2017 chinali chaka chovutitsa chithandizo cha kusamalidwa kwaumoyo, koma pafupifupi onse omwe anatsogolera a GOP kuchotseratu Chithandizo cha Care Affordable (ACA, omwe nthawi zambiri amatchedwa Obamacare) sanathe. Sitikukayikitsa kuti kubwezeretsa ndi kubweza ngongole zomwe zinayambika mu 2017 zidzakhalanso mu 2018, koma tsogolo la ACA ndi kusintha kwa chisamalidwe cha zaumoyo sichikutsimikizika pansi pa Administration Trump ndi Republican Congress.
Imodzi mwa nkhani zomwe zakhala zikuyambira ndi zofunikira ndizokhazikitsidwa kale. ACA inachotsa zolemba zachipatala m'misika ya inshuwalansi ya gulu limodzi ndi yaing'ono, choncho ndondomeko ya gulu limodzi ndi yaing'ono imaperekedwa kwa onse opempha mosasamala kanthu za mbiri yachipatala, ndipo popanda kusiyana kwa mtengo wogwirizana ndi umoyo wawo.
Izi zakhala zikuthandizira kwa anthu omwe alipo kale ndi mabungwe ang'onoang'ono omwe ali ndi mbiri zofunikira zokhudzana ndi zachipatala, komanso amapereka mtendere wa mumtima kwa anthu omwe sakhalapo kale, monga momwe matenda amatha kukhalira nthawi zina, nthawi zina popanda chenjezo.
N'zosavuta kuwona chifukwa chidziwitso cha zikhalidwe zomwe zakhalapo kale zakhala chimodzi mwa zinthu zofala kwambiri za ACA. Koma ndi chimodzi mwazinthu zomwe zakhala zikugwiritsira ntchito ndalama zogulitsa malonda. Ndalama zothandizira ndalama zowonjezera ndalamazo zimapangitsa ndalama zambiri kuti anthu ambiri azikhala ndi ndalama zogulitsa, koma omwe alibe ndalama zothandizira (kuphatikizapo aliyense amene akugula malonda kunja kwa kusinthanitsa), msonkhowo ukhoza kukhala katundu wolemetsa.
Tsono ngakhale kuti malamulo a ACA akuwoneka kuti akufuna kuti zithandizo zaumoyo zizikhalapo kale, nkhaniyi ikhalabe yotsutsana kwambiri. Zina mwa malamulo omwe olemba malamulo a GOP amapereka amatha kubwezeretsa mbali zosiyanasiyana za chitetezo cha ACA cha anthu omwe alipo kale, ndipo ndizofunika kumvetsetsa momwe izi zidzakhalire, makamaka chifukwa chakuti mawu ovomerezeka a malamulowa amapereka zambiri Maganizo okhudza momwe anthu okhalapo kale anali akadakali pano.
AHCA ndi Zomwe Zidakalipo
Pa May 4, 2017, a Republican House adadutsa American Health Care Act (AHCA), ndipo adawatumizira ku Senate. AHCA ndi zotsatira za ndondomeko ya bajeti ya Januwale 2017 yomwe inauza makomiti a Congression kuti alembe malamulo oyanjanitsa kuti abwezeretse ndalama zomwe zikugwirizana ndi ndalama za ACA (zinthu monga thandizo , thandizo la Medicaid , ntchito ndi ntchito za abwana ).
Mabungwe oyanjanitsa ndiwotsimikiziridwa ndi filibuster, kotero iwo amafunikira ambiri wambiri mu Senate. Koma zimangoperekedwa kuzinthu zomwe zimakhudza kwambiri ndalama zomwe zimagwiritsidwa ntchito ku federal, choncho sizingathetse mavuto onse a Care Act. Akatswiri a zamalamulo adakayikira kuti chokonzekera chotsutsa chikhalidwe cha ACA chisanakhalepo chidzaloledwa kupitilira mu Senate ngati ndalama yobwereranso.
Komabe, MacArthur Kusintha kwa AHCA, yowonjezeredwa mu Nyumbayi mu April pofuna kuyesetsa kuyimilira oyimilira okha, akanachita zomwezo. Choncho, panali malingaliro akuti ndalamazo ziyenera kusinthidwa kwambiri kuti apite Senate. Pamapeto pake, a Seneti Republican adafuna kusintha malemba angapo, omwe sanagwiritsidwe ntchito (kubwezeretsa, " Better Care Reconciliation Act" , "Obamacare Repeal Reconciliation Act", ndi Graham-Cassidy-Heller-Johnson).
