Ingabe uzovimba izibonelelo nemingcele ye-per capita ezilimaza i-Medicaid?
Ukuguqulwa kwezeMpilo bekulokhu kugxile empikiswaneni yamuva yezombangazwe. Ingabe i-GOP izosusa uMthetho Wokunakekelwa Onganakekelwa, i-Obamacare, noma ingabe amaRiphablikhi angayithola ezinye izindlela zokubuyisela izinqubomgomo zayo? Ngemuva kokuba umthetho we- American Health Care Act (ACHA), aka-Trumpcare, wehlulekile ukuthola ivoti eNdlu ngoMashi 2017, kunzima ukwazi ukuthi yini ongayilinda ngaphansi kokuphathwa kwamanje.
Ukulwa kuphelile. USomlomo weNdlu uPaul Ryan usafuna ukuthatha isinyathelo ekunakekelweni kwezempilo, nakuba engakaze azinikele ekupheleni kwesikhathi. Sethemba ukuthi uhlelo lokunakekelwa kwezempilo olucabangelayo olunzulu luzokwethulwa egameni labantu baseMelika. Ucwaningo olunjalo luzobandakanya yini iMedicaid, uhlelo lwezempilo oluphatha abampofu nabakhubazekile?
Indlela uHulumeni waseHulumeni ahlela ngayo ukubhekana neMedicaid
I-Medicaid uhlelo olulawulwa yizo zombili ohulumeni basezifundazweni kanye nezombuso. Uhulumeni wesifunda ubeka izindinganiso zokuthi ngubani nokuthi yini okufanele ihlanganiswe, futhi isimo ngasinye sinquma ukuthi noma cha ukwengeza izinsizakalo ezengeziwe ohlelweni lwaso. Abakwazi ukunikela kancane. Ngokuqondene nezimali, ohulumeni basezingeni likahulumeni kanye nesifundazwe bahlanganyela ngokuhlanganyela ezinhlelweni zabo eziphathelene neMedicaid.
Ukuze siqonde izinguquko ezingenzeka, sizodinga ukuqonda ukuthi uhulumeni wesifundazwe usekela kanjani i-Medicaid ekuqaleni kokuphathwa kweTrump.
Zonke izifunda zithola izimali zikahulumeni ngemithombo emithathu.
- Izinkokhelo ezingabonakali zengane (Hospital) (DSH): Ngokubuyiselwa kweMedicaid ngokuphawulekayo okuphansi, izibhedlela ezikhathalela inombolo ephakeme kakhulu yabantu baseMedare noma labo abangaqinisekisiwe bangalwela imali. Izinkokhelo ze-DSH zikhokhwa emazweni ukuze zisatshalaliswe ezibhedlela ezidingayo.
- Amaphesenti we-Federal Medical Assistance (FMAP): Uhulumeni wesifundazwe ufanisa ukusetshenziswa kwemali ku-dollar Medicaid ye-dollar futhi unikeze amanani aphakeme emazweni anemali engenayo engaphansi kwe-per capita.
- Amanani afanayo ahambisanayo: Uhulumeni wesifundazwe ukhokha ngenhla nangaphezulu kwama-FMAP amanani ezinsizakalo ezithile ezibandakanya kodwa ezingalinganiselwe ukwelashwa komdlavuza wesifuba nomlomo wesibeletho , ukuhlela umndeni, amasevisi wezempilo ekhaya, nokuhlola ukuvimbela abantu abadala .
Umbuzo wukuthi lezi zindlela zokwesekwa komasipala zizoqhubeka ngaphansi kukaMongameli Trump noma uma zizoshintshwa ngenye indlela yokuxhasa imali.
Ukuxhaswa kwe-Federal for Growing Medicaid
Ukwandiswa kwe-Medicare kwaqala ukusebenza ngonyaka ka-2014 futhi kwakuyingxenye enkulu yoMthetho Wokunakekelwa Onganakekelwayo. Yashintsha umkhawulo wokuthola imali owawuzofanelekela abantu ku-Medicaid futhi uvumele abantu abangabodwa abangenabantwana ukuba bafaneleke uma behlangabezana nalawo mingcele engenayo.
I-poverty level ye-federal (FPL), echazwe unyaka wonke, incike ekutheni ungumuntu oyedwa noma emndenini, nokuthi ubukhulu bomndeni wakho. Amazwe abeka ukufaneleka kwe-Medicaid ngokusekelwe kumaphesenti we-FPL. U-Obamacare ukwandisa indlela yokuthola imali yokuthola imithi ye-Medicaid kuya kuma-133 amaphesenti e-FPL kumazwe akhetha ukubamba iqhaza, kanti kuthiwa ukuthi ukunyuswa kwe-Medicaid kungahle kugcine izinga lokufaneleka emkhakheni odlule, amaphesenti angu-44 eFPL.
Amazwe angabambe iqhaza angaqhubeka nokukhipha abantu abadala abangenabantwana kusukela ekufundeni.
Ngokwemvelo, lokhu kwathinteka ngemali ehambisana ne-federal. Izizwe ngokukhuliswa kweMedicaid zithole amanye amadola ase federal ukuze abasize, izindleko zokunwetshwa ezingaphezulu kwamaphesenti angu-100 ngonyaka ka 2016 kanti amaphesenti angu-90 alawo abiza ngo-2022.
