Gawo la Odwala Lidzakalipira Pansi pa BCRA
Ndalama ya Bill ya kusintha kwa chisamaliro cha zaumoyo yomwe idakhazikitsidwa pa July 20 ikhoza kubweretsa ndalama zambiri. Ndipotu mapulojekiti a Congressional Budget Office (CBO) omwe anthu ambiri amawatenga kuti akhale adiresi ya ndalama adzakhala $ 13,000 mu 2026. Zomwe zili choncho, izi ndi zazikulu kusiyana ndi momwe angagwiritsire ntchito ndalama zomwe zidzaloledwa chaka chimenecho pokhapokha ngati ndondomeko yowonjezera ndalama zopezeka pakhomo zimasinthidwa.
Mwachiwonekere, ndilo vuto lomwe lifunikira ntchito yowonjezeramo malamulo.
Mu 2017, imodzi mwa nkhani zofunika kwambiri pa Congressional Republican yakhala ikugwiritsira ntchito ndikuchotsa ACA (Obamacare). Nyumbayo inadutsa American Health Care Act (AHCA) kumayambiriro kwa mwezi wa May, ndipo inatumiza ku Senate. GOP Asenetiti anasonkhanitsa gulu lochita nawo mbali kuti lilembetse ndalama zawo, zomwe zinatchedwa Better Care Reconciliation Act (BCRA), ndipo zinayambira kumapeto kwa June. Mabungwe a Republic of Senate anamasulira ndondomeko yosinthidwayo ya malamulo masiku angapo pambuyo pake, kuphatikizapo zofunikira zowunikira, zomwe sizinaphatikizidwe muzoyambirira zawo (mungathe kuona zonse za Senate pano).
Mabaibulo atsopano a BCRA adayambitsidwa pa July 13 (chigawo cha ndime ndi gawo), ndipo pa July 20 (gawo-by-section summary summary ). Panthawi yonseyi, Senatayi sanakhale ndi zokambirana za komiti kapena zokambirana za bipartisan zokhudzana ndi malamulo .
Bungwe la BCRA linavota voti ku Senate pa Julayi 27 pamene idasinthidwa ndi chinenero cha Bill-Pass Bill. Idalephereka pamtunda waukulu, 43-57. Senate inakana kukana "Health Care Freedom Act", yomwe idakhazikitsidwa kuti ikhale njira yopita ku komiti ya msonkhano ndi utsogoleri wa House GOP.
Ndalama ya Nyumba ikhoza kubwereranso ku kalendala ya Senate ngati ndi pamene atsogoleri a GOP ali ndi mavoti oti apereke kalata ya Sateti. Ngakhale sitikudziwa kuti mgwirizano-ngati ulipo-udzakwaniritsidwira ndi Republican mu Senate, Baibulo la 20 July la BCRA limatipatsa ife maganizo akuti malo a Sateti Republica akufuna kupita ndi kusintha kwa chisamaliro.
BCRA yomwe Senate idaganizira pa July 27 inali yofanana ndi kalembedwe, koma inaphatikizaponso Cruz Amendment ndi Portman Amendment. Palibe aliyense amene atengedwa ndi CBO, kotero tilibe nambala iliyonse malinga ndi zotsatira zake. The Cruz Amendment ikanalola kuti inshuwalansi azigulitsa macimpy, osati ACA-malingaliro awo malinga ngati adagulitsanso ndondomeko imodzi ya golidi, ndondomeko imodzi ya siliva ndi ndondomeko imodzi ya "malamulo" omwe ali pansi pa malamulo a BCRA, omwe angakhale ndi mtengo wapatali wa 58 peresenti. The Portman Amendment idzapereka ndalama zokwana $ 100 biliyoni kuti mayiko azigwiritsa ntchito kuchepetsa ndalama zopezera ndalama za olembetsa ndalama zochepa, ndipo amapereka mayiko ena kuti athe kugwiritsa ntchito ndalama za Medicaid kuti achepetse ndalama zowonongeka kwa olembetsa ndalama zochepa kuchoka ku Medicaid kupita ku chinsinsi pa BCRA.