Chotsatira chake, kuyesa ndi kubwezeretsa mbali zazikulu za ACA ndi 2017 sizinapambane. Olemba malamulo a GOP adapambana kubwezera chilango cha ACA payekha monga gawo la msonkho wawo womwe unakhazikitsidwa mu December 2017, koma kubwezeretsedwa sikugwira ntchito mpaka 2019 ( pakadalibe chilango chosavomerezedwa mu 2018 ).
Zambiri mwa ACA zimakhalabe zoyenera kumayambiriro kwa chaka cha 2018, kuphatikizapo thandizo la ACA lomwe likufuna inshuwalansi kuti achepetse ndalama zowonjezera kwa olembetsa ndalama zochepa. Izi zothandizira kuchepetsa ndalama (CSR) sizikugulitsidwa ndalama ndi boma la federal, koma mapindu adakalipo kwa olembetsa oyenerera.
Koma chithandizo chamankhwala chimasintha zokambirana sizingatheke, ndipo sizikudziwika bwino kuti ACA ingathe kuwonongedwa kapena kusinthidwa mu miyezi yotsatira kudzera mwa malamulo ovomerezeka ndi / kapena malamulo apamwamba. Choncho ndikofunikira kumvetsa zoyesayesa kale kuti musinthe malamulo okhudza zomwe zakhalapo kale, popeza tikhoza kuona zomwe zikuchitika mtsogolomu.
The MacArthur Amendment
Mu April 2017, Rep. Tom MacArthur (R, New Jersey) adayambitsa kusintha kwa AHCA pofuna kulandira chithandizo kuchokera kwa anthu omwe amadziwika kuti House Freedom Caucus. Izo zinali zopambana, ndipo kuthandizidwa kuchokera ku Freedom Caucus pamapeto pake kunachititsa mavoti okwanira kuti AHCA apite mnyumbamo.
MacArthur Amendment ikanalola kuti mayiko akufunafuna kuchotsa-pansi pa zomwe zimawoneka kuti ndizovomerezeka-zomwe zikanawathandiza kusintha mazinthu angapo a chitetezo cha ACA:
- Anthu omwe alipo kale omwe amalembetsa malonda omwe ali ndi malingaliro amodzi (osachepera masiku 63 m'miyezi khumi ndi iwiri yapitayi) adzalandira malipiro awo chifukwa cha mbiri yawo yachipatala kwa miyezi 12 yoyambirira pansi pa ndondomeko yatsopanoyi. Panalibe malire a momwe malipiro awa angakhalire apamwamba, omwe angapangitse kufalitsa kosavuta kwa ena ofuna, malingana ndi mbiri yawo yachipatala. Chiwongoladzanjachi chikanakhala m'malo mwa kuwonjezeka kwakukulu kwa 30 peresenti kwa chaka chimodzi (mosasamala za mbiri yachipatala) kuti AHCA idzayendetse ntchito pamene ogulitsa malonda akugwiritsidwa ntchito pambuyo pa kusiyana kwa chithandizo.
- AHCA imafuna ndalama zomwe zingakhale zazikulu kuposa zisanu ndi ziwiri (50 - 64) kusiyana ndi akuluakulu. The MacArthur Amendment ikanalola dziko kuti liwononge chiŵerengero ichi ndikupanga malo apamwamba m'malo mwake. Mwachidziwitso, ACA imapereka chiŵerengero cha 3: 1, kutanthauza kuti anthu achikulire sangathe kulipidwa katatu kuposa achinyamata.
- MacArthur Amendment iyenso inalola kuti mayiko akufunafuna kuchoka kumasulira malingaliro ofunikira kwambiri . Izi zikanatanthauza kuti ntchito zina zomwe ziyenera kuchitika pansi pa ACA siziyenera kuchitika m'madera ena ngati AHCA yakhazikitsidwa. Kwa anthu omwe analipo kale, ichi chinali chodetsa nkhaŵa kwambiri, monga momwe chithandizo chawo chofunikira chithandizo sichinayikidwenso ndi inshuwaransi. Pansi pa ACA, zopindulitsa zofunika zaumoyo ndizofunikira zokhazikitsidwa ndi ndondomeko ya gulu limodzi ndi ing'onoing'ono, ndi Medicaid. Magulu akuluakulu sakufunika kuti awaphimbe, ngakhale ambiri atero.
Kodi Zosagwirizana Zonse Ndi Ziti?
Ngati munawona a Republican ndi a Democrats akutsutsana za AHCA pambuyo pa kukhazikitsidwa kwa MacArthur Amendment, mwinamwake munawona a Democrats akunena kuti lamulo lidzatulutsira kale kutetezedwa kwa chikhalidwe, pomwe a Republican adanena kuti lamulo limateteza anthu omwe analipo kale. Kotero chinali chiyani?
