I-BCRA iqoqa ezinye izingxenye ze-AHCA, kodwa ihluke kwezinye izindlela ezibalulekile
NgoJuni 22, 2017, iNational Senate yase-United States yavula umthethosivivinywa wokulungisa isimo sezempilo ukuthi basebenzile ngokuphelele iminyango evaliwe emasontweni kusukela iNdlu idlulisela uMthetho wezeMpilo we-American Health Care (AHCA) ngoMeyi 4. Nanobe inenani lenani elifanayo (HR1628) ), i-Senate ibize ngokuthi i- Better Care Reconciliation Act (BCRA) ka-2017 . Umthethosivivinywa ugcine okuningi kwe-AHCA, kodwa futhi unemibono eyinhloko.
Emasontweni alandelayo, i-Senate yaveza ukuhlukahluka okuncane kwe-BCRA, kodwa baqhubeka nokwakhela umthetho ngomthetho wokubambisana, kungekho ukuzwa kwekomiti noma ingxabano ye-bipartisan. Ukubuyekezwa kokuqala, okukhishwe ngoJuni 26, kuhlanganisa isidingo sokuqhubeka somsebenzi, esingakafakiwe kunguqulo yabo yangaphambilini (ungabona kokubili izinguqulo ze-Bill ye-Senate lapha). Izinguqulo ezengeziwe ze-BCRA zafakwa ngo-Julayi 13 ( isifinyezo sesigaba-by-sigaba), futhi ngo-Julayi 20 (isigaba-by-isigaba summary ).
I-Senate iphinde yafaka uMthetho Wokubuyisana Wokubuyiswa Kwe-Obamacare (ORRA), okwenza kube lula ukubeka imithetho emakhomishini amabili owadlula ngo-2015 (HR3762) ukuchitha izinhlinzeko eziningana ze-ACA. Lo mthetho uvame ukubhekwa ngokuthi "ukuchithwa nokulibaziseka" ngoba awuqukethe noma yiluphi uhlaka lokufaka esikhundleni se-ACA. UMengameli Obama uvotele ekuqaleni kwawo-2016, kodwa abanye abameli beSeneti banesithakazelo sokuphinda baphinde baphinde baphinde bamemezele ukuthi uMongameli Trump usehhovisi (lo mthetho wawungenalutho oluncane lokudlulela, ngenxa yokuthi ukungafuni ukuthi amaRephabliki ahlolisise eSenate abonise lapho ifika ekuqedeni i-ACA ngaphandle kokushintshwa okuqinile emphemeni; yalethwa phansi kwe-senate yokuvotela ngoJulayi 27, futhi yahluleka 45-55).
I-BCRA nayo yalethwa phansi eSenate ngoJulayi 27, futhi yahluleka ngokuvota 43-57. Ama-Democrats angama-46 kanye nama-Independents amabili (amabili bobubili i-caucus namaDemocrats) avotela ngokulinganisa, futhi ahlanganiswa yi-Republican Senators ayisishiyagalolunye. Emzamweni wokugcina umgogodla wokudlulisa uhlobo oluthile lwe-Obamacare ukuchithwa, i-GOP Senators yathatha ukuchithwa kwe-"skinny" (i-Health Care Freedom Act) kusihlwa ngoJulayi 27.
Leyo nganiso nayo yahluleka, 49-51 (uSenen Collins, uMurkowski, noMcCain bavotela, kanye nabo bonke abaDemocratic and Independents).
Kubalulekile ukuthi uqaphele ukuthi iSenate isengakwazi ukuletha isikweletu seNdlu sokubuyiselwa kabusha, kanti ezinye izichibiyelo zicatshangelwa ukuthi zingashintshwa esikhundleni somthethosivivinywa owadlulela iNdlu (yilokho iSenate ivotele khona i-ORRA, i-BCRA, kanye noMthetho Wokunakekelwa KwezeMpilo; zafakwa njengezichibiyelo zokufaka esikhundleni sombhalo okhona we-bill).
Yize i-BCRA ingazange idlule, asazi nokuthi izoshintshwa kanjani futhi izobuyiselwa kabusha. Ngakho ake sibheke ukuthi yiSénate Republican yalungisa yini, futhi siqonde ukuthi kanjani uma kuqhathaniswa ne-AHCA ukuthi amaPhalamende aseNdlu adlulisa (ekhumbula ukuthi amakamelo amabili kuzodingeka avumelane ngokwemigomo yomthetho wokuqeda / ukubuyisela i-ACA ngaphambi kokuba angayithumela kuMongameli). Sinezihloko eziningana mayelana ne-AHCA, ukukusiza ukuthi uqonde kabanzi mayelana nohlelo lwezindlu lwezinguquko zokunakekelwa kwezempilo:
Ngakho ake sibheke izindlela i-BCRA ehluke ngayo ku-AHCA.
