Kodi Zosintha Zosamalidwe Zosamalidwe Zomwe Zidzakhala Zosintha Zidzakhala Zosintha, Zogwira Ntchito, Kapena Zonse?
Pa January 20, maola atangotsala pang'ono kutsegulira, Pulezidenti Trump anasaina lamulo loti "kuchepetsa chuma cha Affordable Care Act." Akuluakulu a boma akuti boma la Trump likufuna kubwezeretsa ACA, koma pakalipano, Trump amafuna mabungwe a federal kukhala osasinthasintha komanso omvera monga momwe angathere pokwaniritsa zofunikira za ACA.
Mabungwe a federal akulangizidwa kuti "asamangidwe, asamapereke ndalama, asamapereke malipiro, kapena asachedwe kukhazikitsa" njira iliyonse ya ACA yomwe idzabweretsere ndalama kapena zolemetsa pazigawo kapena "anthu, mabanja, othandizira zaumoyo, ogulitsa inshuwalansi, odwala, odwala za chithandizo cha zaumoyo, ogula inshuwalansi ya umoyo, kapena opanga mankhwala, mankhwala, kapena mankhwala "-ndipo makamaka omwe akugwira nawo ntchito zaumoyo.
Kuwonjezera pamenepo, bungwe lolamulira limalangiza bungwe la federal kuti likhale "losinthasintha" kunena kuti likufuna kugwiritsa ntchito mapulojekiti awo apadera ndi kusintha kwa chisamaliro.
Kodi Zonsezi Zikutanthauzanji?
Ngakhale kuti ACA yokha ili pafupi masamba okwana chikwi, pali mapepala angapo zikwizikwi za malamulo a federal-makamaka kuchokera ku CMS / HHS ndi IRS-zomwe zamasulira ndi kufotokoza mbali zosiyanasiyana za lamulo, ndipo zimapereka malangizo pamene pakufunika.
Mbali zina za ACA monga zovuta zowonjezera zovuta , komanso zina zomwe zimatengedwa kuti ndizochitetezo - zimaperekedwa kwa malamulo a federal kuti adziwe mwatsatanetsatane pambuyo pake (mwachitsanzo, chifukwa chake chisamaliro chodziletsa cha amayi sichinasankhidwe mpaka 2011, ngakhale kuti ACA inakhazikitsidwa mu 2010).
Kusintha ACA palokha kumafuna msonkhano wa Congress. Koma malamulo osintha omwe agwiritsidwa ntchito ndi mabungwe a federal amafunika malamulo atsopano a boma.Sikuti ndi ophweka ngati kupweteka kwa pensulo, komabe. The Administrative Procedure Act, yomwe yakhazikitsidwa kuyambira mu 1940, ikulamulira momwe mabungwe a federal amalengezera malamulo.
Kwa malamulo a HHS, lamulo lolemba lidasindikizidwa, ndiyeno pali nthawi yowunikira anthu. Kumapeto kwa nthawi ya ndemanga ya anthu, HHS imapanga zisankho mogwirizana ndi ndemanga za anthu ndipo imafalitsa malamulo omaliza, kuphatikizapo ndemanga za ndemanga zomwe adalandira ndi mayankho awo ku ndemangazo. Choncho malamulo atsopano samachitika usiku umodzi (ngakhale kuti ndi bwino kuzindikira momwe njira yokonza malamulo ikugwiritsidwira ntchito ingasinthe pansi pa Ulamuliro wa Trump).
Koma makamaka, Boma la Trump likuuza mabungwe a federal kukhala omvera monga momwe angathere pokwaniritsa malamulo a ACA omwe amachititsa misonkho, chilango, kapena mavuto ena. Mfundo zazikuluzikulu zomwe zagwiritsidwa ntchito ndi ndondomekoyi ndizimene zimakhazikitsidwa ndi munthu aliyense payekha komanso kusintha kwazomwe boma likuyendetsera polojekiti ya chisamaliro.
Mfundo Yokha
Udindo waumwini umafuna ambiri a ku America kuti azikhala ndi inshuwalansi ya umoyo kapena kuti adzalandire chilango pamene akupereka msonkho wawo.
