Kodi kuletsa ndalama ndi malipiro zimapweteka Medicaid?
Kusintha kwaumoyo wakhala kutsogolera mkangano wandale watsopano. Kodi GOP adzachotsa ntchito yosamalira katundu, aka Obamacare, kapena kodi a Republican adzapeza njira zina zobwereranso pazinthu zake? Pambuyo pa American Health Care Act (ACHA), aka Trumpcare, sanathe kulandira voti mu Nyumba ya March 2017, n'zovuta kudziwa zomwe tingayembekezere pansi pa kayendetsedwe kano.
Nkhondoyo ili kutali kwambiri. Pulezidenti wa nyumba Paul Ryan akuyang'anitsitsa kuti achitepo kanthu pa chithandizo chamankhwala, ngakhale kuti sanachitepo kanthu patsiku lomaliza. Tikuyembekeza, ndondomeko yowonjezera yowonjezera yowonjezera idzaperekedwa m'malo mwa anthu a ku America. Kodi ndondomeko yotereyi ikuphatikizapo Medicaid, pulogalamu yachipatala yomwe imachitira osauka ndi olumala?
Momwe boma la Federal liyenera kukhalira Medicaid
Medicaid ndi pulogalamu yomwe imayendetsedwa ndi maboma a federal ndi boma. Boma la federal limakhazikitsa mfundo zomwe ziyenera kukhazikitsidwa komanso zomwe ziyenera kuchitika, ndipo boma lirilonse limasankha kapena ayi kuonjezerapo zina zowonjezera pulogalamuyi. Iwo sangakhoze kupereka zochepa. Pogwiritsa ntchito ndalama, mabungwe a federal ndi boma amathandizira nawo mapulogalamu awo a Medicaid.
Kuti timvetse kusintha komwe kungabwere kudzakhalapo, tifunika kumvetsetsa momwe boma la federal linathandizira Medicaid kumayambiriro kwa kayendetsedwe ka Trump.
Zonsezi zimalandira ndalama za federal kudzera m'magulu atatu.
- Malipiro ogawanika a chipatala (DSH): Pokubwezeredwa kwa Medicaid mosadziwika bwino, zipatala zomwe zimasamalira chiwerengero chokwanira cha anthu a Medicare kapena cha uninsured zimatha kulimbana ndi ndalama. Malipiro a DSH amaperekedwa kwa mayiko kuti aperekedwe ku zipatala zomwe zikusowa.
- Mapepala othandizira azachipatala a federal (FMAP): Boma la federal likugwirizana ndi ndalama za boma pa dola ya Medicaid ya dola ndipo imapereka ndalama zowonjezereka m'mayiko omwe ali ndi ndalama zochepa.
- Mapulogalamu othandizira: Boma la federal likulipira ndalama zopitirira ma ARV pazinthu zina monga kuphatikizapo khansa ya m'mawere ndi chiberekero , kulera mabanja, ntchito zaumoyo, komanso kuwonetsetsa anthu akuluakulu .
Funso ndiloti njira izi zothandizira boma zidzapitilira Purezidenti Trump kapena ngati zidzasinthidwa ndi njira ina yoperekera ndalama.
Ndalama Zachigawo za Kuwonjezeka kwa Medicaid
Kuwonjezera pa Medicare kunayamba mu 2014 ndipo inali gawo lalikulu la Care Affordable Care Act. Zinasintha malipiro omwe angakwaniritse anthu a Medicaid ndikulola anthu osakwatira opanda ana kuti akhale oyenerera ngati atakumana ndi malire awo.
Ulamuliro wa umphawi wadziko (FPL), womwe umatanthauzidwa chaka chonse, umadalira ngati ndinu munthu kapena m'banja, komanso kukula kwa banja lanu. Mayiko akukhazikitsa Medicaid malinga ndi magawo a FPL. Obamacare yowonjezeranso ndalama za Medicaid kwa 133 peresenti ya FPL chifukwa cha mayiko omwe adasankha kutenga nawo mbali, pamene akunena kuti kuchepetsa Medicaid kuwonjezeka kungapitirizebe kuyenerera pa mtengo wapitawo, 44 ​​peresenti ya FPL.
Maboma omwe sali nawo omwe angathe kutenga nawo mbali angapitirize kupatula akuluakulu opanda ana polemba.
Mwachidziwikire, izi zinakhudza ndalama za federal pulogalamuyi. Mayiko ndi kuwonjezereka kwa Medicaid analandira ndalama zina zowonjezera kuti aziwathandiza, mpaka peresenti ya ndalama zowonjezera kudutsa mu 2016 ndipo 90 peresenti ya izo zimadutsa kupyolera mu 2022.