Ukukhipha intela
I-Affordable Care Act (i-ACA), ukuchithwa okuyiyona ndlela ekuhloswe ngayo kokubili izindlu zezindlu zeNdlu nezeSenate, kufaka phakathi izintela ezihlukahlukene eziMelika nabanakekeli bezempilo, kanye nezinhlawulo zentela ezihambisana nomuntu ngamunye igunya nokuqashwa komqashi .
Izimali ezivela kulezi zentela zisetshenziselwa ukunciphisa uhlelo lokunakekelwa kwezempilo futhi zinikeze ukuthengwa okungcono, okungaphezulu okuthengekayo kubantu abaningi. Ukugunyazwa ngabanye kuyithuluzi lokugqugquzela abantu abanempilo ukuba balondoloze, futhi igunya lomqashi likhuthaza abaqashi abaphezulu ukuba banikeze ukuhlinzekwa okuphezulu, okungabizi kakhulu kubasebenzi besikhathi esigcwele.
I-AHCA inqabela intela, futhi izinguqulo zokuqala ze-BCRA nazo ziyabasusa. Kodwa-ke izinguqulo zamuva ze-BCRA, zigcina izintela ezimbili ezibalulekile esikhundleni: I-0.9 iphesenti ye-Medicare yokukhokha intela yokukhokhwa intela kubanikezeli abanemali ephezulu, kanti inzuzo engamaphesenti angu-3.8 (okusho, imali engenayo engenayo) intela ekhokhelwa intela ephezulu (ukuchithwa kwezi izintela zizohlomula abantu abathola okungenani izigidigidi zamaRandi ngonyaka).
I-AHCA ne-BCRA zombili ziholela ekunciphiseni kwezimali zomphakathi, nakuba lezi zimali ezimbili zinamashejuli ahlukene ngokuya lapho izintela ezihlukahlukene zizochithwa. Futhi ukuncishiswa kwemali engenayo ye-federal kuncane kakhulu ezinkampanini zakamuva ze-BCRA, njengoba igcina intela ye-Medicare kubantu abahola imali ephezulu (ngaphezu kweminyaka eyishumi ezayo, ukugcina lezo zindleko ezimbili kuvimbela ukulahlekelwa kwezingu-dollar ezingama-231 kumali engenayo ye-federal, ngokusho ukuhlaziywa kweHhovisi likaHhovisi likaHulumeni le- Congressional of the BCRA ).
Ukunciphisa ukukhishwa kwentela (eziningi zazo ezisaqhubeka zisebenza ngaphansi kwe-BCRA), imali ye-federal ye- Medicaid ne- premium yokusizwa iyancipha.
I-Medicaid
Izimali eziningi zeMedicaid zisetshenziselwa ukuhlinzeka ukunakekelwa isikhathi eside kwabaseMelika asebekhulile, nokuhlinzeka ngemithi yokwelashwa kwabantwana abahola imali encane, abesifazane abakhulelwe, nabantu abakhubazekile (cishe izingxenye ezimbili kwezintathu zabahlali basekhaya abahlengikazi bahlanganiswa iMedicaid, futhi cishe ingxenye kuzo zonke ukuzalwa e-US zimbozwe yi-Medicaid).
Ngaphansi kwe-ACA, i-Medicaid nayo isandisiwe ukuze ibheke abantu abadala abahola imali engenayo. Kokubili i-AHCA ne-BCRA ivuselela ukunwetshwa kwe-Medicaid, futhi inqume ngokukhululeka ukuxhasa ngemali yonke i-Medicaid. Ukunyuka kwe-Medicaid emuva kuzoba ngaphansi kwesigaba sokuqeda i-ACA (injongo ekhonjisiwe ye-Republican yokunakekelwa kokunakekelwa kokunakekelwa kokunakekelwa kwezempilo), kodwa jikelele ukuxhaswa kwemali eFedicaid kudlula ngaphesheya kwe-ACA.
Ngokusho kokuhlaziywa kwe-Congressional Budget Office (CBO), ukusetshenziswa kwemali yaseMedicaid kuzokwenyuka ngamaRandi ayizigidi eziyizinkulungwane ezingu-834 eminyakeni eyishumi ezayo ngaphansi kwe-AHCA. Ukuhlaziywa kwe-CBRA ka-Julayi 20 kwe-BCRA iphrojekthi engu-$ 756 billion ku-Medicaid ngemali ye-Medicaid inciphisa ngo-2026, kodwa kuyaphawuleka ukuthi i-BCRA inciphisa i-Medicaid ngokuthe xaxa kusukela ngo-2025, ngakho-ke ukusikeka ngaphansi kwe-BCRA kuyoba mkhulu kunezicucu ngaphansi kwe-AHCA uma siqhubeka ukuhlaziywa kwesinye ishumi (i-CBO ibike ukuthi ngo-2036, ukusetshenziswa kwemali yaseMedicaid kuyoba ngamaphesenti angu-35 ngaphansi kwe-BCRA kunokuba ngabe ngabe i-ACA igcinwa).