Mwachidziwitso, MacArthur Amendment adanena kuti anthu sangakanidwe kufotokozera chifukwa chokhalapo kale. Ili ndilo lamulo la Republican limene likunena kuti lamuloli linalipo kale kuti zikhale zotetezedwa. Nthawi zina amathanso kuthana ndi vutoli powauza kuti anthu omwe alipo kale sangawononge zotsatira zake pokhapokha atapitirizabe kufalitsa.
Koma mdierekezi ali m'zinthu zonse. Pansi pa MacArthur Amendment, ndizoona kuti ntchitoyo siidakaniratu (zomwe zinkakhala zikuchitika m'mayiko ambiri asanatengere ACA, pamene anthu anali ndi zikhalidwe zomwe zinalipo kale ndipo adagwiritsa ntchito malonda awo). Koma mabungwe a inshuwalansi akanatha kulipira ngongole zambiri pamsika pamsika ndi boma, ngati zidazo zinalipo kale ndipo adakhala ndi kusiyana kwa miyezi 12 yapitayi.
Zimenezo zikanatha kupanga kufotokozera mosavuta. Kotero ngakhale kuti ntchitoyo siidakanidwe, wogula malonjezowo sakanakhala olondola. Tonsefe tili ndi "mwayi" wa Lamborghinis. Koma izi sizikutanthauza kuti tonse tikhoza kukhala ndi Lamborghinis.
The MacArthur Amendment adayambitsanso zovuta zokhuza ubwino wa thanzi. Ngati boma linasankha kumasula malamulo ogwiritsira ntchito mankhwala osokoneza bongo, mwachitsanzo (limodzi mwa mapindu othandizira azaumoyo a ACA), tikhoza kuona mapulani omwe sanaphimbe mtundu wonse wa dzina la mankhwala ndi mankhwala apadera. Ichi ndi vuto lalikulu kwa anthu omwe alipo kale omwe amafunikira mankhwala okwera mtengo.
Mofananamo, ngati boma linasankha kupanga chithandizo chokwatira amayi (ndicho chimodzi mwa zinthu zofunika kwambiri zaumoyo ndipo motero ndilovomerezedwa pansi pa ACA), ambiri a inshuwalansi pamsika pawokha sangathe kuwaperekanso, monga momwe zinaliri patsogolo pa ACA .
Choncho ngakhale kuti a Republican anali okonzeka kunena kuti kusintha kwa AHCA sikungalole kuti mabungwe a inshuwalansi akane mapulogalamu pogwiritsa ntchito zikhalidwe zomwe zisanachitikepo, MacArthur Chicheperecho chikanakhala chitapangitsa chitetezo m'misika ya anthu omwe analipo kale. Ndipo chifukwa cha kusintha kosinthika ku kutanthawuza kwa phindu la thanzi labwino, zotsatirazi zikhoza kupitilira ku msika wogulitsidwa ndi abwana.
Kodi AHCA Adachita Zotani Zina?
AHCA ikanachotsa chilango cha ACA payekha kumayambiriro kwa 2016, kuchotsa chimodzi mwa zolimbikitsa zomwe zikusungira anthu a thanzi labwino mu chipinda cha inshuwalansi (inshuwalansi imagwira ntchito ngati anthu ali ndi thanzi labwino mu dziwe kuti athetse zifukwa za anthu omwe amafunikira chithandizo chamankhwala). Koma kufalitsa kungakhalebe wotsimikizika, mosasamala kanthu za mbiri yachipatala cha wolembayo.
[Zindikirani kuti chilango chaufulu payekhacho chinachotsedwa mu msonkho wa msonkho wa GOP womwe unakhazikitsidwa kumapeto kwa 2017, koma kubwezeretsa sikugwira ntchito mpaka 2019. Zonse zoyesayesa zowononga ndi kubwezeretsa ACA mu 2017 zinaphatikizapo kubwezeretsedwa kwa udindo wa munthu aliyense, koma msonkho wa msonkho unatulutsira mtsogolo m'malo mwake.]
Pofuna kulimbikitsa anthu kuti apitirize kufotokozera, pofotokoza kuti sankafuna kuchoka pansi pa MacArthur Amendment, AHCA akadali m'malo mwake kuti azidalira anthu omwe sanapitirize kulumikizidwa. Kwa olembetsa mu 2018 (kutanthauza kuti aliyense amene akulembetsa nthawi yolembetsa mu 2018, kapena pa nthawi yolembera kuti apite 2019 ndi kupitirira), olembapo angayesedwe ndalama zokwana 30 peresenti kuposa momwe angakhalire ngati ali ndi kusiyana pakati pa masiku 63 kapena patapita miyezi 12 isanafike. Mapepala apamwamba akanakhalabe m'malo mwa chaka chotsaliracho.