Izinguquko Zezimali Ezihlongozwayo Zokuxilongwa Nge-Medicaid
I-American Health Care Act yafaka amalungiselelo amaningi anquma imali ye-Medicaid. Nakuba lolu hlelo luyandisa kakhulu ukunwetshwa kwe-Medicaid, lisho ukuthi luzohlinzeka ngemali eyengeziwe ekukhulunywe ngayo okwethenjiswe ngo-2022.
Ngokusho kweNational Health Expenditure Data, ukuchithwa kweMedicaid kudlule imali engamaRandi ayizigidi ezingama-545 ngo-2015, kubalwa amaphesenti angu-17 azo zonke izindleko zezempilo.
Njengoba lelo nani likhuphuka, amaRiphabhuliki afuna indlela yokunciphisa leyo mali. Iziphakamiso ezimbili eziyinhloko zokuguqulwa kweMedicaid zishintsho kumkhawulo we-per capita noma ukuvimba izibonelelo.
Imingcele ye-per capita iyinani elilinganiselwe lemali elizokhokhwa kumbuso unyaka ngamunye. Inani lisekelwe kunani labantu abakuhlelo lwe-Medicaid. Lokhu kuzovumela ukuthi i-dollar federal inani likhule eminyakeni eyalandela uma abantu abaningi befaneleka futhi bebhalisiwe ohlelweni. Imingcele ye-Per capita kwi-Medicaid iphakanyisiwe nge-draft yokuqala ye-American Health Care Act.
AmaRephabhuliki amaningi, ikakhulukazi i-Freedom Caucus, ayekholelwa ukuthi imingcele yemingcele ayizange ihambe ngokwanele ukunciphisa ukusetshenziswa kwemali ku-Medicaid. I-American Health Care Act yashintsha ekunikezeni imingcele ye-per capita yokusebenzisa izibonelelo ze-block for Medicaid. Ngokungafani nemingcele yomuntu ngamunye, izibonelelo ze-block azicabangi inani labantu abakwaMedicaid. Izinkokhelo zase-Federal zihlakazekile ngenani elilinganiselwe elizokwandisa kancane ngonyaka ukuze lilandele imali yamanani emali. Inkinga yukuthi ukwehla kwamandla emali kungakhuphuka kunezindleko zokwelashwa.
Ukuhlaziywa okwenziwe ngu-Avalere, inkampani yokunakekela ezempilo, kulinganisa ukuthi eminyakeni engaphezu kwemihlanu uhulumeni wesifundazwe uzosindisa imali engaba yizigidi eziyizigidi eziyizinkulungwane eziyizigidi eziyizinkulungwane zamaRandi uma besebenzisa imingcele ngayinye noma amaRandi ayizigidi ezingu-150 uma basebenzisa izibonelelo ze-block for Medicaid.
Izimo Zama-Medicaid zizoshintsha kanjani?
Umbuzo uhlala uma ngabe ezinye zalezi ziphakamiso zizofakwa njengengxenye yokunakekelwa kwezempilo kweRyan esikhathini esizayo. Uma ukulinganiselwa komuntu ngamunye noma ukuvimba ama-grant, kushiwo ukuthi kuzolahlekelwa imali ebalulekile. Ukubhekana nalabo balahlekile, kungadingeka benze izinguquko ezenza izinhlelo zabo ze-Medicaid ziphumelele.
Izwe lingase lidingeke ukuthi lisetshenziswe imali yokuchitha imali yama-Medicaid, yinqume ukuthi yiziphi izinsizakalo ezihlanganiswe yi-Medicaid, noma zibeke imingcele ukuthi bangaki abantu abangabhalisa, ngisho noma labo bantu behlangabezana nemigomo yokufaneleka. Ukuvimbela izibonelelo kuzokukhawulela ikakhulukazi ngoba kusho ukuthi kuzokwenyuka kokubili ukukhula nokubhalisa.
> Imithombo:
> HR1628 - UMthetho Wokunakekelwa Kwezempilo Kwemelika ka-2017. Iwebhusayithi ye-Congress.gov. https://www.congress.gov/bill/115th-congress/house-bill/1628. Kubuyekezwe ngomhla ka-24 Mashi, 2017.
> I-National Health Expenditure Data Fact Sheet. Amasevisi we-website ye-Medicare ne-Medicaid Services. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html. Kubuyekezwe ngomhla kaDisemba 2, 2016.
> Pearson CF. Ukuxhaswa Kwezimali Eziphethwe Ngama-Medicaid Kungabonakalisa Ngokuphawulekayo Ukunciphisa Ukusetshenziswa Kwezimali. Avalere.com. http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-nomqondo ophawulekayo- owenziwe -federal -spending. Ishicilelwe ngo-February 6, 2017.
> Rosenbaum S, Schmucker S, Rothenberg S, Gunsalus R. Yini Eyovimba Izibonelelo noma Imingcele Ngomthamo Wama-Per Capita Okushoyo Ukuxilongwa? Issue Brief (IsiKhwama Esivamile). 2016 Nov; 39: 1-10. https://www.ncbi.nlm.nih.gov/pubmed/27959479.
> Izinkombandlela ze-US Federal Poverty Usetshenziselwa Ukunquma Ukufaneleka Kwezezimali Kwezinhlelo Ezizimele Zikahulumeni. Ihhovisi likaMnumzane uNobhala Wezokuhlela Nokuhlola, Iwebhusayithi YaseMelika YezeMpilo kanye NezemiSebenzi Yabantu. https://aspe.hhs.gov/poverty-guidelines. Kubuyekezwe ngoJanuwari 31, 2017.