Izinguquko ezinokwenzeka ziyoxoshwa ngokuya lapho Uthola Umshwalense Wakho
U-Donald Trump wamemezela ngesithembiso sokuthi uzosula ngokushesha uMnyango Wokunakekelwa Ongenakusiza (u-Obamacare), futhi awubeke esikhundleni "ngochungechunge lwezinguquko ezilungele ukusebenza okulandela imigomo yamahhala yamahhala futhi ezobuyisela inkululeko yezomnotho nokuqiniseka kuwo wonke umuntu kulelizwe. "
AmaRiphabhulikhi aseCongress achithe isikhathi sokuthi ibhola liqhubekele ekuqedeni kwe-ACA, sidlulisele isinqumo sebhajethi ngaphambi kokuvulwa kukaTrump, iqondise amakomidi e-congressional ukuba aqale ukuhlelwa komthetho ukuze aqede izici ezihlobene nokusetshenziswa kwe-ACA.
Futhi ngosuku lokuqala lukaTrump ehhovisi, wakhipha i-executive order eqondisa izinhlangano zikahulumeni ukuba zenze kahle ekusebenziseni izintela ze-ACA nezinhlawulo.
Kodwa i-ACA iboniswe ukuthi igxilile kakhulu ohlelweni lwethu lokunakekelwa kwezempilo, futhi kunzima ukuphinda kunokuba ubuholi be-GOP kulindeleke. Naphezu kwalokhu iqiniso lokuthi amaRiphabhulikhi alawula iNdlu, iSenate, ne-White House, ukuchithwa kwe-ACA kwehlulekile ngo-2017. Amaphabliki aseNdlu ayedlulisa indlela yabo yokuqeda (i- American Health Care Act ) ngoMeyi 2017, kodwa iSenate Republican yahluleka ukudlulisa izinguqulo ezintathu zomthethosivivinywa ngoJulayi 2017, kanti umzamo wokugcina wamanzi ngoSepthemba 2017 awuzange uvotelwe phansi kweSenate, ngenxa yokungabi nesekelo.
Kodwa iCongress kanye ne-Administration Trump baye behlukana nomthetho wokuguqulwa kwezempilo ngezindlela ezincane, ezinye zazo ezingathinta ukuhlinzeka ngezempilo abantu:
Isijeziso somuntu ngamunye siqedwe ngo-2019
Ngenyanga kaDisemba 2017, uMthetho weNtela yokuThutha kanye neMisebenzi ususe i-ACA's punishment penalty, kusukela ngo-2019.
Kukhona inhlawulo yokungaqinisekisiwe ngo-2018 , kodwa ngeke kube nesijeziso sokungaqinisekisiwe ngo-2019 nangaphezulu, ngaphandle uma useMassachusetts noma kwenye isifunda esisebenzisa isijeziso sayo.
Ezinye zezintela ze-ACA, kuhlanganise nentela yeCadillac , nazo ziye zaphuza, ngaphansi kwemigomo ye-HJ Res.125, isilinganiso sokuchitha imali esasungulwa ekuqaleni kuka-2018.
Ukuqedwa kwezimali ze-CSR
Uhulumeni weTrump ususe izimali zikahulumeni zokunciphisa ama-cost (CSR) ngo-Okthoba 2017. Kodwa izinzuzo zokunciphisa izindleko ezisezindleko zisatholakala kubabhalisi abafanelekile, futhi iningi lababhalisi bezokushintshanisa alikho nakakhulu, noma empeleni kungcono, manje izimali zaqedwa. Lokhu kungenxa yokuthi ababhalisi abaningi emazweni amaningi bavele bangeze izindleko ze-CSR kumaprimiyamu omsebenzi wesiliva we-2018 , okwaholela ekusizeni imali enkulu yokukhokhela imali yonke yabanelungelo lokuthola izinsizakalo ze-premium.