Koma pali zowonjezera zambiri pa udindo . Zina mwa izo ndizofotokozedwa momveka bwino m'malemba a ACA, koma ena-makamaka, zomwe zimayenerera ngati zovuta zapadera -zizisiya kwa HHS kudziwa.
Pansi pa Dipatimenti ya Utumiki, Dipatimenti ya Zaumoyo ndi Zaumunthu imatha kusankha kukulitsa kukwanitsa kuthetsa zovuta, kulola anthu ochulukirapo kuti apite osatetezedwa popanda kulandira chilango cha msonkho pochita zimenezo (ndithudi, kupita kosavomerezeka ndi chiopsezo chachikulu chomwe chimapita kutali kupyola chilango cha msonkho, ngati simukuthandizidwa ndikusowa chithandizo chamankhwala, mumakhala nokha kuti mupereke ndalama zothandizira, ndipo simungathe kupeza chisamaliro chonse kupatula kuunika kwanu / kukhazikika kuti zipinda zowonjezera ziyenera kupereka ).
Ngati maudindo apadera akuchotsedwa ( kudzera mwa malamulo ) kapena osasunthika (kudzera mu zochita zoyendetsera zochokera ku bungwe lolamulira) posachedwa, msika wa inshuwalansi wa umoyo umatha kukhazikika . Mitengo ingakwere mowonjezereka mu 2018, ndipo ogulitsa ena ambiri angasankhe kuchoka pamsika pawokha.
Koma kubwereza kapena kumasula udindo wa munthu kumayambiriro kwa nthawi ya Trump kukwaniritsa mbali ya malonjezano omwe adapanga kuti achotse ACA (Obamacare), ndipo adzapempha anthu omwe sakonda udindo wawo. Kufotokozera, ngakhale kuti udindo wawo ndi umodzi mwazinthu zochepa kwambiri za ACA, ndizofunika kwambiri pa inshuwalansi yaumoyo yomwe imapereka chithandizo cha zinthu zomwe zakhalapo kale, zomwe ACA imafunikanso. Simungathe kukhala ndi zochitika zomwe zakhalapo kale popanda njira yowonjezera kuti anthu azikhala ataphimbidwa pamene ali ndi thanzi labwino, osati kuyembekezera mpaka atadwala.
Kukhazikika kwa Boma mu Kusintha kwa Zaumoyo
Dziko la ACA lili ndi zovuta zowonjezereka: A 1332 waivers amalola kuti mayiko atenge njira zatsopano zogwirira ntchito ACA, malinga ngati akutsatira malangizo osiyanasiyana omwe ali mu ACA. Hawaii posachedwapa inapatsidwa 1332 waiver yomwe imalola boma kuti lipewe kukhala ndi inshuwalansi ya thanzi labwino, popeza Hawaii kale ili ndi mphamvu yothandizira inshuwalansi yothandizira boma.
Ndipo mayiko angapo akhala akugwiritsa ntchito maofesi 1115 kuti agwiritse ntchito kuwonjezereka kwa Medicaid ndi kusintha komwe kumasiyana ndi kuwonjezeka kwa Medicaid kuyitanidwa ku ACA. Koma pansi pa Obama Administration, CMS yakana kulola zina mwazidakwa zomwe zasankhidwa mu zokwanira 1115 zaiver.
Mwachitsanzo, mayiko angapo apereka ntchito yofunikira kwa anthu akuluakulu kuti akhale oyenera kuwonjezera Medicaid (kutanthauza kuti iwo ayenera kugwira ntchito, kugwira nawo ntchito, kufufuza ntchito, kapena kusamalira ana odalira mu kulandira madalitso a Medicaid). Pazochitika zonse, CMS yakana zotsutsa monga choncho, ndipo yalola kuti mapulogalamu odzipereka a ntchito aziphatikizidwa. Koma pansi pa Dipatimenti ya Utumiki, titha kuona maiko akusankha kuwonjezera Medicaid (potero amalandira ndalama zowonjezera za boma pa dongosolo lawo la Medicaid) ndi ntchito yovomerezedwa ndi CMS.
