Ndizovuta kwambiri kusiyana ndi kubwezeretsa ndi kubwezeretsa kumapeto
Pamene Donald Trump adagonjetsa chisankho cha pulezidenti mu November 2016, tsogolo la inshuwalansi ya umoyo ku US linali mwadzidzidzi kwambiri - pamene anthu anayamba kuyambitsidwa ndi Care Affordable Care Act (aka, Obamacare).
Sitikukayikira kuti kukhazikitsa kwa ACA kunali ndi zovuta zambiri m'zaka zingapo zapitazi, koma zinali zitakhazikika kwambiri kumapeto kwa chaka cha 2016.
Nthawi yachinayi yolembera pamsika pamsika (payekha ndi kusinthanitsa ) inali ikuyenda. Olemba ntchito anali kulowa m'chaka chawo chachiwiri kapena chachitatu (malingana ndi kukula kwake) kuti azitsatira ntchito ya abwana a ACA . Anthuwa anali akuzoloŵera kufunsa mafunso okhudza inshuwalansi za umoyo pa msonkho wawo, komanso chilango cha anthu omwe sanalimbikitsidwe pa chaka.
Anthu adziwonetsa kuti zinthu zomwe zakhalapo kale sizinali zopinga pothandizira inshuwalansi ya umoyo, komanso kuti anthu omwe amagula malonda pamsika, amapereka ndalama zothandizira ndalama, malinga ndi ndalama ( izi zathandiza kuchepetsa masewerawo kwa anthu ogula inshuwalansi ya umoyo wawo , popeza anthu omwe ali ndi inshuwalansi ya inshuwalansi akhala akuthandiza kwambiri).
Ndiye mwadzidzidzi, zonse zinali mmwamba. Pulezidenti Trump adalonjeza kuti adzalanda ACA; webusaiti yake yachitukuko inati, "Pa tsiku limodzi la Utumiki wa Trump, tidzapempha Congress kuti iwononge Obamacare nthawi zonse."
A Republican adasunga malamulo awo ku Nyumba ndi Senate, ndipo akhala akukakamiza kubwezeretsa ACA kuyambira pomwe idakhazikitsidwa mu 2010. Ntchito yawo yakale idakhumudwitsidwa ndi cholembera cha Pulezidenti Obama, koma izi sizotsutsana ndi Utsogoleri wa Trump.
Kubwereza ACA Sikumakhala kosavuta monga kumveka
Msonkhano wa 2017 utangochitika, Senator Mike Enzi (R, Wyoming), Pulezidenti wa Komiti ya Budget ya Senate, adayankha ndondomeko (SCR 3) kuti ayambe kubwezeretsa ACA pogwiritsira ntchito ndalama.
Cholinga cha Enzi chimapereka malangizo kwa makomiti anayi kuti azitsatira malamulo, kuphatikizapo kuchepetsa kuchepa, zomwe ziyenera kuwonetsedwa ku Komiti ya Zigawo. Nyumba ziwiri za Congress zinapereka SCR 3 mpaka pakati pa mwezi wa Januwale, ndipo makomiti a congressional akhala akugwira ntchito mwatsatanetsatane pochotsa malamulo kuyambira nthawi imeneyo.
Congressional Republican akukonzekera pa nthawiyi kuti awononge bizinesi ya chiyanjano posachedwa. Zomwe ankayembekezera zinali kuti zidzakhala zofanana ndi HR3762, zomwe zinaperekedwa kumayambiriro kwa 2016 koma adatsutsidwa ndi Purezidenti Obama.
Poyera, iwo alibe mavoti oyenera kuti awononge kwathunthu ACA, pakuti izi zikanafuna mavoti 60 mu Senate kuti athetse filibuster. Koma ngongole yothandizira-yomwe imayankhula za ndalama zokha-imatha kudutsa ndi mowirikiza, ndipo sichigonjetsedwa ndi filibuster. Bungwe loyanjanitsa mgwirizano wa ACA lingadutse ndi 51 Asenema akuvotera, ndipo alipo 52 a Republican Senators mu 2017.
Zothandizira zapadera, kugwirizanitsa ndalama, ndi kuwonjezereka kwa Medicaid kungathetsedwe ndi biliyano. Zikanakhala kuti msonkho wa ACA monga wogwiritsira ntchito chilango, ntchito ya chilango, ndi zinthu monga msonkho wa chipatala komanso msonkho wa Cadillac.
Ndalama zoyanjanitsika sizidzatha kubwezeretsa ziwalo za ACA zomwe sizikugwiritsidwa ntchito, monga kufotokozedwa kwabwino (mosasamala za mbiri yachipatala), zofunika zathanzi , komanso kulola achinyamata kuti akhalebe pazinthu za makolo awo mpaka zaka 26 Koma ngati ACA ikubwezeredwa, magawo otsalawo sangapulumutsidwe pokhapo pokhapo malamulo ena athandizidwa kuti athetse mgwirizano wa inshuwaransi.
