Pa December 22, 2017, Purezidenti Trump anasaina lamulo la Tax Cuts and Jobs Act (HR1). Lamuloli limaphatikizapo kusintha kwakukulu kwa misonkho ya msonkho wa ku US, koma kumatulutsanso chaka chovutitsa chisamaliro cha kusintha kwa thanzi. Mwinamwake mukuganiza ngati bili ya msonkho ya GOP idzakhudza inshuwalansi ya umoyo wanu, monga kubwezeretsa kwa ACA kukhala chinthu choyambirira kwa oweruza Republican ndi Administration Trump.
Koma msonkhowo sungaphatikizepo zambiri zomwe zinali mbali ya kubwezeretsedwa kwa ACA kumayambiriro kwa chaka cha 2017. Icho chimafafaniza chilango cha munthu aliyense payekha chaka cha 2019, koma zina zonse zogulitsa mankhwalawa zatsala m'malo. Ndipo zina zothandizira zaumoyo zokhudzana ndi zaumoyo zomwe zanenedwa kale chaka, monga kusintha malamulo okhudza ndalama zothandizira ndalama (HSAs) sizinaphatikizidwe mu msonkho wa msonkho.
Kubwereza chilango cha munthu aliyense
Ndalama ya msonkho imaphwanya chilango cha munthu aliyense payekha chaka cha 2019. Kotero pali chilango cha anthu omwe sali otsimikiziridwa mu 2018 (chilango chimenecho chidzayankhidwa pamene msonkho udzabwezedwa kumayambiriro kwa 2019). Izi zikusiyana ndi zoyesayesa za GOP kubwezera chilango chaumwini kale mu 2017, monga momwe mabanki akale angapangitsire kubwezeretsa. Pamapeto pake, msonkho wa msonkho umapangitsa kuti chilango cha munthu aliyense chikhale chilango kwa zaka zonse zoyambirira, ndipo chaka cha 2017 ndi 2018.
Koma kubweranso kwa msonkho kwa 2019 kumayambiriro kwa chaka cha 2020 sikuphatikizapo chilango chosavomerezedwa.
Kubwezeretsa chilango chomwe chikugwirizana ndi udindo wa ACA payekha wakhala wofunika kwambiri kwa Congressional Republican, ndipo udindo womwewo ndi chimodzi mwa zinthu zochepa zomwe ACA imapatsidwa. Koma ngakhale kuti sichikukondweretsedwa, ndi chimodzi mwa zinthu zomwe zimalola kuti ACA ikhale lamulo lovomerezeka kwambiri kuti lizigwira ntchito.
Nkhani yotsimikiziridwa ikutanthawuza chithandizo chomwe chaperekedwa kwa onse opempha, mosasamala za mbiri yawo yachipatala. ACA imagwiritsanso ntchito kusintha kwa midzi, zomwe zimatanthawuza kuti malipiro a insurer omwe ali m'misika yamagulu ndi yaing'ono amasiyana mosiyana ndi zaka, fodya, ndi zipcode. Pambuyo pa ACA, ndalama zowonjezereka zimakhazikanso pazinthu monga za amai ndi zaumoyo.
Kusintha malamulo kotero kuti mbiri yachipatala sichikuthandizani kuyenerera kapena payimayi yadziwika bwino. Koma ndi zophweka kuona momwe anthu angayesedwe kuti apite popanda chidziwitso pamene ali ndi thanzi labwino, ndi kulembapola pamene akudwala ngati akudziwa kuti sangakanidwe-ndipo zimenezo sizidzakhala zosatheka. Choncho ACA ikuphatikizapo zinthu ziwiri zomwe zingathandize kupewa izi: Udindo wina womwe umapereka chilango kwa anthu omwe amasankha kupita popanda inshuwaransi, ndi mawindo olembetsera ochepa omwe amalembetsa kulembetsa (mwachitsanzo, simungathe kulembetsa nthawi iliyonse yomwe mumakonda).
Kulembetsa kolembera ndi mawindo apadera olembetsa adzakhalabe osasintha, zomwe zimapangitsa kuti zikhale zovuta kwa anthu kuyembekezera mpaka atadwala kuti azilembetsa inshuwalansi ya umoyo pawokha (wogulitsa inshuwalansi wathandizira wakhala akugwiritsanso ntchito nthawi yolembetsa; anthu sangathe kulemba chifukwa cha dongosolo la thanzi la abwana awo pamene akufuna).
