Sitikukayikira kuti pulezidenti wa Donald Trump-kuphatikizapo anthu ambiri a Republican mu Congress-adzakhala ndi mphamvu yaikulu pa Affordable Care Act (Obamacare) ndi momwe inshuwalansi ya umoyo imagwirira ntchito ku US
Koma atatha kulengeza za lonjezo lochotsa Obamacare "tsiku limodzi," Trump anadalira udindo umenewo m'masiku otsatira pambuyo pa chisankho, podziwa kuti pali mbali zina za lamulo zomwe angafune, kuphatikizapo kufotokozedwa mosasamala kanthu za zinthu zomwe zakhalapo kale, ndi zomwe zimalola achinyamata kuti akhalebe pa dongosolo la thanzi la makolo kufikira zaka 26.
Zoonadi, mbali zonse zalamulo ndizovomerezeka kwambiri ndipo zimathandizidwa kwambiri ndi bipartisan, monga malamulo omwe amalepheretsa anthu ogwira ntchito zaumoyo kuti asamapange chaka chilichonse kapena nthawi zonse zowonjezera .
Koma palinso zinthu zina za ACA zomwe sizikudziwika bwino, kuphatikizapo lamulo loti anthu onse a ku America-kupatula ngati ali oyenerera kupereka malipiro - akupeza inshuwalansi yothandizira kapena akumana ndi chilango cha msonkho .
Zokonda zapang'ono pomwezi ndizo "kubwezeretsa ndi kubwezeretsa" zomwe Congressional Republicans zinayambitsa pa tsiku limodzi la gawo la 2017 lovomerezeka. Pulezidenti Trump asanayambe ntchito, Congress idakhazikitsa ndondomeko ya bajeti yomwe ikuwongolera makomiti oyendetsera malamulo kuti alembe malamulo kuti abweretse mbali za ndalama za ACA kudzera mu mgwirizano. Ndipo pa tsiku loyamba la Trump pantchito, adasaina lamulo lotsogolera bungwe la federal kuti likhale lovomerezeka poyendetsa msonkho wa ACA ndi zilango.
Ndondomeko yowonongeka ndi kubwezeretsa ACA ikhoza kukwera pa 2017, koma ngati idutsa, mgwirizanowu ndi wakuti kukhazikitsidwa kwa kusintha kulikonse kungachedwetsedwe mpaka 2018, ndipo mwina 2019.
Pewani
Ngati Congress imapereka ndalama zoyanjanitsika (zomwe zimangotanthauza kuchuluka kwa anthu omwe ali ndi umboni wa filibuster), akhoza kuchotsa zofunikira zogulira ndalama ku ACA.
Izi zingaphatikizepo zinthu monga chithandizo choyambirira , kugwirizanitsa ndalama , ndi kuwonjezereka kwa Medicaid , pamodzi ndi zilango zomwe zimagwiridwa ndi udindo wa abwana ndi udindo wawo .
Koma ngongole yobwezeretsa sungathe kubwezeretsa mbali za ACA zomwe sizikugwirizana ndi kugwiritsa ntchito-zinthu monga zoperekedwa kuti chitsimikizo chonse chikhale chotsimikizika mosasamala za mbiri yachipatala, ndi chofunika kuti gulu lonse ndi gulu laling'ono liphimbe zofunika zathanzi .
Kusintha malamulowa kungapangidwe ndi malamulo okhazikika, ndipo a Republican adayankha zinthu zingapo pazaka zingapo zapitazi, kuphatikizapo ndondomeko ya masomphenya awo a zaumoyo komanso malamulo ambiri, kuphatikizapo ndalama zina zomwe zinayambitsidwa m'masabata oyambirira gawo la 2017 lovomerezeka.
Ndipo ndithudi, pali njira zambiri zothetsera kusintha inshuwalansi ya umoyo ndi kayendedwe ka zaumoyo ku US Palibe kukayika kuti ACA yokha inkafunikira kusintha kwa zaka zingapo zapitazi, koma ndi mbatata yotentha ya ndale yomwe olemba malamulo sakanatha kupeza njira yothetsera kusamvana komwe kungapambane voti okwanira.