Ndikofunika kuzindikira kuti mapepala apamwamba angagwiritse ntchito kwa aliyense amene akulembetsa malingaliro ake pamsika potsatira mpata wowerengera. Zingakhalebe kanthu ngati wopemphayo ali wathanzi kapena wodwala. Mwanjira ina, izi zimalepheretsa anthu wathanzi kulembera pamapeto pake, ndipo angapangitsenso zipangizo za inshuwalansi kwa anthu odwala.
Kodi ACA idzayesa kubwezeretsa chifukwa kubwerera ku malamulo a Pre-ACA a Inshuwalansi?
Dongosolo laposachedwapa la Kaiser Family Foundation limasonyeza kuti 27 peresenti ya anthu omwe sali achikulire ku US ali ndi zinthu zomwe zakhalapo kale zomwe zingawathandize kukhala osatetezeka pamsika womwewo ngati titabwerera ku miyezo ya zachipatala yomwe inalipo pafupi ndi boma lililonse pamaso pa 2014 .
AHCA sanathe kupambana mu 2017, chifukwa matembenuzidwe onse a Senate sanathe kudutsa. Koma ngakhale AHCA itadutsa, izi sizinafike pobwerera kumalo momwe iwo analiri Pre-ACA. Ngakhale pali olemba malamulo ambiri omwe amawauza kuti azichita zimenezi , kubwereranso kwa zolemba zachipatala pamsika pamsika ndilo lingaliro losavomerezeka pa ndale.
Koma ngakhale ngati ACA ilipo kale chitetezo chikhalidwecho chidzachotsedwa, ambiri Ambiri akadali kutetezedwa, chifukwa malamulo omwe asanakhale tsiku ACA. Tiyeni tiwone momwe amagwirira ntchito:
Pre-ACA: Malamulo Osiyana Malingana ndi Mtundu wa Inshuwalansi
Pali njira zinayi zazikulu zomwe Amerika amapezera inshuwalansi ya umoyo: Kuwunikira kwa ogwira ntchito, Medicare, Medicaid, ndi msika uliwonse. Mukhoza kuyembekezera zinthu zosiyana pa aliyense wa iwo pansi pa Utumiki wa Trump .
Ngati ma chitetezo a ACA omwe analipo kale asanakhalepo, zotsatira zake sizikanakhala zofanana pa magulu anaiwo. Kusintha kwakukulu kochitidwa ndi ACA mwazinthu zomwe zinalipo kale zinali pamsika wamsika, komwe pafupifupi 7 peresenti ya anthu a ku United States amapeza inshuwaransi yawo ya thanzi.
HIPAA Ingatetezebe Mapulani a Gulu la Gulu
HIPAA (Act Insurance Actability and Accountability Act) inabwerera kumapeto kwa zaka za m'ma 90, ndipo yayamba kuteteza kwambiri anthu omwe amapeza chithandizo kuchokera kwa abwana (pafupifupi 49 peresenti ya chiwerengero cha anthu a US omwe ali ndi chithandizo cholimbikitsidwa ndi abwana). Ngakhale kubwezeretsedwa kwathunthu kwa ACA-mosiyana ndi ndalama yobwezeretsa monga AHCA-sikungathetsere zofunikira za HIPAA, kotero anthu omwe amapeza chithandizo kuchokera kwa abwana awo akadakali ndi chithandizo cha zinthu zomwe zakhalapo kale.
Koma isanafike ACA, pansi pa malamulo a HIPAA, ndondomeko zogwiritsidwa ntchito ndi ogwira ntchito zingapangitse nthawi zodikira kuti zikhalepo kale (kupatula kubereka, kuganiza kuti pulogalamuyi inapereka ubwino wokhuza amayi) ngati olembawo sanagwiritse ntchito chithandizo chotsatira asanalembedwe.
Malingana ngati munthuyo anali atapitirizabe kulumikizidwa kwa miyezi khumi ndi iwiri popanda kupumula kwa masiku 63 kapena kuposerapo, zikhalidwe zomwe zinalipo kale zinali zitangotanganidwa mwamsanga pamene kufalitsa kwathunthu kunayamba kugwira ntchito. Koma ngati olembetsawo anali ndi kusiyana kwa masiku osapitirira 63 asanalembedwe mu ndondomeko yomwe amagwiritsidwa ntchito ndi abwana, ndondomekoyi ikhoza kudikira kwa miyezi 12 kuti izi zitheke.
