Malamulo atsopano Amapereka Chikhululukiro Chochuluka Kuchokera Kumagwirizano Oletsa Kulera
The Affordable Care Act ndi zotsatira zake zidawathandiza kupeza njira zowonjezeretsera kulera. Koma amayi tsopano akudabwa ngati chithandizo cha inshuwalansi cha njira zothandizira kulandira chithandizo chidzatha, komanso ngati akuyenera kupeza ndalama zambiri posachedwapa, ngati angabwererenso ndalama zokwana madola mazana angapo.
Ndipo chifukwa cha kukhululukidwa kwa makhalidwe ndi malamulo okhululukirana achipembedzo omwe amafalitsidwa mu Federal Register pa October 6, pali chifukwa choyenera kukhala nacho chidwi.
Koma kusintha kumeneku kunayang'anizana ndi zovuta zalamulo ndipo chiwerengero cha olemba ntchito omwe akuyembekezerapo kugwiritsa ntchito zifukwazo ndizochepa.
Tiyeni tione udindo wa kulera za ACA, zotsatira zake, ndi zomwe tingayembekezere kupita patsogolo.
Zolinga zapakati Pansi pa ACA
Chimodzi mwa zinthu zovuta kwambiri za Care Affordable Care Act (Obamacare) ndizowunikira kulera. Pansi pa ACA, ndondomeko zonse za thanzi labwino zisanawonongeke-zosagwiritsidwa ntchito phindu - osachepera limodzi mwa mitundu 18 ya mitundu yosiyanasiyana ya FDA-yovomerezeka ya kulera kwa amayi (ndizodziwika kuti mapulani a abambo amapitirizabe kuchuluka kwa abwana - Malinga ndi ndondomeko yowonongeka, anthu 36.5 miliyoni omwe ali ndi chithandizo chogwiritsidwa ntchito ndi abwana ali ndi ndondomeko zazikulu, zomwe sizikuyenera kupereka chithandizo popanda kulandira ndalama).
Ngakhale zida zambiri za ACA sizinafike mpaka chaka cha 2014, chiwerengero chakuti mapulani okhudzana ndi kulera anapezekapo kuyambira August 2012, chifukwa cha mapulani atsopano ndi atsopano.
Kwazinthu zomwe sizinali zazikulu zomwe zinasinthidwa pambuyo pa mfundo imeneyi, chithandizo cha kulera chinawonjezeredwa pa nthawi yoyamba yokonzanso. Choncho pofika mu August 2013, mapulani onse omwe sanakhale nawo anaphatikizapo kulandira chithandizo. Kupatulapo kuperekedwa kwa mabungwe achipembedzo, komabe, ndipo kunakula mu 2014 (chifukwa cha chigamulo cha Supreme Court ku Burwell v Hobby Lobby) kuti aphatikize mabungwe "ogwirizana" omwe eni ake amatsutsa zachipembedzo pa udindo wa kulera.
Kufufuza kwa Zaumoyo mu 2015 kunapeza kuti ntchito ya kulera kwa ACA inali kupulumutsa ndalama zokwana $ 255 pachaka, komanso osagwiritsa ntchito ndalama za $ 248 pachaka (popanda ntchito ya kulera kwa ACA, ma CDs amawononga $ 500 mpaka $ 1,000. kuti azilipidwa-kutsogolo, koma ndalama zikuwerengedwera pachaka, kufalikira pazaka zomwe mkaziyo ali nacho chipangizo).
Pansi pa ACA, amayi omwe ali ndi inshuwalansi omwe sali ndi ana ambiri amafunika kulandira chithandizo pokhapokha atagwiritsa ntchito njira zawo zothandizira kubereka, poganiza kuti amasankha njira zothandizira njira zothandizira ana awo a zaumoyo. chimodzi mwa mtundu uliwonse; izo sizikufuna kuti aziphimba mavesedwe onse a mtundu uliwonse).
Ngakhale kuti nthawi zambiri amatchulidwa kuti "ufulu" kubadwa, otsutsa amanena kuti palibe chilichonse. Zoona zake, mtengo wa kulera ndikutsekedwa mu malipiro omwe amayi ndi abwana awo amalipiritsa kuti awathandize. Kotero kuti tifotokoze momveka bwino, zokambirana za kuziteteza kwaufulu mu nkhaniyi zikukhudzana ndi kubeletsa komwe kumaperekedwa popanda kugawana mtengo panthawi yomwe ipezeka.