Kusintha Kwenizeni
Pakadutsa mtedza ndi mabotolo ochotsa Obamacare, pali mavuto ena omwe angayambe ngati cholinga chake ndi kusunga zofunikira zalamulo ndikuchotsa zochepa zomwe zimapezeka.
Pansi pa Boma la Trump ndi ambiri a Republican mu Congress, zakhala zikutsimikiziridwa kuti inshuwalansi yathu yaumwini ya inshuwalansi idzakhalabe m'malo mwake, osati kusintha kwa malipiro amodzi. Poganizira zimenezo, payenera kukhala cholinga choonetsetsa kuti inshuwalansi alimbikitsenso kupitiriza kupereka chithandizo pamsika wa inshuwalansi.
Inshuwalansi yathanzi yaumwini ndi chithandizo chogwiritsidwa ntchito ndi abwana, ndipo izi zidzapitirirabe kukhala zowonjezereka m'tsogolo: Makampani akuluakulu ambiri amapereka inshuwalansi kwa antchito awo nthawi yayitali A ACA asanati awafunse, ndipo ambiri Pitirizani kuchita zimenezi ngakhale ngati ntchito ya ACA yowonjezera ikuchotsedwa; inshuwalansi ya umoyo ndi gawo la mapikisano opindulitsa omwe abwana amagwiritsa ntchito kukopa ndi kusunga antchito.
Ngakhale kuti ACA inasintha mbali zina za inshuwalansi yomwe inalandizidwa ndi abwana, zambiri zomwe zinasinthidwa zinali zogwirizana ndi malonda a inshuwalansi. Pali anthu okwana 22 miliyoni ku US omwe ali ndi inshuwaransi yaumwini (kutanthauza chithandizo chomwe amadzigulira okha, osati kupeza kwa abwana kapena boma). Pofika m'chaka cha 2016, pafupifupi theka la iwo anali ndi chithandizo pazitsulo zomwe zinakhazikitsidwa pansi pa ACA. Theka lina linagula zofalitsa zawo kuchokera ku inshuwalansi zonyamulirapo, kapena kuti anali ndi chithandizo pamakonzedwe apamwamba kapena abambo.
Ndi inshuwalansi ya umoyo uno - yomwe yakhala ikusintha kwambiri pansi pa ACA. Ndipo palinso mbali zinayi zofunika zalamulo zomwe zimagwiritsidwa ntchito kugwira ntchito pamodzi kuti zitsimikizire kuti inshuwalansi yaumwini imapezeka kwa aliyense amene akufunikira:
- Ndalama zoyamba zopangira chithandizo chotheka kwa anthu omwe mwina sangathe kulipira malipiro. Ndalama zoyamba zothandizidwa ndi ACA zimapezeka kuti zilembetse ndalama zoposa 400 peresenti ya umphaŵi, zomwe ndi $ 97,200 kwa banja la anayi mu 2017.
- Kufotokozedwa kwotsimikiziridwa , kutanthauza kuti kulembedwa kwachipatala sikugwiritsidwenso ntchito kudziwa ngati anthu angapeze chithandizo pa msika wina aliyense, kapena kuti apereke malipiro awo. Asanafike chaka cha 2013, mayiko onse koma asanu adalola makampani aza inshuwalansi kuti azichita zolemba zambiri zachipatala kuti aone ngati wopemphayo angayambe kufotokozera, ndi ndalama zotani zomwe angapereke. Kulipira kwapamwamba-kapena kukana kufotokoza kwathunthu-kunayesedwa kawirikawiri kwa chirichonse kuyambira mimba mpaka mbiri ya khansara yokhala wochuluka kwambiri kuti akhale ndi mphumu.
- Nthawi zolembera zochepa . ACA inakhazikitsira nthawi yolembera chaka chilichonse (yomwe imagwiritsidwa ntchito pamasinkhu komanso osagwirizana), yomwe HHS inkagwira ntchito yolemba. Nthawi yoyamba yolembetsa (kwa chaka cha 2014) inatenga miyezi isanu ndi umodzi. Kuchokera apo, chaka chilichonse kutsegulidwa kwa olembapo kwakhala kwa miyezi itatu, ndipo chiwerengerochi chidzakhalabe chaka cha 2018.
