Ingabe Ukuguqulwa Kwezempilo Kuzoshintsha Izinguquko Zomthetho, Ezokuphatha, Noma Zomibili?
NgoJanuwari 20, amahora emva kokuvulwa kwakhe, uMongameli Trump wasayina i-oda elihle elihloswe "ekunciphiseni umthwalo wezomnotho we-Care Affordable Act." I-oda eliphezulu liphawula ukuthi i-Trump Administration ifuna ukuchithwa kwe-ACA, kodwa okwamanje, i-Trump ifuna i-ejensi yenhlangano ukuba ibe nemibandela futhi ihloniphe ngangokunokwenzeka ekuphoqeleleni izinhlinzeko ze-ACA.
Izinhlangano ze-Federal ziyalwa ukuba "zilalele, zibekezelele, zinikeze izikhwama, noma zilibale ukuqaliswa" kwanoma yikuphi ukuhlinzekwa kwe-ACA okuyobeka umthwalo wezimali noma wokulawula emazweni noma "kubantu, imindeni, abahlinzeki bezempilo, abahlinzeki bezempilo, iziguli, abamukeli izinsizakalo zezempilo, abathengi bomshuwalense wezempilo, noma abenzi bamadivayisi wezokwelapha, imikhiqizo noma imithi "-ngokuthi noma ubani ohilelekile ohlelweni lokunakekela impilo.
Ngaphezu kwalokho, i-executive order iyala izinhlangano zikahulumeni ukuba "zinikeze ukuguquguquka okukhulu" ukuthi zifisa ukusebenzisa izinhlelo zabo zokunakekelwa kwezempilo ezihlukile kanye nokuguqulwa kwezempilo.
Kusho Ukuthini Konke Lokhu?
Yize i-ACA ngokwayo inamakhasi angaba yizinkulungwane ubude, kunamakhasi ayizinkulungwane eziningana zeziqondiso zombuso-ikakhulukazi kusuka ku-CMS / HHS kanye ne-IRS-ehumushe futhi ecacise izingxenye ezihlukahlukene zomthetho, futhi yakha isiqondiso lapho kudingeka khona.
Ezinye izingxenye zemininingwane yokukhishwa kobunzima be-ACA, kanye nalokho okubhekwa njengokunakekelwa kokuvikela-okushiwo ngemithethonqubo eyengeziwe yombuso ukuze kusetshenziswe imininingwane ngemuva kweqiniso (isibonelo, yingakho ukunakekelwa okuvimbela abesifazane okwakungasetshenziswanga kuze kube ngo-2011, naphezu kokuthi i-ACA yenziwa ngo-2010).
Ukushintsha i-ACA ngokwayo kudinga isenzo seCongress. Kodwa iziqondiso ezishintshayo ezenziwe yizinhlaka zikahulumeni zidinga imithetho emisha yombuso.Kodwa akuyona into elula njenge-stroke ipeni, noma kunjalo. Umthetho Wokuphatha, oye waba khona kusukela ngo-1940, ulawula ukuthi ama-ejensi asezinhlanganweni azwakalisa kanjani imithetho.
Kumithetho ye-HHS, umthetho wokubhaliwe ushicilelwe, bese kukhona isikhathi sokuphawula esidlangalaleni esidingekayo. Ekupheleni kwesikhathi sokuphawula komphakathi, i-HHS yenza izinqumo ngokusekelwe kumibono yomphakathi bese ishicilela imithethonqubo yokugcina, kufaka phakathi imininingwane mayelana namazwana abatholile kanye nezimpendulo zabo kulawo mazwana. Ngakho-ke imithethonqubo emisha ayenzeki ebusuku (nakuba kufanele kuqaphele ukuthi indlela yokwenziwa komthetho kuthathwa ngayo ingase ishintshe ngaphansi kwe-Trump Administration).
Kodwa ngokuyinhloko, i-Trump Administration ithi ama-federal ejensi kufanele abe njengobunono ngangokunokwenzeka ekusebenziseni izinhlinzeko ze-ACA eziholela intela, izinhlawulo, noma ezinye izibopho. Izimpikiswano eziyinhloko eziye zagxila kulokhu okulandelwayo yiziphathimandla ngabanye kanye nokuguquguquka kwezimo zokubhekana nokuguqulwa kwezempilo ngendlela ethile.
Isimiso somuntu ngamunye
Ukugunyazwa ngabanye kudinga abantu abaningi baseMelika ukuthi balondoloze umshuwalense wezempilo noma babhekane nesigwebo uma befaka intela yabo yentela.
