Kodi Senate ya Health Care Bill ikusiyana bwanji ndi Bill House?

by Louise Norris

BCRA imasunga mbali zina za AHCA, koma zimasiyana mu njira zina zofunika

Pa June 22, 2017, Senate ya ku United States inalongosola lamulo lokonza chisamaliro cha zaumoyo kuti lidalembedweratu pakhomo patsikulo kuyambira pamene Nyumbayi inadutsa American Health Care Act (AHCA) pa May 4. Ngakhale ili ndi nambala yomweyo ya ndalama (HR1628) ), Senate idatchulidwa kuti buku la Better Care Reconciliation Act (BCRA) la 2017 . Ndalamayi imakhala ndi AHCA zambiri, komanso imasiyanasiyana kwambiri.

M'masabata otsatirawa, Senate inayambitsa zosiyana zatsopano za BCRA, koma adapitiriza kulembera malamulo potsatira mgwirizanowu, popanda zokambirana za komiti kapena zokambirana za bipartisan. Choyamba chosinthidwa, chomwe chinatulutsidwa pa June 26, chinaphatikizapo zofunikira zowonjezeredwa, zomwe sizinaphatikizidwe muyambirira yawo (mungathe kuwona zonse za Senate pano). Zina zowonjezera za BCRA zinayambika pa July 13 (chigawo chapakati-gawo-gawo), ndipo pa July 20 (gawo-by-section summary summary ).

Senate inafotokozeranso lamulo la kubwezeretsa kubwezeretsa kwa Obamacare (ORRA), lomwe limangobwereza malamulo omwe zipinda zonse ziwiri zidapitilira mu 2015 (HR3762) kuti zikawononge zinthu zazikuluzikulu za ACA. Lamulo limeneli nthawi zambiri limatchedwa "kubwereza ndi kuchedwa" popeza liribe dongosolo lililonse lothandizira ACA. Purezidenti Obama adavumbulutsira kumayambiriro kwa chaka cha 2016, koma oweruza ena a Senate akufuna kuti apitenso panopa pulezidenti Trump ali mu ofesi (malamulo awa analibe mwayi wambiri wopita, chifukwa chokana kuti a Republican omwe awonetsere bwino pa nthawiyi amabwera kudzachotsa ACA popanda kuimika pamtunda, adabweretsedwa pansi pa senati pa voti pa July 27, ndipo analephera 45-55).

BCRA inabweretsedwanso pansi pa Senate pa July 27, ndipo inalephera pavoti 43-57. Mabungwe a Senateti 46 ndi a Independents awiri (omwe onse a khungu ndi a Democrats) adavomereza motsutsana, ndipo adayanjanitsidwa ndi asanu ndi atatu a Republican Senators. Pa ntchito yomaliza kuti awononge mtundu wina wa Obamacare, abambo a GOP adatulutsa "Health Care Freedom Act" madzulo madzulo pa July 27.

Mchitidwe umenewo unalephera, 49-51 (A Senators Collins, Murkowski, ndi McCain adavomereza, pamodzi ndi a Democrats onse ndi a Independents).

Ndikofunika kuzindikira kuti Senate ikhoza kubweretsanso msonkho wa Nyumbayi kuti ipitirize kulingalira, ndipo pali kusintha kwina komwe kungagwiritsidwe ntchito m'malo mwa ndondomeko ya ndalama zomwe zidadutsa Nyumbayi (ndi momwe Senate inavomerezera Bungwe la ORRA, BCRA, ndi Health Care Freedom Act; iwo adasinthidwa kuti asinthe malemba omwe alipo kale.

Ngakhale kuti BCRA siidadutse, sitikudziwa momwe zingasinthidwe ndi kuyang'aniranso. Choncho tiyeni tiwone zomwe a Senate Republican adalemba, ndikumvetsetsa momwe akufananirana ndi AHCA omwe a Republica apita (kukumbukira kuti zipinda ziwiri ziyenera kuvomereza motsatira malamulo kuti abwezeretse / asinthe ACA iwo asanayambe akhoza kutumiza kwa Pulezidenti). Tili ndi nkhani zingapo za AHCA, kukuthandizani kumvetsetsa zambiri za ndondomeko ya Nyumba yothetsera mavuto a zaumoyo:

Kotero tiyeni tione njira zomwe BCRA zimasiyanirana ndi AHCA.