Uma nje uhulumeni wesifundazwe eqhubeka nokuvumela abakwa-inshurensi ukuba bangeze izindleko ze-CSR kumaprimiyamu omsebenzi wesiliva esikhathini esizayo, abhalise abaningi bazovikelwa emthelela wokuqedwa kwezimali ze-CSR, futhi abaningi bazoqhubeka beba ngcono, ngenxa izinsizakalo ezinkulu ze-premium.
Imithetho Ehlongozwayo
Futhi i-Trump Administration ibuye ihlongoze imithethonqubo ezovumela ukuthi izinhlelo zesikhathi esifushane ziphinde zibe nezinsuku ezingama-364 (umthetho owawuqinisekiswa yi-Obama Administration, ngomzamo wokuvikela imakethe evamile), futhi uvumele kabanzi abantu abaziqashile nabamabhizinisi amancane ukubhalisa ezinhlelweni zezempilo .
I-Leniency engeziwe ye-Medicaid Waivers
I-Trump Administration ibuye yaphawula ukuthi iyoba ngcono ngaphezu kokuphatha kuka-Obama ngokuvumelana nokwamukelwa kwama-1115 waivers kumazwe afuna ukwenza izinguquko ezinhlelweni zabo ze-Medicaid.
Esikhathini esiphezulu kwezinye izintandokazi zokuthi 'izintandokazi zomsebenzi ziyimfuneko yomsebenzi weMedicaid (okwakuhlala njalo yenqatshwa yi-Obama Administration), kanti izifunda ezintathu sezivele zamukele imvume yemisebenzi ngo-2018: i-Arkansas, iKentucky, ne-Indiana, nezinye izinto eziningana uthi 'ukuxoshwa okuhlongozwayo okucatshangwa nguhulumeni wesifundazwe.
Ngakho-ke nakuba i-ACA ngokwayo ihlala ingapheli kahle, kungase kube namanje izinguquko. Ake sibheke ukuthi lezo zinguquko ezingenzeka kanjani zingathinta umshwalense wakho wezempilo, kuye ngokuthi uthola kuphi ukuthunyelwa kwakho okwamanje. Sizobheka izindawo ezine eziyinhloko zokuhlanganisa ezibandakanya umthombo omkhulu womshuwalense wezempilo waseMelika:
- Izinhlelo ezixhaswe ngabasebenzi (amaphesenti angu-49 aseMelika)
- Ukuthengwa kwemakethe ngayinye (amaphesenti angu-7 aseMelika)
- Medicare (amaphesenti angu-14 aseMelika)
- Medicaid (amaphesenti angu-19 aseMelika)
Umshuwalense Wezempilo Oxhaswe Ngumqashi
Ngamafuphi:
- Uma umqashi wakho enikezela ukufakwa kwezimali manje, cishe uzoqhubeka enza kanjalo. Isikhundla somqashi, esidinga abaqashi abakhulu ukuba banikeze ukukhokhelwa, asihlali singashintshi.
- Ama-premium akho kungenzeka ahlale ekhokhwa intela.
- Ungabona ukushintshwa kumacebo aphezulu okudonswa (HDHPs) kanye nama-akhawunti wokulondoloza impilo (ama-HSA).
- Uma usebenzela ibhizinisi elincane, umqashi wakho angagcina eshintshela ohlelweni lwezempilo lomhlangano.
Imininingwane:
Cishe ingxenye yabantu baseMelika bathola umshwalense wabo wezempilo kumqashi. Futhi ngenkathi i-ACA yenza ngokuphelele izinguquko eziphawulekayo ngokuphathelene nokuqashwa okuxhaswe ngumqashi, izinhlelo ezixhaswe ngumqashi zase zivele zilawulwa ngokweqile, ngaphansi kwe-HIPAA, kunezinguquko zomakethe ngamunye.
