Kusintha kwa chithandizo cha zaumoyo kwakhala nkhani yandale yandale ku US kwa zaka zambiri, ndipo ndi Dipatimenti ya Utumiki m'malo mwake, tsogolo la Care Affordable Care Act silikudziwika. Kodi phwando lililonse likufuna chiyani? Tiyeni tiwone momwe mapepala akuluakulu a Democratic Party ndi Republican Party angakhudzire inshuwalansi ya umoyo wanu.
Makhazikitsidwe a Care Affordable Care Act
Ma Democrat amathandizira ACA, koma akufuna kukonza zolakwika zake ndikusintha malamulo.
Atsogoleri a Demokarasi adalonjeza kuti akhoza kuwonjezera ACA ku madera a US, ndipo akufuna kuwapatsa mphamvu zogwiritsa ntchito njira zowonongeka (1332 waivers) kuti apange njira zawo zowonongolera zaumoyo zomwe ziri bwino kapena zabwino kuposa momwe zilili panopo. Amademokiti ambiri amathandizanso kukonzanso "ACIT's" glitch "pokhala ndi chiwerengero cha ndalama zogulira ntchito zomwe zimaperekedwa ndi abwana pa ndalama zapabanja m'malo mopereka ndalama zokhazokha.
Trump ndi a Republican ambiri akufuna kubwezera ACA ndikuyamba njira yatsopano. Pakhoza kukhala pali kusintha kuno pano; A Republican Senators awiri adayambitsa malamulo mu January 2017 omwe akanati apatse mayiko njira yosunga ACA kapena kusintha kwa dongosolo latsopano.
Kuwonjezeka kwa Medicaid
Kuwonjezeka kwa Medicaid ndi mwala wapangodya wa ACA ndipo zimapereka gawo lalikulu la kuwonjezeka kwa chiwerengero cha Amereka omwe ali ndi inshuwalansi ya thanzi.
ACA inaitanitsa Medicaid kuti iwonjezedwe m'mayiko onse, kupereka chithandizo kwa anthu omwe ali ndi ndalama zapakhomo mpaka 138 peresenti ya umphaŵi.
Koma Khoti Lalikulu la Chigamulo linagamula mu 2012 kuti Medicaid ikuwonjezeka kuti ikhale yoyenera kwa mayiko, ndipo kuyambira kumayambiriro kwa chaka cha 2017, adakalibe mayiko 19 omwe sanalandire ndalama zowonjezereka ku fedesi.
Mu 18 mwa maiko onse (onse koma Wisconsin), pali kusiyana kwa chithandizo cha Medicaid; anthu pafupifupi 2.6 miliyoni adakanizidwa opanda mwayi wa Medicaid OR OR subsium thandizo m'mayiko amenewo.
Atsogoleri a Democrati akufuna kukakamiza kuti ACA isamangidwe mu Medicaid m'mayiko 19 omwe sanayambe kufalikirapo, ndipo akutsutsana ndi zotsutsa zopereka thandizo la ndalama Medicaid ndalama ku mayiko (zopereka zopereka ndalama zimaphatikizapo kuchotseratu dongosolo la boma lomwe likugwirizana ndi ndalama za boma Medicaid ndalama, ndipo m'malo mwake amapereka chiwerengero cha ndalama zomwe boma liyenera kuzigwiritsa ntchito monga momwe ziyenera kukhalira pulogalamu yawo ya Medicaid).
A Republican akufuna kubwezera ACA, zomwe zikuphatikizapo kubwezeretsa Medicaid. Njira yawo yokondwerera Medicaid imalepheretsa kupereka, ndipo pulatifomu ikunena kuti idzakupatsani mayiko a ufulu ufulu wogwiritsira ntchito Medicaid ndi chipika-kupereka pulogalamu popanda zingwe. A Republican adakonzeranso munthu wina dzina lake Medicaid zomwe akulembazo.
Mauthenga Osunga Zaumoyo
Malingaliro Omwe Amapulumutsa Odwala (HSAs) ndi akaunti zomwe anthu angagwiritse ntchito kusunga ndalama kuti azilipiritsa ndalama zowonjezera zamankhwala. Zili ngati trifecta yosungitsa msonkho:
- Ndalama zomwe mumayika mu akauntiyi zimachokera pa msonkho wanu wa msonkho (kapena kulipira msonkho kwathunthu ngati mutapereka ndalama zanu ku HSA kudzera mu chiwongoladzanja).
- Ndalama zomwe zili mu akauntiyi zikukula misonkho.
- Simukulipira msonkho pa ndalama mutasiya ndalamazo, malinga ngati mukuzigwiritsira ntchito ndalama zomwe mukuyenera kuchipatala (anthu ena amagwiritsa ntchito nkhaniyi monga ndondomeko ya IRA, popeza ndalama zimachotsedwa m'malo mwa ndalama zowonjezera popanda mankhwala. chilango chokhala ndi zaka 65. Koma pakakhala choncho, kuchoka kwa ndalamazo kungakhale ngati msonkho wokhazikika).