Misonkho ya msonkho

The Affordable Care Act (ACA), kubwezeretsanso zomwe zili ndi cholinga cha Nyumba ndi Senate, kuphatikizapo misonkho yatsopano kwa anthu a ku America omwe amapeza ndalama zambiri komanso mabungwe a zaumoyo, komanso zilango za msonkho udindo ndi abwana udindo .

Ndalama zomwe zimachokera misonkhoyi zimagwiritsidwa ntchito poyang'anira njira zothandizira zaumoyo ndikupereka chithandizo chabwino komanso chotheka kwa anthu ambiri. Udindo womwewo ndi chida chothandizira anthu a thanzi kukhalabe ndi chitukuko, ndipo udindo wa abwana umalimbikitsa antchito akulu kuti apereke chithandizo chokwanira, chokwera mtengo kwa antchito awo a nthawi zonse.

AHCA imaphwanya msonkho, ndipo Mabaibulo oyambirira a BCRA adawachotseranso. Komabe mapepala a BCRA amatha kusunga misonkho ikuluikulu iwiri: 0.9 peresenti ya Medicare malipiro a msonkho omwe amawapatsa ndalama zambiri, ndipo 3.8 peresenti ya ndalama zomwe zimapeza ndalama (mwachitsanzo, msonkho wopanda malipiro) pa olemba ndalama zambiri Misonkho ingapindulitse anthu omwe amalandira madola milioni pachaka).

AHCA ndi BCRA zonse zimapangitsa kuti ndalama za boma zichepetse, ngakhale kuti ngongole ziwirizo zimakhala ndi ndondomeko zosiyana panthawi imene msonkho wosiyanasiyana udzachotsedwa. Ndipo kuchepetsa ndalama za federal kumakhala kochepa kwambiri mu BCRA, chifukwa imakhala ndi msonkho wa Medicare kwa opeza ndalama zambiri (pa zaka 10 zikubwerazi, kusunga misonkho iwiri kumataya ndalama zokwana madola 231 biliyoni mu federal federal, malinga ndi Kufufuza kwa Congressional Budget Office ku BCRA ).

Kuchotsa malipiro a msonkho (ambiri omwe angagwiritse ntchito pansi pa BCRA), ndalama za federal za Medicaid ndi thandizo la premium zachepetsedwa.

Medicaid

Ndalama zambiri za Medicaid zimagwiritsidwa ntchito pothandiza anthu achikulire a ku America nthawi yaitali, komanso kupereka chithandizo kwa ana omwe ali ndi ndalama zochepa, amayi apakati, ndi anthu olumala (pafupifupi theka la magawo atatu mwa anthu osungirako anthu ogwira ntchito kunyumba kwawo amapezeka ndi Medicaid, ndipo pafupifupi theka mwa onse obadwira ku US akuphimbidwa ndi Medicaid).

Pansi pa ACA, Medicaid yathandizidwanso kuti ikhale ndi anthu opeza ndalama zochepa. AHCA ndi BCRA zikubwezeretsa kukula kwa Medicaid, ndipo kudula ndalama zonse za Medicaid. Kupititsa patsogolo mankhwala a Medicaid kudzagwa pansi pa gulu la kubwezeretsa ACA (cholinga chomwe chinakambidwa cha Republican chisamaliro chisamalidwe cha chisamaliro chachisamaliro), koma ku federal kudula malipiro a Medicaid kumadutsa njira yowonjezera ya ACA.

Malinga ndi kufufuza kwa Congressional Budget Office (CBO), ndalama za boma za Medicaid zidzachepetsedwa ndi madola 834 biliyoni pa khumi khumi otsatirawa pansi pa AHCA. Kusanthula kwa CBO ka 20 July kwa BCRA kumapanga $ 756 biliyoni ku Medicaid ndalama kudula kupyolera mu 2026, koma ndizodabwitsa kuti BCRA idula Medicaid kwambiri kuyambira 2025, kotero kuti kudula pansi pa BCRA kudzakhala kwakukulu kusiyana ndi kudula pansi pa AHCA ngati tikuwonjezera kufufuza kwa zaka khumi (CBO inanena kuti pofika chaka cha 2036, ndalama za Medicaid zimakhala zochepa pansi pa BCRA kuposa momwe ACA idzasungire).