I-ACA idinga ukuthi abaqashi abakhulu (abasebenzi abangu-50 noma ngaphezulu) banikeze ukuthengwa okuphelele, okugcweleyo kuze kube sesikhathini esigcwele (abasebenzi abangu-30 + amaviki ngalinye). Futhi nakuba isigwebo somuntu ngamunye we-ACA sizoqedwa kusukela ngo-2019 (okungukuthi, ngeke kusaba nesigwebo esinikezwe kubantu abangenawo ukukhokhelwa), umyalo wokuqashwa komqashi uhlala endaweni, futhi abaqashi abakhulu kumele baqhubeke nokunikeza ukufakwa .
Ngisho noma igunya lomqashi kufanele liqedwe ngomthetho wesikhathi esizayo, abaqashi abaningi kakhulu bazoqhubeka behlinzeka ngekhava. Cishe bonke abaqashi abaqashile kakade banikeze izinzuzo zezempilo ngaphambi kwe-ACA. I-Kaiser Family Foundation idatha ibonisa ukuthi abaqashi abakhulu abangu-96 (abasebenzi abangu-50 + bahlinzeka ngezinzuzo zezempilo ngonyaka ka-2015.) Lokhu kwakungaphezulu kwamaphesenti angu-95,7 abaqashi abakhulu abahlinzeka ngezinzuzo zezempilo ngo-2013, lapho igunya lomqashi lingekho okwamanje endaweni.
Abaqashi basebenzisa inshuwalense yezempilo-kanye nezinye izinzuzo zephakheji zabo-ukuheha nokugcina abasebenzi abakhulu. Futhi basebenzisa izimali zangaphambi kwentela ukukhokha izinzuzo abazinikezayo ( njengoba kwenza abasebenzi ). Ngokufaka ushintsho olukhulu kukhodi yentela, kungenzeka ukuthi abaqashi bazoqhubeka nokunikeza ukuhanjiswa phambili, okungenani esikhathini esiseduze.
Kungenzeka ukuthi umthetho wesikhathi esizayo ungabangela ushintsho kukhodi yentela esebenza kumalungiselelo axhasiwe oqashi. Indlu yamaRephabhuliki yanyathelisa isilungiso sokulungisa isimo sezempilo ngoJuni 2016 esidinga ikhefu ngokukhipha izinzuzo zezempilo kusuka engenayo engenayo. Isiphakamiso sichaza indlela lokhu kuzohluka ngayo kwi- ACA's Cadillac Tax kodwa kusukela ekuboneni komsebenzi, umphumela uzoba ngendlela efanayo: Abaqashi bazoqala ukulahla izinhlelo ezibiza izindleko eziphezulu, ngoba ingxenye yama-premium ingase iphele ekukhokhwa intela. Kodwa akukho okufana nalokhu okwenziwe ngo-2017, futhi izinguquko ezinkulu empilweni yezempilo cishe akunakucatshangwa ngonyaka wokhetho, ngakho-ke kungenzeka ukuthi kuphezu kwetafula isikhathi.
Uma usebenzela umqashi omncane futhi umqashi wakho athola uhlelo lweqembu elincane kusukela ngo-2014, uhlelo lwakho luhlanganisa ukuhlinzekwa kwezinzuzo zezempilo ze- ACA ezibalulekile . Uma izinzuzo zezempilo ze-ACA ezidingekayo zizoguqulwa phambili, lokho okushiwo yi-akhawunti yakho kungashintsha. Kodwa umthetho owawuzoshintsha izinzuzo ezibalulekile zezempilo awuzange udlule ngo-2017, ngakho-ke akukho lutho olushintshile ngesikhathi. Ngisho noma ngabe yashintsha esikhathini esizayo, kwakukhona izinguquko ezihlukahlukene-ezifana ne- HIPAA kanye noMthetho wokuThathelana nokukhulelwa- okwakusuvele usetshenziselwa imakethe yempilo yomshwalense ekhokhelwa umqashi ngaphambi kwe-ACA, futhi ngeke ihlaselwe yimuphi izinguquko ezenziwe ku-ACA.