Ichi ndi chitsanzo chimodzi chokha; Pali mbali zambiri za kusintha kwa chisamaliro chomwe boma la Republican likutsutsana ndi Obama Administration, ndipo dongosolo la Trump likuyang'anira njira yowonjezereka yopangira kusintha mwa njira yawo. Nyumba ya Oimira a Minnesota inapereka malamulo mu January 2017 omwe angalolere inshuwalansi zaumoyo kugulitsa malonda popanda zopindulitsa zosiyanasiyana zomwe pakali pano zikugwera pansi pa ambulera ya mandata ofunikira. Komiti ya Minnesota Senate inakana gawolo la malamulo, koma silinayambe kukhazikitsidwa. Koma ngati malamulo ofananawo ayenela kukhazikitsidwa ndi mayiko ena akupita patsogolo (kuganiza kuti ACA iwowo siidasinthidwe) mayikowa adzafunikanso 1332 kuikira. Boma la Obama silikanaperekanso mwayi wotere, koma Ulamuliro wa Trump ndizovuta kwambiri.
Ndikoyenera kuzindikira pano kuti dongosolo la Medicaid palokha limasintha pansi pa Ulamuliro wa Trump ndipo pamapeto pake pamakhala malamulo a ACA. Oweruza a Republican akukakamiza kuti pulogalamuyi ipewe zoperekera ndalama kapena magawo omwe ali nawo, m'malo momveka bwino zomwe boma likugwiritsa ntchito kulipira Medicaid.
Kodi N'chiyani Chimachitika Patsogolo?
Pafupifupi chirichonse chikukwera mmwamba ponena za tsogolo la kusintha kwa thanzi. Lamulo la ACA lolembedwa tsopano likulembedwa ndi makomiti anayi a congressional. Olemba malamulo sanagwiritse ntchito mofanana, ngakhale kuti pali zowonjezera zokambirana pa tebulo (kuphatikizapo zina zomwe zatulutsidwa mu 2017 zokambirana zokambirana, monga Bill bill Cassidy-Collins).
Nkhani kuchokera ku Dipatimenti ya Utumiki yakhala yochepa kwambiri ndipo ikusemphana ndi momwe ndondomeko yoyendetsera ntchito idzakhazikitsire, koma tsopano kuti ambiri omwe adasankhidwa ndi abambo a Trump atsimikiziridwa, zochita zowonongeka zokhudzana ndi chigamulochi zikhoza kudza.
Maboma ena adzatenga nkhani zawo m'manja mwawo, kupatsa malamulo kusunga mbali zina za ACA mmalo mosasamala kusintha kwa federal. Mwachitsanzo, tsiku lotsatira Trump atayina lamulo lolamulira, New York adalengeza malamulo a boma kuti ateteze kupeza njira zopatsira ndalama zopanda malipiro komanso zofunikira zochotsa mimba pazinthu zowonongeka za boma.
Kwa nthawiyi, palibe chomwe chasintha pa inshuwalansi ya umoyo wanu kapena malamulo a inshuwalansi ya umoyo. ACA ikadalipo, mukufunikabe kulumikiza, ndondomeko zaumoyo sizingagwiritse ntchito zolemba zachipatala kapena kupatula kufotokozera zochitika zomwe zakhalapo kale, ndipo ndalama zothandizira ndalama zowonjezereka (ie premium tax credits) zikadalipobe ndikusinthana ndikuthandizani kupeza chithandizo.
> Zotsatira:
> Magulu a Medicare ndi Medicaid Services, Center for Information Consumer Information ndi Inshuwalansi. Gawo 1332: Zowonongeka ndi boma.
> Cornell University Law School, Institute of Information Information Institute. 5 US Code Administrative Procedure.
> HealthCare.gov. Werengani Yopanda Thandizo Labwino. Malembo Otsatira a Care Act ndi Reconciliation Act.
> Medicaid.gov. Pafupi Gawo 1115 Waivers.
> White House, Ofesi ya Mlembi wa Press. Order Order Yothetsera Kulemera Kwachuma kwa Ntchito Yodalirika Yopanda Ntchito Kudikira Kubwereza.