Pansi pa ACA, boma likupereka ndalama zokwana 95 peresenti ya mtengo wophimba anthu omwe adalandira Medicaid pansi pa kukula kwa pulogalamuyo . Zomwe zaikidwa kuti zichepetsere kufika pa 90 peresenti kuyambira 2020, ndikukhalabe pamtunda umenewo kupita patsogolo.

AHCA sitingalole kuti mayiko atsopano athandizire Medicaid pambuyo pa March 1, 2017, ndipo angasinthe ku Medicaid yodziwika nthawi zonse (pakati pa 50 peresenti ndi 75 peresenti; mayiko osauka amatenga machesi akuluakulu) monga a 2021. kuthetsa kulembetsa kwa odwala Medicaid atsopano, monga mayiko ayenera kuyendetsa phindu la ndalamazo.

AHCA imatembenuziranso Medicaid (ndondomeko yonse, osati kuchulukitsa kwa ACA's Medicaid), kuphatikizapo ndalama zomwe zimaperekedwa kuchokera ku boma la boma lokonzedwa chaka ndi CPI-Medical +1 (mankhwala a wogula ndondomeko yamtengo, kuphatikizapo peresenti imodzi). Ndikofunika kuzindikira kuti chiwerengero cha Medicaid chimakhala chodwala kwambiri kuposa chiwerengero cha anthu onse, choncho nambala yachipatala ya CPI sichisonyeza bwino kukula kwa ndalama zachipatala m'dera la Medicaid.

Bungwe la BCRA lidzakonzanso kuwonjezereka kwa Medicaid kuti lidzawonjezeka mu March 2017. Koma mmalo mochepetsa federal ndalama zowonjezereka kwa Medicaid panthawi imodzi, chiwerengero cha federal chidzatsikira ku 85 peresenti mu 2021, 80 peresenti mu 2022, ndipo 75 peresenti mu 2023. Kuyambira mu 2024, iko kudzatembenuzidwira ku Medicaid yowonongeka ya boma yofanana. Izi zikutanthawuza kuti dziko silidzataya mwadzidzidzi ndalama zonse zomwe zikugwiritsidwa ntchito ku federal zomwe zikugwiritsidwa ntchito pokhapokha kuwonjezereka kwa anthu a Medicaid, koma pali mayiko ambiri omwe boma lidzathetsa kuwonjezereka kwa Medicaid ngati mgwirizano wa federal ukugwa pansi pa 90 peresenti (Arkansas, Arizona, Illinois , Indiana, Michigan, New Hampshire, New Mexico, ndi Washington).

BCRA ingasinthe Medicaid kuti ikhale yogawa gawo, koma mmalo mwa kusintha ndalamazo ndi CPI-Medical + 1, BCRA ingangosintha ndi CPI-Medical kupyolera mu 2024, komanso ndi CPI (osati mankhwala) kuyambira mu 2025. CPI-Medical ndi chiwerengero chachikulu kuposa chiwerengero cha CPI, popeza ndalama zamankhwala zimagwira mofulumira kuposa ndalama zina. Gulu lonse la CPI likhoza kukhala loipa, lomwe lingapangitse kuti ndalama za Medicaid zisawonongeke kwa chaka chimodzi. Akuti boma likhoza kudula malipiro awo ku Medicaid ndalama zomwe zimaperekedwa pansi pa BCRA.

Chofunika Chokhala ndi Inshuwalansi ya Umoyo

ACA imafuna anthu ambiri kuti asunge inshuwalansi ya umoyo kapena kuti apeze chilango cha msonkho. Pali mndandanda waukulu wa zoperekedwa ku chilango , koma IRS inanena kumayambiriro kwa chaka cha 2017 kuti 6,5 miliyoni za msonkho za msonkho zinayesedwa pafupifupi $ 3 biliyoni mu chilango chifukwa chosayitsimikiziridwa mu 2015.

AHCA ndi BCRA zonsezi zimathetsa chilangocho, zowonongeka kumayambiriro kwa chaka cha 2016. AHCA imalowa m'malo mwa chaka chimodzi, peresenti 30 peresenti ya anthu omwe ali ndi kusiyana kwa masiku 63 kapena kuposerapo miyezi 12 yapitayi (kapena, monga momwe tafotokozera m'munsimu, akuti akhoza kusankha kulola a inshuwalansi kukhazikitsa malipiro pa mbiri yachipatala pamene olembapo alibe mwayi wopeza).