BCRA (popanda Portman ndi Cruz kusintha) yakhala ikuyendetsedwa ndi CBO ndipo inafotokozedwa ndi akatswiri ambiri a ndondomeko za thanzi, kotero ife tikudziwa bwino lomwe momwe zidzakhudzire. Portman Amendment ayenera kuti adabweretsa kuchepa kwa- ndalama zowonjezera, koma ndizofunikira kudziwa kuti ndalamazo zikanangoperekedwa kwa zaka zisanu ndi ziwiri; Panalibe ndalama zopitilirapo malamulo.
Cruz Amendment iyenera kuti inachititsa kuti aliyense wogula malingaliro omwe sakanapindula angasinthe. Kuwongolera kumeneku kumachokera pa CBO zikalata za BCRA. Popeza kuti kusintha kwa Cruz ndi Portman sikunatengedwe ndi CBO, zotsatira zake sizinaphatikizidwe pazokambirana zotsatirazi zokhuza ndalama zogulitsa.
Ngakhale kuti BCRA idzasintha mbali zambiri za inshuwalansi ndi Medicaid, tiyeni tione momwe zingakhudzire mtengo wa ndalama (kumbukirani kuti ngakhale kuti ndalamazi sizinapite ku Seneti, akhoza kubwereranso ku nyumba ya Senate).
Kodi Senate Idachita Zotani Zopanda Phukusi?
Mawu akuti "kunja kwa mthumba" amafotokoza zonse zomwe anthu ayenera kulipira akafuna chithandizo chamankhwala, atatha kampani yawo ya inshuwalansi atapereka gawo la ndalamazo. Komabe, sizinaphatikizepo mtengo wa malipiro , omwe ayenera kulipidwa mwezi uliwonse, mosasamala kanthu kuti mumagwiritsa ntchito chithandizo chamankhwala chilichonse.
Nkhani yaying'ono ndi yakuti BCRA ikhoza kubweretsa ndalama zowonjezera. Tiyeni tione chifukwa chake izi zikanachitika.
Pansi pa ACA, ndondomeko yonse ya gulu limodzi ndi yaing'ono iyenera kugwira ntchito zosiyanasiyana zomwe zimaonedwa kuti ndizofunikira zathanzi , ndipo ndondomeko zonse (kuphatikizapo magulu akuluakulu a gulu) ziyenera kuwononga 60 peresenti ya ndalama zowonongeka (izi zimagwira ntchito chiwerengero cha ndalama zomwe munthu amapatsidwa zimadalira kuchuluka kwa chithandizo chamankhwala chomwe munthuyo akuchifuna chaka chonse). Zowonjezera ndalama zomwe ndondomekoyi imatchedwa actuarial value (zolemba kuti pamsika pawokha, a inshuwalansi angagulitse mapulani oopsa - omwe ali ndi mtengo wapatali pansi pa 60 peresenti-kwa anthu ochepa, ngakhale thandizo la ACA premium siligwiritsidwe ntchito kwa iwo zolinga).
Ndondomeko yomwe ili ndi phindu la 60 peresenti imayikidwa ngati ndondomeko ya mkuwa panthawi ya inshuwalansi ya thanzi laling'ono ndi yaing'ono, ndipo imakwaniritsa zofunikira zopezera "mtengo wochepa" pa nkhani yaikulu ya gulu. Popeza zimakhala zovuta kwa makampani a inshuwalansi kuti agwirizane ndi ndondomeko yowonjezera, inshuwalansi amaloledwa kugwiritsa ntchito 2 / + 2 de minimus range, kotero kuti ndondomeko ya bronze isintha kuyambira 58 mpaka 62 peresenti. Izi zinakonzedwa kuti ziwonjezeke ku -2 / + 5 mu 2018, koma malamulo omwe anamaliza mu April 2017 akuyitanitsa kukula kwa bronze dongosolo la minimus range, mpaka -4 / + 5. Kotero pansi pa malamulo omwe alipo, mapulani a bronze mu 2018 adzaloledwa kufalitsa pafupifupi 56 mpaka 65 peresenti ya ndalama zamankhwala.
