CBO imati anthu 23 miliyoni akhoza kutaya chithandizo pansi pa AHCA. Iwo ndi ndani?
Mu Januwale 2017, Congress idapereka ndondomeko ya bajeti yophunzitsa makomiti a congressional kuti alembe malamulo oyanjanitsa kuti abweretse ndalama zogwiritsira ntchito ndalama za Affordable Care Act (ACA, yomwe imatchedwanso Obamacare). Ntchitoyi inatsikira pa March 6, pamene makomiti awiri a Nyumba (Njira ndi Njira, ndi Mphamvu ndi Zamalonda) adawonetsa malamulo omwe amadziwika ndi American Health Care Act (AHCA).
Ndalamayi inakhazikitsidwa mwakhama kunyumbayi pa March 20.
Pambuyo poyenda mwadongosolo kupyolera mu ndondomeko ya malamulo, AHCA inadutsa Nyumbayi pa May 4, ndi voti ya 217 mpaka 213. Inkafunika 216 kuti idutse, kotero inali yopambana kwambiri. Mademokrasi anali ogwirizana pakutsutsana ndi ndalamazo, ndipo oimira Republican 20 anagwirizana nawo povotera.
AHCA ndi lamulo lalifupi kwambiri, lophweka kwambiri kuposa ACA, koma ndilo lamulo loyanjanitsa lomwe lingathetsere zinthu zomwe zimakhudza kwambiri ndalama za boma. Zolinga za kuyanjanitsa ndizowonetsa mafilimu, kotero iwo amatha kupitako ku Senate ndi anthu ambiri, m'malo mofuna mavoti 60. Koma zili zochepa kwambiri kusiyana ndi malamulo omwe ali ndi filibuster.
Kaiser Family Foundation ili ndi chidule cha AHCA, pamodzi ndi chida chomwe chidzakupangitsani kuti mufanane ndi AHCA ndi ACA, komanso ndi malamulo ena atsopano .
Office Congressional Budget Office Scores Bill
Pa March 13, bungwe la Congressional Budget Office (CBO) linatulutsa kafukufuku wawo woyamba wa AHCA, poyesa kuti kukhazikitsidwa kwa lamulo kudzawonjezera chiwerengero cha anthu osatetezedwa ku US ndi 24 miliyoni pazaka khumi zikubwerazi.
Bungwe la CBO ndilo ntchito yosagwirizana ndi kukonza masamu omwe amatsatira malamulo ena.
Oweruza a Republican anagwiritsira ntchito kuwonetsa CBO masiku otsogolera AHCA atayambitsidwa, koma popanda thandizo la CBO, palibe njira yeniyeni yolingalira mobwerezabwereza kuchuluka kwa ndalamazo, popeza chiwerengero cha olemba malamulo ndi ogwira ntchito awo chingawathandize kukonda.
Panthawi yomwe chiwerengero cha CBO chinayamba kupezeka, AHCA idadutsa kale Komiti ya Njira ndi Nyumba ndi Komiti ya Energy Energy ndi Commerce; makomiti awiri adadutsa Billyo popanda chidziwitso kuchokera ku CBO. Komiti ya Bungwe la Ndalama za Nyumba ya Bungwe la AHCA inabwera patapita masiku awiri chiwerengero cha CBO chikatulutsidwa, choncho vuto la anthu ambiri omwe angathenso kufalitsa linali gawo la zokambirana m'komitiyo.
Pa March 23, CBO inapezanso AHCA kachiwiri kuti isonyeze kusintha komwe kwawonjezedwa, koma zina zowonjezera zinawonjezeredwa mu April ndi May (izi zikufotokozedwa m'munsi mwatsatanetsatane). Chifukwa cha kufulumizitsa kuti apite voti, Nyumbayi siinayambe kudikira kuti CBO ipezepo malipiro omaliza musanavotere.
