Ngemvume kaMengameli uBarack Obama ngonyaka ka-2010, uMnyango Wokuvikelwa Kweziguli kanye Nokunakekelwa Kwezinkinga Ezithintekayo kubhekene nezinguquko eziqhubekayo ohlelweni lwezempilo lwe-United States kusukela ngo-1965 weMedricare neMedicaid .
Ingemuva
Ukuphikisana ngokufudumele emidlalweni yamaqembu, amaRepublican aphikisana noMthetho Wokunakekelwa Okuncintisayo, ngokudabukisayo usebenzisa igama elithi Obamacare ukuchaza uMthetho.
Ngo-2012, uMengameli Obama wayemukele igama elithi Obamacare, futhi manje lisetshenziselwa kabanzi abalandeli nabaphikisi bomthetho. Kodwa impikiswano mayelana ne-ACA yaqhubeka ngemva kokuhamba kwayo, nezinselele eziningi zenkantolo; umthetho uhlala ungqubuzana ngaphansi kwezokuPhatha kweTrump.
Yiziphi izinguquko?
Ezinye zezinguquko ezenziwe nguMthetho Wokunakekelwa Kwezezimali ezinenzuzo zibandakanya ukusungulwa kweMpilo Yomshuwalense WezeMpilo , noma izimakethe, lapho abantu, imindeni namabhizinisi amancane bangathenga inkinga eqinisekisiwe yokuhlelwa kwemishwalense yempilo ngamaprimiyamu athengekayo. Lezi zinhlelo ziyanelisa igunya le-ACA elidinga ukuba labo abangenawo umshuwalense wezempilo bathenge inqubomgomo yomshuwalense wezempilo.
I-ACA inikeza abathengi abaphansi nabangaphakathi-nzuzo ngemali yokuthenga umshwalense wezempilo okungabizi kakhulu (ababhalisile abafanelekayo abanakho imali engenayo ngaphezu kwamaphesenti angu-400 ebuningi bobuphofu, noma i-$ 98,400 emndenini wezine), kanye nezinsizakalo zokunciphisa ngaphandle kwepokhethi izindleko zababhalisi abafanelekile (imali engenayo ayinakudlulela amaphesenti angu-250 ebunini lobuphofu noma i-$ 61,500 emndenini wesine ngo-2018).
Ngesikhathi esifanayo, umthetho ubeka inkokhelo yentela kulabo abahlala bengagciniwe; inhlawulo yaqala ukusebenza ngonyaka ka-2014, futhi kancane kancane yanciphisa izinga eliphakeme kakhulu ngo-2016. Lokho kuzolungiswa ukuze ukukhuphuka kwemali kuqhubekele phambili, kodwa ngo-2017 no-2018, ukuguqulwa kwamanani e-inflation kwaba yi-$ 0, ngakho-ke inhlawulo isiguqukanga kusukela ngo-2016 iSenate ngoDisemba 2017 ozoqeda isigwebo somuntu ngamunye, kodwa ukungafani ne-House version kwakudingeka kuhlanganiswe, ngakho-ke sekuyisikhathi, akukho lutho olushintshile mayelana nesigwebo somyalo).
I-ACA ivimbela inshuwalense ekwenzeni ukumboza abantu abanesimo esandulele , noma ukuyikhokhela amaprimiyamu aphezulu ngenxa yesimo esandulele. Lokhu kuyiqiniso kokubili futhi kuvaliwe ukuhwebelana futhi kubonisa ushintsho oluphawulekayo kusuka endleleni umakethe ngamunye osebenza ngayo ngaphambi kuka-2014 cishe cishe wonke amazwe.
I-ACA inqamule ama-caps wonyaka nonyaka wokuphila ukuthi inkampani yomshuwalense izokhokhela kanjani ukunakekelwa kwempilo ekhokhelwa yomshuwalense, futhi ibeke ama-maximums out-of-pocket .