Koma pokhapokha ndondomeko zowonongeka zomwe tatchulazi, ndondomeko zamkuwa ndizochepa zomwe zimaperekedwa ndi inshuwalansi. Ndondomeko ya zizindikiro, yomwe imakhala yotchuka kwambiri ndi olembetsa, ndi ndondomeko ya siliva, yomwe ili ndi chiwerengero cha 70 peresenti. Zothandizira ndalama za ACA zimagwirizana ndi mtengo wa ndalama, ndipo ACA kugawana ndalama zothandizira ndalama zimapezeka pokhapokha ngati olembetsa amasankha mapulani a siliva.
Pokumbukira zonsezi, tiyeni tsopano tiwone zomwe bungwe la BCRA likuchita. Kawirikawiri, pali mbali zingapo za msonkho umene ungapangitse ndalama zowonjezera:
- Mayiko angathe kumasula malamulo ponena za mapindu omwe ayenera kuwonetsedwa m'misika yamagulu ndi gulu laling'ono, ndipo ndi mautumiki otani omwe akugonjetsedwa ndi zikhomo za ACA ndizoletsedwa pa moyo wawo wonse ndi maola opindulitsa pachaka pamisika yonse , kuphatikizapo magulu akuluakulu.
- Pofika m'chaka cha 2026, zolinga za "benchmark" zidzatha kuchoka pafupipafupi za $ 5,000 kuti zikhale zopitilira $ 13,000 . (onani kuti ngati ACA ikhalapo, ndalama zokwana $ 5,000 zomwe zaperekedwa mu 2026 zingagwiritsidwe ntchito kwa anthu omwe sali oyenerera ndalama zogawana ndalama , kwa munthu yemwe ali ndi ndalama zokwana madola 26,500 mu 2026, ntchito za CBO zomwe zimakhala zochepa zowonongeka Pangani ndalama zokwana madola 800 ngati akulembera ndondomeko, monga momwe ACA ikugawira ndalama zothandizira ndalama zomwe zimapereka ndalama zambiri zogulira ndalama zambiri.
- Kupereka ndalama zothandizira ndalama kungathetsedwe ndi BCRA, zomwe zimachititsa kuti anthu omwe ali ndi ndalama zochepa (monga momwe taonera pamwambapa, ndalama za ACA zothandizira ndalama zothandizira ndalama zothandizira ndalama zothandizira ndalama zowonjezera ndalamazo zidzasokoneza ndalama zowonongeka kuchokera pa $ 5,000 mpaka $ 800 kuti munthu alandire ndalama 175 peresenti ya umphaŵi mu 2026 ... koma kokha ngati ACA ndi ndalama zopatsana ndalama zikukhalabe).
Ngakhale kuti mapulani a CBO akuti ndondomeko yokhala ndi ndalama zokwana madola 13,000 ndi 2026, amawonetsanso kuti ndalama zowonongeka zomwe zimaloledwa kuti zikhale zofunikira m'thupi zimakhala madola 10,900 pansi pake. ndondomeko yamakono yomwe amagwiritsidwa ntchito kuti mudziwe kuchuluka kwa chilolezo chololedwa chokwanira chikupita mmwamba chaka chilichonse . Ndondomekoyi siinasinthidwe mu BCRA, koma izi mwachionekere ndizosiyana zomwe ziyenera kuchitidwa ngati BCRA iyenera kuyendetsedwa. Chofunikira kwambiri, lamulo likuyitanitsa zolinga zomwe zidzakhale zopindulitsa kwambiri zomwe sizidzaloledwa kugulitsidwa.
