Ngakhale ndi ACA Gawo 1557, ndi zovuta
Ufulu woyenerera wa a transgender America akhala akubwera nthawi yayitali, koma Care Affordable Care Act (ACA) ikupita patsogolo kukulinganiza mu chisamaliro . Gawo 1557 la ACA limaletsa kusankhana pa zifukwa zosiyanasiyana za "pulogalamu yachipatala kapena ntchito" iliyonse yomwe imalandira thandizo lililonse la ndalama za federal.
Koma izi sizikutanthauza kuti anthu onse omwe ali ndi inshuwalansi tsopano ali ndi mwayi wogula chithandizo chilichonse chomwe akufuna.
Gawo 1557 la ACA
ACA Chigawo 1557 chakhala chikugwira ntchito kuyambira 2010, koma ndi ndime zingapo zokha, komanso zachilengedwe. Pofuna kufotokozera zofuna zotsutsana, Dipatimenti ya Zaumoyo ndi Ufulu wa Anthu (HHS) ndi Ofesi ya Civil Rights (OCR) inafalitsa lamulo lomaliza la masamba 362 lokhazikitsa gawo lachigawo 1557 mu May 2016.
Gawo 1557 limaletsa chisankho chotsatira ndondomeko zomwe zilipo-Civil Rights Act, Mutu IX, Age Age, ndi Gawo 504 la Rehabilitation Act-zomwe kale zimadziwika bwino kwa Ambiri ambiri (ie, zaka, kulemala, mtundu, mtundu, chiyambi ndi kugonana). Gawo 1557 la ACA likugwiritsanso ntchito malamulo omwewo osasankhana pa mapulani azaumoyo ndi ntchito zomwe amalandira ndalama za federal.
Mu ulamuliro womaliza, HHS ndi OCR zimamveketsa kuti chidziwitso cha amuna ndi akazi chikhoza kukhala chachimuna, chachikazi, kapena, kapena kuphatikiza mwamuna ndi mkazi. Ndipo lamuloli limaletsera ndondomeko zaumoyo ndi ntchito zomwe zimalandira ndalama za federal kuchoka pakusalidwa kwa anthu payekha chifukwa chodziwika ndi amuna kapena akazi kapena kugonana.
Gawo 1557 likugwiritsidwa ntchito ku bungwe lirilonse lomwe limapereka chithandizo chaumoyo kapena inshuwalansi ya umoyo (kuphatikiza mabungwe omwe ali ndi ndondomeko zaumoyo wothandizira ogwira ntchito awo) ngati alandira mtundu uliwonse wa ndalama za federal inshuwalansi kapena ntchito zaumoyo.
Izi zimaphatikizapo zipatala ndi zipatala zina, Medicaid , Medicare (kupatulapo Medicare Part B ), ndondomeko za umoyo wa ana, Inshuwalansi ya Ana zaumoyo , ndi omwe ali ndi inshuwalansi zapadera omwe amalandira thandizo la federal (kuphatikizapo kuthandizira pa mgwirizano wa olembetsa malonda awo; Zomwe zili choncho, zolinga zonse za inshuwalansi ziyenera kukhala zogwirizana ndi Gawo 1557, osati zokhazokha zotsatsa malonda awo).
Mabungwe omwe amayenera kutsatila Gawo 1557 amatchulidwa kuti "mabungwe ophimbidwa."
Zambiri mwazomwe zimakhazikitsidwa mu lamulo lomaliza zimayamba pa July 18, 2016, koma ngati kusintha kumayenera kupangidwira dongosolo la thanzi labwino, izo zikhoza kuchedweka mpaka chiyambi cha chaka choyamba choyamba chomwe chiyamba kapena pambuyo pa 1 January 2017 Choncho, ndondomeko yaumoyo yomwe ili ndi chaka chokonzekera kuyambira August mpaka July sichiyenera kukhazikitsa kusintha kotheka mu ulamuliro womaliza kufikira August 2017.
OCR ili ndi ntchito yotsatila Gawo 1557, ndipo akhala akutero kuyambira 2010. Zolingalira ndi kutsatiridwa zikugwiridwa pazomwe zili choncho, ndipo anthu amaloledwa kubweretsa milandu yoweruza ku khoti la boma pansi pa Gawo 1557.