Uma Ulawulo Lwezintambo luqedela imithethonqubo ehlongozwayo yezinhlelo zezempilo zomphakathi , ingavula lawo maphuzu amabhizinisi amancane amancane. Lokhu kungabangela amaphrimiyamu omshwalense wezempilo omncane, kanye nezinzuzo zempilo ezincishisiwe, amabhizinisi amancane ajoyina izinhlelo zezempilo zomphakathi. Lokhu kungase kubangele izinkokhelo zemishwalense ephakeme yamabhizinisi amancane aqhubeka nokuthenga ukukhangisa kwe-ACA, ngoba kuzoba nempilo, amaqembu amancane aya emaphakathini ezempilo, futhi ashiye i-ACA echibini eliyingozi kakhulu izinhlelo ezivumelanisiwe.
Umshwalense Wezempilo Wemakethe Individual
Ngamafuphi:
- Isimiso somuntu ngamunye sisesekhona, futhi usadinga ukugcina ukubhalwa ngo-2018. Uma ungazange ubhalise ngesikhathi sokubhalisa okuvulekile, usengabhalisa ngaphansi kwezimo ezithile uma uhlangabezana nesenzakalo esifanelekayo (lungele ukunikeza ubufakazi bokufaneleka umcimbi).
- Ukuxhaswa kwe-premium nokunciphisa ukwabelana ngezindleko kusekhona kubhalisile abafanelekile.
- Ukuvunywa kusekuqinisekisweni okwamanje okuqinisekisiwe.
- Ama-Akhawunti Wokulondoloza Impilo (ama-HSA) kanye nezinhlelo zempilo ezidonswa kakhulu (HDHPs) cishe zizogcizelela eminyakeni ezayo.
- Amacebo wesikhathi esifushane angase atholakale ngezinkathi ezide emazweni amaningi.
- Izinhlelo zezempilo zomphakathi zingatholakala kubantu abazimele.
Imininingwane:
Uma uthenga umshuwalense wakho wezempilo, noma ngokushintshaniswa noma ukushintshaniswa , usuvele wazi ukuthi i-ACA yenza izinguquko ezinkulu kumakethe yomshuwalense wezempilo ngamunye.
Zonke lezo zinguquko zisendaweni, futhi kungenzeka ukuthi zihlale endaweni yesikhathi esizayo. Isijeziso somuntu ngamunye sichithwe ngokuphumelelayo ngo-2019, kodwa sisekhona ngo-2018, futhi sizoqoqwa ngo-2018 ukubuyisa intela, kufakwe ekuqaleni kuka-2019.
Ukuxhaswa kwe-premium ye-premium nokunciphisa izindleko kuyaqhubeka kutholakala kubhalisa abafanelekayo bezokushintshanisa, futhi akukho lutho ngalokhu okuzoshintsha esikhathini esizayo esiseduze. I-Congressional Democrats iye yahlongoza umthetho ozobambelela phansi izinsizakalo, okwenza kube namandla kakhulu futhi atholakale kubantu abaningi, kodwa ushintsho olunjalo luyokwenzeka kuphela uma amaDemokhrasi enamalungu amakhulu eCongress ngemuva kokhetho lwama-2018 phakathi nonyaka.
Emithethweni ehlongozwayo yokuhlinzeka ngo-2019, i-HHS iphawula ukuthi ihlela "ukukhuthaza abakhiqizi ukuba banikeze i-HDHPs [izinhlelo eziphezulu zokunakekelwa kwempilo] ezingahle zihlangane ne-HSA [akhawunti yokulondoloza impilo] njengendlela engabiza imali yokubhalisa." Le nhlangano iphinde ithi "ihlola indlela yokusebenzisa izinketho zokubonisa izinhlelo ku-HealthCare.gov ukukhuthaza ukutholakala kwama-HDHP kubafakizicelo." Ngakho abathengi bangabona izinhlelo zezempilo ze-HSA ezifanelekayo ezitholakalayo emakethe ngayinye ngo-2019 nangaphezulu. Kodwa izinhlelo ezingenayo i-HSA-ezifanelekayo zizoqhubeka nokwenza okuningi kwezinketho zamakethe ezikhona.
