Ngomhla ka-22 Disemba, 2017, uMongameli Trump usayine uMthetho weNtela yokuThutha neMisebenzi (HR1). Umthetho uhlanganisa izinguquko ezishisayo kumakhodi yentela yase-US, kodwa futhi ususa unyaka wokuhlukunyezwa komthetho wokuguqula impilo. Ungase uzibuze ukuthi umthetho we-GOP wentela uzothinta umshwalense wakho wezempilo, njengoba ukuchithwa kwe-ACA kuye kwaba yinto ebaluleke kakhulu kubameli beRiphablikhi kanye ne-Trump Administration.
Kodwa umthethosivivinywa wentela awuhlanganisi iningi lezinhlinzeko ezabe yingxenye yemizamo yokuphinda i-ACA ekuqaleni kuka-2017. Iyakususa isigwebo somuntu ngabanye ngo-2019, kodwa konke okushiwo uMthetho Wokunakekelwa Ongenakusiza kushiywe endaweni. Futhi ezinye izinguquko zokunakekelwa kwezempilo ezihlobene nentela eziye zahlongozwa ekuqaleni konyaka, njengokushintsha imithetho ephathelene nama-akhawunti wokulondoloza impilo (HSAs) azange zifakwe kumthethosivivinywa wentela.
Ukuphinda kuhlawulwe isigwebo somuntu ngamunye
Umthethosivivinywa wentela uchitha isigwebo somuntu ngamunye kusukela ngo-2019. Ngakho-ke kusenhlawulo yabantu abangaqinisekisiwe ngo-2018 (leso sinxephezelo sizohlolwa uma ukubuyiswa kwentela kufakwa ekuqaleni kuka-2019). Lokhu kuhluke emizamweni ye-GOP yokuqeda isigwebo somuntu ngamunye ekuqaleni kuka-2017, njengoba izindleko ezedlule ziyokwenza ukuphinda kuvuselelwe. Ekugcineni, umthethosivivinywa wentela ugcina isigwebo somuntu ngamunye ngaphambi kwayo yonke iminyaka eyandulela, futhi ngo-2017 no-2018.
Kodwa izinkokhelo zentela ezingu-2019 ezifakwe ekuqaleni kwawo-2020 ngeke zifake isijeziso sokungaqinisekisiwe.
Ukuphindaphinda isigwebo esivumelana nesigunyazo somuntu ngamunye se-ACA sekuyisikhathi eside sibe yinto ebaluleke kakhulu kwi-Congressional Republicans, futhi igunya ngokwalo ngokuqinisekile liphakathi kwezinhlinzeko ezingathandwa kakhulu ze-ACA. Kodwa naphezu kokungathandeki kwayo, kungenye yezinhlinzeko ezivumela ukuthi i-ACA ibe nomthetho oqinisekisiwe kakhulu wokuqinisekisa ukukhishwa.
Ukukhishwa okuqinisekisiwe kusho ukukhishwa okukhishwa kubo bonke abafakizicelo, kungakhathaliseki ukuthi umlando wabo wezokwelapha. I-ACA iphinde isebenzise ukulinganisa komphakathi okuguquliwe, okusho ukuthi amaphrimiyamu anikezwe ngabakwa-insurer kumakethe amancane neqembu amancane ahluke kuphela ngokususelwa eminyakeni yobudala, ukusetshenziswa kwegwayi kanye ne-zipcode. Ngaphambi kwe-ACA, ama-premium ayebuye asekelwe ezintweni ezifana nobulili nesimo sezempilo.
Ukushintsha imithetho ukuze umlando wezokwelapha ungabe usadlala indima ekufanelekile noma ama-premium ashintshiwe ngokuthandwayo. Kodwa kulula ukubona ukuthi abantu bangalingeka kanjani ukuba bahambe ngaphandle kokuqashwa lapho bephilile, bese ubhalisa uma begula uma bekwazi ukuthi ngeke banqatshelwe-futhi lokho bekungeke kube khona. Ngakho i-ACA ihlanganisa amalungiselelo amabili okuvimbela lokhu: Isigunyazo somuntu ngamunye esilungisa abantu abakhetha ukuhamba ngaphandle komshuwalense, kanye namafasitela okubhalisa okuvulekile okubhalisiwe kanye nezinkathi zokubhalisa ezikhethekile (okungukuthi, awukwazi ukubhalisa noma kunini lapho uthanda khona).