Kufikira Kufikira kwa Kulera Kumachepetsa Kutulitsa Mimba & Birthrate Teen
Mu November 2016, CDC inasindikiza chiwonetsero chomwe chikusonyeza kuti pofika chaka cha 2013, chiwongoladzanja cha mimba chinali panthawi yonse ku US
Otsutsa mimba amatsutsa kuti izi zikhoza kukhazikanso chifukwa cha malamulo ochuluka omwe aperekedwa m'mayiko osiyanasiyana kuti athetse kuthetsa mimba m'zaka zaposachedwapa. Koma umboni wochokera ku Colorado-umene si umodzi mwa malamulo omwe wapereka malamulo oletsa kuthetsa mimba-umasonyeza kuti kupeza mwayi kwa njira zothandizira kulera kumawathandiza kwambiri: The Colorado Family Planning Initiative inayamba kupereka njira zothandizira njira zothandizira njira zowonongeka zowononga nthawi yaitali (ma IUDs ndi implants) kuti azimayi achichepere ndi azimayi osauka mu 2009, isanafike lamulo la ACA. Pofika chaka cha 2014, chiŵerengero cha mimba ndi kubala mimba chidafooka ndi 48 peresenti.
IUDs ndi Implants Kupezeka Popanda Malamulo a ACA
CDC imanenanso kuti kugwiritsa ntchito njira zogwiritsira ntchito njira zowonongeka mobwerezabwereza (LARC) kwa nthawi yayitali pakati pa amayi a ku America.
Izi zikutheka chifukwa cha kuphatikiza maphunziro apamwamba pa LARC komanso kuti ACA inachotsa vutoli lomwe nthawi zina linaletsa akazi kupeza LARC asanayambe kutsatira malamulo a ACA.
Mayankho a Lamulo Othandiza Kubwezeretsa ACA Alephera
Boma la Trump ndi Congress ya GOP inayamba 2017 ndi chiyembekezo chachikulu chochotsera ACA, koma izi sizinachitike mu 2017. A Republican House adapititsa American Health Care Act (AHCA) mu May 2017, koma Senate sanadutse Mapeto ake a malamulo, ndipo chaka cha 30 chakumapeto kwa chaka chautali chinali nthawi yomaliza kugwiritsira ntchito chiyanjanitso kuti athetsere ACA ndi mavoti 50 okha (kuphatikizapo voti yosokoneza mavoti kuchokera kwa vice perezidenti).
Nyumba ya AHCA ndi mabungwe osiyanasiyana omwe adayikidwa mu Senate sakanachotsa udindo wothandizira ku ACA, koma ambiri a iwo akanawalola kuti mayiko azifuna kuti athetseretu ntchito za umoyo. Chisamaliro chodziletsa, chomwe chimaphatikizapo kulera, ndi chimodzi mwa zinthu zofunika kwambiri za thanzi la ACA . Ngati malamulo akhazikitsidwa omwe amalola kuti boma lipeze ndalama zowonjezerapo zomwe zimapindulitsa phindu la thanzi labwino, kulandira chithandizo sikuyenera kutero.
Makomandanda osiyanasiyana a ACA omwe anagwiritsidwa ntchito ndi a Republican lawmakers mu 2017 akadatha kuthetsa ndalama za Planned Parenthood kwa chaka chimodzi, kuchepetsa mwayi wopeza chithandizo kwa amayi omwe amadalira Planned Parenthood kuti azisamalira.
Koma palibe malipiro awo omwe adadutsa, ndipo mwezi wa Oktoba umasonyeza kutha kwa mwayi womwewo kuti apange lamulo lochotsa ACA. A Republican lawmakers adalonjeza kuti apitirize kumenya nkhondo, koma Trump Administration ikuyesetsanso kusintha malamulo ndi malamulo atsopano.
Kodi mu Malamulo atsopano?
Pa May 4, 2017-Tsiku lomwelo a Republic Republic adapereka AHCA-Pulezidenti Trump Anakhazikitsa lamulo lotsogolera alembi a Treasury, Labor, ndi HHS, kuti " aganizire kupereka malamulo osinthidwa, mogwirizana ndi lamulo lothandizira, kuthana ndi chikumbumtima- zotsutsana ndi chithandizo chodziletsa. " Izi zinayambitsa maziko atsopano, omwe, malinga ndi New York Times, Ulamuliro wa Trump unali kuganizira kumapeto kwa May.
Pa May 31, Vox analandira ndondomeko yowonongeka ya malamulo atsopano a HHS ndi IRS, omwe angawononge kwambiri mphamvu yopezera kulera. Palibe chomwe chinachitika kwa miyezi ingapo yotsatira, ndipo nthawi yonse ya chilimwe, ntchitoyi inkayesa kubwezeretsa ACA.