Kuwononga Mavuto Amtengo Wapatali Azaumoyo = Zofunika Kwambiri kwa Odwala
Bungwe la BCRA lingalole kuti, kudzera mu ndondomeko yomwe ikupezekapo 1332 - koma ndi zochepa zoletsedwa ndi zowonjezereka kuposa momwe ACA ikuyendera-kusintha ndondomeko ya ubwino wathanzi. Choncho, boma lingaganize kuti kulandira chithandizo chakumayi sikulinso phindu la thanzi labwino, ndipo mabungwe a inshuwalansi sakanati ayenela kuziyika pazinthu zatsopano zaumoyo (pachitsanzo, gulu laling'ono lomwe liri ndi antchito khumi ndi awiri kapena ochulukirapo angaphatikizepo kulandira amayi, chifukwa cha malamulo omwe akhalapo kwa zaka zambiri).
Ngati ndondomeko ziloledwa kugulitsidwa opanda zopindulitsa zomwe zaikidwa pakalipano, anthu omwe amafunikira thandizoli adzawona ndalama zambiri zowonongeka, popeza sakanakhalanso ndi inshuwalansi yazinthu zazinthu. Zinthu monga mankhwala osokoneza bongo, mankhwala osokoneza bongo / mankhwala osokoneza bongo, komanso chisamaliro cha amayi ndi zinthu zonse zomwe sizingatheke kuti athe kufotokozera ubwino wa thanzi la pansi pa BCRA.
Ndikofunika kumvetsetsa kuti kuletsedwa kwa ACA nthawi zonse komanso malipiro apachaka , pamodzi ndi chikhomo cha malamulo pa ndalama zowonongeka, zimagwiritsidwa ntchito pazinthu zofunika zathanzi-izi zimagwiritsidwa ntchito pazinthu za gulu limodzi ndi zazing'ono, komanso zolinga zazikulu za abwana. Kotero ngati boma liyenera kuchepetsa chiwerengero cha misonkhano yomwe ili pansi pa ubwino wa thanzi la ambulera, inshuwalansi angaperekebe chithandizo cha mautumikiwa, koma sangafunikire kuyika ndalama zogwiritsira ntchito ndalama zawo, ndipo iwo akanatha kuika miyezi yopindulitsa ya moyo ndi ya pachaka kwa mautumikiwa saganiziranso zopindulitsa zofunika za thanzi.
Mabungwe a BCRA Angakhudzidwe ndi Mapulani a Bronze Mmalo mwa Silver
Bungwe la BCRA lidzapitiriza kupereka ndalama zothandizira ndalama zomwe zingasamalire ku ACA premium chithandizo, koma osati zamphamvu. Iwo amangowonjezera anthu omwe amapeza 350 peresenti ya umphawi, m'malo mwa ACA a 400 peresenti (chifukwa cha chiwerengero, ndalama zothandizira ndalama zothandizira ndalama za banja la anayi kuyambira mu 2017 umphaŵi zingakhale $ 86,100, osati $ 98,400) . Iwo amafunanso kuti anthu okalamba (nthawi zina, ali ndi zaka 40) ali ndi ndalama zoposa 250 peresenti ya umphaŵi kuti athepire kuchuluka kwa ndalama zawo pa ndondomeko ya malire.
Koma makamaka chofunika kwambiri, thandizo la ndalama za BCRA zingakhale zogwirizana ndi ndondomeko yokhala ndi 58 peresenti yokwanira mtengo (mmalo mwa mapulani a siliva omwe alipo, omwe ali ndi phindu la 68 mpaka 72 peresenti).
Kotero kuyambira mu 2020, dongosolo "laling'ono" lingakhale ndi chiwerengero cha actuarial chofanana ndi mapulani omwe ali pansi pano. Pofufuza za BCRA , CBO imanena kuti pazinthu zasiliva zamakono, pafupifupi ndalama zokwana madola 3,600, koma dongosolo la bronze liri ndi ndalama zokwana madola 6,000. Koma ndalama zowonongeka ndi ndalama zonse zowonjezera zimakhala ndi kupuma kwa mankhwala. Mu kafukufuku wawo wa July 20 wa BCRA, mapulani a CBO omwe amadzipatulira pazinthu zoyendera pansi pa BCRA angakhale $ 13,000. Ndipo kachiwiri, m'malo mokhala pang'onopang'ono kwambiri pamakwerero, izi zikanakhala mapulani.