Kodi N'chiyani Chimabwera Patsogolo?
Congressional Republican ayenda mwamsanga kuti ayambe kubwezeretsa ACA mwa kuigwiritsa ntchito, koma sanayambe kugwirizana potsatizana. Mipingo yambiri ya GOP yoti idzalowe m'malo mwa ACA yakhazikitsidwa zaka zingapo zapitazo, kuphatikizapo Nyumba ya Pulezidenti Paul Ryan ya " Njira Yabwino" , ndi Tom Price wa Mphamvu ya Patient First Act ya 2015 (HR2300) - yomwe inagwiritsidwa ntchito kwambiri pamene mtengo unasankhidwa kutsogolera HHS pansi pa Utsogoleri wa Trump (Senate inatsimikizira kuti anasankhidwa mu February 2017).
Zolingazo zimakhala ndi mfundo zambiri zomwe zimagwirizana, kotero tili ndi lingaliro labwino la momwe atsogoleri a Republican akufuna kupitilira.
Misonkho yambiri yatsopano yakhala ikuyambitsidwa m'masabata oyambirira a gawo la 2017 lovomerezeka, mwachidziwitso kutsatira mfundo zofanana zomwe zafotokozedwa m'makalata oyambirira a kusintha kwa chisamaliro cha Republican. Koma palibe amene adalandira thandizo la bipartisan kapena kuthandizidwa kwathunthu kuchokera ku Republican mbali ya kanjira.
Mwachidule, mfundo zenizeni za zomwe zingathetsere ACA sizilipo. Anthu ena a ku America ali bwino pansi pa ACA, ndipo ena ali ovuta, koma palibe amene ali nawo mwayi wokhoza kuwonekeratu. Ndipo mwina chofunikira kwambiri, inshuwalansi ya umoyo ndi mafakitale sakudziwa chomwe chimabwera pambuyo pake.
Atsogoleri a Congression adanena kuyambira pachiyambi kuti sipadzakhalanso kusiyana pakati pa anthu. Ngakhale adanena mobwerezabwereza kuti ndondomeko yawo ndi kubwezera ACA mwamsanga, iwo alibe cholinga choti kubwezeretsa kugwire ntchito yomweyo. Kuchedwa kwa zaka ziwiri kapena zinayi pofuna kubwezeretseratu ntchito, kungatanthauze kuti akhoza kuvotera kuti achotse ACA kumayambiriro kwa m'ma 2017, koma kubwezeretsa kumatenga nthawi ina pakati pa 2019 ndi 2021.
Chifukwa cha kuchepetsa kubwezeretsa ntchito ndikupatsa olemba malamulo mwayi wogwiritsa ntchito ndalama zowonjezerapo, kuzigwiritsa ntchito, ndikukhala ndi nthawi yokwanira kuti azigwirizanitsa nthawi yomweyo. Rep. Chris Collins (R, New York), yemwe ali membala wa gulu la Trump Transition, adanena kumayambiriro kwa mwezi wa 2017 kuti lamulo lokonzanso m'malo mwake lidzakonzedwenso ndi June kapena July 2017. Iye ananenanso kuti palibe chomwe chingasinthe pa zaumoyo akukonzekera mu 2017 kapena 2018, koma adanena kuti kubwezeretsedwa kwa ACA kunali kofunika chifukwa olemba malamulo anali kukonza kuti abwereze mwamsanga zinthu monga "msonkho wa chipatala, msonkho wa inshuwalansi pa makampani a inshuwalansi, ntchito ya abwana, udindo wa wogwira ntchito [ponena za munthu aliyense]. "
Nyumba Yankhululu Paul Ryan (R, Wisconsin) adanena kuti akuyembekeza kubwezeretsa voti kudzachitika mu March kapena April, koma Pulezidenti Trump, amene adayankhula kale za kubwezeretsa voti kumapeto kwa Januwale, omwe adatchulidwa kumayambiriro kwa February kuti kubwezeretsedwa kuvota sikungakhoze kuchitika mpaka 2018.
Zomwe Amitundu Amauzidwa
Uthenga umene a Congressional Republican adawunikira ukuwonekera kwa Ambiri ambiri:
- Bwezerani ACA, koma ndi nthawi yaitali kuti anthu asawonongeke pamene akudikirira m'malo.
- Ndondomeko yowonjezera yomwe omulonjeza adalonjeza idzakhala yabwino kuposa ACA (ngakhale popanda kuwona lamulo lenilenilo, anthu amangotenga mawu awo), zomwe zidzachitike nthawi imodzimodzimodzi ndi kuchotsedwa kwa Obamacare, popanda phokoso pakati.