Chochititsa chidwi n'chakuti Baibulo la BCRA limene linatulutsidwa pa June 22 silinalowe m'malo mwa chiwonongeko cha chilango ndi chirichonse. Zikanati zitha kuzichotsa, ndipo siziphatikizapo makonzedwe aliwonse omwe angapangitse anthu kuti azipitirizabe kufalitsa.

Koma nthawi yomweyo, pamakhala mphekesera kuti zofunikira zina zowonjezereka zowonjezera zidzawonjezeredwa patsiku lomaliza, ndipo lamulo latsopano lidafalitsidwa pa June 26, lomwe limaphatikizapo zofunikira zowunikira (mungathe kuona mbali ndi mbali Mabaibulo a June 26 ndi June 22 a BCRA pano; gawo latsopano lonena za chidziwitso chotsatira likuyamba patsamba 135 la June 26). Chofunika chotsatira chithandizo chakhala chikusinthidwa m'ma BCRA.

Pansi pa bungwe la BCRA, anthu adzalandira chithandizo nthawi zonse kapena asanakumane ndi nthawi yodikira asanalandire chithandizo pa malonda a inshuwalansi. Nazi momwe zingagwire ntchito:

Anthu omwe ali ndi chidziwitso chapadera (mwachitsanzo, m'miyezi khumi ndi iwiri yapitayi, iwo analibe nthawi yolembera masiku 63 kapena kuposerapo) adakhoza kulembetsa pa nthawi yolembera kapena nthawi yolembera yapadera , ndi masiku ogwira ntchito (woyamba mwezi wotsatira kapena mwezi wachiwiri wotsatira, malingana ndi tsiku lolembetsa).
Anthu opanda chidziwitso cholembedwa nthawi zonse omwe amalembetsa nthawi yolembetsa kapena nthawi yolembera yapadera akhoza kukhala ndi nthawi yoyembekezera miyezi isanu ndi umodzi asanafike polemba.
Anthu opanda chidziwitso chotsatira omwe amalembetsa kunja kwa olembetsa ndipo osakhala ndi nthawi yapadera yolembera ayenera kuyembekezera nthawi yowonjezera ya miyezi isanu ndi umodzi kapena chiyambi cha ndondomeko yotsatira chaka choyamba chisanafike. (Kulembetsa mu February popanda nthawi yolembetsa yapadera ingatanthauze kuti kutsegula kwanu kudzachitika mu Januwale wotsatira).
Anthu omwe ali ndi malonda paokha malingana ndi tsiku lomwe mapulani awo atsopano a msika akugwira ntchito sangakhale pansi pa nthawi ya kuyembekezera kwa miyezi isanu ndi umodzi, ngakhale atakhala ndi kusiyana kwa chaka chaka choyamba (mwachitsanzo, munthu amene amalembetsa pa nthawi yolembera, pamapeto pa miyezi isanu ndi umodzi yolindira, kenaka akapeza choyenerera pakangopita dongosolo latsopano, akhoza kusintha kusintha pakapita nthawi yolembera yapadera popanda nthawi yodikira, ngakhale kusiyana kwake koyambirira kudakali mkati mwa miyezi 12 yapitayo).
Ana atsopano ndi ana omwe angoyamba kumene kulera sangakhale ndi nthawi yodikirira pokhapokha atalembedwa m'masiku 30 atabadwa kapena kutengedwanso (note kuti ACA amapereka makolo atsopano masiku 60 kuti alembe mwana wakhanda kapena mwana watsopano).

Zofunikira Zathanzi Zaumoyo

ACA imafuna kufotokozera zofunika zathanzi kwa onse omwe sali abambo , osagwira ntchito, magulu a anthu ndi aang'ono. Zopindulitsa zofunikira zaumoyo ndizofunikanso kuzikwaniritsa pazinthu zonse zoonjezera za Medicaid.

AHCA sichisintha phindu la thanzi labwino ku federal, koma liloleza kuti mayiko afunefune kubwezeretsapo kuti athe kufotokozera ubwino wathanzi ku boma.