Koma pa October 6, malamulo atsopano awiri adasindikizidwa mu Federal Register omwe amalola abwana kukhala ndi mwayi waukulu wotsutsa ufulu wa kulera: kukhululukidwa kwa chikhalidwe ndi kusamalidwa kwachipembedzo .
Malamulo amayamba nthawi yomweyo, popanda chizoloŵezi chodziwika ndi ndemanga. Ndemanga zikuvomerezedwa kwa masiku 60 (kupyolera mu December 5), koma malamulo adayamba pa October 6. HHS mwachizolowezi amavomereza ndemanga pagulu pa malamulo operekedwa, amawaganizira, ndikufotokozera momwe mawonedwe a anthu anakhazikitsa lamulo lomaliza.
Koma pakadali pano, akunena kuti ali ndi " chifukwa chabwino " kuti agwiritse ntchito malamulowo nthawi yomweyo komanso kuti " sizingatheke ndipo sizotsutsana ndi chiwonetsero cha anthu kuchepetsa kuika izi mmalo mpaka padzakhala zowonongeka-ndi-ndemanga "" Pofuna kutsegula chidziwitso ndi nthawi ya ndemanga, HHS inanenanso kuti safunikanso kudutsa ndondomeko ya ndondomekoyi, popeza adalandirapo kale ndemanga pazomwe ntchito ya kulandira chithandizo ya kulera ikasindikizidwa zaka zapitazo. Komabe, ndikuyenera kuzindikira kuti malamulo atsopanowa ndi oposa kwambiri kusiyana ndi lamulo la HHS lomwe laperekedwa kale, ndipo zomwezo zikanakhala zosiyana kwambiri.
Pansi pa malamulo atsopano, abwana aliyense, yunivesite, kapena inshuwalansi ya zaumoyo angathe kupempha kuti asamaloledwe kugwira ntchito yothandizira kulera, ngakhale zilizonse zachipembedzo kapena zoyenera kuti zikhale zovomerezeka. Kukhululukidwa sikuyenera kuvomerezedwa ndi ogwira ntchito za boma omwe sakufuna kubisa za kulera m'magulu awo a umoyo wathanzi amangoyenera kuwadziwitsa antchito awo kusintha kwa phindu.
Malamulo atsopanowa akufotokoza kuti " Kukulitsa chikhululukirocho kumachotsa zipsinjo zachipembedzo / makhalidwe omwe mabungwe ndi anthu ena angakumane nawo omwe angafune kutenga nawo mbali msika wogulitsa mankhwala. " ali ndi njira zenizeni zopezera njira za kulera, makamaka njira zakulera zowonongeka nthawi yaitali (zizindikiro ndi ma implants) omwe amatha kukhala ndi ndalama zapamwamba ngati sakuphimbidwa ndi inshuwalansi.
Pamene malamulowa adayambika mwezi wa Meyi, ACLU idalonjeza kuti " idzayang'anira ndondomeko ya Trump kukhoti ngati ayesa kutsata ndondomeko izi. " Ndipo ndithu, ACLU inatulutsa suti yomweyo pa October 6, monga Massachusetts Attorney General Maura Healey.
Kuti awonetsetse, Obama Administration adachitapo kanthu pofuna kutsimikizira kuti olemba zachipembedzo sankayenera kulipira mwachindunji phindu la kulera, komabe ntchitoyi ikuonetsetsa kuti amayi omwe akugwiritsidwa ntchito ndi ndondomeko za olemba ntchitoyi akupitirizabe kupeza mwayi wopeza chithandizo chamankhwala (sikuti nthawi zonse zimalimbikitsidwa mofanana, komabe amayi ena omwe ali ndi olemba achipembedzo alibe mwayi wopeza njira zopatsira ndalama zopanda malipiro kudzera mwa dongosolo lawo labwino la umoyo). Koma iyi ndi yankho limene olemba anzawo achipembedzo amakhulupirira amatsutsanabe ndi ufulu wawo wachipembedzo.
Kodi N'chiyani Chimachitika Patsogolo?
Malamulo atsopanowa amakumana ndi mavuto omveka bwino, ndipo ndiwotheka kwambiri kuti adziwe ngati angapite kukhoti. Ponena za malamulo, HHS inati malamulo atsopano "sadzakhudza 99.9 peresenti ya amayi 165 miliyoni ku United States" chifukwa amayembekeza chabe mabungwe 200-omwe atha kale milandu chifukwa cha udindo wa kulera zachipembedzo kapena zamatsutso-zidzakakamiza kukhululukidwa pamilandu yatsopano.