Uma imithethonqubo ehlongozwayo yezinhlelo zesikhashana esifushane iphelile, abantu basezifundazweni eziningi bangase baqale ukubona izinketho zesikhathi esincane zesikhathi sokusebenza ngezikhathi ezinsukwini ezingama-364. Ukubhalisa okunempilo, lezi zinhlelo cishe zizoba izindlela ezikhangayo ezinhlelweni ze-ACA ezivumelanisiwe, ngoba zizobiza kakhulu. Futhi kusukela ngo-2019, ngeke kusaba nesigwebo somuntu ngamunye esihlolwe kubantu abathengisa isikhathi esifushane. Kodwa izinhlelo zesikhathi esifushane zilinganiselwe ekufinyeleleni kwabo (iningi alifihli umama, impilo yengqondo, noma izidakamizwa zemithi), futhi bavame ukuba neziqephu zezingubo ezimweni ezikhona ngaphambili. Ngaphezu kwalokho, izinhlelo zesikhathi esifushane zinama-maximums ezinzuzo zonyaka nesikhathi sokuphila ezingahle zibe ziphansi kakhulu, kuye ngohlelo.
Izinhlelo ezimfushane zesikhashana zizobheka kuphela abantu abanempilo, njengoba izimo ezandulele zingekho. Kuye ngokuthi bangaki abantu abathengisa izinhlelo zesikhathi esifushane, ichibi eliyingozi lezinhlelo ze-ACA-ezihambisanayo zingaba nempilo enhle kakhulu kubathengi abagulayo, asebekhulile, okubangelwa ukukhushulwa kwama-premium. Kubantu abathola izinsizakalo ze-premium, amaphrimiyamu akhule azokwenziwa yizinsizakalo ezinkulu ze-premium. Kodwa kubantu abangakufanelekeli izinsizakalo ze-premium, amaphrimiyamu akhula azokwenza kuphela ukuhlanganisa okungenakugwenywa.
Okufanayo kuzokwenzeka ngokuhlelwa kwezinhlelo zezempilo kubantu abaqashile. Uma imithethonqubo isuqedile evumela abantu abazimele ukuthi bathenge ukuhlinzeka ngempilo yomphakathi esikhundleni se-ACA ehambisana nokuhlinzekwa okukhulu kwezokwelapha, abantu abasebenza ngokuziqhenya bangase bakwazi ukushintshela emaqenjini abambisene nezindleko eziphansi, beshiya abantu abadala, abagulayo ku-ACA izinhlelo ezixhasayo, ezinama-premium ahambelana kakhulu.
Izinkokhelo ezimakethe ze-ACA ezivumelanako nazo zingase zibe ngaphezulu ngenxa yokuqedwa kwesigwebo somuntu ngabanye ngo-2019. Ihhovisi le- Congressional Budget (i-CBO) libike ukuthi abantu abayizigidi ezimbalwa bazoba nokuthengwa komakethe ngamunye ngo-2019 njengomphumela sokuqothulwa kwesigwebo, okukhulisa izigidi ezingu-5 ngo-2021. I-CBO ibikezela ukuthi amaphrimiumamu azoba ngamaphesenti angu-10 aphakeme ngonyaka kunokuba bebengaba yiyo uma isigwebo segunya sisekhona, ngoba abantu abangase bahlehlise ngaphandle kokugunyazwa abantu abanempilo (abantu abagulayo bazogcina ukufaka kwabo, kungakhathaliseki ukuthi kukhona inhlawulo).