Koma kuyambira chaka cha 2019, kufotokozedwa kotsegulidwa kudzakhala kochepa , kuthawa kuyambira November 1 mpaka December 15 chaka chilichonse (HHS ikukonzekera pempho lofupikitsa nthawi yolembetsa 2018, ndikupangitsani kusintha kwa nthawi yochepa chaka chimodzi kuposa kale). ACA imaperekanso nthawi zolembera zapadera zomwe zimapatsa anthu mwayi wopezera malonda pamsika kunja kwa olembera, ngati ali ndi chikhalidwe choyenera chomwe chimayambitsa nthawi yolembetsa .
Zitsanzo ndizokwatirana, kukhala ndi mwana, kapena kutaya mwayi wothandizira inshuwalansi yaumoyo. Koma popanda chiyeneretso, inshuwalansi ya inshuwalansi sangathe kugulidwa kunja kwa kulembetsa, ngakhale pa kusinthanitsa kapena mwachindunji kuchokera ku inshuwalansi ya chithandizo cha inshuwalansi. Mfundo ya mawindo olembetsa ndi olepheretsa anthu kuti asayambe kulembetsa chidziwitso mpaka atasamalidwa. - Lamulo laumwini lomwe limafuna kuti aliyense akhale ndi inshuwalansi ya thanzi kapena kulipira chilango cha msonkho. Chilango cha anthu omwe sanalimbikitsidwe mu 2014 chinali pafupifupi $ 210, koma chinawonjezeka kufika pa $ 470 kwa anthu omwe sanalimbikitsidwe mu 2015, ndipo chidzakhala chokwera kwambiri pamene chilango cha 2016 chidzayankhidwe pa msonkho wa msonkho womwe unaperekedwa mu 2017.
Kuwunikira kwotsimikizirika kwakhala kufalikira. Zothandizira zapadera zimakhala ndi mbiri yambiri, ngakhale kuti zifukwa zingapo zothandizira ACA zimadalira zikalata zochuluka za msonkho zomwe sizinagwirizanitsidwe ndi ndalama, koma zomwezi sizingatheke kuwerengedwa ku mtengo weniweni wa inshuwalansi ya umoyo. Zikalata zoterezi zingakhale zosakwanira pamene nthawi ikupita ngati mtengo wa chithandizo cha zaumoyo ukupitirirabe mofulumira kuposa kulemera konse kwa mankhwala.
Koma udindo wa munthu payekha ndi wokongola kwambiri, ndipo mapulani a zotsitsimutsa za Republican amatanthawuza kuthetsa izo (ngakhale kuti lingaliro la munthu payekha ndilo lotchuka ndi mabanki oganiza bwino ndi olemba malamulo omwe amatha zaka 80 ndi 90).
Kodi Mungakhale ndi Chotsimikizirika-Chotsatira Chokha popanda Mphamvu?
Ngati mutapereka chithandizo chovomerezeka ndi ACA koma mutha kukwaniritsa udindo wanu, mutha kulimbana ndi vuto lalikulu: Anthu akhoza kupita opanda chithandizo pamene ali ndi thanzi labwino, kenaka amalembetsa inshuwalansi akamafuna chithandizo. Zopuma za inshuwalansi zodabwitsazi zimakhala zosavuta kulosera muzochitikazo.
New York inakhazikitsidwa podutsa zaka makumi anayi asanamveke kuti ACA ibweretse mfundoyi ponseponse, koma analibe udindo uliwonse. Chotsatiracho chinali malipiro omwe anali apamwamba kwambiri kuposa dziko lonse (ngakhale mu 2017, ndalama za inshuwalansi za inshuwalansi za malonda ndi zoposa 50 peresenti m'munsi ku New York kuposa momwe zinaliri mu 2013).
Inde, izi ndizo zina mwa vuto lomwe ACA lakhala nalo pazaka zingapo zapitazo: Olemba mapepala amodzi akhala akulirapo komanso odwala kuposa momwe amachitira (chifukwa osakwanira, anthu odwala amatha kulembetsa dziwe loopsa), Sizinali zokwanira kubisa ndalama zomwe inshuwalansi akhala akugulitsa pamsika. Pali zifukwa zosiyanasiyana izi, kuphatikizapo kuti chilango cha ACA cha munthu aliyense sichikakamizidwa, komanso kuti nthawi yokwanira yolembera imakhala yovuta; palibe chifukwa chimodzi chowerengera cha owerengeka omwe ali ochepa kuposa omwe amayembekezera.