ACA inathetsa pulogalamuyi. Pansi pa ACA, zikhalidwe zomwe zakhalapo kale zimayikidwa pa ndondomeko iliyonse ya abwana, komanso pazinthu zonse za malonda zomwe sizinali zazikulu (ndipo sizing'onozing'ono), pokhapokha ngati polojekitiyi ikugwira ntchito.
ACA inaletsanso olemba inshuwalansi kuti asawononge magulu ang'onoang'ono ndalama zowonjezerapo ndalama zoonjezera zochokera ku mbiri yakale ya ogwira ntchito. Kugawidwa kwa magulu ang'onoang'ono kunali kovomerezeka kale pansi pa HIPAA, koma ogwira ntchito angathe kubweza ndalama zowonjezereka ku magulu omwe ali ndi thanzi labwino kwambiri. Pamene ACA inayamba kugwira ntchito, izi zinali zoletsedwa, ndipo mapepala oyambirira a magulu angakhale osiyana ndi zaka za olemba, malo, kukula kwa banja, ndi kugwiritsa ntchito fodya.
Ngati ACA inachotsedweratu ndipo m'malo mwake simunaphatikizepo ndondomeko yotsutsa nthawi yowonjezerapo kuti zikhalepo kale, malamulowa angasinthe momwe analiri patsogolo pa 2014. Anthu omwe akhalabe ndi chitukuko chokhazikika sangakhale ndi nthawi yodikira kuti athe kukhalapo kale zochitika pamene mukulowa nawo ndondomeko ya thanzi la abwana. Koma anthu omwe ali ndi phokoso lotha kufotokozera akhoza kukhala ndi nthawi yodikira kuti akhalepo kale. Ndipo magulu ang'onoang'ono omwe ali ndi antchito osauka angakumane ndi malipiro apamwamba kuposa magulu ang'onoang'ono omwe ali ndi antchito abwino.
Koma AHCA sichikanachotsa zofunikira za ACA (kukumbukira kuti ndilo lamulo loyanjanitsa, ndipo kotero linali lochepa pa zomwe lingasinthe). Pansi pa AHCA, kulekanitsidwa kwa nthawi yomwe idalipo kale kuyembekezera kuti ntchito zothandizidwa ndi abwana zikanakhalabe zogwira ntchito, ndipo malipiro a msika wa magulu ang'onoang'ono sakanakhala odalira umoyo wa gulu la abwana.
Medicare ndi Medicaid Adzapitiriza Kuphimba Zinthu Zomwe Zilipo Kale
Medicaid ndi Medicare chivundikiro chokhalapo kale. Pali zina zogwiritsira ntchito ndi Medicare, komabe, zomwe ziribe kanthu ndi ACA:
- M'mayiko ambiri, anthu akulembera mapulani a Medigap pambuyo pawindo lawo loyamba lolembetsa (ndipo popanda kupeza mwayi wowerengera wapadera wa Medigap) amavomerezedwa ndi zolemba zachipatala. Mapulogalamu awo akhoza kukanidwa, akhoza kupatsidwa ndondomeko yokhala ndi apamwamba kuposa omwe ali nawo, kapena wonyamulirayo angapangitse kuti chikhalidwe chikhalepo kale.
- Kawirikawiri, ngati muli ndi matenda otchedwa renal stage (ESRD), simungathe kulemba Medicare Advantage .
Ngakhale kuti ACA siinasinthe kanthu pa chithandizo choyambirira chomwe chinakhalapo pansi pa Medicare ndi Medicaid, icho chinachulukitsa mwayi wopita ku Medicaid. Kulembetsa kwa Medicaid / CHIP kwawonjezeka ndi anthu oposa 17 miliyoni kuyambira kumapeto kwa chaka cha 2013, chifukwa cha mbali yaikulu ya kukula kwa malamulo a Medicaid.
Pambuyo pa ACA, Medicaid (yomwe inkaphatikizapo kufotokozera zinthu zomwe zinalipo kale) inalipo m'mayiko ambiri okha ndi amayi omwe ali ndi pathupi lochepa omwe ali ndi pathupi, makolo ena ochepa kwambiri, komanso okhala ndi okalamba.
Pansi pa ACA, chigawo 31 ndi District of Columbia zakhala zikuwonjezera Medicaid kwa anthu onse akuluakulu omwe ali ndi ndalama zapakhomo pamsinkhu wokwana 138 peresenti ya umphaŵi, womwe ndi ndalama zoposa $ 16,700 pamsonkhano wa pachaka kwa munthu mmodzi mu 2018.