Pamapeto pake, mapepala a CBO a AHCA a nyumba yomaliza adasindikizidwa pa May 24, pafupifupi milungu itatu pambuyo pa Nyumbayi. Zotsatira ziwirizo zisanachitike zakhala zikuwonetsa kuti chiwerengero cha Amwenye omwe sali olimbikitsidwa adzakula ndi anthu 24 miliyoni m'zaka khumi zikubwerazi.
Pambuyo pokonza mapulani atatu omwe adawonjezeredwa mu April ndi May, CBO inafotokoza kuti chiwerengero cha Amwenye omwe sichilimbikitsidwa chidzawonjezeka ndi anthu mamiliyoni 23 m'zaka khumi zikubwerazi.
Kotero kusintha komwe kunawonjezeredwa mu April ndi May kunasintha malingaliro onse ndi anthu 1 miliyoni (anthu oposa 23 miliyoni omwe ali ndi inshuwalansi ndi 2026, mosiyana ndi 24 miliyoni). Izi ndi chifukwa chakuti anthu ena mamiliyoni 4 adzakhala ndi chithandizo chogwiritsidwa ntchito ndi aboma pofika 2026 pansi pa AHCA (mosiyana ndi kalembedwe la ndalama), koma kuti anthu ochepa mamiliyoni atatu adzakhala ndi chidziwitso pamsika.
Ntchito za CBO zomwe anthu ambiri adzakhala ndi chithandizo chogwiritsidwa ntchito ndi abambo pansi pa AHCA makamaka posachedwapa chifukwa akuyembekeza kuti zosankha zomwe zili pamsika pawokha zikhoza kuchepa pa khalidwe lomwe likufuna kuchotsa ma AWCA (MacArthur Amendment) kuchokera ku chitetezo cha ogulitsa ACA . Chotsatira chake, amakhulupirira kuti olemba ntchito ambiri adzapereka chithandizo kwa gulu kwa antchito awo, chifukwa zomwe angagwiritse ntchito pa msika wosakhala gulu zidzakhala zosauka (mwazimene zimakhala zofuna kuchotsa, mwachitsanzo, kufotokozera amayi kumakhala kosakhalanso ngati Kupindula pa mapulani a msika, ndi ntchito za CBO zomwe wokwera payekha angapereke ndalama zoposa $ 1,000 / mwezi).
23 Mipingo Yambiri Yotsalira: Kodi ndi Chifukwa Chiti?
Kusanthula kwa CBO komaliza kwa AHCA kuli masamba 41, ndipo kumaphatikizapo nkhani zosiyanasiyana, kuphatikizapo momwe ndalamazo zingakhalire ndi ndalama zothandizira inshuwalansi, mgwirizano wa msika, ndi ndalama za boma. Koma tiyeni tiganizire za polojekiti yomwe anthu 23 miliyoni angathenso kulandira pazaka 10 zikubwerazi. Kodi anthu awo ndi ndani, ndipo n'chifukwa chiyani amatha kutayika?
Akatswiri a zaumoyo adanena mobwerezabwereza kuti anthu mamiliyoni ambiri adzatha kulandira chithandizo pansi pa AHCA, ndipo kuti kusintha kumeneku kuwonjezeredwa kuti apambane chithandizo mu Nyumbayi sikungapangitse kuti ndalamazo zikhale zovuta. Poyankha, Nyumba Mtumiki Paul Ryan (R, Wisconsin) adanena kuti ndithudi, anthu ochepa adzakhala ndi chithunzi ngati palibe lamulo la boma lomwe likufuna kuti anthu adziwe. Polimbikitsidwa ponena kuti ndi anthu angati omwe sali otetezedwa kumeneko adzakhala pansi pa AHCA, Ryan adalongosola kuti "zili kwa anthu," zomwe zikuwonetsa kuti kutayika kutayika kungakhale mwaufulu (mwachitsanzo, anthu angasankhe kupita popanda kutsegulira pokhapokha ngati udindo wawo ulipo kuchotsedwa).
Izi ndi zoona, kwa anthu ena. Koma zambiri zowonjezera kutayika pansi pa AHCA zikhoza kuchitika pamene inshuwalansi imakhala yosasokonezeka.