Kodwa kunezizathu eziningi ezinikezwa igunya . Ezinye zazo zichazwe ngokucacile emibhalweni ye-ACA, kodwa abanye-ikakhulukazi, okushiwo yilokho okufaneleka njengendlela yokukhishwa kanzima- okushiywa ku-HHS ukucacisa.
Ngaphansi kolawulo lweTrump, uMnyango wezeMpilo kanye nezinsizakalo zabasebenzi ungakhetha ukwandisa ukufaneleka kokukhululwa kanzima, ukuvumela abantu abaningi ukuba bahambe bengavunyelwe ngaphandle kokubhekana nesigwebo sentela sokwenza kanjalo (Yebo, ukungena uninsured kuyinto engozini enkulu eya kude ngaphesheya kwesigwebo sentela; uma ungaqinisekisiwe futhi udinga ukunakekelwa kwezokwelapha, uwedwa ngokwakho izikweletu zezokwelapha, futhi ungase ungakwazi ukuthola ukunakekelwa kunoma yikuphi ukuhlolwa okuyisisekelo / ukuzinza ukuthi amakamelo okuphuthumayo kudingeka ahlinzeke ).
Uma igunya lomuntu ngamunye lichithwa ( ngomthetho ) noma likhululekile (ngesenzo sokulawula esivela ku-oda oluphezulu) esikhathini esizayo esiseduze, imakethe yomshuwalense wezempilo yomuntu ngamunye ingase ihlaziywe . Amanani angase akhuphuke ngokuqinile ngo-2018, futhi abanye abathwali bangase bakhethe ukuphuma emakethe ngayinye ngokuphelele.
Kodwa ukuphinda noma ukuphumula umyalelo ngamunye ekuqaleni kwesikhathi seTump uzogcwalisa ingxenye yomkhankaso wesikhankaso ayewenza ukuze aqede i-ACA (Obamacare), futhi uzocela abantu abangawuthandi igunya elilodwa. Ukuze kucacise, nakuba noma yikuphi ukugunyazwa ngabanye kungenye yezinhlinzeko ezingathandwa kakhulu ze-ACA, kuyincenye ebalulekile yomshuwalense wezempilo ohlinzeka ngokubheka izimo zangaphambili ezikhona, okuyinto i-ACA idinga futhi. Awukwazi ukuhlinzekela izimo zangaphambili ezikhona ngaphandle kokunye indlela yokuqinisekisa ukuthi abantu bahlala bembozwe uma bephilile, kunokuba balinde baze bagule ukubhalisa.
Ukuguquguquka Kwesimo Sokuvuselelwa Kwezempilo
Izizwe sezivele ziguquguquke ngaphansi kwe-ACA: 1332 waivers zivumela amazwe ukuba athathe indlela entsha yokusebenzisa i-ACA, uma nje ehambisana neziqondiso ezihlukahlukene ezibekwe ku-ACA. I-Hawaii isanda kukhishwa ngo-1332 waiver evumela isimo ukuba sigweme ukushintshaniswa kwemishwalense yezempilo yebhizinisi, kusukela eHawaii isivele inesimiso somshuwalense wezempilo oqashiwe ngumqashi ogunyaziwe nguhulumeni.
Futhi amaqembu amaningana asetshenzisile ama-1115 waivers ukuze asebenzise ukwandiswa kweMedicaid ngezinguquko ezihlukile ekunwetsheni kweMedicaid okudingekayo ku-ACA. Kodwa ngaphansi kwe-Obama Administration, i-CMS yenqabe ukuvumela amanye amalungiselelo okulondoloza okulondoloziwe okuceliwe ku-1115 waiver iziphakamiso.
Isibonelo, izifunda eziningana ziye zaphakamisa imfuneko yomsebenzi kubantu abadala abafanelekayo ukuba bafanelekele ukunwetshwa kweMedicaid (okusho ukuthi kuzodingeka basebenze, bahileleke ekusebenzeni umsebenzi, esikoleni / ekuqeqesheni umsebenzi, noma banakekele izingane ezisekelwe oda ukuthola izinzuzo zeMedicaid). Kuzo zonke izimo, i-CMS inqatshelwe iziphakamiso ezinjengaleyo, futhi ivumela kuphela izinhlelo zokuqeqesha umsebenzi wokuzibandakanya. Kodwa ngaphansi kwezokuPhatha kweTrump, sibona izifunda ezikhetha ukwandisa i-Medicaid (ngaleyo ndlela zithola imali eyengeziwe yokuxhasa uhlelo lwazo lwe-Medicaid state) ngemfuneko yomsebenzi evunyelwe i-CMS.