Ngati ACA idzachotsedwapo ndipo m'malo mwake sangakhale olimba, mamiliyoni a anthu omwe ali ndi Medicaid panopa akhoza kutaya mwayi wowonjezera. Adzatha kugula malonda pa msika wina aliyense (mwinamwake ali ndi mtundu wina wa msonkho wa msonkho), koma izi sizingakhale zosatheka ndalama kwa iwo omwe ali ndi ndalama zochepa kwambiri. Ngati iwo sakanati atsimikizidwe, zikhalidwe zawo zomwe zinalipo kale sizikanati zidzakumbidwe, ngakhalenso chithandizo chamankhwala chosayembekezereka chomwe angafunikire.
AHCA imafuna kulembetsa anthu olemba malire poonjezera Medicaid kuyambira mu 2020, ndikusintha Medicaid ku gawo linalake kapena kubwezera chithandizo m'malo mogwiritsa ntchito dongosolo lomwe likugwiritsidwa ntchito masiku ano.
Izi sizinachitike, koma Utsogoleri wa Trump wayamba kutenga njira yosiyana yolepheretsa kulembedwa kwa Medicaid mwa kumasula malamulo omwe akutsutsa kuti angathe kufunafuna mapulogalamu awo a Medicaid (Medicaid imathandizidwa pamodzi ndi boma ndi boma, motero dzanja popanga malamulo ena). Zinthu monga zofuna za ntchito komanso zolemba za moyo nthawi zonse siziloledwa pansi pa Obama Administration, koma zikuvomerezedwa kapena kuganiziridwa ndi Administration Trump. Pamapeto pake, cholinga cha Boma la Trump ndi olemba malamulo a GOP ndi kukhala ndi anthu ochepa omwe ali ndi Medicaid. Tsoka ilo, palibe chithunzi chowonekera bwino cha momwe anthuwa ayenera kukhalira kufotokozera, ndipo ambiri angokhala osatsimikiziridwa popanda kupeza Medicaid.
Makhalidwe omwe alipo kale ndi Msika Wawokha
Monga tafotokozera pamwambapa, AHCA-ndi MacArthur Amendment-akanatha kubwezeretsanso zinthu zina zotetezedwa kale zomwe zinapangidwa ndi ACA.
Kumvetsetsa momwe zinthu zinalili kale zisanayambe kugwiritsidwa ntchito pre-ACA ndi mbali yofunikira kwambiri yodziwa chifukwa chake ACA inali yofunikira poyamba, ndipo zomwe zingakhalepo ngati zowonongeka kale zikusintha.
Kuwonjezera pa malonda payekha m'mayiko onse koma asanu anali olemba mankhwala omwe asanamvekedwe chaka cha 2014, pamene ACA inaletsa chizoloŵezichi (kugawidwa kwa malonda ndi mtundu womwe mumagula nokha-kupyolera mu kusinthanitsa kapena kusinthanitsa -kusonkhanitsa kusiyana ndi kuzilandira kwa abwana ).
Pali anthu oposa 17 miliyoni omwe ali ndi malonda pamsika. Ambiri a iwo anali kale ndi malonda a msika wa PreA ACA, koma ena adatha kupeza chithandizo pamene malamulo a ACA adayamba kugwira ntchito ndipo ogwira ntchitoyo sakanatha kukana zofunikiranso pogwiritsa ntchito mbiri ya mankhwala.
Zolemba zachipatala zimatanthauza kuti malonda pamsika pawokha amaphatikizapo mndandanda wa mafunso okhudza mbiri yachipatala ya olemba. Kuyenerera kuyenerera kunadalira mayankho, ndipo kwa anthu omwe analoledwa kulembetsa mosasamala kanthu za zomwe analipo kale, ndalama zowonjezera zinkakhala zapamwamba kwambiri kusiyana ndi chiwerengero chawo.
Zinthu zomwe zakhalapo kale zinaphatikizansopo mankhwala alionse omwe alipo. Kukhala wolemera kwambiri, wokhala ndi cholesterol kapena kuthamanga kwa magazi, mbiri ya kuyendera chiropractor ... zonse zidasanthuledwa ndi olemba mabuku a zachipatala kuti aone ngati wopemphayo akuyenera kulandira chithandizo, ndipo ngati ndi choncho, pa mtengo wake.
ACA inasintha zonsezi. Kwa msika uliwonse, malamulo a ACA omwe analipo kale anali osintha masewera. Mapulogalamu omwe anakanidwa ndi kuwonjezeka kwapadera chifukwa cha mbiri yachipatala inakhala chinthu chakale, monga momwe kale zinkayendera nthawi yodikira.