Bungwe la BCRA silinasinthe malingaliro ofunikira ofunikira ku federal, ndipo sichiphatikizapo mtundu wa ndondomeko ya boma yotchulidwa mu AHCA. Koma amalola kuti zikhale zambiri zopezeka ku ACA's 1332 waivers. Izi "zowonongeka" zimalola dziko kuti libwere ndi njira zosiyana siyana za kusintha kwa chisamaliro cha zaumoyo (ku Hawaii mpaka pano ndi dziko lokha limene liri lovomerezeka 1332 kuchotsedwa pansi pa ACA).

ACA ili ndi malamulo olimbitsa chitetezo cha ogulitsa kuti zitsimikizo kuti anthu ali pansi pa 1332 waiver ndi abwino, akuphimba anthu osachepera, ndipo sali okwera mtengo kuposa momwe zingakhalire popanda kuchotsedwa. ACA imafunikanso kuti 1332 zikhale zopanda bajeti kwa boma la federal, ndipo lamuloli likusungidwa ndi BCRA. Koma ogulitsa amateteza amachotsedwa, m'malo mwazofuna kuti boma lifotokoze momwe angachitire "kuwonjezeka kwa kufalitsa, kuchepetsa malipiro owonjezereka, ndi kuwonjezeka kwa chiwerengero." Kotero boma likhoza kusintha malamulo ofunikira okhudzana ndi thanzi pogwiritsa ntchito Kuwombera 1332 pansi pa BCRA, popeza sipadzakhalanso chofunikira kuti kufalitsa kulibe kwina pansi pa kuchotsedwa monga kale.

Buku la BC 13 la July 13 linali ndi Cruz Amendment (lolembedwa ndi Senator Ted Cruz, waku Texas). The Cruz Amendment sichinachitikepo ndi CBO, ndipo sizikudziwika bwino ngati atsogoleri a Seteti akukonzekera kuti aziyikamo pamsonkhanowu womwe umabweretsa voti (ngati izi zikuchitika).

The Cruz Amendment idzakhala ndi zotsatira zowonjezereka pa zofunikira za thanzi. Zingalole kuti inshuwalansi agulitse malingaliro omwe sakugwirizana nawo malinga ngati akugulitsanso ndondomeko imodzi ya siliva, ndondomeko imodzi ya golide, ndi gawo limodzi la 58 peresenti yotsimikizika yamtengo wapatali ( iyi ndiyo njira yokhazikitsira pansi pa BCRA ). Malinga ndi malamulo a boma, Cruz Amendment idzawalola kuti mabungwewa asatengere malamulo osiyanasiyana omwe akukhudza zokhudzana ndi umoyo, kuphatikizapo ubwino wa thanzi.

Chiwerengero cha Zomwe Zilipo Kale

ACA imafuna kuti gulu limodzi ndi gulu laling'ono likonzekeretsedwe, mosasamala za mbiri yachipatala.

AHCA ikhoza kulola mayiko kufunafuna kuchoka komwe mabungwe a inshuwalansi angathe, pokhazikitsa dongosolo limodzi la chaka, malipiro apadera pa mbiri yachipatala ngati wopemphayo ali ndi kusiyana kwa masiku 63 kapena kuposera miyezi 12 yapitayo. Ogwirizanitsa sangathe kukana ntchito yonseyi malinga ndi mbiri yachipatala (monga momwe amachitira m'mayiko ambiri asanafike chaka cha 2014), koma amatha kulipiritsa ndalama zopanda malire - popanda chikhomo chomwe chingachititse kuti anthu omwe ali ndi chithunzithunzi chisanafike, mikhalidwe yomwe ilipo ndi phokoso loyambira.

Bungwe la BCRA limakwaniritsa zofunikira zogwirizana ndi ACA komanso momwe anthu amakhalira, zomwe zikutanthauza kuti anthu sangathe kulipiritsa zambiri malinga ndi mbiri yawo yachipatala. Koma chifukwa cha ziwongolero 1332 zomwe zimapezeka mosavuta, zidzatha kufotokozera ubwino wa thanzi, zomwe zimachititsa kuti anthu asawononge anthu omwe alipo kale. Mwachitsanzo, ngati mapulani azaumoyo sakuyeneranso kutsegula mankhwala osiyanasiyana a mankhwalawa ndipo chikhalidwe chanu chokhalapo kale chimafuna mankhwala okwera mtengo, kuti zinthu zomwe zakhalapo kale "zophimbidwa" sizidzathandizidwa kwambiri.