Ngaphansi kwe-ACA, uhulumeni wesifundazwe manje ukhokha amaphesenti angu-95 ezindleko zokuhlanganisa abantu abaye bafanelekela i-Medicaid ngaphansi kokwandiswa kohlelo lwe - ACA . Lokho kusethelwe ukwehla kuya kumaphesenti angama-90 kusukela ngo-2020, futhi uhlale kuleyo nqanaba uya phambili.
I-AHCA ngeke ivume ukuthi noma yiziphi izifunda ezintsha zokwandisa i-Medicaid ngemuva kuka-Mashi 1, 2017, futhi izoshintshela kumaphesenti afanayo ejwayelekile wombuso we-Medicaid (phakathi kwamaphesenti angu-50 no-75%; amazwe ampofu athola umdlalo omkhulu) ngo-2021. ukuqeda ukubhaliswa okusha kwe-Medicaid, njengoba amazwe kufanele athathe iphesenti elingenakulungiswa lomthethosivivinywa.
I-AHCA ibuye iguqulwe i-Medicaid (yonke uhlelo, hhayi nje ukwandiswa kwe-ACA's Medicaid) ohlelweni lokuhlukaniswa komuntu ngamunye, ngemali eyisibonelelo esivela kuhulumeni kahulumeni oshintshwa njalo ngonyaka yi-CPI-Medical +1 (ingxenye yezokwelapha yomthengi inkomba yezindleko, kanye nephuzu elilodwa lamaphesenti). Kubalulekile ukuqaphela ukuthi inani labantu baseMedicaid livame ukugula kunabantu abaningi, ngakho-ke inombolo yezokwelapha ye-CPI ayibonakali ngokunembile ukukhula kwezindleko zezokwelapha kubantu baseMedicaid.
I-BCRA nayo izovimbela ukukhuliswa kwe-Medicaid ukuthi isandise kusukela ngo-March 2017. Kodwa esikhundleni sokusika izimali zikahulumeni ze-Medicaid ukwandisa konke ukuhamba, izinga elilinganayo lezempi lizokwehla ngamaphesenti angu-85 ngo-2021, amaphesenti angu-80 ngo-2022, futhi Amaphesenti angama-75 ngo-2023. Kusukela ngo-2024, bekuzobuyela emaphesenti afanayo ejwayelekile eMelika. Lokhu kusho ukuthi izwe ngeke lilahlekelwe ngokuzumayo zonke izinsizakalo zezimali ezithuthukisiwe ezisebenza njengamanje kubantu baseMedicaid ukwandisa, kodwa kunezifunda eziningana lapho umthetho wezwe uzoqeda ukukhuliswa kwe-Medicaid uma umdlalo wesifunda ungena ngaphansi kwamaphesenti angu-90 (i-Arkansas, i-Arizona, i-Illinois , E-Indiana, eMichigan, eNew Hampshire, eNew Mexico naseWashington).
I-BCRA izophinde ishintshe i-Medicaid ohlelweni lwesabelo somuntu ngamunye, kodwa esikhundleni sokulungisa izimali nge-CPI-Medical + 1, i-BCRA izongena kuphela yi-CPI-Medical ngo-2024, futhi nge-CPI ejwayelekile (hhayi ingxenye yezokwelapha) kusukela ngo-2025. I-CPI-Medical ngokuvamile inomboro enkulu kunayo yonke i-CPI, ngoba izindleko zezokwelapha zivame ukwehlisa ngokushesha kunezinye izindleko. I-CPI ejwayelekile ingaba yinto engalungile, engabangela ukuxhaswa kwemali yonyaka we-Mederalid federal. Ngakho uthi uzobona ukunyuka okunamandla emalini yabo eFedical Medicaid njengoba izikhathi zihamba ngaphansi kwe-BCRA.
Isidingo Sokugcina Impilo Yomshuwalense Wezempilo
I-ACA idinga abantu abaningi ukuba balondoloze ukutholakala komshuwalense wezempilo noma babhekane nesigwebo sentela. Kukhona uhlu olukhulu lokukhululwa kwezigwegwe , kodwa i- IRS ibike ekuqaleni kuka-2017 ukuthi izihlungi eziyizigidi eziyizigidi ezingu-6.5 zihlolwe cishe ama-dollar ayizigidi eziyizinkulungwane ezingu-3 ezikhokhweni ngenxa yokungaqinisekiswa ngo-2015.
I-AHCA ne-BCRA zombili ziqeda inkokhelo, ibuyele emuva ekuqaleni kuka-2016. I-AHCA iyishintsha ngonyaka owodwa, ukukhuphuka kwamaphesenti angu-30 kubantu abangenayo igebe ekukhokhweni kwezinsuku ezingu-63 noma ngaphezulu ezinyangeni eziyi-12 ezedlule (noma, njengoba kuchaziwe ngezansi, amazwe angakhetha ukuvumela abakwa-insurer ukuba basekele amaphrimiyamu emlandweni wezokwelapha lapho abafakizicelo benesiphakamiso sokubanjwa).