Kuphatikiza pa AHCA, zidutswa zingapo za ACA kubwezeretsa / kulembetsa malamulo zinayambitsidwa ndi olemba GOP mu 2017. Ambiri a iwo adafuna kuti asungidwe ndi ACA zomwe zimatetezera anthu omwe alipo kale.
Koma ngati zofuna za ACA sizidasungidwa, pali njira zikuluzikulu ziwiri zoyenera kukhazikitsa zikhalidwe zomwe zakhalapo kale zomwe zakhala zikuphatikizidwa muzinthu zambiri zomwe zaperekedwa zaka zingapo zapitazo: zida zapamwamba kwambiri kapena zofunikira zowonjezera " , kapena onse awiri.
Zonsezi zikuphatikizidwa ndi Pulezidenti Woyamba Act, yomwe inalandiridwa ndi Tom Price (R, Georgia), yemwe adatsimikiziridwa ndi Senate mu February 2017 kuti akhale mlembi wa Health and Human Services (Price adavomera mu 2017, pakati pa malipoti omwe Anagwiritsa ntchito jets payekha mmalo mwa ndege zamalonda paulendo wake wamalonda). Zonsezi zikuphatikizidwanso mu Njira Yabwino, ndondomeko yosinthira zaumoyo yotchedwa House Republicans mu June 2016.
Madzi Oopsa
Zambiri za kusintha kwa zachipatala za Republican zikuphatikizapo kubwereranso kumadzi omwe amadziwika kuti ali ndi chiopsezo chachikulu pofuna kulimbikitsira anthu omwe sangathe kupeza chithunzi pamsika (pamapangidwe omwe amaphatikizapo zopereka zowonjezereka, zida zoyenera kuti ziphimbe anthu omwe sakhala nawo nthawi zonse, komanso omwe alipo kale ndi ofunika kwambiri moti sangathe kupeza chithandizo cha mankhwala).
Madzi otentha kwambiri adakhazikitsidwa m'mayiko 35 m'zaka za m'ma 90 ndi 00. Koma zolephera zonse zapansi yazidzidzidzizi zinali mbali ya chifukwa ACA inkafunika poyamba. Zolingazo zinkakhala zodula, ndipo nthawi zambiri zimakhala ndi zowonongeka kwambiri ndipo zimakhala zopindulitsa kwambiri pa moyo wawo wonse. Kuonjezera apo, madera ena omwe anali pangozi akuluakulu anayenera kuchepetsa kulemba kwa zaka zambiri chifukwa cha zovuta za bajeti.
Madzi ambiri omwe amapezeka pangozi amatha kugwira ntchito pokhapokha ngati malonda akugulitsidwa pa 2014. Ndi ndalama zokwanira za boma, zida zapamwamba zitha kukhala njira yothetsera. Koma popanda ndalama zokwanira, sizikawoneka kuti zingapindule kwambiri kuposa momwe zinalili m'zaka zomwe zikutsogolera kukhazikitsa kwa ACA.
AHCA ikadapatsa ndalama za boma kuti zigwiritse ntchito padziwe, koma akadatha kuzigwiritsa ntchito pochita khama. Ndipo akatswiri ambiri amanena kuti ndalama zopezeka m'madzi akuluakulu a AHCA sizikanakhala zokwanira kuti zidazi zikhale bwino.
Kupitiliza Zowonjezera
Pansi pa ACA, kufotokoza ndikutsimikizika, nthawi. Zilibe kanthu kuti mwakhala osatetezedwa mpaka liti pamene mukulembetsa, ndipo ziribe kanthu kuti muli ndi zifukwa ziti zomwe muli nazo kale (koma mungathe kulembetsa pa nthawi yolembera chaka, kapena pa nthawi yolembera yapadera ngati inu amapeza choyenerera).
Pansi pa zolemba zosiyanasiyana za GOP zomwe zimafuna kuti pitirize kufotokozedwa, lingalirolo ndilokulitsa zina za chitetezo cha HIPA kwa msika uliwonse. Anthu omwe amapitirizabe kulumikizidwa (kaya ndi ndondomeko ya gulu kapena ndondomeko ya munthu payekha) adzatha kulembetsa dongosolo latsopano pokhapokha ngati zilipo kale (mwachitsanzo, popanda kulembedwa kwachipatala).
Koma anthu omwe ali ndi vuto la kufotokozera amatha kulangidwa. Lingaliro ndilo kulimbikitsa anthu kuti azikhala ndi chitukuko chopitirira popanda kugwiritsa ntchito udindo wa ACA wokhala wosavomerezeka.