Pano pali kuwonongeka kwakukulu kwa omwe akuyesedwa kuti asatonthozedwe, ndipo chifukwa chiyani:
Mu 2017, anthu mamiliyoni 4 chifukwa cha kuthetsa chilango cha munthu aliyense
AHCA idzachotsa chilango cha munthu aliyense payekha, ndikuyambiranso kumayambiriro kwa chaka cha 2016. Chifukwa cha zimenezi, ntchito za CBO zomwe anthu 1 miliyoni (zomwe zili ndi malonda pamsika, kuphatikizapo kusinthanitsa) zidzataya chaka cha 2017 pakati pa chaka, ngati ndipo pamene lamulo likukhazikitsidwa.
Pofika mu 2018, Miliyoni 14 Chifukwa cha Zopambana Zambiri ndi Chilango Chokhalitsa
Pofika mu 2018, kuwonjezeka kwa chiwerengero cha anthu osalimbikitsidwa (pokhudzana ndi kupitiriza ACA) kudzakula kufika pa milioni 14, ndipo pofika mu 2012, lidzakula kufika pa milioni 19. Bungwe la CBO limanena kuti ambiri mwa anthuwa angayambe kulandira chithandizo chifukwa sipadzakhala lamulo loti iwo azikhala nalo, koma nthawi zambiri, kusintha kwawo "mwaufulu" kuti asatetezedwe kudzachitika chifukwa cha kuwonjezeka koyamba.
Izi zidzakhala zowona makamaka mu 2020 ndi kupitirira, pamene malipiro a msonkho wa AHCA adzalowetsa misonkho ya msonkho wa ACA (ngongole za AHCA zidzakhala zazing'ono kwa anthu ambiri, makamaka kwa olembetsa ndalama zochepa omwe sangakwanitse kupirira za kuwonjezeka kwa chiwombankhanga chachitsulo).
Bungwe la CBO linaneneratu kuti m'mayiko omwe akufuna kuti athetsere malonda kuti athe kugulitsidwa popanda kuphimba ntchito zonse za ACA zomwe zimapindulitsa kwambiri, komanso kulola ogulitsa okhawo malonda kukhazikitsa malipiro pa mbiri yachipatala pamene olembapo alibe mwayi wopeza malipiro, malipiro angakhale osasokonekera kwa anthu okhala ndi mikhalidwe yomwe ilipo kale komanso kusiyana pakati pa anthu.
Pofika chaka cha 2021, anthu mamiliyoni 21: Kuwonjezeka kwa Medicaid kumasula Kuchita Ntchito Yaikuru
Kuyambira mu 2021, chiwerengero cha anthu omwe ataya Medicaid chiposa kuchepetsa chiŵerengero cha anthu omwe ali ndi malonda pamsika. Kuyambira nthawi imeneyo kupita, kuchepetsedwa kwa chiwerengero cha anthu omwe ali ndi Medicaid ndi mbali yaikulu kwambiri pa chiwerengero cha anthu omwe ali ndi chithandizo cha umoyo.
Ndichifukwa chakuti AHCA imasokoneza kuwonjezeka kwa ACA kwa Medicaid kuyambira 2020. Kuchokera nthawi imeneyo, kuwonjezeka kwa kulembedwa kwa Medicaid kudzatha, zomwe zikutanthauza kuti anthu opanda ana omwe ali ndi ndalama zoposa 138 peresenti ya umphawi sangathe kulembedwa ndi Medicaid makamaka boma la federal.
Anthu omwe atha kale kulembedwa ku Medicaid panthawiyi adzapitilizidwa, koma ngati ndalama zawo zowonjezera chiwerengero cha 138 peresenti za umphaŵi, zomwe zimachititsa kuti awonongeke ku Medicaid, sakanakhoza kulembanso ku Medicaid pambuyo pake, ngakhale ndalama zawo zitayambiranso.