Ngokuthakazelisayo, inguqulo ye-BCRA eyakhishwa ngoJuni 22 ayizange ithathe isikhundla sokuqedwa kwenhlawulo nganoma yini. Kungaba nje ukuyichitha, futhi akubandakanyi noma yimaphi amalungiselelo okukhuthaza abantu ukuthi balondoloze ukuqhubeka okuqhubekayo.
Kodwa cishe masinyane, kwakukhona amahemuhemu okuthi uhlobo oluthile lwezimfuneko zokufaka isicelo oluzoqhubeka luzofakwa ngosuku oluthile, futhi inguqulo entsha yomthetho yanyatheliswa ngoJuni 26, okubandakanya imfuno eqhubekayo yokusabalalisa (ungabona ohlangothini olulodwa amakhophi wezinguqulo zikaJune 26 noJuni 22 ze-BCRA lapha; isigaba esisha mayelana nokufakwa okuqhubekayo kuqala ekhasini 135 le-June 26). Imfuneko yokuqhubeka yokusabalalisa igcinwe ngezihumusho zamuva ze-BCRA.
Ngaphansi kwe-BCRA ebuyekeziwe, abantu kuzodingeka balondoloze ukufakwa okuqhubekayo noma babhekane nesikhathi sokulinda ngaphambi kokuba bathole ukutholakala emakethe yomshuwalense wezempilo. Nakhu ukuthi kuzosebenza kanjani:
- Abantu abanezinkinga eziqhubekayo (okungukuthi, phakathi nezinyanga eziyishumi nambili ezedlule, babengenayo igebe ekubhalweni kwezinsuku ezingu-63 noma ngaphezulu) bazokwazi ukubhalisa ngesikhathi sokubhalisa okuvulekile noma isikhathi sokubhalisa esikhethekile , ngezinsuku ezivamile eziphumelelayo (okokuqala inyanga elandelayo noma inyanga yesibili elandelayo, kuye ngokuthi usuku lokubhalisa).
- Abantu abangabhalwanga ngokuqhubekayo ababhalisa ngesikhathi sokubhalisa okuvulekile noma isikhathi sokubhalisa esikhethekile singaphansi kwenkathi yokulinda inyanga eyisithupha ngaphambi kokuba ukufakwa kwabo kusebenze.
- Abantu abangabhalwanga ngokuqhubekayo ababhalisa ngaphandle kokubhaliswa okuvulekile futhi ngaphandle kwesikhathi sokubhalisa esikhethekile kuzodingeka balinde isikhathi esilandelayo sokulinda izinyanga eziyisithupha noma ukuqala kwonyaka olandelayo wokuhlela ngaphambi kokuthi ukufakwa kwabo kusebenze (ukubhalisa ngoFebhuwari ngaphandle isikhathi sokubhalisa esikhethekile singasho ukuthi ukufakwa kwakho kuzoqala ukusebenza ngoJanuwari olandelayo).
- Abantu abanomsebenzi ngamunye wokuthengisa emakethe ngosuku lokuqala ngaphambi kokuba uhlelo lwabo lomakethe olusha lusebenze ngeke lube ngaphansi kwenkathi yokulinda inyanga eyisithupha, noma ngabe babe negebe ekubanjweni phakathi nonyaka odlule (isibonelo, umuntu obhalisa ngesikhathi sokubhalisa okuvulekile, ngaphansi kwenkathi yokulinda inyanga eyisithupha, bese ehlangabezana nesenzakalo esifanelekayo ngokushesha ngemuva kokuba uhlelo olusha luqale ukusebenza, luzokwazi ukushintshela ohlelweni olusha ngesikhathi sokubhalisa esikhethekile esingenayo isikhathi sokulinda, ngisho noma igebe lakhe langaphambilini ekuhambeni likhona kusezinyangeni ezingu-12 zokugcina).
- Izingane ezintsha kanye nezingane ezisanda kutholwa ngeke zibe ngaphansi kwesikhathi sokulinda uma nje zibhalisiwe zingakapheli izinsuku ezingama-30 zokuzalwa noma ukutholwa (inothi ukuthi i-ACA inikeza abazali abatsha izinsuku ezingama-60 ukubhalisa ingane esanda kuzalwa noma entsha).
Izinzuzo zezempilo ezibalulekile
I-ACA idinga ukuhlinzekwa kwezinzuzo zezempilo ezibalulekile kuzo zonke izinhlelo ezingekho ezindala , ezingenakudala , izinhlelo zeqembu ngalinye namancane. Izinzuzo zezempilo ezibalulekile nazo zidingeke ukuba zihlanganiswe kuzo zonke izinhlelo zokukhulisa iMedicaid.