Lesi yisibonelo esisodwa nje; kunezici eziningi zokuguqulwa kwezempilo ezenziwa yizifundazwe zombuso waseRepublican ngokubambisana ne-Obama Administration, futhi ukuhleleka kukaTrump kubenza banikeze indlela ecacile yokusebenzisa izinguquko ngendlela yabo. I-House of Representatives yaseMinnesota yadlulisa umthetho ngoJanuwari 2017 ozovumela abathwali bomshuwalense wezempilo ukuthi bathengise izinhlelo ngaphandle kwezinhlobonhlobo zezinzuzo ezihlanganisiwe okwamanje eziwela ngaphansi kwesambulela sezinhlinzeko zezempilo ezibalulekile. I-Minnesota Senate yenqaba leyo ngxenye yomthetho, noma kunjalo, futhi ayizange isetshenziswe. Kodwa uma umthetho ofanayo wawuzokwenziwa ngamanye amazwe aqhubeka phambili (kuthatha i-ACA ngokwayo ayisuswanga) lezi zizwe zizodinga i-1332 waiver ukuyisebenzisa. Ukuphatha kuka-Obama akukaze kwenzeke ukushiya okunjalo, kodwa ukuphathwa kweTrump kungenzeka kakhulu.
Kumele uqaphele lapha ukuthi isakhiwo se-Medicaid ngokwayo singase sishintshe ngaphansi kwe-Trump Administration kanye ne-ACA ekugcineni esikhundleni somthetho. Abameli beRiphabhuliki baxosha ukushintsha uhlelo lokuvimbela izibonelelo noma ama-per capita allotments, kunokuba kube nokuzibophezela okuhambisana nokuphela okuphethwe nguhulumeni wesifundazwe ukuze akhokhe i-Medicaid.
Kwenzekani Okulandelayo?
Cishe konke kusekhona emoyeni ngokwekusasa lokuguqulwa kwezempilo. Umthetho we-ACA wokuchithwa okwamanje ubhalwa ngamakomidi amane e-congressional. Abenzi bomthetho abakaze bahleleke ngokuzungezile, nakuba kuneziphakamiso eziningi etafuleni (kufaka phakathi ezinye ezishayelwe esimisweni somthetho we-2017, njenge-Bill Cassidy-Collins).
Ukwaziswa okuvela kwi-Trump Administration kuye kwaba okuncane kakhulu futhi okuphambene ncamashi ngendlela okuzosetshenziswa ngayo ukuqondiswa komthetho, kodwa manje njengoba iningi lamalungu akhethwe yiKhabhinethi likaTrump kuqinisekisiwe, isinyathelo sokulawula esiphathelene nokuhlelwa komthetho singase sifike.
Amanye amazwe azothatha izindaba ezandleni zawo, edlulisa imithetho yokugcina ezinye izici ze-ACA endaweni ngaphandle kokushintsha kwezinga likahulumeni. Isibonelo, ngosuku olulandelayo uTrump isayine umyalelo wokuphatha, iNew York yamemezela imithethonqubo yombuso yokuvikela ukungena kwezindleko ezingekho kwemali kanye nokukhipha isisu okudingekayo emiphakathini yezempilo elawulwa yizwe.
Okwamanje, akukho lutho olushintshile mayelana nomshwalense wakho wezempilo noma imithetho elawula umshuwalense wezempilo. I-ACA isesekhona, kufanele usalondoloze ukuhlinzekwa, izinhlelo zezempilo azikwazi ukusebenzisa ukubhala phansi kwezokwelapha noma ukufaka eceleni ukuhlinzekwa kwezimo ezikhona ngaphambili, futhi izinsizakalo ze-premium (okungukuthi izikweletu zentela ye-premium) zisatholakala ekushintshaneni ukukusiza ukukhokhela ukukhokhelwa.
> Imithombo:
> Amasevisi e-Medicare naseMedicaid Services, Isikhungo Sokwaziswa Komthengi kanye Nokuqapha Umshwalense. Isigaba 1332: I-State Innovation Waivers.
> I-Cornell University Law School, i-Legal Information Institute. I-US Code Code Administrative Procedure.
> HealthCare.gov. Funda uMthetho Wokunakekelwa Onganakekelwayo. Umbhalo ogcwele we-Care Affordable Act no-Reconciliation Act.
> Medicaid.gov. Mayelana nesigaba se-1115 Waivers.
> I-White House, iHhovisi likaNobhala Wezindaba. I-Order Yokunciphisa Ukunciphisa Ukulawulwa Kwezomnotho Komthetho Wokunakekelwa Okunganakekelwa Okulindelekile Ukuphinda Uphinde.