Baibulo la Senate N'kutheka kuti limasiyana kwambiri
Pa May 4, 2017, Nyumba ya Oyimilira inapereka American Health Care Act (AHCA) ndikuitumiza ku Senate. Mwamsanga pokhapokha chiwerengerochi chitatha, a Republic Republic House adakhala Pulezidenti Trump, Purezidenti Pulezidenti Pence, ndi Mlembi wa HHS Tom Price pa chikondwerero ku White House. Koma AHCA ikadali ndi tsogolo losatsimikizika.
Vote ya Nyumbayi inadza pambuyo pa masabata angapo ndikuvomerezedwa kuti apindule ndi oimira Republican omwe amatsutsana ndi AHCA mu March.
Pakangotha masabata asanu ndi limodzi (6) isanafike kuti msonkhanowu udutse m'nyumbayi, utsogoleri wa Republican unali utakonzekera chisankhulo cha March, pamene zinali zoonekeratu kuti panalibe chithandizo chokwanira kuchipatsira.
Mademokrasi akutsutsana ndi malamulo onse, ndipo ngakhale a Republican ali ndi ambiri mu Nyumbayi, ngati oimira Republican oposa 22 amatsutsana ndi ndalamazo, sizikanadutsa. Mu March, panali osachepera 33 Republican otsutsana ndi ACHA. Koma pamene voti idadza kumayambiriro kwa mwezi wa May, anthu okwana 20 okha a Republican adavomereza, ndipo idapitanso ndi voti imodzi kuti apereke (217-213; panafunika 216).
Sindikudziwa ngati Senate idzapambana chigamulo cha ACA, ndipo ngati atero, kaya zipinda ziwiri zikhoza kuvomereza kuti zitsatire zomwe zili ndi mbali zina za AHCA.
Zotsatira za Bill Yamakono
AHCA inakhazikitsidwa mwachindunji mu Nyumbayi pa March 20, ndipo idapitanso pasanathe milungu isanu ndi iwiri.
Panthawi imeneyo izi zinasinthidwa ndi kusintha. Chimodzi mwa zovuta kwambiri pazomwe Nyumbayi idavomereza ndikuti idadza pamaso pa ospartisan Congressional Budget Office (CBO) ili ndi nthawi yofufuza ndalama zomwe zasinthidwa ndikuwonetseratu zotsatira zake.
Bungwe la CBO linalemba malipiro pakatikati pa mwezi wa March, ndipo patatha masiku angapo pambuyo poti olemba malamulo adawonjezera kusintha kwa malamulo.
Zomwe zinagwiritsidwa ntchito pazinthu zonsezi zinali kuti AHCA idzabweretsa anthu ena osapitsidwanso 24 miliyoni ku US mwa 2024 . Koma bili yosinthidwayo idakonzedweratu kuchepetsa kuchepa kwa boma ndi $ 150 biliyoni pazaka 10 zikubwerazi, mosiyana ndi kuchepetsa $ 337 biliyoni komwe kunayesedwa koyambirira kwa AHCA.
Pambuyo pa chiwerengero chachiwiri cha CBO, House Republican adawonjezera kusintha kwakukulu kwa AHCA:
- Kusintha kwa kukhazikitsa "pulogalamu yosawoneka yogawidwa ndi ngozi" yomwe ingapereke ndalama zokwana madola 15 biliyoni ku federal federal kuthandiza kuthandizira mtengo wa zifukwa zazikulu pamsika wa inshuwaransi.
- The MacArthur Amendment, yomwe imalola kuti maboma asatuluke muzinthu zina zoteteza ku ACA. Mayiko angasankhe kulola kuti inshuwalansi ikhale ndi chiŵerengero cha zaka zapamwamba kuposa chiwerengero cha 5: 1 chokhazikitsidwa ndi AHCA, poyerekeza zofunikira za thanzi la ACA, ndikugwiritsanso ntchito mbiri yachipatala kuti adziwe mapepala a omwe akufunsidwa omwe adawona kusiyana kwa zaka zapitazo chaka.
- Upton Amendment , yomwe inauza tsiku lomwe Nyumbayi idavomereze kuti idutsa AHCA, idakonzekeretsa nkhawa za Republican zokhudza zotsatira za MacArthur Amendment. Upton Amendment imapereka ndalama zokwana madola 8 biliyoni ku federal federal (kuyambira 2018 mpaka 2023) kuti zigwiritsidwe ntchito pofuna kuthetsa ndalama zambiri zomwe anthu omwe alipo kale omwe angakhale nawo muzinthu zomwe zimalola kulola kuti inshuwalansi akhazikitse malipiro pa mbiri yachipatala pamene olembapo mpata wowerengera.