Makhalidwe a IRS amasiku ano amalola anthu omwe ali ndi Mapulani a Umoyo Wopambana a HSA (HDHPs) kuti apereke thandizo ku HSA, ndipo pali malire othandizira: Mu 2017, ndalama zomwe mungathe kupereka ku HSA ndi $ 3,400 payekha, kapena $ 6,750 ngati Gawo lanu la HDHP ndi la banja.
Ngakhale kuti HSA ndi chida chothandizira kupeza ndalama zothandizira zaumoyo-ndipo ubwino wawo wa msonkho ndizofunikira - tiyenera kukumbukira kuti kuthandiza kwawo kokha kumaphatikizapo momwe munthu alili ndi luso lokongoza ndalama. Potero, amayamba kukondedwa ndi omwe ali ndi ndalama zambiri.
Mademokrasi sananene kuti kusintha kulikonse kwakukulu ku malamulo omwe akutsatira Malamulo Achiwongolero a Health.
Koma a Republican amaganiza kuti a HSA adzakhala njira yothetsera mavuto a zaumoyo. Mzere woyamba wa tsamba lachipatala cha Trump pa msonkhanowu unati " Bwezerani ndi kubwezeretsa Obamacare ndi Mauthenga a Health Savings ." Amapanga kusintha kwakukulu, kuphatikizapo malire apamwamba omwe angapereke ndalama (mwinamwake akugwirizana ndi HDHP yachitsulo), malamulo ochepa omwe angapereke kwa HSA, ndi malamulo ochepetsetsa okhudza momwe ndalama za HSA zingagwiritsidwe ntchito popanda msonkho kapena chilango.
Misonkho iwiri yomwe inauzidwa ndi Republican Senators mu Januwale 2017 idapempha kusintha kwa HSAs: Patient Freedom Act idzasintha HSAs ku Roth HSAs (zopereka sizikanatha kuchepetsedwa, koma kukula sikudzakhala msonkho, ndipo kuchoka kwa ndalama zowonjezera ndalama -masana), ndipo idzawonjezera malire a zopereka. Bungwe la Obamacare Replacement Act lidzathetsa malire a zopereka kwathunthu, komanso zidzalola kuti HSAsagwiritsidwe ntchito ndi anthu omwe alibe HDHPs.
Zothandizira zapadera ndi kupirira
Chofunika kwambiri posachedwapa pazinthu za inshuwalansi za umoyo waumphawi komanso zomwe zimatha kugula zimakhala pa msika wina aliyense , komwe mitengo yawonjezeka mofulumira kwa 2017. Msika uliwonse ndi gawo laling'ono kwambiri la anthu, komabe kuwonjezeka kwawonjezeka kwasintha kwambiri chiwerengero chonse.
Mademokrasi athandiza njira zosiyanasiyana zopangira chithandizo komanso zosamalika. Zimaphatikizapo ndalama zothandizira msonkho kwa anthu omwe ndalama zawo zogwiritsira ntchito ndalama zoposa 5 peresenti ya ndalama zawo, komanso kupititsa patsogolo ndalama zothandizira ndalama kuti asapereke ndalama zoposa 8.5 peresenti ya ndalama zowonjezera ndalama, zomwe zingathetsere "malipiro othandizira" omwe pakali pano ilipo kwa ena olembetsa.
Mademokrasi awonetsanso njira yowonjezera yaumoyo yomwe ingapikisane ndi ogulitsa inshuwalansi zaumoyo pofuna kuthandiza kuchepetsa mitengo, komanso kuthekera kwa anthu a zaka zapakati pa 55 ndi zapitazo kugula ku Medicare, yomwe ikupereka chithandizo kuyambira pamene anthu akusintha 65 .
Ma Democrats amafunanso kupereka mphamvu kwa boma kuti achepetse kuwonjezeka kwa ndalama zomwe zimawoneka zosayenera. Pakali pano, kuti mukhale ndi "ndondomeko yowonongeka kwa mapiri", boma-kapena boma la boma-limangoyenera kubwereza mitengo yotsatiridwa ndikudziwitsani ngati iwo ali olondola kapena ayi. Koma pokhapokha boma litakhazikitsa malamulo omwe amavomereza kuletsa chiwerengero chosayenerera, palibe njira yokonzedwera ya izo. Tiyenera kuzindikiranso kuti malamulo omwe akugwiritsidwa ntchito masiku ano okhudzana ndi zachipatala amafunika kuti azinesi aziwatumizira ziphuphu kwa mamembala ngati ndalama zawo zowonongeka zimadya zoposa 20 peresenti ya malipiro; izi zimapanga chitetezo chodzitetezera ku mtengo wogula pofuna cholinga choyendetsa phindu kapena chiwongoladzanja.