I-AHCA ayishintshi izinzuzo ezibalulekile zezempilo ezingeni likahulumeni, kodwa izovumela izizwe ukuba zifune ukuxoshwa lapho zingakwazi khona ukuchaza kabusha izinzuzo ezibalulekile zezempilo ngaphakathi kuhulumeni.
I-BCRA nayo ayishintshi izinzuzo ezibalulekile zezempilo ezingeni likahulumeni, futhi ayifaki uhlobo lwenqubo yokushiya isimo evezwe ku-AHCA. Kodwa kuvumela ukuthi kufinyelela kokufinyelela okukhulu kakhulu kuma-ACA's 1332 waivers. Lezi "ukukhishwa okusha" kuvumela amazwe ukuba eze nezindlela eziyingqayizivele zokuguqulwa kwezempilo (iHawaii kuze kube manje i-state kuphela ene-1332 yavunywa ngaphansi kwe-ACA).
I-ACA inesethi esiqinile yemithetho yokuvikela abathengi ukuqinisekisa ukuthi abantu bokufakazela ngaphansi kwesigidi esingu-1332 waiver kuhle kakhulu, akubopheli abantu abambalwa, futhi akubizi kubiza kunokuba kungabikho ukuyeka. I-ACA idinga ukuthi ama-1332 waivers abe yisabelomali-engathathi hlangothi kuhulumeni wesifundazwe, futhi le mfuneko igcinwa yi-BCRA. Kodwa ukuvikelwa komthengi kuqedwa, kufakwe esikhundleni sokuthi umbuso uvele ucacise ukuthi uzokwenzani kanjani "ukwandisa ukufinyeleleka kokufinyelela okuphelele, ukunciphisa ama-premiums ajwayelekile, nokwandisa ukubhaliswa." Ngakho-ke izwe lingakwazi ukushintsha imithetho ebalulekile yokuzuzisa impilo ngokusebenzisa i-1332 waiver ngaphansi kwe-BCRA, ngoba bekungeke kube khona isidingo sokuthi ukusabalala kuhlala kunomqondo ophelele ngaphansi kokushiya njengoba ngaphambili.
Inguqulo ka- Julayi 13 ye-BCRA yayihlanganisa i-Cruz Amendment (eyabhalwa uSenator Ted Cruz waseTexas). I-Cruz Amendment ayikaze ilandelwe yi-CBO, futhi akucaci ukuthi ngabe abaholi beSenate bahlela yini ukuyifaka encwadini yesikweletu esilethwe ngokuvota (uma lokho kwenzeka ngempela).
I-Cruz Amendment izoba negalelo elibalulekile ekusakazeni izinzuzo ezibalulekile zezempilo. Kuzovumela abakwa-insurer ukuba bathengise izinhlelo ezingavumelani uma nje bethengisa okungenani uhlelo olulodwa lwesiliva, uhlelo olulodwa lwegolide, kanye nesilinganiso esisodwa sama-58 amapulani we-actuarial value ( lokhu kuyoba uhlelo lokubheka ngaphansi kwe-BCRA ). Ngokuya ngemithetho kahulumeni, i-Cruz Amendment izovumela abaqashi ukuba bagweme imithetho ehlukahlukene ephathelene nokuhlinzeka ngezempilo, kubandakanya nezinzuzo zezempilo ezibalulekile.
Ukuhlinzekwa kwezimo zangaphambili ezikhona
I-ACA idinga ukuthi zonke izinhlelo zeqembu ngalinye nezincane ziqinisekiswe-kungakhathaliseki ukuthi umlando wezokwelapha.
I-AHCA izovumela izifunda ukuba zifune ukuxoshwa lapho abakwa-inshuwalense abangakwazi khona, ngonyaka owodwa wezinhlelo, amaphrimiyamu asekelwe emlandweni wezokwelapha uma lowo ofake isicelo enesiphakamiso sokuqala kwezinsuku ezingama-63 noma ngaphezulu ezinyangeni ezingu-12 ezedlule. Ababambisisi ngeke bakwazi ukulahla uhlelo lokusebenza ngokuphelele ngokusekelwe emlandweni wezokwelapha (njengoba bebengakwazi kakhulu emazweni amaningi ngaphambi kuka-2014), kodwa bazokwazi ukukhokhisa amaphrimiyamu aphakeme-kungekho cap-okuzokwenza kube lula ukuhlinzekwa okungenakulungiswa kubantu abane- izimo ezikhona kanye negebe ekukhunjweni.
I-BCRA igcina izidingo eziqinisekisiwe ze-ACA nokulinganisa komphakathi, okusho ukuthi abantu abakwazi ukukhokhiswa okuningi ngokusekelwe emlandweni wabo wezokwelapha. Kodwa ngenxa yezinguquko ezingu-1332 ezitholakalayo, izifunda zizokwazi ukuhlenga kabusha izinzuzo ezibalulekile zezempilo, okuholela ekuhloleni okungase kungabalandeli abantu abanezimo ezikhona ngaphambili. Isibonelo, uma izinhlelo zezempilo zingasadingeki zimboze izinhlobo eziningi zemithi kadokotela kanye nesimo sakho esandulele sidinga izidakamizwa ezibizayo, iqiniso lokuthi izimo ezandulele "zimbozwe" ngeke zibe usizo olukhulu.