Koma kubwezera udindo wawo kudzakhala ndi zotsatira zosokoneza pa msika wa inshuwalansi. Ntchito za Congressional Budget Office (CBO) kuti pofika chaka cha 2027, padzakhala anthu 13 miliyoni ochepa inshuwalansi ya umoyo kuposa momwe zikanakhalire ngati chilango chalamula chikanakhalabe. Mwa anthu 13 million ochepa insureds, 5 miliyoni akanakhala nawo kufalitsa pa msika pawokha. Ndipo ndilo gawo lalikulu la msika, womwe umayesedwa pa anthu oposa 18 miliyoni mpaka 2017 (chifukwa cha malingaliro, mapulani a CBO omwe angokhala 2 miliyoni pa 13 miliyoni insureds ochepa adzakhala anthu omwe akanadakhala nawo chithandizo pothandizidwa ndi abwana malingaliro azaumoyo, ndi anthu 158 miliyoni ali ndi chithandizo pamakonzedwe omwe amagwiritsidwa ntchito ndi abwana).
Anthu omwe amasiya kupereka chithandizo popanda ntchito, amakhala ndi thanzi labwino, monga momwe anthu odwala amachitira zonse zomwe zingawathandize kuti azikhala nawo. Phokoso lolowera ku dziwe la oopsa limabweretsa mapepala apamwamba, omwe amachititsa anthu omwe ali ndi thanzi labwino kwambiri kunja kwa msika.
Kwachilendo, CBO ikulingalira kuti ndalama zothandizira msika wa inshuwalansi zidzakula ndi zina 10 peresenti patsiku, pamwamba pa kuchuluka kwa ndalama zomwe zikanakhala zikukula ngati ntchitoyo ikanakhala yogwira ntchito.
Koma CBO imanenanso kuti msika wa inshuwalansi udzapitirizabe kukhala wosasunthika pafupifupi mbali zonse za dzikolo muzaka 10 zikubwerazi. Mwachiyero, amakhulupirira kuti madera ambiri a dzikoli adzalinso ndi inshuwalansi yopereka malonda, chiwerengero chokwanira cha olembetsa kuti mapulaniwo akhale okhazikika. Izi ziyenera, makamaka, kuti thandizo la ACA's premium likuthandizira kuti liziyenda bwino ndi malipiro. Kotero ngakhale kuti kuthetsedwa kwa udindo wa munthu payekha kudzachititsa kuti ndalama zowonjezereka zikule kwambiri, ndalama zowonjezera zidzakula komanso zofunikira kuti asunge ndalama zoyendetsera ndalama pamsika wokwera mtengo.
Kwa anthu amene amalandira ndalama zothandizira ndalama, zomwe zimaphatikizapo banja la anayi omwe amalandira $ 98,400 m'chaka cha 2018, kuwonjezeka kwa ndalama zowonjezera zidzathetsedwa ndi kuchuluka kwa ndalama zothandizira. Koma kwa anthu omwe sapatsidwa thandizo la premium, kufalitsa pa msika pawokha kungakhale kovuta kwambiri m'zaka zam'tsogolo. Ndikofunika kumvetsetsa kuti zopereka zothandizira msonkho zowonjezera msonkho komanso / kapena HSA (ngati mugula ndondomeko ya thanzi la HSA ) zidzasintha ndalama zowonongeka (ACA-zina zofanana ndi MAGI), ndi Zingakuchititseni kuti mulandire malipiro opindulitsa a premium ndi mlangizi wa msonkho musanayese kuti simukuyenera thandizo.
Koma kawirikawiri, kuwonjezeka kwapadera komwe kumabwera chifukwa cha kuchotsedwa kwa chilango cha munthu aliyense chidzagunda anthu omwe amagula malonda awo ndipo sali woyenerera kupereka ndalama zowonjezera ndalama (ie, iwo omwe ali ndi ndalama zapakhomo pampingo 400 peresenti ya umphaŵi, ndi mu kusiyana kwa chithandizo cha Medicaid, kapena kusagwirizana ndi chithandizo chothandizira pothandizira banja ). Ndipo ngakhale kuti ntchito za CBO zimakhala kuti msika uliwonse umakhala wolimba m'madera ambiri a dzikoli, pakhoza kukhala malo ena omwe msika wina umangowonongeka, ndipo palibe mabungwe omwe amapereka chithandizo. Izi ziyenera kuthandizidwa pazochitika-ndi-chifukwa maziko, zomwe zingakhale ndi malamulo a federal ndi / kapena boma. Koma ndizochitika zomwe zingatheke kapena sizichitika.
Zotsatirapo kwa Wogwira Ntchito-Inshuwalansi Za Thanzi Labwino
Ambiri omwe si achikulire Achimerika amapeza inshuwalansi ya umoyo kwa abwana awo, ndipo ndalama za msonkho sizisintha kalikonse kokhudza inshuwalansi ya umoyo. Udindo wa abwana udzakhalabe wogwira ntchito , monganso malamulo onse omwe ACA imapereka pazinthu zothandizira zaumoyo.
Mipukutu yosiyanasiyana ya ACA yomwe inaganiziridwa kumayambiriro kwa 2017 idawononga udindo ndi ntchito ya abwana, koma msonkho wa msonkho umaphwanya lamulo lokhalokha. Olemba ntchito zazikulu (50 kapena kuposa omwe amagwira nawo ntchito nthawi zonse) adzapitiriza kufunika kuti apereke inshuwalansi ya moyo kwa antchito awo a nthawi zonse.