Ngokuphindaphindiwe, njengokwenyuka kwe-premium okuzobangelwa izinhlelo zesikhashana esifushane kanye nezinhlelo zezempilo zomphakathi, abantu abathola izinsizakalo ze-premium bazobe besetshenziselwa ukuhamba ngezinyathelo (nge-premium subsidies subsidies), kanti labo abangafaneleki ukuthola usizo kuzobe kuncike ekukhethweni kokungena okungafaneleki.
Medicare
Ngamafuphi:
- Akukho okuguqukayo okwamanje. Iziphakamiso zokulungiswa kwe-GOP azikho ngaphansi kokucutshungulwa kwamanje, futhi uma ekugcineni zenziwe, zibiza izinguquko zesikhathi eside, kunokuba kushintshwe ngokushesha.
- Indlu yePhalamende uPaul Ryan ubelokhu ephikisana nokuguqulwa kweMedricare kubantu abaneminyaka engaphansi kwengu-55, kanti amathuba akhe okwenza lokhu kwenzeke kakhulu ngaphansi kolawulo lweTrump kunokuba bebengaba ngaphansi kukaMongameli Obama. Kodwa uhlelo lukaRyan luzoxhomeke kumaRiphabhliki agcina iningi labo eCongress ngemuva kokhetho luka-2018.
- I-ACA iqhubeka ukuvala umgodi we-donut we-Medicare Part D, futhi akukho lutho olushintshile mayelana nalokhu kuqhubeka.
Imininingwane:
I-ACA ayenzanga izinguquko eziningi ku-Medicare. Yayidinga ukuthi iMareare iqale ukumboza ukuvakashelwa kweminyaka yonke, futhi ilokhu ivala imithi ye - Medicare Part D donut , ezovalwa ngokugcwele ngo-2020. Futhi nakuba iyancishiswa ukubuyisela ama-Medicare Advantage amapulani, ukubhaliswa kwi-Medicare Advantage kwande minyaka yonke kusukela i-ACA yenziwe.
Ukuguqulwa kweMedare kanye nokuzibandakanya sekuyisikhathi eside kube yikhulumi ekukhulumeni kwezempilo kwe-GOP. I-House Republican yashicilela isinqumo sokuvuselela i-Medicare ngo-2016, kodwa ayizange iqhube phambili ngo-2018, futhi umthetho omkhulu awunakwenzeka manje, ozofika ehlobo lonyaka wokhetho.
Kodwa isiphakamiso se-House Republican sika-2016, esingaqhubeka sisetafuleni esikhathini esizayo uma amaRiphabhulikhi egcina ama-majorities aseCongress ngenkathi i-Trump Administration isendaweni, ebizwa izinguquko eziningana ku-Medicare, kuhlanganise nokuqinisa i- Medicare Advantage , ukhetho olukhona lwamanje lwe-Medicare abhalise.
Kusukela ngo-2020, isiphakamiso seNdlu yamaRephabliki sizobiza ukuthi izinhlelo zeMedigap zivinjelwe kakhulu. Njengamanje, kunezinhlelo ezithile ze-Medigap ezihlanganisa wonke noma cishe zonke izindleko zokubhalisa ngaphansi kwe-Original Medicare. Isiphakamiso seNdlu sizobe sinciphisa ukuthi kungakanani ukuphuma kwepokhethi okukhokhisa ukuthi izinhlelo zikaMedigap zingabhekana, ngomzamo wokuvimbela ukudlula ngokweqile (umqondo wokuthi uma ababhalisile bengenazo izindleko ezingaphandle kwezepolitiki, kungenzeka ukwandisa izinsizakalo, okwenza kube nezindleko eziphakeme kakhulu). I-HR2, i-Medicare Access kanye ne-CHIP Reauthorization Act, noma i-MACRA, esayinwe ngomthetho ngo-2015, isivele idinga ukuthengiswa kweMigodi ye-Medigap F no-C ekupheleni kuka-2019, njengoba lezo zinhlelo zifakaza ngokugcwele i-Medicare Part B.