Kuwonjezera apo, BCRA imapereka nthawi ya kuyembekezera kwa miyezi isanu ndi umodzi kwa aliyense amene akulembera kuunikira atatha kupeza kusiyana kwa masiku osapitirira 63 chaka chotsatira. Choncho munthu yemwe satha kufotokozera sangathe kupeza chithandizo kwa miyezi isanu ndi umodzi, ngakhale atalembetsa panthawi yolembera. Zidzakhala zofunika kwambiri kwa aliyense amene ali ndi chikhalidwe chisanayambe kuti azikhala ndi nthawi zonse.

Ndalama Zogwirizana ndi Zaka Zolembera

ACA imalola olemba inshuwalansi kuti azilipiritsa olembetsa okalamba katatu kuposa olembetsa zaka 21. Koma chiwongoladzanja chomwe chimapereka thandizo ku ACA chimachokera ku lingaliro lakuti ndalama zowonjezera (pambuyo pothandizira) ziyenera kukhala zofanana kwa anthu omwe ali ndi malipiro ofanana (okwana 400 peresenti ya umphaŵi, pamwamba pazimene thandizo la ACA sililipo). Choncho ngakhale ndalama zapayimayi zili zazikulu kwa olembetsa achikulire, ndalama zothandizira ndalama zowonjezera ndi zazikulu kwa olembetsa akale kuti athetse malipiro apamwamba.

AHCA ikhoza kulola a inshuwalansi kuti azilembera okalamba zaka zisanu ndi zisanu kuposa momwe akulembera olembetsa zaka 21 (kapena ambiri pokhapokha ngati boma likufuna kuti lilole). Lamuloli lingapereke ndalama zothandizira zaka zomwe zingakhale zazikulu kwa olembetsa achikulire, koma osati mokwanira kuti athetse kusiyana kwa malipirowo. Anthu achikulire amatha kupereka malipiro ambiri kuposa achinyamata, ngakhale atapatsidwa thandizo.

Bungwe la BCRA lingalole kuti inshuwalansi azilembera anthu okalamba kawiri kuposa momwe akulembera olembetsa achinyamata. Zothandizira ndalama zowonjezera zikhoza kukhala zazikulu kwa anthu achikulire, koma osati mokwanira kuti athetse ndalama zoyenera, ndipo malamulowa akuphatikizapo dongosolo lomwe likufuna anthu achikulire kubwezera chiwerengero chokwanira cha ndalama zawo pambuyo pothandizira ndalama zothandizira.

Thandizo Loyamba

ACA imapereka ndalama zothandizira pazinthu zomwe zimaperekedwa pokhazikitsa ndondomeko yoyendera ndondomeko ya ndalama (yachiwiri-yamtengo wapatali kwambiri ya siliva) m'dera lililonse pamsika wokwera mtengo. Izi zikutanthauza kuti thandizoli ndi lalikulu mmadera momwe kufalitsa kuli kotsika mtengo, komanso kwakukulu kwa anthu okalamba. Zothandizira zapadera zomwe zili pansi pa ACA sizipezeka kwa anthu omwe ali ndi ndalama zoperewera pa umphawi - popeza akuyenera kukhala ndi Medicaid m'malo mwake - ndipo palibe omwe ali ndi ndalama zapakhomo pakhomo laumphawi (kwa banja yachinayi, ndi $ 97,200 mu 2017).

AHCA ili ndi malipiro apadera omwe amasiyana kwambiri ndi msinkhu wawo, ndipo musaganize kuti ndalama zapayimenti ndizopambana kwambiri m'madera ena a dziko kusiyana ndi ena. Ndipo monga taonera pamwambapa, kusintha kosinthidwa kwa zaka zomwe zimapereka ndalama zothandizira ndalamazi sizingatheke kupititsa patsogolo ndalama zapamwamba zomwe anthu achikulire adzapatsidwa. Koma thandizo la AHCA lidzapezeka kwa anthu omwe ali ndi malipiro apamwamba (omwe amapezeka mokwanira kwa iwo omwe ali ndi ndalama zokwana madola 75,000 kwa munthu mmodzi yekha ndi $ 150,000 kwa anthu okwatirana, ndi kutulutsidwa pamtunda umenewo), motero kutambasula chithandizo kukuthandizira kwambiri gulu lapakati kuposa ndalama za ACA.