Pansi pa malamulo a ACA amasiku ano, anthu omwe ali oyenerera Medicaid angathe kulemba nthawi iliyonse, ndipo pali "churn" yochulukirapo mu chiwerengero cha anthu owonjezereka a Medicaid. Mwachitsanzo, wogwira ntchito zakumunda yemwe ali ndi ndalama zomwe zimasintha kwambiri m'chaka chingakhale Medicaid woyenera kwa chaka chimodzi. Kusintha kumeneku kuchokera ku Medicaid yowonjezereka kupita ku ntchito yogulitsidwa ndi ogwira ntchito kapena kugulitsidwa kwa malonda sikungaloleredwe pansi pa AHCA kuyambira mu 2020.
Pakapita nthawi, kuchepetsa chiŵerengero cha anthu omwe ali ndi chithandizo cholimbikitsidwa ndi abwana chidzakula, chifukwa cha anthu osankha kulemba (chifukwa sipadzakhalanso chilango cha munthu) komanso chifukwa cha olemba osankha kupereka chithandizo (chifukwa sipadzakhala chilango cha abwana). Olemba ntchito ambiri angapitirize kupereka chithandizo, komabe, pochita zimenezi ndi njira yabwino yokopa ndi kusunga antchito apamwamba. Ndipo chiwerengero cha May CBO chikuwonetsa dontho la anthu 3 miliyoni okha lokhazikitsidwa ndi ndondomeko zopangira aboma monga za 2026-mosiyana ndi dontho la 7 miliyoni lomwe linayesedwa mu kafukufuku wawo wam'mbuyowo.
Pofika chaka cha 2025, Miliyoni 23, Otsalira pa Mzere Wawo Kupyolera mu 2026
Ntchito za CBO kuti pofika chaka cha 2025, padzakhala anthu osapitilizidwa mamiliyoni 23 ku US kuposa momwe angakhalire ngati ACA iyenera kukhalapo. Izi zimakhalabe choncho kudzera mu 2026, chomwe chiri mapeto a zomwe zikuchitika tsopano.
Kuphatikiza pa zomwe takambiranazi, AHCA idzasinthiranso ndalama za Medicaid ku dipatimenti ya malipiro kapena kubwezera ndalama, kuyambira mu 2020. Izi ndi zosiyanitsa ndi zomwe zikuchitika panopa zomwe zikugwirizanitsidwa. Zotsatira zake zidzakhala ndalama zothandizira boma la federal, koma osachepera Medicaid ndalama zowonjezera nthawi. Kulipilira malipiro, akuti angakhale ndi mwayi wopeza ndalama zawo zambiri pa Medicaid, koma ambiri amakakamizika kuchepetsa kuyenerera kuti athetse ndalama.
AHCA Poyamba Analephera, Koma Anatsitsimutsidwa ndi Kudutsa Nyumbayo
Onse a Democratic lawmakers akhala akutsutsana ndi AHCA kuyambira pachiyambi, ndipo ambiri a malamulo a Republican awonetsanso nkhawa za malamulo. Izi zimaphatikizapo a Republican omwe ali oderamtima omwe akudandaula za kusintha kwa Medicaid komwe kumachokera kumalo awo popanda kupeza ndalama zowonjezera, komanso kumaphatikizapo Republican omwe ali ndi ufulu, kuphatikizapo House Freedom Caucus, amene angasankhe bilo yomwe imachotseratu ACA.
Pamsonkhano wa Bungwe la Ndalama za Nyumba ya AHCA, zomwe zinachitika pambuyo polemba mapepala a CBO, Woimira Tom McClintock (R, California) adanena kuti kusintha kunayenera kuperekedwa ku msonkho wa msonkho wa AHCA kuti pitirize kulandira ndalama zogulira ndalama zochepa (pakalipano ndalamazo zimayitanitsa anthu omwe ali ndi ndalama zokwana madola 75,000, zomwe zimapereka ndalama zokwana madola 20,000, zomwe zimapereka ndalama zokwana madola 70,000).