Isiphakamiso sika-2016 sizohlanganisa i-Medicare Part A ne- Part B , nge-single deductible kanye ne-coinsurance ehlanganisiwe. Kungase futhi kwandise iminyaka kancane ukufaneleka kwe-Medicare yokufaneleka ukuhambisana nokukhula komhlalaphansi wezenhlalakahle.
Isiphakamiso seNdlu yamaRephabliki sicelela uhlelo lweMedricare "ukwesekwa kwe-premium" oluzosetshenziselwa cishe eminyakeni eyishumi phansi komgwaqo, futhi ngokuyinhloko luyoba nesimiso esithembele ngisho nakakhulu kwi-Medicare Advantage-style coverage. Njengoba bekuyoba ukubambezeleka kweminyaka eyishumi, abantu abaneminyaka engama-55 noma ngaphezulu bazobe benesifo seMedare ngendlela ekhona namuhla. Kodwa abasebancane baseMelika babeyokwazi ukukhetha-uma befinyelela ukufaneleka kukaMedricare-ukuba babhalise ohlelweni lwangasese esikhundleni salokho, ngokukhokhelwa kwe-Medicare premium ukwesekwa egameni labo.
Leyo nkokhelo izofaka konke noma ingxenye ye-premium, izoshintshwa phezulu kubantu abagulayo ababhekana nezinkokhelo eziphakeme, futhi bebezoba mncane kubantu abadala abacebile abangakwazi ukukhokhela iholo elikhulu lama-premium abo. Kuzobe kukhona usizo olwengeziwe lwezezimali kubantu abadala abahola imali encane abadinga usizo lokumboza izindleko zabo ezingaphandle.
I-Medicaid
Ngamafuphi:
- Uma isimo sakho sandise iMedicaid ngaphansi kwe-ACA, lezo ziqondiso ezifanelekile zisasebenza, futhi iningi lazo lihlose ukuligcina lisebenza, noma mhlawumbe ngezidingo ezengeziwe zokufaneleka.
- I-Kentucky, i-Arkansas, ne-Indiana ziqalise izidingo zomsebenzi kubantu abadala abangenabo abakhubazekile, kanti nezinye izifunda eziningana zilindele imvume yombuso wokusebenzisa izidingo ezifanayo.
- Izizwe ezingazange zandise iMedicaid zingasenza kanjalo, ngezimali ezifanayo zezimali ezisebenza kwezinye izifundazwe sezivele zandisa i-Medicaid ngaphansi kwe-ACA.
Imininingwane:
Uhlelo ngalunye lwe-State Medicaid luxhaswe ngokuhlanganyela ngemali kahulumeni kanye nesifundazwe. Amazwe anemali engenayo engenayo yamaphesenti aphezulu athola iphesenti elincinci lezimali ezihambisanayo, kanti labo abanemali engenayo ephansi bathola imali eyengeziwe ehambisana nezimali. Ezizweni eziye zandisa i-Medicaid (izifunda ezingu-31 kanye nesifunda sase-Columbia), uhulumeni wesifundazwe ukhokha amaphesenti angu-94 ezindleko zokumboza abantu abasanda kutholakele ngo-2018. Lokho kuzokwehlela ngamaphesenti angu-90 ngo-2020, futhi uhlale kulelo zinga uya phambili.
Ezinye ezinye ezingu-19 zisengakhetha ukwandisa iMedicaid. Umthetho owawucatshangwa ngo-2017 ukuqeda i-ACA wawuvimbela izifunda ezengeziwe ekukhuliseni iMedicaid, kodwa lowo mthetho awusakaze wenziwe. Abavoti baseMaine bavumile ukwandiswa kweMediicaid ngoNovemba 2017, ngakho uMaine uhlelelwe ukwandisa iMedicaid ngehlobo lika-2018.