Ngaphezu kwalokho, i-BCRA ibeka isikhathi sokulinda izinyanga eziyisithupha kunoma ngubani obhalisa ekufundeni ngemuva kokuthola igebe ekukhokhweni kwezinsuku ezingama-63 ngaphambi konyaka odlule. Ngakho-ke umuntu ongena ngaphandle ukukhokhela ngeke akwazi ukuthola ukuthunyelwa okungenani izinyanga eziyisithupha, noma ngabe kufanele abhalise ngesikhathi sokubhalisa okuvulekile. Ngakho-ke kuyoba kubaluleke kakhulu kunoma ubani onesimo esandulele sokugcina ukugcinwa okuqhubekayo ngaso sonke isikhathi.
Amaphrimiyamu asekelwe ku-Age of Enrollee
I-ACA ivumela ababheki bomshuwalense ukuba bakhokhele ababhalisile abadala kuze kube kathathu baningi ababhalisile abaneminyaka engu-21 ubudala. Kodwa izinsizakalo ze-premium ku-ACA zisekelwe emcabangweni wokuthi amaphrimiyamu enarheni (ngemuva kokusizwa) kufanele alingane nabantu abaneholo elilinganayo (phezulu kwamaphesenti angama-400 ebunini bobuphofu, ngaphezulu lapho izinsizakalo ze-ACA zingatholakali). Ngakho-ke ngenkathi ama-premiums ephakeme kubabhalisi abadala, ukuxhaswa kwe-premium kukhulu kunabhalisi asebekhulile ukuze kukhuphule amaphrimiyamu aphezulu.
I-AHCA izovumela abakwa-inshurensi ukuba bakhokhise abhalisile abadala ngokuphindwe kasikhombisa njengoba bekhokha ababhalisile abaneminyaka engu-21 ubudala (noma ngisho nangaphezulu kakhulu uma amazwe ekhetha ukuyivumela). Lo mthetho uzohlinzeka ngezinsizakalo ze-premium ezisekelwe eminyakeni yobudala ezobe zikhudlwana kubhalisile abadala, kepha hhayi ngokwanele ukulungisa umehluko kuma-premium. Abantu asebekhulile bezophela ekukhokheleni ngaphezulu amaphrimiyamu kunabantu abasha, ngisho nangemva kokusizwa.
I-BCRA ingavumela abakwa-insurers ukuba bakhokhise ababhalisile abadala ngokuphindwe kasikhombisa njengoba bephethe ababhalisile abasha. Izinsizakalo ze-Premium zizoba ezinkulu kubantu asebekhulile, kodwa hhayi ngokwanele ukwehlisa amaprimiyamu aphezulu, futhi umthetho uhlanganisa ngokukhethekile ukuhlinzekwa okudinga abantu asebekhulile ukuba bakhokhe amaphesenti amakhulu emali yabo engenayo kumaphrimiyamu emva kokusizwa.
Ukuxhaswa kwe-Premium
I-ACA inikeza izinsizakalo ze-premium ezisekelwe ekugcineni i-premium yecebo lokubheka (uhlelo lwesibili lwezindleko zesiliva) endaweni ngayinye ezingeni elingabizi. Lokho kusho ukuthi izinsizakalo zikhudlwana ezindaweni lapho ukuthengwa kubiza khona, futhi kukhulu kubantu abadala. Izinsizakalo ze-Premium ngaphansi kwe-ACA azikho kubantu abanenzuzo engaphansi kwezinga lobuphofu-ngoba kufanele babe ne-Medicaid esikhundleni-futhi abatholakali kunoma ubani ongenayo imali engenayo emakhaya ngaphezu kwamaphesenti angama-400 ebunini lobuphofu (indlu ezine, okungama $ 97,200 ngo-2017).
I-AHCA inezinsizakalo ezikhokhelwayo eziphezulu ezihlukahluka ngokususelwa eminyakeni yobudala, futhi ungazi ukuthi ama-premium aphezulu nakwezinye izindawo zezwe kunezinye. Futhi njengoba kuphawuliwe ngenhla, ukulungiswa kwe-age-based kwizinsizakalo ze-premium ngeke kususe kude amaphrimiyamu aphakeme ukuthi abantu asebekhulile bazokhokhiswa. Kodwa izinsizakalo ze-AHCA zizotholakala kubantu abanemali ephakeme (etholakale ngokugcwele kulabo abanezinkokhelo ezifinyelela ku-$ 75,000 kumuntu oyedwa kanye no-$ 150,000 kumbhangqwana oshadile, futhi bahlukaniswe ngenhla kwalelo zinga), ngaleyondlela ukwandisa umxhaso kusize kakhulu isigaba esiphakathi kunezinsizakalo ze-ACA.