Kodi ACA Amafuna Inshuwalansi Kuti Ayang'anire Opaleshoni Yopereka Chithandizo Chogonana?
Ngakhale kuti lamulo lomaliza la Gawo 1557 likufotokoza mwatsatanetsatane chisankho chozikidwa pa chidziwitso cha amuna, sichimafuna inshuwalansi za umoyo wathanzi kuti "ziphimbe njira iliyonse kapena chithandizo chamankhwala othandizira kusintha."
Malamulowo samapewa mgwirizano wochokera ku "kugwiritsa ntchito miyezo yosalowerera ndale yomwe imayendera momwe zidzathandizira kufotokozera olemba ake onse mosalongosola." Mwa kuyankhula kwina, njira zamankhwala ndi opaleshoni ziyenera kuperekedwa mwanjira yopanda tsankho, koma palibe chofunikira kuti inshuwalansi azikhala ndi njira zina zothandizira kuchipatala, ngakhale ataganiziridwa kuti ndizofunikira.
OCR yatanthauzira kuti ngati bungwe lopangira bungwe likugwira ntchito kapena likulipira njira zina kwa anthu ena, silingagwiritse ntchito chidziwitso cha amuna kapena akazi kapena kugonana kuti asapereke njira imeneyi kwa munthu wolakwa. Mwachitsanzo, ngati inshuwalansi imaphatikizapo zowononga kapena kupewa khansa kwa amayi a cisgender , iyenera kugwiritsa ntchito njira zopanda tsankho, zomwe sizitsankho pofuna kudziwa ngati zidzasokoneza zowononga za matendawa.
Ndipo chidziwitso cha amai sizingagwiritsidwe ntchito kukana chithandizo chomwe chiri chofunika kuchipatala, mosasamala kanthu kuti chikugwirizana ndi chikhalidwe cha amai omwe ali okondedwa.
Mwachitsanzo, mwamuna wa transgender sangakanidwe mankhwala a khansa ya ovari chifukwa chakuti amadziwika ngati mwamuna.
Koma nkhaniyi imakhala yovuta. Asanayambe kutsogoleredwa mu lamulo lachigawo cha 1557 chomaliza, panali mayiko 17 omwe amaletsa mwachindunji inshuwalansi zaumoyo kuti asapangidwe ndi bulangete chifukwa cha chisamaliro cha transgender, ndi 10 zomwe zinalepheretsa zobvala zoterezi m'mapulogalamu awo a Medicaid. Pansi pa ulamuliro womalizira, mabungwe ovomerezeka m'mayiko onse amaletsedwa kugwiritsa ntchito ziboliboli kuti asamayang'anire kugonana kwa denda, ndipo ayenera kugwiritsa ntchito njira zopanda tsankho pozindikira ngati ndondomeko idzaphimbidwa.
Komabe pamene Gawo 1557 ndilo gawo lalikulu loyendetsera chisamaliro pakati pa azinthu zachipatala a transgender Achimereka, sikutanthauza kufotokozera opaleshoni yowonongeka kwa amayi ndi chithandizo chamankhwala chogwirizana.
Kodi Mapulani a Inshuwalansi Zaumoyo Amaphimba Kubwereranso kwa Magulu?
Ngakhale kuti Gawo 1557 lakhalapo kuyambira 2010, lamulo lomaliza silinabwere mpaka zaka zisanu ndi chimodzi kenako, ndipo olemba inshuwalansi ndi ogwira ntchito zaumoyo akuyesetsabe kufotokoza tsatanetsatane. Makamaka amapatsidwa kuti lamulo lomaliza pa Gawo 1557 silikufuna inshuwalansi kuti apeze njira iliyonse-ngakhale ngati yowona kuti ndizofunikira-pamakhalabe malo amtundu wambiri.
Healthcare.gov imapereka chitsogozo cha momwe mungayankhire kugonana kwa olembera pa ntchito yopereka chithandizo pa inshuwalansi ya umoyo muzogwiritsira ntchito Healthcare.gov, ndikufotokozera momwe mungaperekere kuwonetsera chisankho.