Bungwe la MacArthur Amendment linagonjetsa nyumba yowonongeka ya House Freedom Caucus, ndipo Upton Amendment analandira chithandizo chokwanira kuchokera ku Republican kuti ndalamazo zikhoze kupambana mu Nyumba.
Koma pamene olemba malamulo m'nyumbayi adadutsa ndalamazo, sankadziwa kuti ndalama zawo zingakhudze bwanji ndalama zomwe sizingatetezedwe, kapena kuti ndalama za boma. Iwo adasankha pamsonkhanowu maola angapo atangomaliza kusintha komaliza, ndipo idatenga CBO pafupifupi masabata atatu kukwaniritsa zolemba zawo pamsonkhanowu.
Ndondomeko yosinthidwa: Miliyoni 23 Ochepa Insureds; $ 119 mabiliyoni mu kuchepa kwa kuchepa
Pa May 24, CBO inafotokozera ndondomeko yatsopano ya AHCA, yowerengera kusintha kwasintha katatu.
Iwo anatsimikiza kuti kusintha kwa AHCA (yomwe idadutsa Nyumbayi pafupi masabata atatu m'mbuyomo) kudzachititsa anthu okwana 51 miliyoni osavomerezedwa ndi 2026, kuchokera pa 28 miliyoni pansi pa ACA. Kuwonjezeka kumeneko kwa osapitilizidwa 23 miliyoni kunali kochepa kusiyana ndi chiwerengero cha anthu oposa 24 miliyoni omwe sankathandizidwapo, komabe akadali chiopsezo choopsya chifukwa cha msinkhu wosatetezedwe.
Ntchito zowonongeka za CBO zomwe zowonjezereka zidzatsitsimutsidwa ndi $ 119 biliyoni pansi pa AHCA (ndalama zochepa kuposa ndalama zomwe madola okwana madola 337 biliyoni ndi madola 150 biliyoni adayesedwa mu March).
AHCA mu Senate: Kodi idzayesa mayeso a Byrd?
Mabungwe a Republican ali ndi ambiri mu Senate, koma malire awo ndi ochepa kwambiri mu chipinda chimenecho. Alipo Republican 52 mu Senate, pamodzi ndi 46 Democrats ndi awiri Independents, onse awiri omwe ali a caucus ndi a Democrats. Popeza AHCA ndi ndalama zoyanjanitsirana, zikhoza kudutsa mwachisawawa ku Senate, m'malo mofuna mavoti 60.
Koma izi zikutanthauza kuti ngati a Republican Senators oposa awiri sakukana, sichidzadutsa (Vice Purezidenti Pence akhoza kutulutsa voti yoyamba ngati chiwerengero chomaliza chiri 50-50). Kumatanthauzanso kuti a Democrats sangathe kulamulira zotsatira za ndalamazo; Demokalase aliyense mu Senate sangathe kuvota, limodzi ndi Republican mmodzi kapena awiri, ndipo akadakalibe.
Mfundo yakuti AHCA ndi ndalama zoyanjanitsila zimatanthawuza kuti ili ndi malamulo enieni omwe ayenera kutsatira. Boma lachiyanjanitso lingathe kukonza zokhazokha zomwe zimakhudza ndalama za federal. Pulezidenti wa Byrd amalepheretsa Senate kuganizira "nkhani yowonjezereka" (mwachitsanzo, zinthu zomwe sizikukhudzidwa ndi ndalama) monga gawo la ndalama zoyanjanitsika.
Pakhala pali mkangano wochuluka wokhudzana ndi momwe MacArthur Amendment angapititsire mayesero a Byrd; Sitiyo ikhoza kuyipitsa chifukwa chakuti sichikumana ndi mayesero a zomwe zingaphatikizidwe mu ngongole yobwereranso. Mwa kuyankhula kwina, Parliamentary Senate, Elizabeth MacDonough, anganene kuti chinenero cha MacArthur Chimake chimafuna kuti mavoti 60 apite, osati 51; Izi ziyenera kuchotsedwa pamsonkhanowu, monga momwe a Senate Republican sangapezere mavoti 60 kuti awononge ACA.