I-BCRA igcina isakhiwo somxhaso esinjenge-ACA, kodwa ngezinye izinguquko ezibalulekile. Kusukela ngo-2020, izinsizakalo zizobe zitholakala kubantu abanenzuzo kusuka kumaphesenti angu-0-350 wezinga lobuphofu, ngokumelene namaphesenti angu-100-400 wezinga lobuphofu ngaphansi kwe-ACA. Lokho, ngokusobala, kuzosusa igebe elikhona lokubhekana ne-Medicaid , ngoba ukuxhaswa kuzoba khona kubantu abanenzuzo engaphansi kwezinga lobuphofu emazweni angakhulanga i-Medicaid.
Kodwa ukutholakala okutholakala kubantu abahola imali abaphansi kuzoba namandla kakhulu kunalokho okuhlinzekwa yi-Medicaid noma izinhlelo zamanje ze-ACA. Lokhu kuzoba yiqiniso ikakhulukazi emva kokunciphisa izindleko zokunciphisa izindleko kupheliswa ngo-2020 njengenhlinzeko ye-BCRA. Futhi kubantu abasemaphethelweni aphezulu ohlelweni lwezimali lwe-ACA lwamanje, izinsizakalo zizoqedwa kubantu abanenzuzo phakathi kwamaphesenti angu-350-400 wezinga lobuphofu. Uma ngabe lo mthetho wawusebenza ngo-2017, bekuyosho ukuthi umndeni wezingane ezine wawuzofanelekela kuphela izinsizakalo ze-premium ngenzuzo engamaRandi ayi-85,050 esikhundleni se-$ 97,200 (izinombolo zombuso wobumpofu ezilungiswayo ngonyaka zilungiswa, ngakho-ke lezo zingqimba zizohluka uma lapho imithetho ye-BCRA iqala ukusebenza).
Futhi i-BCRA nayo izobopha izinsizakalo kumsebenzi omusha wokubheka, okuzofaka isilinganiso samaphesenti angu-58 ezindleko zokunakekelwa kwezempilo kubantu abajwayelekile. Ukuze kukhonjiswe, izinsizakalo ze-ACAs premium ziboshwe ohlelweni lokubheka ukuthi luhlanganisa isilinganiso sama-68-72 wezindleko zezinga elijwayelekile. Lokhu kusho ukuthi izindleko zokudonswa kwemali kanye nezindleko ezingaphandle kwe-pocket zizophakama kakhulu ngaphansi kwe-BCRA.
Kubantu abavela kwamanye amazwe, i-BCRA nayo izokhawulela ukufaneleka kwemali yokuxhasa ukuba " abafokazi abafanelekayo ," okusho ukuthi abantu abasebenza ngesikhashana kanye nama-visas abafundi ngeke besakwazi ukuthola usizo, njengoba bengaphansi kwe-ACA .
Ukuxhaswa Ngezindleko
I-ACA inikeza izinsizakalo zokwabelana ngezindleko ukunciphisa izindleko ezingaphandle kwe-pocket ukuthi abhalisiwe abangenayo imali. Abantu abanezinkokhelo ezingamaphesenti angama-250 ezingeni lobuphofu banelungelo lokuthola ulwazi olufaka ngokuzenzekelayo izinsizakalo zokwabelana ngezindleko, uma nje bekhetha uhlelo lwesiliva.
I-AHCA izoqeda ukuxhaswa kwemali eyabiza izindleko ngemuva kowezi-2019. Kodwa ngokuphawulekayo, futhi ayizange ihambise imali ngemali okwesikhashana. Ukuxhaswa ngemali yokwabelana ngezindleko kungenxa yecala eliqhubekayo elilethwe yiPhalamende yamaPhalamende ngo-2014, ngenxa yokuthi izinsizakalo ezingakaze zithathwe yiCongress. Kube nokungaqiniseki okukhulu mayelana nezinsizakalo zokwabelana ngezindleko ngo-2017, futhi kubangelwa ukuthi abahlinzeki bomshuwalense baphakamise amaphrimiyamu aphezulu ngo-2018 kunokuba bebengaba khona uma ngabe ukuzibophezela okuqinile kuhulumeni wesifundazwe ukuxhasa izibonelelo zokwabelana ngezindleko.
I-BCRA nayo izoqeda ukuxhaswa kwemali eyabiza izindleko emva kuka-2019. Kodwa futhi ibeka ngokukhethekile imali yokuyikhokhela phakathi kwesikhashana. Lokhu kuzosiza ukunciphisa ukungaqiniseki ukuthi abakwa-inshurensi babhekene nemakethe ngayinye, nakuba ukuqedwa kwezinsizakalo zokwabelana ngezindleko ngemuva kuka-2019 kuzoholela kubantu abahola imali abaphansi abangakwazi ukukhokhela ukunakekelwa kwempilo.