Koma otsatsa malonda akudandaula kuti malamulo angathe kukhala aakulu kwambiri, komanso kuti malamulo atsopanowa ndi ofunika kwambiri m'ntchito ya kulera.
Madera angapo atha kukhazikitsa maudindo awo okhudzana ndi kulera, koma awo amangogwiritsidwa ntchito pazinthu zowonongeka ndi boma. Ndondomeko zodzipangira okha (zomwe ndizogwiritsidwa ntchito kwambiri ndi olemba ntchito) zimayikidwa pansi pa federal, m'malo mwa boma, malamulo. Malamulo a ACA akugwiritsa ntchito njira zothandizira kulera, koma malamulo a boma sakugwiritsidwa ntchito pazinthu zodzikweza.
Pulezidenti wakale Tom Price (ndiye woimira Republican wochokera ku Georgia, amene pambuyo pake anakhala Mlembi wa HHS kwa kanthawi pansi pa Ulamuliro wa Trump asanayambe mu September 2017) adanena mu 2012 kuti "palibe mkazi" yemwe sankatha kutenga chithandizo cha kulera. Ntchito ya ACA. Koma kafukufuku wa 2010 wokonzedwa ndi Planned Parenthood anapeza kuti 34 peresenti ya akazi "anali ndi vuto la kumwa mankhwala nthawi zina."
Mu 2012, wophunzira wa yunivesite ya Georgetown, Sandra Fluke, adachitira umboni pamaso pa bungwe loona za kulera kwa ACA. Iye adachitira umboni kuti 40 peresenti ya ophunzira a University of Georgetown ophunzira adanena kuti kusowa kwa njira za umoyo wa yunivesite chifukwa cha kusowa kwa njira za kulera kwawapangitsa kuti azivutika ndi ndalama.
Kubwezera ndalama kugawidwa kapena kusowa kwa inshuwalansi zokhudzana ndi njira zothandizira kulera sikuthera vuto lalikulu kwa amayi omwe ali ndi malipiro omwe amawaika m'kalasi lapakati. Koma izi zingathe kubweretsa vuto lalikulu kwa amayi opeza ndalama zochepa. Ndipo kupeza ma ARV ndi ma implants omwe angapindule kwambiri kungasokonezedwe kwambiri ngati ndalama zawo zowonongeka zimatha kulembedwa ndi inshuwaransi yaumoyo.
> Zotsatira:
> Chithandizo cha Kuteteza Mliri ndi Kuteteza, Kuchotsa Mimba-United States, 2013. November 25, 2016.
> Chithandizo cha Kuletsa ndi Kuteteza Matenda, Padziko Lonse la Zambiri za zaumoyo. Zotsatira za Kuchita Kubereka Kotheka Kwanthaŵi yaitali Zimagwiritsa Ntchito Pakati pa Amayi Amuna Okalamba 15-44. February 2015 .
> Colorado Dipatimenti ya Zaumoyo Zachilengedwe ndi Mazingira, Chiwerewere cha Atsikana ku Colorado Chikupitiriza Kukula. October 21, 2016.
> Dipatimenti ya zaumoyo ndi zithandizo zaumunthu, Health Resources ndi Services Administration, Kupititsa patsogolo Mfundo za Women's Preventive Guidelines, 2011.
> Federal Register. Dipatimenti ya Treasury; Dipatimenti ya zaumoyo ndi zithandizo zaumunthu. Kuwonetsa Makhalidwe Abwino ndi Malingaliro Othandizira Kugwira Ntchito Zina Zothandizira Pansi pa Ntchito Yodalirika Yothandiza . > October 6, 2017.
> Federal Register. Dipatimenti ya Treasury; Dipatimenti ya zaumoyo ndi zithandizo zaumunthu. Kuwonetseredwa kwa Zipembedzo ndi Kukonzekera kwa Kutetezedwa kwa Zipangizo Zina Zothandizira Pansi pa Ntchito Yodalirika Yothandiza . > October 6, 2017.
> HealthAffairs. Akazi Anawona Kutaya Kwambiri Kwambiri Pogwiritsa Ntchito Ndalama Zogwiritsira Ntchito Mankhwala Opatsirana Pambuyo Pomwe Msonkhano wa ACA Unachotsedwa Phindu. Vol 34, No 7, July 2015.