Bungwe la BCRA limapanga chithandizo chomwe chili ngati ACA, koma ndi kusintha kwakukulu. Kuyambira mu 2020, chithandizocho chidzapezeka kwa anthu omwe ali ndi ndalama kuchokera ku 0-350 peresenti ya umphaŵi, kusiyana ndi 100-400 peresenti ya umphaŵi pansi pa ACA. Izi zikhoza kuthetsa kusiyana komwe kulipo pakati pa Medicaid , chifukwa chithandizo chitha kupezeka kwa anthu omwe ali ndi ndalama zoperewera pa umphawi zomwe sizikuwonjezera Medicaid.

Koma kufotokozera kwa anthu otsika ndalama kungakhale kochepa kwambiri kuposa momwe akufotokozera Medicaid kapena mapulani a ACA omwe alipo. Izi zidzakhala zowona makamaka pokhapokha ndalama zothandizira kuchepetsa kugawanitsa ndalama zikuchotsedwa mu 2020 monga bungwe la BCRA. Ndipo kwa anthu omwe ali pamapeto akumalire a ACA, ndalama zothandizira zidzathetsedwa kwa anthu omwe ali ndi ndalama pakati pa 350 mpaka 400 peresenti ya umphaŵi. Ngati lamuloli lidayamba kugwira ntchito mu 2017, zikanatanthauza kuti banja la anayi likanatha kulandira thandizo la premium ndi ndalama zokwana madola 85,050 mmalo mwa $ 97,200 (nambala ya umphaŵi wa federal chakasinthidwa chaka chilichonse, kotero kuti zikopazo zidzakhala zosiyana ngati pamene BCRA idzayamba kugwira ntchito).

Ndipo BCRA idzagwirizanitsa ndondomeko yatsopano, yomwe idzaperekedwe pafupifupi 58 peresenti ya ndalama zothandizira anthu odwala. Kuti muwone, thandizo la ACA's premium likugwirizanitsa ndi ndondomeko ya malire yomwe imaphatikizapo 68-72 peresenti ya ndalama kuti anthu onse azikhala nawo. Izi zikutanthauza kuti ndalama zowonongeka ndi ndalama zonse zomwe zili kunja kwa BCRA.

Kwa anthu othawa kwawo, BCRA iyeneranso kuchepetsa ndalama zothandizira anthu kuti akhale " alendo ogwira ntchito ," zomwe zikutanthauza kuti anthu ogwira ntchito pafupipafupi komanso ma visa a ophunzira sangayenere kulandira thandizo, monga ali pansi pa ACA .

Zothandizira Kugawana Ndalama

ACA imapereka ndalama zothandizira ndalama kuti zithetse ndalama zomwe zili kunja kwa ndalama zomwe olemba malipiro ochepa amapeza. Anthu omwe ali ndi ndalama zopitirira 250 peresenti ya umphawi ali oyenerera kulandira zomwe zimangowonjezera ndalama zopatsana ndalama, pokhapokha atasankha ndondomeko ya siliva.

AHCA idzachotsa ndalama zothandizira ndalama pambuyo pa 2019. Koma makamaka, sizinaphatikizepo ndalama kwa iwo panthawiyi. Kugawidwa kwa ndalama zokhudzana ndi ndalama ndi nkhani yoweruza milandu yomwe inabweretsedwe ndi House Republican mu 2014, chifukwa chakuti ndalamazo sizinafanane ndi Congress. Panalibe kukayikira kwakukulu pokhudzana ndi kugwirizanitsa ndalama mu 2017, ndipo akuchititsa inshuwalansi kuti apange ndalama zowonjezereka za 2018 kusiyana ndi momwe angakhalire ngati kulimbikitsidwa kolimba ku federal boma kulipira ndalama zopatsana ndalama.

Bungwe la BCRA lidzathetsanso kugwirizanitsa ndalama zotsatizana pambuyo pa 2019. Komatu limapatsanso ndalama zoyenera kuzilipira pakati pa nthawi ndi nthawi. Izi zidzakuthandizira kuchepetsa kusatsimikizika kuti mabungwe akukumana nawo pamsika pawokha, ngakhale kuthetsa kugawidwa kwa ndalama mtengo pambuyo pa 2019 kudzachititsa anthu osauka omwe sangakwanitse kupeza chithandizo chamankhwala.