Pakalipano, ndondomeko za siliva ndizowunikira kwambiri. Mu 2017, mwa anthu 9,65 miliyoni omwe adalowetsa mapulani azaumoyo kudzera ku HealthCare.gov, 7.1 miliyoni anasankha ndondomeko zasiliva. Ngati anthuwa akufuna kuti azikhala ndi chitukuko pansi pa BCRA, ayenera kulipira ndalama zambiri, chifukwa ndalama zowonjezera zidzakonzedwa kuti zikhale zochepa kwambiri pazomwe angapezeko ndalama zowonjezera.
Ngati mmalo mwake, amatha kugula mapulaniwa ndi ndalama zomwe amapereka ndalama zothandizira ndi ndalama za BCRA, zomwe zidzathera pokhapokha ngati akufunika kugwiritsa ntchito chithandizo chawo.
Kuchepetsa Zothandizira Kugawana Ndalama = Zozizwitsa Zowonjezera Zopanda Pakati
Ndalama za ACA zopatsana ndalama zimapezeka pokhapokha ngati olembetsa amasankha ndondomeko zasiliva ndikukhala ndi pakhomo la ndalama zomwe siziposa 250 peresenti ya umphaŵi. Koma mwa anthu 7.1 miliyoni omwe anasankha mapulani a siliva ku HealthCare.gov mu 2017, opitirira 5.7 miliyoni adagula mapulani omwe akuphatikizapo kuchepetsa kugula limodzi. Zothandizira izi nthawi zambiri zimachepetsera chiwerengero cha ndalama zokwana madola 1,000, zomwe zimapangitsa kuti anthu azitha kulandira chithandizo chamankhwala, ngakhale kuti sangathe kutero, ngakhale ndi inshuwalansi ya umoyo.
Koma BCRA, monga AHCA, ikhoza kuthetsa ndalama zopatsana phindu pambuyo pa 2019. Izi zikutanthauza kuti anthu omwe panopa angathe kukonzekera ndalama zokwana madola 0 kapena $ 500 akhoza kutsogozedwa ndi $ 6,000 kapena $ 7,000. Ndipo pofika chaka cha 2026, ntchito za CBO zomwe zidakhululukidwa zidzakula kufika $ 13,000 (kachiwiri, poganiza kuti chiwerengero cha kuwerengera miyeso yapamwamba yowonjezera chimasintha kuti BCRA ikwaniritsidwe).
Ngakhale ndalama zopatsana ndalama zimapezeka kuti zilembedwe ndi ndalama zoposa 250 peresenti ya umphawi, zimapindulitsa kwambiri anthu omwe ali ndi ndalama zoposa 200 peresenti ya umphaŵi (zomwe ziri pafupi madola 24,000 kwa munthu mmodzi, koma umphaŵi mlingo ukukwera chaka chilichonse). Anthuwa akadali oyenerera thandizo la premium pansi pa BCRA, koma zolinga zomwe zikanakhalapo kwa iwo-ndipo zogulidwa ndi ndalama zoyendetsera ndalama zowonjezera-zikanakhala zopanda malire zomwe zingadye, nthawi zambiri, theka la ndalama zawo. Ndipo kwa anthu omwe ali ndi ndalama zoperewera pa umphawi, zoperekazo zimakhala zoposa ndalama zawo pachaka.
Zotsatira zake, malinga ndi zomwe bungwe la CBO likulongosola, ndilo kuti anthu opeza ndalama zambiri sangathe kupita popanda inshuwalansi, m'malo mogula chithandizo chomwe chimafuna kuti iwo azilipira gawo lalikulu la ndalama zawo kuti akwaniritse ndalama zotere.