Ndipo pa March 19, Speech Ryan adati ndalama za AHCA ziyenera kusintha kuti zitheke kuti anthu azitha zaka 50 ndi 60. AHCA imayitanitsa kuti ndalama zambiri zilembedwe kwa olembetsa akale, koma lamulo limapatsanso olemba inshuwalansi kuti azilembetsa olembetsa okalamba kasanu kuposa owerengeka aang'ono (mosiyana ndi chiwerengero cha 3: 1), ndipo ngongole za msonkho zotsatiridwa pano sizikanakhala zokwanira kuti anthu azitha kupeza ndalama zowonjezera kwa anthu omwe ali ndi zaka za m'ma 50 ndi 60 ndi ndalama zapakati ndi zapakati.
Mkonzi wa Amendment omwe adawonjezeredwa ku AHCA pa March 20 anali kuyesetsa kupeza olemba malamulo ambiri, ndipo kusintha kwina kunapangidwira panthawi yomaliza kutsogolera voti yomwe idakonzedweratu pa March 23 ndikuponyedwa mpaka Mwezi wa 24. Sizinali zokwanira, komabe patatha maola anayi kukangana pa Nyumbayi pa March 24, msonkhanowo unatengedwa mphindi zisanayambe kuvota.
Pulezidenti Ryan adakamba nkhani yofalitsa nkhani pomwe adanena kuti ACA idzakhalabe yogwira ntchito m'tsogolomu, ndipo oweruza a Republicanwo adzapitirizabe kuzinthu zina.
Maganizo amenewa anali ochepa, komabe, komanso sabata yoyamba mu April, lamuloli linabwereranso patebulo komanso pamakambirano. Koma panali kusiyana kwakukulu pakati pa House Freedom Caucus ndi Republican odzichepetsa.
Ufulu wa Caucus umalola kuti mayiko athetse kufunika kofunikira kwaumoyo wa ACA, ndipo alole a inshuwalansi kuti adziwe olembetsa odwala kuposa olemba bwino (ACA), koma ACA inaletsa kuchita zimenezi, kulola kuti mitengo ikhale yosiyana malinga ndi zaka , zip code, ndi fodya). Akuluakulu a Republican, komabe kudandaula kuti kulola kuti inshuwalansi azilipiritsa ndalama zambiri kwa odwala akuthetsa kuthetsa kuteteza kwa ACA kwa anthu omwe alipo kale, omwe ndi omwe amapezeka kwambiri ndi ACA.
Zosintha Zitatu Zomwe Zinalipo M'kabuku kachitatu ya CBO
Pa April 6, nyumba za Republic Republic zinayambitsa kusintha kwa AHCA (kufotokoza mwatsatanetsatane apa). Zosinthazi ziyenera kukhala ndalama zokwana $ 15 biliyoni ku federal federal pazaka zisanu ndi zinayi (2018 mpaka 2026) chifukwa cha "ndondomeko yosawoneka yoikapo ngozi." Kukonzekera ndi masamba anai okha okha ndipo amalemba zambiri mpaka ku malamulo a CMS omwe adzakhazikitsidwe patsiku lomaliza.
Koma makamaka, boma la federal liyenera kulandira malipiro otsika kwambiri pofuna kuchepetsa malipiro onse. Anthu omwe ali ndi ndalama zodalirika angathe kukhala ndi mapulani a inshuwalansi ofanana ndi ena onse (mosiyana ndi kuti apatsidwe pangozi zoopsa), koma boma likhoza kutenga mavuto omwe akugwira nawo inshuwalansi pamene mamembala amafunikira kwambiri mankhwala. Choncho, gawo losaoneka, ngati mamembala sangathe kuona kusiyana kulikonse pofotokoza momwe akufotokozera.
Pambuyo pake mu April, MacArthur Amendment adayesedwa pofuna kuyesa mavoti ku House Freedom Caucus. Njirayi inagwira ntchito, ndipo Freedom Caucus inathandizira AHCA pambuyo poti MacArther Amendment adawonjezeredwa. Lamuloli limapereka mwayi wosankha zina mwa zoteteza ku ACA. M'mayiko omwe akufunafuna kuchotsa,
- Anthu omwe alipo kale omwe akugula malonda payekha malonda angakhale ndi malipiro apamwamba okhudzidwa ndi zikhalidwe zomwe zakhalapo kale ngati atakhala ndi kusiyana kwa masiku osachepera 63 m'miyezi 12 asanalembedwe.