I-ACA idinga izinhlelo zomshuwalense wezempilo ezimakethe zomuntu ngamunye kanye nezincane ukuze zihlanganise izinzuzo eziyishumi zempilo ezibalulekile . Esinye sezigaba ezibalulekile zokuhlomula ezempilo ukunakekelwa kokuvimbela, futhi izinsizakalo eziningi zokunakekelwa kokuvikela zidingeka ukuba zihlanganiswe ngaphandle kokwabelana ngezindleko .
I-ACA idinga abaqashi abakhulu-labo abanabasebenzi abalingana nesikhathi esigcwele abangu-50 noma ngaphezulu-ukunikela ngemali engabizi, umsindo womshuwalense wezempilo ophansi kunabo bonke abasebenzi (amahora angu-30 + ngeviki), noma ukubeka ingozi ngaphansi komqashi okwabelwana ngemfanelo yomsebenzi . Abaqashi kumele baqinisekise ukuthi ukubhekwa kubhekwa njengengakhokhwa isisebenzi, kodwa akukho ukuhlolwa kokukwazi ukukhokhela izindleko zokuhlanganisa amalungu omndeni ngaphansi kohlelo. Ngenxa yokuthi lokhu kusebenza kanjani nokuthi ukutholakala kwezinsizakalo kunqunywe kanjani ekukhulumisaneni, abanye abantu abakwazi ukuthola ukuthengwa okungabizi ngenxa yezinto okubhekiswe kuzo ngokuthi " umlenze womndeni ."
[Iningi lezinhlinzeko ezingenhla alisebenzisanga ezinhlelweni ezizukulukazi nezinkulu.]
Ezinye izingxenye zoMthetho Wokunakekelwa Onganakekelwayo ziye zachithwa noma zaqedwa
Ezinye izingxenye ze-ACA azisoze zaqaliswa: INkantolo Ephakeme yenqabe ukuhlinzekwa okwakuyokhipha imali ye-Medicaid yase-federal ukuze kuthiwa ayizange ihlinzeke nge- Medicaid kubantu abaningi. Lokhu kuye kwaholela ekungeneni kwekhasi , lapho abantu abayizigidi ezingu-2.4 abayisishiyagalolunye nesishiyagalolunye (18 million) abasho ukuthi abanakho ukufinyeleleka okungokoqobo kokufinyelela.
Ukwengeza kwalokho, iCongress yaqeda ukuhlinzekwa kwe-ACA, okwakubizwa ngokuthi yi- CLASS Act , ngoJanuwari 2013 ngemuva kokuba uMnyango wezeMpilo noHulumeni bezenhlalakahle unqume ukuthi awunakwenzeka.
Izici eziningi ze-ACA zaphuza, kuhlanganise nomqashi wabelane ngokuhlinzekwa komthwalo wemfanelo (kwaqala ukusebenza ngo-2015, hhayi ngo-2014, futhi awuzange uqedwe ngokugcwele kuze kube ngu-2016), intela ye-Cadillac (manje isethelwe ukusebenza ngo-2020), futhi ukupheliswa kwezinhlelo ezingavumelekile, ezingekho ze-ACA ezikhishwe ngaphambi kuka-2014 (lezi zinhlelo ziyisiguquko, noma "zikhulu," futhi ziyavunyelwa ukuba ziqhubeke ziphoqelele kuze kube sekupheleni kuka-2018, ekuqaliseni kwezwe kanye nabashuwalense bezempilo).
> Imithombo:
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi , Ukuqoqwa koMvikeli Weziguli kanye noMthetho Wokunakekelwa Kwezinkinga .
> Kaiser Family Foundation, Umhlahlandlela wokuPhathiswa kweNkantolo Ephakeme kwi-ACA's Medicaid Expansion , ngo-Agasti 2012.
> Kaiser Family Foundation. I-Gap Yezokuxhumana: Abadala Abangenalutho Abazimele Emasimini Angenwetshisi I-Medicaid. Novemba 1, 2017.
> Lemieux, Jeff; kanye noMoutray, Chad, Ngalowo Ntela YaseCadillac, Ezempilo, ngo-Ephreli 25, 2016.