Ukubhalisa okuvulekile namafasitela okubhalisa okhethekile ngeke aguquke, okwenza kube inselele kubantu ukulinda baze bagule ukubhalisa kumshwalense wempilo yamakethe ngamunye (umshuwalense wezempilo oxhaswe ngumqashi usetshenziswe isikhathi eside sokubhalisa okuvulekile; abantu abakwazi ukubhalisa ngenjongo yezempilo yomqashi wabo noma nini lapho bethanda).
Kodwa ukuchitha igunya lomuntu ngamunye kuyoba nomthelela omubi emakethe yomshuwalense wezempilo. Amaphrojekthi we-Congressional Budget Office (CBO) ukuthi ngo-2027, kuzoba nabantu abayizigidi ezingu-13 abambalwa abanomshwalense wezempilo kunokuba bekungeke kube khona uma isijeziso sesigwebo sisekhona. Kulezi zigidi ezingu-13 ezibheke izinkampani ezibheke izikweletu, izigidi ezingu-5 zizobe zinezinkinga emakethe ngayinye. Futhi leyo yingxenye ebalulekile emakethe ngayinye, elinganiselwa kubantu abangaphansi kwezigidi ezingu-18 kusukela ngo-2017 (ngokubheka, amaphrojekthi e-CBO angamaphesenti amabili nje kuphela ama-insureds ambalwa ayizigidi ezingu-13 azoba abantu abangaba khona ukukhokhelwa ngaphansi kokuxhaswa ngumqashi izinhlelo zezempilo, kanye nabantu abayizigidi ezingu-158 banomsebenzi ngaphansi kwezinhlelo ezixhaswe ngumqashi).
Abantu abazoyeka ukwehla kwabo ngaphandle kwemvume bavame ukuba nempilo, njengoba abantu abagulayo ngokuvamile benza noma yini edingekayo ukuze balondoloze. Ukujikijela esikebheni esiyingozi kakhulu kubangelwa amaphrimiyamu aphezulu, okuyiwona oqhuba abantu abaningi abanempilo emakethe.
Ngokubanzi, i-CBO ilinganisela ukuthi amaphrimiyamu emakethe yomshuwalense ngamunye azokhula ngamaphesenti angu-10 ngonyaka, ngenhla ngaphezu kwemali ababeyoyikhulisa uma igunya lomuntu ngamunye lihlala lisebenza.
Kodwa i-CBO ithi futhi imakethe yomshuwalense ngamunye "izoqhubeka igxilile cishe kuzo zonke izindawo zezwe kule minyaka eyishumi ezayo." Ngamanye amazwi, bakholelwa ukuthi izindawo eziningi zezwe zizobe zinezinkampani zomshuwalense ezihlinzeka ngokuthengwa kwamakethe, futhi inani elanele labhalisile ukugcina izinhlelo zizinzile. Lokhu kubangelwa, ikakhulukazi, ukuthi izinsizakalo ze - ACAs premium zikhula ukuze zihambisane nama-premium. Ngakho-ke nakuba ukuqedwa komsebenzi ngamunye kuzodala ama-premiums aphezulu, izinsizakalo ze-premium nazo ziyokhula njengoba kunesidingo ukugcina ama-premiums net ezingeni eliphezulu.