Zosintha Zothandizira za Medicaid
Bungwe la American Health Care Act linaphatikizapo zinthu zambiri zomwe zimadula ndalama za Medicaid. Ngakhale kuti ndondomekoyi idalimbikitsa kwambiri kukula kwa Medicaid, inati idzapereka ndalama zina zowonjezera zomwe zinalonjezedwa kupyolera mu 2022.
Malingana ndi National Health Expenditure Data, ndalama za Medicaid zoposa $ 545 biliyoni mu 2015, zomwe zimapereka ndalama zokwana 17 peresenti ya ndalama zonse zothandizira.
Ndi chiwerengero chimenecho chikukwera, a Republican akufunafuna njira yochepetsera ndalamazo. Zomwe zikuluzikulu zikuluzikulu za kusintha kwa Medicaid ndi kusintha kwa malire a anthu kapena kubwezera ndalama.
Malire amtundu uliwonse ndiwo ndalama zokwanira zomwe zingaperekedwe ku boma chaka chilichonse. Mtengo umachokera pa anthu angati omwe ali mu pulogalamu ya Medicaid. Izi zikhoza kuloleza kuti dollar yowonjezereka ikuwonjezeke m'zaka zotsatira ngati anthu ambiri oyenerera ndikulembetsa pulogalamuyo. Malire a Perigita pa Medicaid adakonzedwa ndi bungwe loyamba la American Health Care Act.
Ambiri a Republican, makamaka ufulu wa Caucus, ankakhulupirira kuti malire a malire sanagwiritse ntchito mokwanira kuti achepetse ndalama za boma pa Medicaid. Bungwe la American Health Care Act linasintha kuchoka ku malire a munthu aliyense kuti agwiritse ntchito ndalama zothandizira Medicaid. Mosiyana ndi malire a anthu, malipiro oletsedwa samaganizira chiwerengero cha anthu pa Medicaid. Malipiro a boma amabalalitsidwa mu ndalama zokhazikika zomwe zikhoza kuwonjezeka pang'onopang'ono chaka chilichonse kukawerengera za kutsika kwa mitengo. Vuto ndilokuti kutsika kwa chuma kumakhala kocheperapo kusiyana ndi mtengo wa chithandizo chamankhwala.
Kufufuza komwe kunachitika ndi Avalere, yemwe ali ndi chithandizo cha zaumoyo, akuganiza kuti zaka zoposa zisanu boma lidzapulumutsa ndalama zokwana madola 110 biliyoni ngati amagwiritsira ntchito malire kapena ndalama zokwana madola 150 miliyoni ngati agwiritsidwa ntchito pogwiritsa ntchito ndalama za Medicaid.
Kodi Medicaid Programs Adapt Adapt?
Funso lidakalipo ngati imodzi mwaziganizidwe izi zidzakhala ngati mbali ya Ryan yobwezeretsa kuchipatala. Ngati munthu akuletsa malire kapena kuletsa ndalama, amapereka ndalama zambiri. Pofuna kuthana ndi zotayika, iwo angafunikire kusintha kuti mapulogalamu awo a Medicaid apindule kwambiri.
Mayiko angafunikire kugwiritsira ntchito ndalama zonse za Medicaid, kudula mautumiki omwe ali ndi Medicaid, kapena kuika malire pa anthu angati omwe angalembetse, ngakhale anthu amenewo atakwaniritsa zofunikira. Kuleka malipiro kungakhale kolepheretsa kunena kuti zikhoza kuchepetsa kukula ndi kulembetsa.
> Zotsatira:
> HR1628 - American Health Care Act wa 2017. Webusaiti ya Congress.gov. https://www.congress.gov/bill/115th-congress/house-bill/1628. Kusinthidwa pa March 24, 2017.
> National Health Expenditure Data Fact Sheet. Maofesi a webusaiti ya Medicare ndi Medicaid Services. Chiwongola dzanja Idasinthidwa pa December 2, 2016.
> Pearson CF. Ndalama Zowonongeka mu Medicaid Zingatheke Kuchulukitsa Ndalama za Federal. Avalere.com. http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-significantly-reduce-federal-spending. Lofalitsidwa pa February 6, 2017.
> Rosenbaum S, Schmucker S, Rothenberg S, Gunsalus R. N'chiyani Chingalepheretse Mphatso Kapena Malire pa Ndalama Zomwe Zimagwiritsidwa Ntchito Pogwiritsa Ntchito Mankhwala? Kutenga Mwachidule (Commonw Fund). 2016 Nov; 39: 1-10. https://www.ncbi.nlm.nih.gov/pubmed/27959479.
> Zotsatira za US Poverty Polikugwiritsiridwa Ntchito Kutsimikizira Ndalama Zokwanira Zazinthu Zakale za Federal. Ofesi Yothandizira Wotsogolera Kukonza ndi Kufufuza, webusaiti ya US Health and Human Services webusaitiyi. https://aspe.hhs.gov/poverty-guidelines. Idasinthidwa pa January 31, 2017.