A Republican apempha kuti anthu azipereka ndalama zawo zothandizira inshuwalansi pamsonkho wawo, zomwe zingachepetse ndalama zenizeni zowonjezera. Ndalama zothandizira inshuwalansi zothandizira ogwira ntchito zothandizira ogwira ntchito panopa zimalipidwa chisonkho chisanayambe msonkho, ndipo anthu ogwira ntchito okhawo amatha kupereka ndalama zawo.
Koma anthu omwe si ogwira ntchito omwe amagula inshuwalansi yawo ya umoyo sangathe kulandira malipiro awo pokhapokha atapanda ndalama zawo. Ngati achita izoemize, amaloledwa kupatula ndalama zothandizira mankhwala-kuphatikizapo ndalama zothandizira ndalama- zomwe zimapitirira 10 peresenti ya ndalama zawo . Izi ndi zopindulitsa kwambiri kwa anthu payekha kuposa malamulo omwe akugwiritsiridwa ntchito ndi inshuwalansi ndi ogwira ntchito pawokha.
A Republican akufunanso kuti anthu agule inshuwalansi yodalirika kudutsa mndandanda wa dziko kuti apititse mpikisano ndi kuchepetsa mitengo. Komabe, sizikudziwikanso ngati a inshuwalansi angakhale ndi chidwi chokulitsa malo omwe akupezeka panopa, chifukwa cha zovuta zomwe zimakhalapo pomanga makanema m'malo atsopano.
Palinso mafunso okhudza kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka ntchito. boma lirilonse likugwirizana ndi malamulo apadera. Ngati malamulo oyendetsera ntchitowa atachotsedwa pazinthu zapathengo komanso kuti ACA iwonongeke chimodzimodzi, chitetezo cha ogulitsa chikhoza kuchepa ngati asungitsi angasankhe kuti azikhala m'mayiko omwe ali ndi malamulo osokoneza bongo.
Kulera Mimba ndi Kuchotsa Mimba
Mau oti kuchotsa mimba amagwiritsidwa ntchito katatu mu Republican Party Platform, koma kasanu ndi kamodzi mu Democratic Party Platform. GOP amavomereza kuti akufuna kuthetsa ndalama zonse za federal kwa mabungwe ngati Planned Parenthood omwe amapereka mimba. Ndipo pamene Democratic Party imakhulupirira kuti "kuchotsa mimba mokwanira kuyenera kukhala mbali ya chisamaliro cha amayi ndi amayi," GOP "imatsutsana" ndi mimba. Trump walandira miyambo yofanana yochotsa mimba .
Hyde Amendment yakhalapo kuyambira 1976, ndipo imaletsa kugwiritsa ntchito ndalama za federal kubweza mimba nthawi zambiri. Ngakhale kuti Democratic Party Platform ikudandaula kuti awononge Hyde Amendment, Republican Party Platform imayitanitsa kuti ikhale yokonzedwanso ndi "ntchito ku boma, kuphatikizapo Obamacare."
Mademokrasi amawathandiza kuti ACA iwonetsere kuti inshuwalansi zonse zaumoyo ziyenera kubisa za kulera popanda kugawana ndalama, ndipo atsogoleri a Demokala adathandizira kupanga chithandizo chakumwa kwadzidzidzi pamsika.
Dipatimenti ya Republican Party imatsutsa zipatala zomwe zimapereka chithandizo cha kulera, ndipo zimatsutsa lingaliro la kulola "kulera kwa mphamvu" kugulitsidwa pa-counter. Koma Trump yanena kuti iye akufuna kulola kugulitsa mankhwala popanda mankhwala.
Mkhalidwe Womwe Ulipo Kale
ACA inasintha nkhope ya inshuwalansi ya umoyo payekha pokhapokha ngati zilipo kale. Ndondomeko za inshuwalansi zamagulu zomwe zakhala zikuyenera kale kuti zizikhalapo kale, koma zikhoza kuika nthawi yoyembekezera nthawi isanakwane chaka cha 2014 (kuti zikhale zomveka, inshuwalansi inaloledwa kulipira olemba ntchito ndalama zambiri m'mayiko ambiri mogwirizana ndi mbiri ya gululo, koma ogwira ntchito pawokha sakanatha kukanidwa chifukwa cha ndondomeko ya gulu chifukwa cha zinthu zomwe zinalipo kale).
Tsopano kuti ACA yakhazikitsidwa, zochitika zomwe zakhalapo kale zimayikidwa pazinthu zonse (kupatulapo malingaliro amodzi a msika) popanda nthawi yodikira. Olemba ntchito angakhalebe ndi nthawi yodikira kwa masiku 90 asanayambe kufotokozedwa, koma atangotero, zikhalidwe zomwe zakhalapo kale zilipo popanda nthawi yowonjezera.