Kuti agwiritse ntchito njira yowyanjanitsa, Senate iyenso ifunikira mapepala ochokera ku CBO pamasom'pamaso omwe amapereka; kuvota popanda ndondomeko, monga Nyumbayi inachitira, sizothekera kubwezeretsa chiyanjano, chifukwa momwe ndalama zowonjezera boma ziyenera kukhalira zidziwike.
Senate Ili Kulemba Bill Yawo. Kodi Adzasunga Zambiri za Nyumbayi?
Tsiku lomwelo AHCA adayendetsa Nyumbayo, malo oyamba atulutsa nkhani kuti Senate ikukonzekera kulembera ndalama zawo m'malo mokonza Nyumbayi. Posakhalitsa, a Senate Republican adalengeza gulu la anthu 13 logwira ntchito lomwe likanakhazikitsa lamulo la Senate, ndipo linatsimikizira kuti lamuloli likhoza kulembedwa pambali, m'malo momvetsera nawo maofesi ndi ma komiti.
Koma kodi nyumba ya Senate idzasunga ndalama zochuluka bwanji? Ndipo Nyumbayi ingavomereze kuti pali kusiyana komwe kulipo pakati pa Nyumba ndi Bungwe la Bungwe la Senate?
Patatha masabata pambuyo pake, MacArthur Amendment anaonjezera mnyumba kuti apeze chipani cha Republican chosungira chipinda m'chipinda chimenecho, ndipo panali kukangana kwakukulu pa nkhani yowateteza anthu omwe analipo kale. Izi zinasanduka nkhani yolankhulana kwa Jimmy Kimmel, yemwe adagwiritsa ntchito nkhani ya opaleshoni ya mwana wake wamwamuna wakhanda kuti afotokoze kufunikira kokhala ndi zinthu zomwe zisanachitikepo popanda kupatulapo.
Chifukwa chakuti chinenero cha MacArthur Chimake sichitsatira malamulo a Byrd, kufooketsa chitetezo kwa anthu omwe alipo kale zinthu sizingapangitse kukhala ndi malamulo a Senate. Senema Susan Collins (R, Maine) adanena poyera kuti sangagwirizane ndi nyumba ya AHCA, kapena ndalama zina zomwe zimapangitsa anthu mamiliyoni 23 osatonthozedwa, kapena kuti 850 peresenti yowonjezera anthu okalamba omwe ali ndi ndalama zochepa (CBO) lipoti la nyumba ya AHCA likuwonetsa kuti kwa zaka 64 zokwana $ 26,500 / chaka, ndalama zothandizira pambuyo pake zidzakula kuchokera $ 1,700 / chaka pansi pa ACA mpaka $ 16,100 / chaka pansi pa AHCA muzinthu zomwe zikuteteza ACA zoteteza, ndi $ 13,600 m'mayiko omwe amalephera kuwateteza ku ACA; njira iliyonse, kuwonjezeka kosasimbika).
Koma pali vuto lalikulu-lomwe silinasamalire kwambiri monga momwe liyenera kukhalira pamene AHCA inali m'nyumba. AHCA idzawononga ndalama za $ 834 biliyoni ku federal federal, malinga ndi momwe bungwe la CBO linayendera.
Kusungirako ndalama kumachokera kuzing'ono zosiyana: Kulimbitsa kuwonjezeka kwa ACA's Medicaid (palibe m'modzi 19 omwe sanatulutse Medicaid angasankhe kuchita zimenezo, ndipo akunena kuti kuwonjezera kufalitsa sikungathe kulembetsa opeza atsopano pazowonjezera za ndalama za federal kumapeto kwa 2019), ndikusintha ndalama za Medicaid ndalama kuchokera pakalipano yomwe ikugwiritsidwa ntchito yotseguka kuti ikhale yoletsera ndalama kapena magawo omwe ali nawo. Njira iliyonse ikhoza kukhala ndi mayiko okhala ndi ndalama zochepa za Medicaid ndalama pa nthawi yayitali.
Nkhani ya Medicaid ikutheka kukhala chokhumudwitsa kwambiri mu Senate. Pali anthu ambiri a Republican senators-kuphatikizapo ena ochokera ku mayiko omwe awonjezera Medicaid-omwe awonetsa nkhaŵa za kuchepetsa ndalama za AHCA ku federal Medicaid komanso momwe angakhalire ndi anthu omwe amadalira Medicaid, kuphatikizapo Medicaid komanso Medicaid.
Kodi N'chiyani Chimachitika Ngati Senate Ikusintha Baibulo Lake?