Koma antchito awo sadzakhalanso oweruzidwa ndi IRS ngati alephera kusunga. Choncho ntchito za CBO zomwe pofika chaka cha 2027, padzakhala anthu ochepa oposa 2 miliyoni omwe ali ndi chithandizo cholimbikitsidwa ndi ogwira ntchito kuposa momwe akanakhalira ngati udindo wawo unali utakhazikika. Koma mozama, kuchepa kumeneku kumachokera kwa antchito akuchepetsera zopereka zawo za olemba ntchito, monga momwe olemba ntchito adzafunikiranso kupereka chithandizo kuti asapezeke zilango zomwe angagwiritsidwe ntchito ndi abwana.
Zopereka za HSA ndi Malamulo Zasintha
Ndalama zosungirako zaumoyo (HSA) zimalola anthu omwe ali ndi HSA omwe amafunika kukhala ndi thanzi labwino (HDHPs) kupatula ndalama zisanapereke msonkho kuti azilipiritsa ndalama zothandizira zaumoyo ( kapena kugwiritsa ntchito monga akaunti ya pantchito ). Atsogoleri a malamulo a Republican akhala akuyesetsa kuti athe kuwonjezera ma HSA poonjezera malire a ndalama ndikupereka ndalama kuti zigwiritsidwe ntchito kulipira inshuwalansi ya inshuwalansi. Posachedwapa, olemba malamulo a GOP afunanso kuchepetsa kuwonjezeka kwa chilango chomwe Care Affordable Care Act anaika pa ndalama zopanda ndalama mankhwala asanakwanitse zaka 65.
Zina kapena zonsezi zinaphatikizidwa mu bili zosiyana siyana za ACA zomwe olemba malamulo a GOP ankaganiza mu 2017 . Koma palibe mwa iwo omwe adawapanga ku Tax Cuts and Jobs Act. Olemba malamulo a GOP angaganizire malamulo ena mu 2018 kuti asinthe kusintha kwa HSA, koma kwa nthawiyi, samasintha.
Mpaka malipiro a 2018 ndi $ 3,450 kwa anthu omwe ali ndi kachilombo kamodzi komwe ali ndi HDHP, ndi $ 6,900 kwa iwo omwe ali ndi mabanja. Palinso chilango cha 20 peresenti pazochotsa ndalama zisanafike zaka 65 ngati ndalama sizigwiritsidwa ntchito pa ndalama zothandizira, komanso ndalama zothandizira inshuwalansi sangathe kulipira ndi ndalama za HSA, kupatulapo ndalama za COBRA, malipiro olipidwa pamene mukulandira ntchito , ndi malipiro a Medicare Mbali A, B, ndi / kapena D.
Kuchotsa Ndalama Zamankhwala Kudzakhala kosavuta mu 2017 ndi 2018
Ndalama zothandizira zamankhwala zimachokera misonkho, koma ngati ziposa 7,5 peresenti ya ndalama zanu. Analipo 7,5 peresenti, koma ACA inasintha kukhala 10 peresenti muyeso yopulumutsa ndalama. Anthu omwe anali ndi zaka 65 kapena kuposerapo adaloledwa kuti agwiritse ntchito 7.5 peresentiyo mpaka kumapeto kwa 2016, koma chiwerengero cha 10 peresenti chidaikidwa mu 2017 kwa onse osuta msonkho.
Pofuna kukweza msonkho kwa ogula, Senator Susan Collins (R, Maine) adapempha kuti abwerere ku 7.5 peresenti. Pamapeto pake, msonkho wa msonkho unaphatikizapo kusintha kumeneku, koma ndi kanthawi. Kwa 2017 ndi 2018, ojambula msonkho amatha kubwezeretsanso ndalama zamankhwala zomwe zimaposa 7.5 peresenti ya ndalama zawo. Koma kuyambira mu 2019, chiwerengero cha 10 peresenti chidzagwiritsidwa ntchito, ndipo ndalama zokha zowonjezera malirezo zidzakhala msonkho woperekedwa.
> Zotsatira:
> Congress.gov. HR1 - Lamulo loperekera mgwirizano mogwirizana ndi maudindo II ndi V a ndondomeko ya mgwirizano pa bajeti ya chaka > 2018. Lowina mulamulo 12/22/2017.
> Congressional Budget Office. Kupititsa Bungwe la Inshuwalansi Yathanzi Lokha: Mandwe Yosinthidwa . November 2017.
> Kaiser Family Foundation. Yerekezerani Zomwe Mungasankhe Kuti Mukhazikitse Chithandizo Chothandizira Chokwanira.
> Kaiser Family Foundation. Inshuwalansi ya Umoyo wa Anthu Onse. 2016
> Mark Farrah Associates. Kuwoneka Mwachidule Pa Inshuwalansi Yaumphawi Yodzipha Malonda. July 19, 2017.