- Kuchotsa mwamsanga misonkho ina ya ACA, kuphatikizapo ntchito yothandizira komanso udindo waumwini, zomwe zonsezi sizinayamikiridwe.
Zimene Zikutanthauza
Izi zimawoneka bwino. Koma pamene tiyang'ana pansi pa hood, pali zochepa zochepa zidutswa. Bungwe la Congressional Budget Office linanena kuti ntchito ya ACA ndi udindo wa munthu aliyense, pamodzi ndi msonkho wa Cadillac, idzabweretsa $ 297 biliyoni muzochokera 2016 mpaka 2025. Zomwe ndalamazo zimagwiritsidwa ntchito kuthandizira ndalama za ACA, zomwe zikuphatikizapo ndalama pa chithandizo cha premium ndi kuwonjezeka kwa Medicaid.
Ngati chuma cha ACA chichotsedwa posachedwa, chikhoza kuthetsa mavuto a zachuma kuti apitirize kupereka chithandizo ndikulandirira Medicaid.
Koma palinso mavuto ena akuluakulu omwe angabwere ngati mavoti a Congress akuchotsa posachedwa ACA (ngakhale kuchedwa kukhazikitsidwa) ndikudikirira miyezi ingapo kuti awonetse malamulo omwe akutsitsimutsa. Zina mwazofunikira kwambiri ndizowonongeke malonda a inshuwaransi ya moyo ndi kuthekera kuti ndalama zowonjezera sizikhoza kudutsa.
Kodi Mukutanthawuza Chiyani, "Kuwonongeka kwa Inshuwalansi Yomwe Akugulitsa Inshuwalansi"?
Kulembetsa kwachinsinsi kwa chaka cha 2017 kunatha, koma olemba inshuwalansi zaumoyo akuganiza kale pokonzekera 2018. Kwa ogwira ntchito amene akufuna kupereka mapulani kumsika wa federally (facilitally-facilitated marketplace) mu 2018, mitengo ndi mapulani liyenera kuperekedwa ndi May 3, 2017 m'madera omwe boma la federal limapanga ndondomeko yowerengera (Missouri, Oklahoma, Texas, ndi Wyoming), ndipo pa July 17 m'mayiko otsalawo.
Ngati ACA ikutsutsa malamulo adutsa kale, koma kubwezeretsedwa sikudziwikidwe ndi / kapena kudutsa, ogulitsa inshuwalansi ya umoyo adzakhala akukayikira kwambiri pokhudzana ndi kukonzekera kwawo kwa nthawi yaitali.
Ndizofanana ndi zonyamulira ngati palibe chomwe chikuchitika mwalamulo-kuphatikizapo kubwezeretsa malamulo-ndi nthawi yomwe mitengo ndi ndondomeko ziyenera kuikidwa. Onyamula katundu amadziwa kuti zonse zili mlengalenga, zomwe zimaphwanyidwa zili patebulo, ndipo kusinthika sikukudziwika.
Ena ogulitsa angapite patsogolo ndikukayikitsa mitengo ndi ndondomeko ya 2018 (omwe amakhala ndi ndalama zapamwamba zomwe akanadapanda popanda kukayikira pakali pano pamsika wamsika). Koma ena angaganize kuti kusatsimikizika ndi pangozi, ndipo amangotuluka kuchoka ku mgulane kapena msika wina aliyense kumapeto kwa 2017.
Ngati ntchitoyi ikuchotsedweratu koma kufotokozera kudzachitikadi mu 2018, n'zosavuta kuona chifukwa chake asungitsi angagwirizane ndi lingaliro lopitiriza kutenga nawo mbali. Zikatero, zidzakhala zophweka kusiyana ndi kale lonse kuti anthu abwinobwino azipita popanda chidziwitso, ndipo zida zoopsya zikanangowonjezereka kwa olembetsa odwala, kutanthauza kuti inshuwalansi angafunikire kuti asatengere nawo mbali, kapena kutenga nawo malipiro apamwamba kwambiri.
Boma la Trump lanena kuti lidzatulutsa malamulo othandizira kukhazikitsa malonda a inshuwalansi, koma zikuwonekeratu kuti malamulowa adzakhala okwanira kuti asungire inshuwalansi pamsika wa 2018, komanso kuteteza mapepala okhudzidwa kuti asatengeke.
Kwa ambiri ogulitsa inshuwalansi, pamsika pawokha ndi chidutswa chochepa cha bizinesi yawo yonse. Zambiri mwa bizinesi zawo zimakhala ndi mapulani a gulu (kapena kuchita monga otsogolera mapulani a gulu lalikulu), Medicare Advantage mapulani, ndi ndondomeko za kusamalira Medicaid. Kuchokera pamsika payekha sizomwe angasankhe pang'onopang'ono, komanso si chisankho chomwe chingasokoneze ntchito yawo yonse.