Kodi Ndi Anthu Angati Amene Angathe Kutaya Zinthu?

Pansi pa AHCA, CBO inanena kuti chiwerengero cha anthu osalimbikitsidwa chidzakula ndi 23 miliyoni pofika 2026 . Izi ziphatikizapo anthu ochepa mamiliyoni 14 omwe ali ndi Medicaid, anthu 6 miliyoni ochepa omwe ali ndi chithunzi cha msika (osati gulu), ndi anthu 3 miliyoni ochepa omwe ali ndi inshuwalansi.

Pansi pa BCRA, CBO inanena kuti chiwerengero cha anthu osalimbikitsidwa chidzakula ndi 22 miliyoni pofika 2026. Izi zikuphatikizapo anthu ochepa mamiliyoni 15 omwe ali ndi Medicaid, ndi anthu ochepa mamiliyoni asanu ndi awiri omwe ali ndi malonda.

Kodi Timachokera Kuti?

Kusiyanitsa komwe tafotokozedwa pamwambapa sikutulutsa mndandanda wazinthu zonse, koma mndandanda wa zinthu zambiri zomwe ogula angazindikire ngati lamulo liyenera kukhazikitsidwa.

Sitikudziwa zomwe Seneti idzachita-ngati chili chonse-potsata ndondomeko ya chisamaliro cha zaumoyo m'chaka cha 2017. Pulezidenti Trump akuwopsyeza olemba malamulo ndi kutaya mwayi wawo wa inshuwalansi wothandizidwa ndi abwana awo ngati sangapereke malamulo kuti abwezeretse (ndipo mwina alowe m'malo) ACA ( apa palifotokozera momwe mamembala a Congress ndi ogwira ntchito awo amapeza inshuwalansi yawo ya umoyo ). Trump adawopseza kuti Obamacare "apemphere" mwa kudula zomwe akunena kuti "ndalama zothandizira ndalama" kwa makampani a inshuwalansi (zenizeni, akukamba za ndalama zothandizira ndalama zothandizira ndalama, zomwe ndizo boma la boma lomwe likulipilira inshuwalansi kuti liwunikire bwino olemba malipiro ochepa; ndithudi sizithukuta).

Amizinesi Lindsey Graham, Bill Cassidy, ndi Dean Heller adayambitsa kusintha komwe kudzasintha ndalama zambiri zomwe boma likugwiritsa ntchito pansi pa ACA kuti alephere kupereka ndalamazo ku mayiko ena. Zidzasunga zina mwazoziteteza ku ACA, koma zidzathetsa ntchito zomwe zimafuna kuti anthu agule ntchito. Sitikudziwikiratu panthawiyi ngati chiyeso chimenecho chidzapereka chithandizo chokwanira kuti ndalama zowonongeka kwa chisamaliro cha Nyumba zisungidwe pansi pa Senate pavota ina.

Kwa nthawiyi, palibe chomwe chasintha, ngakhale msika wa inshuwalansi wa umoyo ukukumana ndi kusakayika kwakukulu ndi kusokonezeka ndi zoopseza za Administration za Trump pakulola Obamacare "kupembedzera." Izi ndizoona makamaka kuti pali njira zomwe Boma la Trump lingathe kuwononga msika uliwonse popanda kuchitapo kanthu.

Zotsatira:

> Congressional Budget Office, HR1628, American Health Care Act wa 2017, Zomwe Zimagwiritsidwa Ntchito . May 24, 2017.

> Congressional Budget Office, HR1628, Act Career Reconciliation Act wa 2017, Kufufuza Ndalama . June 26, 2017.

> Congressional Budget Office, HR1628, Bungwe la Better Care Reconciliation Act la 2017: Kusinthidwa kwa Mtundu Wothandizira [ERN17500], monga Posted on Website Website ya Komiti ya Senate pa Budget pa July 20, 2017 . July 20, 2017.

> Kaiser Family Foundation. Peresenti ya Medical Medical Assistance (FMAP) ya Medicaid ndi Yowonjezera.

> Komiti Yoona za Ndalama za Senate, Ndemanga ya HR1628, Act Career Reconciliation Act ya 2017 . June 22, 2017.

> United States Dipatimenti Yochita Ntchito, Bureau of Labor Statistics. Kuyeza Mtengo Kusintha Thandizo la Zamankhwala ku CPI.