Kuyambira chaka cha 2014, Medicare yakhala ikugwira ntchito yochitidwa opaleshoni yothetsera kugonana , yomwe ikugwirizana ndi zofuna zachipatala. Dipatimenti ya Veterans Affairs (VA) idakonzeratu kuthetseratu kuletsedwa kwa nthawi yaitali polipira opaleshoni yowononga kugonana kwa ankhondo a ku America.
Ndipo mwachidule ichi kuchokera ku Aetna ndi chitsanzo chabwino cha momwe anthu ogwira ntchito zothandizira alimi angagwiritsire ntchito mbali zina za ndondomeko ya kusintha kwa amuna, koma osati onse.
Pamene lamulo lomaliza pa Gawo 1557 likuyendetsedwa, padzakhalanso ndondomeko zowonjezera zaumoyo posankha kulakwitsa pambali yokhudza kuchitidwa opaleshoni ya kugonana. Yunivesite ya Vanderbilt inalengeza mu June 2016 kuti ayamba kufotokoza opaleshoni ya kusintha kwa amai pa maphunziro awo azaumoyo, ndipo mzinda wa Portland, Maine udzayamba kulandira chithandizo chamankhwala cha transgender monga cha mwezi wa 2017.
Komanso mu June 2016, bungweli la Public Library la Cincinnati linasankha mogwirizana kuti lisapitirize okwera nawo ku ndondomeko ya inshuwalansi yamakono. Otsatira omwe akukambiranawo anali kuphatikizapo zachipatala, opaleshoni yachipatala, ndi chithandizo cha kusabereka. Laibulale imaphatikizapo kudzera ku Anthem, ndipo wothandizira amapereka wokwera yekha yemwe makanema angagule kuti asamalire chisamaliro cha transgender.
Koma laibulale siyenela kuonedwa kuti ili ndi gawo lomwe lili pansi pa Gawo 1557 la ACA, chifukwa bizinesi yawo yayikulu siyimapereka chithandizo chamankhwala, inshuwalansi ya umoyo, kapena zaumoyo. Choncho, iwo ndi chitsanzo cha bungwe lomwe silingagwirizane ndi gawo la 1557 la zosalongosoka muzopindulitsa za inshuwalansi za ogwira ntchito.
Mayi wa transgender amene amagwira ntchito ku San Francisco-Based Dignity Health adagonjera abwana ake mu June 2016 chifukwa cha tsankho, chifukwa chipatala cha chipatala sichisamalira mankhwala opatsirana pogonana. Pafupifupi zipatala zonse zili ndi zigawo zomwe zili pansi pa Gawo 1557, koma chipatala chimanena kuti ndondomeko yake yathanzi siichiyanjana chifukwa sichikuphimba "kusokonezeka kwa umunthu" makamaka (osati kutsutsa mwachindunji antchito a transgender).
Mlanduwu umanena kuti kugonana kwa dysphoria si vuto la umunthu, koma nkhaniyi ikutsindika mfundo yakuti Gawo 1557 likumalolezabe kutanthauzira, kutanthauzira kwina.
Magaziniyi ndi yomwe ingakumane ndi zokambirana zokhudzana ndi malamulo pazaka zingapo zotsatira, makamaka kupatsidwa kuti zofunikira zaumoyo zoyenera za ACA sizikuphatikizapo zachipatala, komanso kuti ulamuliro wa gawo la 1557 sumafuna kuti ntchito zaumoyo zikhale zofunikira njira zothandizira zachipatala zokhudzana ndi kubwezeretsedwa kwa amuna, kuphatikizabe zosowa zachipatala.
> Zotsatira:
Dipatimenti ya zaumoyo ndi zithandizo zaumunthu, Nondiscrimination in Health Programs and Activities , yomwe ikugwira ntchito pa July 18, 2016. Inapezeka 6/22/16.
National Center for Transgender Equality, Dziwani Ufulu Wanu: Medicare. Inapezeka 6/22/16.
Dipatimenti Yachilungamo ya United States, Phunziro la Mutu IX wa Maphunziro Ophunzira a 1972, Opezeka 6/22/16.
Nyumba ya Oimira a US, kuphatikiza Chitetezo cha Odwala ndi Ntchito Yabwino Yothandizira, Monga Kusinthidwa Patsiku la 1 May 2010 . Inapezeka 6/22/16.