- Mapindu othandizira azaumoyo a ACA angathe kufotokozedwanso, zomwe zimapangitsa kuti anthu ndi magulu ang'onoang'ono asapereke chithandizo chochepa. Popeza kuti ntchito ya ACA yoletsedwa pa moyo wawo komanso phindu la pachaka, kuphatikizapo kuchepa kwa ndalama zowonongeka, zimagwiritsidwa ntchito pazinthu zofunika za thanzi, kutanthauzira kofunikira kwa thanzi labwino kumapangitsa kuti ACA asateteze chitetezo cha anthu ogwira ntchito msika wa gulu nayenso.
- AHCA imalola olemba achikulire kuti aziwongolera kasanu ndi kawiri kuposa olembetsa achinyamata pa msika wa gulu limodzi. Makhalidwe a MacArthur a AHCA amalola kuti mayiko akhazikitse chiŵerengero chapamwamba kuposa ichi (chifukwa cha kulingalira, ACA imaika 3: 1). Kutalika kwa chiŵerengero ndiko, zilembo zowonjezera zowonjezereka zidzaperekedwa, ndipo ochepa olembetsa adzaperekedwa.
Chosintha china, Upton Amendment , chinawonjezeredwa ku AHCA pa Meyi 3, madzulo pamaso pavotu ku Nyumba. Upton Amendment inali yankho ku zodetsa nkhaŵa zomwe MacArthur Amendment amatha kuteteza anthu omwe alipo kale.
Zimapereka madola 8 biliyoni pa zaka zisanu chifukwa chotsatira malamulo kuti agwiritse ntchito kuthetsa ndalama zowonjezereka zomwe zidzasamalidwe ndi anthu omwe alipo kale omwe ali ndi vuto lakutenga ndipo akufunikira kugula ndondomeko pamsika pawokha. Izi zowonongeka za Republican zokwanira kuti AHCA ipite mnyumbamo, koma pali mavuto omwe nthawi zonse amapeza kuti ndalama zimakhala zochepa kwambiri kuti zikhale zotetezeka bwino kwa anthu omwe ali ndi kale lomweli (CBO inatsimikizira kuti May 8 biliyoni awo adafufuza sangakhale ndi ndalama zokwanira).
CBO inali isanatsirize kukonza mapulani atatu atsopano nthawi yomwe Nyumbayi idavomereza pa AHCA. Izi sizinadabwitsa, chifukwa chakuti Upton Amendment adawonjezeredwa maola angapo asanavotere. Koma chiyembekezero chake chinali chakuti AHCA yosinthidwayo idzapangitsa kuti pakhale mgwirizano wovuta kwambiri pamsinkhu wosatetezedwe, kuyambira pa nthawi yomwe ili yonse yochepa.
Zomwe zakhala zikuchitika, ntchito za CBO zomwe AHCA yosinthidwa zidzakwaniritsa anthu makumi asanu ndi awiri (51 million) osatonthozedwa ndi 2026, kusiyana ndi 28 miliyoni ngati tipitilira ndi ACA.
> Zotsatira:
> Congressional Budget Office, American Health Care Act, March 13, 2017.
> Congressional Budget Office, American Health Care Act ndi Manager's Amendment , March 23, 2017.
> Congressional Budget Office, HR1628, American Health Care Act, kulingalira mtengo , My 24, 2017.
> C-Span, Komiti ya Ndalama Yopereka Ntchito Yogwira Ntchito Yodalirika Bwalo Loyera, Gawo 2, March 16, 2017.
> Nyumba ya GOP, American Health Care Act (ikuphatikizapo zolemba zolimbitsa malamulo).
> House.gov Kusintha kwa Menezi ku American Health Care Act, kusintha kwa ndondomeko , pa March 20, 2017.
> House.gov Kusinthidwa kwa Menezi ku American Health Care Act, Zosintha Zachipangizo , March 20, 2017.