Kusintha kuchokera ku Medicaid kupita ku Private Inshuwalansi = Kutuluka Kwambiri kwa Mthumba
Bungwe la BCRA lidzathera pang'onopang'ono thandizo la federal lomwe likulengeza kuti pakalipano lidzakwaniritse anthu omwe akukhala ndi Medicaid . Izi zidzasinthiranso ndalama zonse za Medicaid ku federali kuchokera pamasewero omwe amatha kuwonetsera ndalama zomwe zidzasankhidwa kuti zikhale zolembera kwa mtengo wogulitsa (zomwe zimayamba kuwonjezeka pang'onopang'ono kusiyana ndi ndalama za Medicaid).
Zotsatira zake, malinga ndi momwe bungwe la CBO likuyendera, lidzakhala kuchepetsa ndalama zokwana $ 756 biliyoni ku Medicaid federal pamapeto pa zaka 10 zikubwerazi, pogwiritsa ntchito ndalama mu 2026 kukhala pafupifupi 26 peresenti kuposa momwe zingakhalire pansi pa lamulo lino. Bungwe la CBO linatulutsanso kufufuza kwina , poyesa kuti ndalama za federal Medicaid pofika 2036 zidzakhala zopitirira 35 peresenti kuposa momwe zidzakhalira pansi pa lamulo lino.
Chotsatira cha zonsezi ndi chakuti pofika mu 2026, anthu pafupifupi 15 miliyoni ochepa pa Medicaid adzakhalapo kusiyana ndi malamulo omwe alipo, ndipo kusiyana kumeneku kudzapitirizabe kukula m'zaka 10 zikubwerazi.
Anthu omwe akuphimbidwa ndi Medicaid ali ndi udindo wokhala ndi ndalama zokhazokha zomwe sizikutanthauza. Ambiri mwa anthu okwana 15 miliyoni sadzangotsimikizika ngati ataya mwayi wopezeka ku Medicaid. Koma omwe amasintha kupita ku inshuwalansi yathanzi (mwinamwake ndi kuthandizidwa ndi ndalama zowonjezera ndalama) adzakumana ndi ndalama zowonongeka kwambiri. Izi ndizowona makamaka kupatula kuchotsedwa kwa ndalama za BCRA, komanso kuti ndondomeko zogwirizira zidzakhala ndi 58 peresenti yokha. Ndalama zokwana $ 13,000 sizingakhale zenizeni kwa munthu yemwe ali umphawi kapena mopitirira pang'ono kuposa umphawi.
> Zotsatira:
> Zigawo za Medicare ndi Medicaid Services, 2017 Malo Olembera Panyumba Nthawi Yoyamba Kulembetsa Anthu Ogwiritsa Ntchito Mafayilo.
> Congressional Budget Office. HR1628, Act Care Better Reconciliation Act ya 2017. June 26, 2017.
> Congressional Budget Office, Kuwerengera mtengo. HR1628, American Health Care Act ya 2017, yomwe idaperekedwa ndi Nyumbayi pa May 4, 2017 . May 24, 2017.
> Congressional Budget Office, Kuwerengera Mtengo, > HR 1628, Bungwe la Better Care Reconciliation Act la 2017: Kusinthidwa kwa Mtundu Wothandizira [ERN17500], monga Posted pa Website ya Komiti ya Senate pa Budget pa July 20, 2017. July 20, 2017.
> Dipatimenti ya zaumoyo ndi zithandizo zaumunthu, Chitetezo cha odwala komanso chithandizo chamankhwala chamtengo wapatali; Msika Ukukhazikika . April 13, 2017.
> Federal Register, Dipatimenti ya Zaumoyo ndi Zopereka zaumunthu. Chitetezo cha Odwala ndi Zopanda Thandizo Labwino; Chidziwitso cha HHS cha Kupindula ndi Kulipira Malipiro a 2018; Kusinthidwa kwa Nthawi Zowonjezera Zapadera ndi Ogulitsa Ogwira Ntchito ndi Okhazikitsa Mapulani Pulogalamu. December 22, 2016.