Ma Democrats amafuna kusunga ACA, kuphatikizapo zomwe zimateteza anthu omwe alipo kale.
Mapulani ena a Republican amafuna kuti ACA iwonongeke mokwanira, zomwe zikutanthauza kuti zinthu zomwe zakhalapo kale zikanatha kulola kuti inshulanse iwonongeke pamsika, kapena kuika nthawi yoyembekezera pamsika. Mapulani ena a Republican amafuna kuti anthu azikhalabe ndi chitetezo.
M'maphunziro a Republican omwe amatha kuthetseratu zomwe bungwe la ACA likupereka, pakhala pali mayitanidwe otsitsimutsa zida zapamwamba zowonongeka ndi boma pofuna kutumikira anthu omwe alipo kale. Trump adanenanso kuti njira zake zopezera malonda (monga kulola kugulitsa mapulani kudutsa mndandanda wa dziko) zikhoza kulola ogwira ntchito kuti apitirize kufufuza mikhalidwe yomwe ilipo kale popanda malamulo omwe akufuna, koma pali umboni wochepa umene ungakhale weniweniwo.
Ndalama Zamagwiritsidwe Ntchito Mankhwala
Mademokrasi amafuna kuchepetsa ndalama zomwe zimadulidwa mwezi uliwonse chifukwa cha mankhwala (zomwe zikudetsa nkhawa pano ndizofunika kwambiri mankhwala osokoneza bongo, omwe nthawi zambiri amaphimbidwa ndi coinsurance-peresenti ya mtengo-osati ndalama zolimbitsa thupi; - ndalama zolembera zolemba).
Atsogoleri a Democrats amafunanso kuthetsa " kulipirirako ," (zomwe zimachititsa kuti mankhwala osokoneza bongo apite kunja kwa msika). Chipani cha phwandochi chimaphatikizapo kulola kutumizidwa kwa malamulo kuchokera ku mayiko ena, ndikukweza ntchito ya Medicare yomwe ikuletsedweratu kukambirana mitengo ndi mankhwala opanga mankhwala.
Republican Party Platform sichitsatira zolemba zina osati mu nkhani ya mliri wa opioid ndi kuyesetsa kuthetsa kumwa mankhwala osokoneza bongo. Pamsonkhanowu, Trump adanena kuti akufuna kukambirana ndalama ndi makampani ogulitsa mankhwala, komanso kuloleza kuitanitsa mankhwala osokoneza bongo ochokera m'mayiko ena. Komabe, udindo wake pa kukambirana mitengo ya mankhwala idasintha kumapeto kwa January.
Makhalidwe Aumwini
Udindo wa ACA (aliyense payekha udindo wothandizira) umafuna anthu ambiri a ku America kuti azikhala ndi inshuwalansi ya zaumoyo kapena kuti awone chilango cha msonkho. Ogwirizanitsa akutsutsa kuti iyi ndiyo njira yokhayo yotsimikiziridwa yothetsera inshuwalansi ya umoyo ndiyotheka, ndipo chisanachitike chidziwitso chimakhala chothandizira kuthandizira.
Ma Democrat amathandizira munthu aliyense.
A Republican amatsutsa, ngakhale, kumayambiriro kwa chaka cha 2016, Trump adawonekera. Anasintha mofulumira udindo wake, podziwa kuti akuthandizira kubwezeretsa kwa ACA, kuphatikizapo udindo wake.
Bungwe la ACA ndilo limodzi mwa magawo omwe amakangana kwambiri, ndipo chilango chomwe chimagwirizanitsidwa nacho chingathetsedwe ndi bizinesi yowonetsera chiyanjano. Izi zingachititse kusakhazikika kwa malonda a inshuwalansi, komabe, ndipo nkhaniyi ikupitilizidwanso ndi olemba malamulo, ndi malingaliro ochokera ku malonda a inshuwalansi ndi ogulitsa malonda.
> Zotsatira:
> Barnett JC, Vornovitsky MS. Ofesi Yoyang'anira Kuchuluka ku United States, Health Insurance Coverage ku United States: 2015 . Inatulutsidwa mu September 2016
> Blumberg LJ. Urban Institute. Malonda a Inshuwalansi Padziko Lines Lines, June 2016.
> Magulu a Medicare ndi Medicaid Services, Center for Information Consumer Information ndi Inshuwalansi. Gawo 1332: Zowonongeka ndi boma
> Garfield R, Damico A. Kaiser Family Foundation, Gawo Lophatikizapo: Osalimbikitsidwa Akuluakulu Okalamba M'mayiko Osawawonjezera Kugonjetsedwa - Chosintha. January 21, 2016.