Kubantu abathola izinsizakalo ze-premium, ezihlanganisa umndeni wezingane ezine ezifinyelela ku-$ 98,400 ngo-2018, ukwenyuka kwama-premium kuzokwenyuswa ngokukhuphuka okujwayelekile kumali yesibonelelo. Kodwa kubantu abangatholi izinsizakalo ze-premium, ukufakwa emakethe ngayinye kungase kungabi nakakhulu eminyakeni engomuso. Kubalulekile ukuqonda ukuthi izinkokhelo ezinhlelweni zokuthatha umhlalaphansi ngaphambi kokukhokhela intela kanye / noma i-HSA (uma uthenga uhlelo lwezempilo lwe-HSA ) uzothola imali engenayo eguquliwe ehlelwe kabusha (i-ACA-ethize; ayifani ne-MAGI ejwayelekile), futhi kungenza ube nelungelo lokukhulumisana nezinkokhelo ze-premium nomeluleki wezezimali ngaphambi kokucabanga ukuthi awufanelekile ukuthola izinsizakalo.
Kodwa ngokujwayelekile, ukwanda kwe-premium okubangelwa ukuqedwa kwesigwebo somuntu ngabanye kuyoshaya abantu abathengisa emakethe ngayinye futhi abafanelekeli ukukhokhelwa kwe-premium (okungukuthi, labo abanemali engenayo engaphezu kwamaphesenti angu-400 ebunini bobuphofu, emkhawulweni we-Medicaid, noma awuvumelekile ukuthola izinsizakalo ngenxa ye- glitch yomndeni ). Futhi nakuba amaphrojekthi e-CBO ukuthi imakethe ngayinye izohlala ezinzile ezindaweni eziningi zezwe, kungase kube nezindawo ezithile lapho imakethe ngayinye ivele ivele khona, futhi akukho bhukhwalense abanikezela ukukhokhelwa. Lokho kuzodingeka kulandelwe esimweni-nge-case basis, okungenzeka kube nomthetho wesifundazwe kanye / noma wombuso. Kodwa kungumphumela ongahle noma ongafinyeleleki.
Umthelela kumshuwalense wezempilo oxhaswe ngumqashi
Abaningi baseMelika abangewona asebekhulile bathola umshwalense wabo wezempilo kubaqashi babo, futhi umthethosivivinywa wentela awuguquli lutho ngomshuwalense wezempilo oxhaswe ngumqashi. Isigunyazo somqashi sizohlala sisebenza , njengoba kuzokwenza yonke imithetho ehambisana ne-ACA emisebenzini yezempilo exhaswe ngumqashi.
Izindleko ezehlukene ze-ACA zokuchithwa ezacatshangwa ekuqaleni kuka-2017 zizoqeda kokubili igunya lomuntu ngamunye kanye nomsebenzi wabasebenzi, kodwa umthethosivivinywa wentela uchitha kuphela igunya lomuntu ngamunye. Abaqashi abakhulu (izisebenzi ezingama-50 ezilingana nesikhathi esigcwele) bazoqhubeka nokudingeka banikeze umshuwalense wezempilo kubasebenzi besikhathi esigcwele.
Kodwa labo basebenzi ngeke baphinde bahlawulwe yi-IRS uma behluleka ukugcina ukwaziswa. Ngakho-ke amaphrojekthi we-CBO ukuthi ngo-2027, kuyoba nabantu abangaba ngu-2 million abantu abambalwa abanokuqashwa okuxhaswe ngumqashi kunokuba bekuyoba khona uma ngabe igunya lomuntu ngamunye limile. Kodwa ngokubanzi, lokhu kuncipha kuzokwenzeka kubasebenzi abayekezela ukunikezelwa kokuqashwa kwabaqashi, njengoba abaqashi bazobe besadingeka banikeze ukuhlinzekwa ukuze bagweme izigwegwe ezingahle zibe ngaphansi kwegunya lomqashi.
Imihlomulo ye-HSA nemithetho ayishintshi
Ama-akhawunti wokulondoloza impilo (HSA) avumela abantu abanezinhlelo zezempilo eziphakeme ezifanelekile ze-HSA (HDHPs) ukubeka eceleni imali yentela ngaphambi kokukhokhela izindleko zabo zokunakekelwa kwezempilo esikhathini esizayo ( noma ukusebenzisa njenge-akhawunti yomhlalaphansi ). Ababhali beRiphabhulikhi sebeye bagxila emisebenzini yokwandisa ama-HSA ngokukhulisa imingcele yokunikela futhi bevumela izimali ukuba zisetshenziselwe ukukhokhela amaprimiyamu omshwalense wezempilo. Muva nje, abameli be-GOP nabo bafuna ukunciphisa ukukhushulwa kwenhlawulo ukuthi uMthetho Wokunakekelwa Onganakekelwayo unqunywe ekuhoxisweni kwezindleko ezingekho zezokwelapha ngaphambi kweminyaka engu-65.