Ukuphathwa kweTrump kuye kwacaca ukuthi bayobe banempilo ngaphezu kukahulumeni we-Obama ngokuvumelana nokuvunywa kuka-1115 waivers kwezizwe ezifuna ukwenza izinguquko ezinhlelweni zabo ze-Medicaid. Ngo-2018, iKentucky, i-Indiana, ne-Arkansas seyitholile imvume yokugunyazwa kombuso ukuze kusetshenziswe izidingo zomsebenzi zokubhalisa kwabakwaMedicaid. Ezinye izifunda eziyisikhombisa zinezicelo zokulinda ezilindile, kanti ezinye eziningana zibheke iziphakamiso zokulahlekelwa. Ngakho-ke, umuntu omdala oselekhulile uMedicaid obhalisa kwezinye izindawo angase athole ukuthi kufanele ahlinzeke ubufakazi bokusebenza kwamahora (noma ukuzithandela, isikole, ukuqeqeshwa komsebenzi, njll.) Ukuze kugcinwe ukuhlolwa kwabo nge-Medicaid.
Amazwe ambalwa, kuhlanganise ne-Arizona, Kansas, Maine, Utah, nase-Wisconsin, nawo aphakamise ukufaka izinzuzo zokuphila eMedicaid izinzuzo eminyakeni emihlanu ngenxa yokungabhaliswa kwabakhubazekile, nakuba kungekho sezwe esamukele imvume yalokho ekuqaleni kuka-2018.
Ngakho-ke ngenkathi yonke imihlahlandlela yokufaneleka kwe-Medicaid ihlala ingaguquki, ababhalisile bangase babe ngokuya ngokwemithetho eminingi yokufaneleka, efana nemisebenzi yomsebenzi noma ama-premium amancane, nokuqinisekiswa okuvame ukufaneleka.
Izwi elivela
Nakuba i-ACA ibilokhu isendaweni iminyaka eyisishiyagalombili, kuhlale kube umthetho ohlukanisayo wezombusazwe. AmaRiphabhulikhi aseCongress akakwazanga ukuwachitha ngo-2017, kodwa imizamo yokumisa imithetho kanye nokulawula ukuphuma ku-ACA iyaqhubeka.
Ngokuyinhloko, ukuvikelwa kwabathengi kanye nemithetho yomshuwalense kuhlale kungashintshi ngo-2018, futhi umthetho omkhulu awunakwenzeka uma sibheka phakathi nonyaka wezinqumo. Kodwa izinguquko zokunakekelwa kwezempilo zizoqhubeka ziyingqinamba enkulu kuzo zonke izinhlaka zikahulumeni kanye nezombusazwe eminyakeni embalwa ezayo, kanti amapulatifomu ka-2020 omongameli angase afake iziphakamiso eziningi zokunakekelwa kwezempilo.
> Imithombo:
> UMnyango Wezezimali, uMnyango Wezabasebenzi, uMnyango WezeMpilo kanye Nezisebenzi Zabantu. Umshuwalense Wesikhathi Esifishane, Isikhathi Esincane (imithetho ehlongozwayo). February 2018.
> I-Federal Register. Ukuvikelwa Kweziguli Nomthetho Wokunakekelwa Okungathintekiyo, Isaziso Esiphakanyisiwe Sokuzuza Nezikhawulelo Zokukhokha Zonyaka ka-2019. Novemba 2, 2017.
> Indlu yabaMamele, Isiphakamiso sezempilo se-GOP. Indlela Engcono, Umbono Wethu Wokuqinisekisa I-America . NgoJuni 22, 2016.
> Kaiser Family Foundation. Ukuphepha Kwezempilo Kwempilo Yonke Inani Labantu. 2016.
> Kaiser Family Foundation. Sibutsetelo se-Medicidal Per Capita Cap Proposals, ngoJuni 22, 2016.
> I-Kasier Family Foundation. Amaphesenti Ezikhungo Ezizimele Ezizimele Ezihlinzekela Umshwalense Wezempilo Kwabasebenzi, ngeFirm Size. 2012-2015.