Ngati Bwino Lidzasinthidwa
Vuto lina poletsa tsopano (ndi kuchepetsa kukhazikitsa) ndiyeno kugwira ntchito kuti likhazikitse m'malo ndilo kuti kubwezeretsedwa sikungatheke. Mwinamwake Congress silingagwirizane pa kapangidwe kowonjezera, kapena mwinamwake sangathe kupanga nambala kugwira ntchito malinga ndi ndalama za boma pa dongosolo lokonzanso.
Monga zikuwonetseredwa ndi ndondomeko yaitali, yovuta kutsutsana ndi kudutsa ACA mmbuyo mu 2009/2010, zikuwonekeratu kuti kutenga mgwirizano pazondomeko zatsopano zothandizira chisamaliro sichidzakhala chophweka.
Ndipo chimachitika ndi chiyani ngati sangathe kupeza chilichonse chotsatira? Zikatero, lamuloli lidakalipobe, ndi kukhazikitsidwa kwathunthu kwa 2019 kapena kenako. Ndipo ngati palibenso kanthu koti kalowe m'malo mwake, msika wogonjetsedwa womwe ukufotokozedwa pamwambawu udzakhala wochititsa chidwi kwambiri, popeza mbali zina za ACA (monga chitsimikizidwe chotsimikiziridwa) zikanakhalabe m'malo, pamene ena (monga udindo ndi ndalama zowonjezera) zidzathetsedwa.
Pakati pa anthu mamiliyoni 20 ndi 30 miliyoni akhoza kutaya inshuwalansi ngati ACA idzachotsedwa ndipo sichidzaloledwa ndi chinthu china cholimba. Bungwe la Congressional Budget Office linanena kuti mu January 2017 kuti anthu 18 miliyoni angayambe kulandira chithandizo chaka choyamba mutatha kalata yofanana ndi HR3762, ndipo chiwerengero cha anthu omwe angathenso kulengeza chidzakula kufika pa 32 miliyoni pazaka khumi.
Trump Inena Kuti Malamulo Adzakhala Panthawi imodzi
Pakati pa chisokonezo chokhudza malamulo awiri akutsatiridwa miyezi ingapo, ambiri a Republican senators anayamba kuyika kukayikira pa njirayi. Rand Paul (Kentucky) Lamar Alexander (Tennessee), ndi Tom Cotton (Arkansas) onse adanena kuti ndi bwino kuchepetsa kubwezeretsa voti mpaka ndondomeko yowonjezereka ikupezeka. Pali mwayi wawung'ono koma wochulukitsa kuti mwamsanga kubwezeretsa ndalama sizingadutse ngati lamulo lokhazikitsidwa lisanakonzedwe kupita nthawi yomweyo.
Pamsonkhano wa press 10 wa January, Trump adati ndalama zowonongeka ndi kubwezeretsa ACA zimayambitsidwa "panthawi imodzimodzi" Pambuyo pa Mtengo Mtengo umatsimikiziridwa kuti uwatsogolere HHS (Mtengo unatsimikiziridwa pa February 10). Trump adalongosola pang'ono, akuti "Zidzakhala zigawo zosiyanasiyana, mumvetsetsa, koma zikhoza kukhala tsiku lomwelo kapena sabata lomwelo, koma mwinamwake tsiku lomwelo.
Izi zimapangitsa kuti olemba malamulo azikambirana mofulumira ndikukonzekera ndondomeko yowonjezera, koma izi zikhoza kukhala zosavuta kunena. Pakalipano, tsogolo la ACA limakhalabe mlengalenga. Koma pamene akukambirana za momwe kulibe vuto ndi "kubwereza ndi kuchepetsa" chifukwa dongosolo latsopano lidzakankhira ngati ACA ikupita, kumbukirani kuti ndi zovuta kwambiri kuposa izo.
> Zotsatira:
> Congress of the United States, Congressional Budget Office. Kusinthidwa kwa Budget Projections, 2015 mpaka 2025 . March 2015.
> Dipatimenti ya zaumoyo ndi zithandizo zaumunthu. 2018 Kalata kwa Otsutsa ku Msika Wamsika Wokonzedweratu. December 16, 2016.
> DonaldJTrump.com. Kusintha kwa Zaumoyo. Pulogalamu ya 2016.
> Price, Tom, US Nyumba ya Oimira. Kulimbitsa Patient First Act ya 2015. May 11, 2015.
> United States Komiti ya Senate pa Budget. Senate Yoyambira Kusamvana pa Zomwe Zidzakhala Zosintha. January 3, 2017.