Bangaki Abantu Abangaphambukisa Umphakathi?
Ngaphansi kwe-AHCA, i-CBO inqume ukuthi inani labantu abangaqinisekisiwe lizokhula ngezigidi ezingu-23 ngo-2026 . Lokhu kuzobandakanya abantu abayizigidi ezingu-14 abambalwa abane-Medicaid, abantu abayizigidi ezingu-6 abambalwa abanomkhawulo ngamunye wemakethe (okungewona iqembu), kanye nabantu abayizigidi ezingu-3 abambalwa abanomshwalense oxhaswe ngumqashi.
Ngaphansi kwe-BCRA, i-CBO inqume ukuthi inani labantu abangaqinisekisiwe lizokhula ngamaphesenti angu-22 ngo-2026. Lokhu kuzobandakanya abantu abayizigidi ezingu-15 abambalwa abane-Medicaid, kanti abantu abayizigidi ezingu-7 abambalwa abanomkhawulo ngamunye wemakethe.
Sikuvelaphi Kulapha?
Ukungezwani okuchazwe ngenhla akulona uhlu oluphelele, kodwa uxazulule izinto eziningi abathengi abangayiqaphela uma umthetho kufanele uqaliswe.
Asisazi ukuthi iSenate izokwenzenjani-uma kukhona-ngokwemibandela yokuguqulwa kwezempilo ngesikhathi sonyaka ka-2017. UMongameli Trump uye wasongela ngokuqondile abomthetho ngokulahlekelwa izinzuzo zomshuwalense wezempilo wabo oqashiwe ngumqashi uma bengadluli umthetho ukuze bachithe (futhi mhlawumbe bangene esikhundleni) i-ACA ( nansi incazelo yokuthi amalungu eCongress nabasebenzi abathola kanjani umshuwalense wabo wezempilo ). I-Trump iphinde isongela ukuvumela u-Obamacare ukuba "akhiphe" ngokunqamula lokho akubiza ngokuthi "ukukhishwa kwezimali" ezinkampanini zomshuwalense (empeleni, ukhuluma ngemali yokuxhasa ngemali eyabelwe izindleko , okuwukuphela kukahulumeni ophephile ukukhokhela ukukhokhela ababhalisi abahola imali encane; ngokuqinisekile akuyona imali yokukhokhela imali).
AmaSenenja uLindsey Graham, uBill Cassidy noDean Heller baye bafaka isichibiyelo esizoguqula eziningi zezimali ezisetshenziswayo ngaphansi kwe-ACA ukuvimba izibonelelo zezizwe. Lungalondoloza ezinye ze-ACA zokuvikelwa komthengi, kepha kuzoqeda igunya lomuntu ngamunye elidinga ukuthi abantu bathenge ukuthengwa. Akucacile kuleli phuzu uma lokho kulinganisa kuzokwenzela ukwesekwa okwanele ukuthola umthethosivivinywa wezokuvuselela ukunakekelwa kwezempilo kweNdlu emuva kweSénate enye yevoti.
Okwamanje, akukho lutho olushintshile, nakuba imakethe yomshuwalense wezempilo yomuntu ngamunye ibhekene nokungaqiniseki okukhulu nokuphazamiseka kokusongela okukhulu kwezokuphatha kwe-Trump yokuvumela u-Obamacare "acele." Lokhu kunikezwa ngokukhethekile ukuthi kunezindlela iNdawo YokuLawula I-Trump ingabhubhisa ngempela imakethe ngayinye ngaphandle kokusebenza kwe-Congressional.
Imithombo:
> Ihhovisi le-Budget ye-Congressional, i- HR1628, uMthetho wezeMpilo waseMelika ka-2017, Ukuhlaziywa Kwezindleko . Ngo-May 24, 2017.
> Ihhovisi le-Budget ye-Congressional, i- HR1628, uMthetho ongcono wokubuyisana wokunakekelwa kuka-2017, Ukuhlaziywa Kwezindleko . NgoJuni 26, 2017.
> Ihhovisi likaBongameli labakwa- Congressional, i- HR1628, uMthetho we-Better Care Reconciliation Act ka-2017: Ukuchitshiyelwa Ngokwemvelo Ye-Substitute [ERN17500], njengoba Kuthunyelwe kwiwebhusayithi yeKomidi leSenethi kwiBelomali ngoJulayi 20, 2017 . Julayi 20, 2017.
> Kaiser Family Foundation. I-Federal Medical Assistance Percentage (FMAP) ye-Medicaid ne-Multiplier.
> Ikomidi lezezimali leSenate, Umbhalo we-HR1628, uMthetho we-Better Care Reconciliation Act ka-2017 . NgoJuni 22, 2017.
> UMnyango Wezabasebenzi wase-United States, i-Bureau of Labor Statistics. Ukushintsha Ukushintsha Kwezindleko Zokunakekelwa Kwezokwelapha ku-CPI.