Chifukwa chakuti a Senate Republican ayenera kusonkhanitsa pafupifupi mamembala awo onse-kutayika zosaposa awiri-kuti apititse ma AHCA, ndime sizowona. Koma chimachitika ndi chiani ngati bwalo la Senate likupanga nkhokwe mavoti 51 (kuphatikizapo voti yotsutsana ndi Vice Presidenti)?
Chifukwa chakuti Senate ikulemba malamulo awo, komanso chifukwa cha nkhaŵa zomwe MacArthur Amendment silingagwirizane ndi malamulo a Byrd, ndipo chifukwa ambiri a Republican Senators adandaula za momwe msonkho wa Nyumba umakhudzidwira pa mankhwala, ndizowona kuti Nyumba ndi Senate Misonkho idzakhala ndi kusiyana kwakukulu.
Ngati izi zitachitika, komiti ya msonkhano idzakhazikitsidwa, yokhala ndi mamembala ochokera ku Nyumba yonse ndi Senate. Ntchito yawo idzagwirizanitsa kusiyana pakati pa ngongole ziwirizo ndikupanga lipoti la msonkhano. Kuchokera kumeneko, Nyumba ndi Senayo ziyenera kupereka lipoti la msonkhano, zomwe zingatsutsane ndi olemba malamulo koma zisasinthe .
Ngati Nyumba ndi Senate zonse zikadutsa lipoti la msonkhanowu, zimatumizidwa kwa pulezidenti kuti alembedwe. Pulezidenti Trump akhoza kusindikiza ndalama iliyonse yomwe imaperekedwa kwa iye yemwe amaletsa kapena kusintha mbali zina za ACA. Sitikukayikira, komabe kaya zipinda zonse za Congress zingathe kuvomereza pamtunda wotumizira perezidenti.
N'zotheka kuti olemba malamulo akufuna kwambiri kubwezera ena a ACA-ntchito yothandizira ambiri a iwo-adzawathandiza kuti avotere chifukwa cha ndalama zomwe sakugwirizana nazo.
Komano Nyumba ya Ufulu Caucus inasiya kuthandizira AHCA mu March, ndipo sanavomereze kuvota ndalamazo mpaka MacArthur Amendment adawonjezeredwa, kulola kuti zimasule malamulo okhudzana ndi ubwino wathanzi komanso kufalitsa -kukhalapo. Kodi ufulu wa Caucus ungalole kuvomerezana ndi lipoti lapadera la msonkhano limene limapangitsa kuti zinthu zisinthe? Mwina, koma sitinganene motsimikiza.
Mawu Ochokera
Ngakhale utsogoleri wa Nyumba ndi Utumiki wa Trump anakondwerera ndime ya AHCA mu Nyumba, lamuloli liri ndi njira yayitali. Ngati Seneti ikudutsa, iyenera kukhala yosiyana kwambiri ndi Nyumbayi, ndipo palibe chitsimikizo kuti zipinda zonse ziwirizi zigwirizana zogwirizana ndi zochitika ziwiri zomwe ziyenera kuyanjanitsa ngongole ziwirizo.
Kwa nthawiyi, ACA ikhala lamulo la dzikolo. Inshuwalansi ya umoyo pa msika umodzi payekha ndiyomwe imatsimikiziridwa mudziko lirilonse, mosasamala kanthu za mbiri yachipatala ( zochitika zoyenerera ndizofunikira kuti alembetse kunja kwa olembetsa). Ndalama zothandizira ndalama , zokhudzana ndi phindu komanso ndalama zowonjezera m'deralo, zimapezekabe mu kusintha kwa boma, ndipo kuwonjezereka kwa Medicaid sikusinthika m'mayiko 31 ndi DC komwe kwakula. Chofunika cha ACA kuti chikhale chiwerengero kapena chilango cha msonkho chikugwiransobe ntchito, ndipo chidzakhalapo mpaka lamulo likukhazikitsidwa kuti liwonongeke.
> Zotsatira:
> Congress.gov. HR1628, American Health Care Act ya 2017. Yatulutsidwa March 20, 2017.
> Congressional Budget Office, American Health Care Act . March 13, 2017.
> Congressional Budget Office, American Health Care Act , pa March 23, 2017.
> Congressional Budget Office, HR1628, American Health Care Act , May 24, 2017.
> Hall M; ndi Bagley N, Kupanga Kuzindikira "Gawo Losasokonezeka Losaopsa" Zochitika zaumoyo, pa April 12, 2017.
> Nyumba ya Oimira a US, Komiti ya Malamulo, Chidule cha Byrd Rule.