Urban Institute, ngubani owathola ukuphepha komshuwalense wezempilo ngaphansi kwe-ACA futhi bahlalaphi ? Disemba 2016.