Koma ndalama zowonongeka pamsikawu ndichifukwa chake ambiri a inshuwalansi adasankha kuchoka pamsika kapena makampani awo pachaka a 2017. Iwo sanangokhala gawo la msika waphindu kwa iwo, ndipo ndi gawo laling'ono la msika, A inshuwalansi omwe amachoka pamsika pamsika amatha kuganizira zigawo zazikulu za msika, kuphatikizapo aboma omwe amalandira inshuwalansi, Medicare Advantage , ndi chisamaliro cha Medicaid.
Mwachidule, mabungwe a inshuwalansi sangapereke chithunzi pamsika wawo pokhapokha atatsimikizika motsimikiza kuti msikawo udzakhalabe wokhazikika, ndipo anthu okhutira bwinowo adzalembetsa kuti athetse ndalama zoyenera kulemba olembetsa omwe akusowa chithandizo chamankhwala.
Pali njira zosiyanasiyana zochitira izi, koma zonsezi zimaphatikizapo njira zina zomwe zimapangitsa kuti zikhale zovuta kapena zosatheka kuti anthu apite popanda chidziwitso pamene ali ndi thanzi labwino. Ikhoza kukhala udindo wa munthu aliyense, kapena ukhoza kukhala wapamwamba kwambiri kwa anthu omwe salembetsa ngati poyamba ali oyenerera (ndi momwe amagwiritsira ntchito Medicare Part B ndi Part D ntchito). Kapena ikhoza kukhala malipiro apamwamba okhudzana ndi kulembedwa kwachipatala kwa anthu omwe sakhalabe ndi chidziwitso chokhazikika (ichi ndi gawo la ndondomeko yolembedwa ndi Republic Republicans mu 2016).
Koma njira imodzi kapena ina, payenera kukhala ndi zolimbikitsa kuti anthu ayambe kulembetsa, malinga ngati tikudalira dongosolo lomwe limagwiritsa ntchito inshuwalansi ya umoyo waumwini ndi olembetsa mwaufulu. Musanafike chaka cha 2013, izi zinkalimbikitsa kuti kufalitsa sikungakhale kosavomerezeka m'mayiko ambiri, kotero kuti anthu adzilembetse pamene anali athanzi-ndipo alembetse-kuti asakhale osatsutsika ngati atakhalapo kale.
Tikhoza kubwerera ku kachitidwe kameneko, koma kubwereranso ku zikhalidwe zomwe zakhalapo kale komanso zolembedwera zachipatala pafupifupi pafupifupi konsekonse sizidzakhala zandale. Zowonjezereka, kufotokozedwa kotsimikiziridwa kuli pano kuti mukhale, mwa mawonekedwe ena. Ndipo izo zikutanthauza kuti mtundu wina wa chilango cha kusalembera ndiponso kuti ukhale, mwa mawonekedwe ena. Zingakhale zapamwamba kwa anthu omwe amalembetsa mtsogolo kapena mtundu wina wa mankhwala olembedwera kwa anthu omwe sakhala nawo nthawi zonse. Koma palibe njira yothetsera vutoli la ACA popanda kuonetsetsa kuti anthu omwe ali ndi thanzi labwino amalembera kuti athetse chiwopsezo.
> Zotsatira:
> Zopangira za Medicare ndi Medicaid Services, pa March 31, 2016, Snapshot yolembetsa yotsatira.
> Nyumba ya Oimira, Pulogalamu ya GOP Healthcare. Njira Yabwino, Lingaliro Lathu la Chikhulupiriro cha America . June 22, 2016.
> Kaiser Family Foundation, Health Insurance Coverage ya Chiwerengero cha Anthu, 2015.
> Koskinen, John, Internal Revenue Service, Letter to Congress pa zotsatira zoyambirira kuchokera mu nyengo ya 2015 yomwe ikugwirizana ndi Ntchito Yodalirika Yopereka Chithandizo mu October 2015 . January 8, 2016.
> Koskinen, John, Internal Revenue Service, Letter to Congress ponena za msonkho wa msonkho wa 2016 wokhudzana ndi Ntchito Yodalirika yothandizira. January 9, 2017.