Ezinye noma zonke lezi zinhlinzeko zifakwe emithethweni ehlukene yokuchithwa kwe-ACA abaphathi be-GOP ababhekene nayo ngo-2017 . Kodwa akekho owakwenza ku-Act Cuts and Jobs Act. Abomthetho be-GOP bangase bacabange ngomthetho owengeziwe ngo-2018 ukwenza izinguquko kuma-HSA, kodwa okwesikhashana, ashintshiwe.
Imikhawulo yomnikelo ka-2018 ingamaRandi ayizigidi ezingu-3,450 kubantu abanezinkampani eziyingqayizivele ngaphansi kwe-HDHP, kanye ne-$ 6,900 kulabo abanomndeni. Kukhona isamba samaphesenti angama-20 ekuhoxisweni okuthathwe ngaphambi kweminyaka engu-65 uma imali ingasetshenziselwa izindleko zezokwelapha, kanti izinkokhelo zomshuwalense wezempilo angeke zikhokhwe ngezimali ze-HSA, ngaphandle kwama-premium ama-COBRA, ama-premium akhokhelwa ngenkathi uthola ukungasebenzi , kanye nama-premium we-Medicare Parts A, B, kanye / noma D.
Ukuqeda Imali Yezokwelapha kuyoba lula ngo-2017 no-2018
Izindleko zezokwelapha zikhokhiswa intela, kodwa kuphela uma zidlula amaphesenti angu-7.5 wemali engenayo. Kwakuvame ukuba ngamaphesenti angu-7,5, kodwa i-ACA isishintshe ibe ngamaphesenti angu-10 kwisilinganiso sokulondoloza imali. Abantu abaneminyaka engama-65 noma ngaphezulu bavunyelwe ukuqhubeka nokusebenzisa umkhawulo wamaphesenti angu-7.5 kuze kube sekupheleni kuka-2016, kodwa umkhawulo wamaphesenti angu-10 ungene phakathi kuka-2017 kuwo wonke amafayili yentela.
Ngomzamo wokwamukela umthengi wesikweletu sentela, uSenenja uSusan Collins (R, Maine) wancoma ukucindezela ukubuyela kumaphesenti angu-7.5. Ekugcineni, umthethosivivinywa wentela wawubandakanya lolu shintsho, kodwa okwesikhashana. Ngo-2017 no-2018, abafaki bentela bangaphinda bathathe izindleko zezokwelapha ezidlula amaphesenti angu-7.5 emali yabo engenayo. Kodwa kusukela ngo-2019, i-threshold ye-10% izosebenza, futhi izindleko zezokwelapha kuphela ezingaphezu kwalowo mkhawulo zizokhishwa intela.
> Imithombo:
> Congress.gov. I-HR1 - Umthetho wokuhlinzekela ukubuyisana ngokuhambisana nezihloko II no-V zesinqumo esiphelele kwisabelomali sezimali > ngonyaka wezi-2018. Ingene ngemvume emthethweni 12/22/2017.
> Ihhovisi le-Budget ye-Congressional. Ukuphinda Umgomo Womshuwalense Wezempilo Wodwa: Ukulinganiswa Okubuyekeziwe . Novemba 2017.
> Kaiser Family Foundation. Qhathanisa iziphakamiso zokufaka esikhundleni soMthetho Wokunakekelwa Onganakekelwayo.
> Kaiser Family Foundation. Ukuphepha Kwezempilo Kwempilo Yonke Inani Labantu. 2016
> Mark Farrah Associates. Ukubheka Ngokubheka Umshwalense Wempilo Yomshwalense Womuntu Omusha. NgoJulayi 19, 2017.