M'mayiko omwe sankafuna kuti athetse chigamulo cha MacArthur Amendment, AHCA ikanaphatikizapo msonkho wapadera kwa anthu omwe sanasunge chithandizo chokhazikika. Zowonjezerapo ndalamazi zikanati zigwiritse ntchito mofanana, kwa onse odwala komanso odwala.
Izi ndi zosiyana ndi chithandizo chopitiriza chomwe chingawathandize inshuwalansi kuti azigwiritsa ntchito zolemba zachipatala pamene olemba ntchito akulembera pamapeto pake. Ndiyo njira yomwe ingagwiritsidwe ntchito pansi pa AHCA muzinthu zomwe zinkafuna kuti zitheke. M'madera amenewo, anthu wathanzi omwe ali ndi phokoso lotha kufotokozera akanatha kulembetsa pa malonda omwe ali ndi malonda omwe ali nawo. Koma anthu omwe analipo kale (omwe ali mndandandanda waukulu kwambiri) akanakhala kuti ali ndi malipiro apamwamba kwambiri ngati atagwiritsa ntchito malonda awo payekha popanda mbiri yakale ya chaka chapitacho.
Kodi Ndikufunika Kudandaula?
Mwinamwake, ngakhale zimadalira chidziwitso cha kusintha kwa chisamaliro chamtsogolo chamtsogolo chimatenga. AHCA sichiwerengedwanso, koma zofanana ndizo zikhoza kuwonetsedwa mu 2018 kapena chaka cha mtsogolo, makamaka ngati a Republican ali ndi zikuluzikulu ku Congress pambuyo pa chisankho cha 2018 pakati pa nthawi ya chisankho.
Ndalama ya AHCA yomwe inadutsa Nyumbayi idawonongeke kwambiri anthu omwe alipo kale omwe akufunafuna kufalitsa pamsika. Zinali zovuta kwambiri ponena kuti mwina phindu la thanzi labwino likanatha kuthiridwa, zomwe zimapangitsa kuti zikhale zovuta kuti anthu omwe ali ndi kagulu kakang'ono akukonzekere kufotokozera zochitika zawo zomwe zakhalapo kale.
Ndipo ngakhale m'msika waukulu, magulu a ACA omwe amaletsa moyo wathanzi ndi ndalama zapadera zapachaka ndikugwiritsira ntchito ndalama zowonongeka zomwe zimagwiritsidwa ntchito pokhapokha pothandiza phindu laumphawi (zomwe sizingafunikire kuziphimbidwa pansi pa magulu akuluakulu a gulu, koma ngati ndi-ndipo kawirikawiri ndi-nthawi ya moyo / kuletsedwa kwa phindu la pachaka ndipo ndalama zomwe zili kunja kwa ndalama zimagwiritsidwa ntchito). Choncho ngati phindu la thanzi lidzagwedezedwe, anthu omwe akusowa thandizo lachipatala omwe akukonzekera malonda angathe kuthandizidwa .
Mu 2017, malamulo a Republican adanena mobwerezabwereza kuti AHCA idzapitiriza kuteteza anthu omwe alipo kale, ngakhale kuti sizinali zoona. Tsogolo la chisinthidwe cha zaumoyo likupitirirabe kuwona, ndipo nkhaŵa zokhudzana ndi zikhalidwe zomwe zakhalapo kale ziri zomveka. Koma kwa nthawiyi, palibe chomwe chatsintha pazinthu zofunika zathanzi komanso chitukuko cha zinthu zomwe zakhalapo kale.
> Zotsatira:
> Congressional Budget Office, American Health Care Act, pa March 13, 2017.
> HealthCare.gov, Ndondomeko za Inshuwalansi za Grandfathered Health.
> Kaiser Family Foundation, Inshuwalansi ya Umoyo wa Anthu Onse. 2016.
> Kaiser Family Foundation, Pre-exist Conditions ndi Medical Underwriting mu Individual Inshuwalansi Market Asanafike ACA. December 12, 2016.
> Kaiser Family Foundation, Kaiser Health Tracking Poll-June 2017: ACA, Mapulani, ndi Medicaid. June 23, 2017.
> United States Dipatimenti Yogwira Ntchito, Thandizo Labwino Pakati pa Federal Law. September 2014.
> United States Dipatimenti Yachigwirizano, Health Inshuwalansi Portability ndi Accountability Act (HIPAA) Kukhalitsa Kwa Moyo Wathanzi ndi Kusasamala Zofunikira FAQs.