CBO inoti vanhu vanosvika mamiriyoni 23 vangarasikirwa nekugoverwa pasi peAHCA. Ndivana ani?
MunaJanuary 2017, Congress yakagadzirisa sarudzo yebhajitori inorayira congressional komiti kuronga kuyananisira mitemo yekuderedza kushandiswa kwemari-yezvimwe zvinhu zve Affordable Care Act (ACA, inowanzonzi Obamacare). Izvozvo zvakaguma musi waMarch 6, apo mahofisi maviri eDzimba (Nzira uye Nzira, uye Simba neAmabhizimisi) akazarura mutemo unobatanidza pamwe chete neAmerican Health Care Act (AHCA).
Mutemo uyu wakatanga kuiswa muImba musi waMarch 20.
Mushure mekufamba runyararo kuburikidza nekugadzirisa mitemo, AHCA yakapfuurira imba musi waMay 4, nevhoti ye 217 kusvika ku 213. Yakaida 216 kuti ipfuure, saka yakanga iri kukunda zvakanyanya. VaDemocrate vakabatana mukupikisana kwavo nemutemo, uye vamiririri 20 veRepublican vakabatana navo mukuvhota maererano nechiyero.
IAHCA inongova mutsara wakadii, wakaoma kunzwisisa kupfuura weAACA, asi izvi ndezvekuti ibasa rekuyananisa rinogona kungogadzirisa zvinhu izvo zvakakonzerwa nehuwandu hwemari. Kuyananisira mabhiriji kune huwandu hunoratidza, saka vanogona kupfuura muSénate nehuwandu huzhinji, panzvimbo yekuda mavhoti makumi matanhatu. Asi ivo vanonyanya kukoshesa muhuwandu kupfuura mutemo unotarirwa newa filibuster.
Kaiser Family Foundation ine chidimbu chakanaka cheAHCA, pamwe chete nechimwe chinhu chichakutendera kuti uenzanise neAHCA neAACA, uye nemimwe mitemo ichangobva kuiswa .
Congressional Budget Office Chikamu Bill
Musi waMarch 13, Congressional Budget Office (CBO) yakabudisa kuongorora kwavo kwekutanga kweAHCA, ichifungidzira kuti kuiswa kwemurairo kwaizowedzera huwandu hwevanhu vasina kuvimbiswa muUnited States nemamiriyoni makumi mana nemakumi maviri emakore gumi anotevera.
ICOO inzvimbo isina kubhadhara basa rinoshandiswa nekugadzirisa mathemusi anowirirana nemitemo yemitemo.
Vatongi veRepublican vakashanda kushora CBO mumazuva anotevera kuiswa kweAHCA, asi pasina ruzivo rweBBC, hapana nzira chaiyo yekufungidzira zvakakwana kukosha kwenhamba yemutemo, sezvo kuongororwa kubva kune vateereri nevashandi vavo vangangodaro vanobatwa nezvematongerwo enyika kusarura.
Nenguva iyo chikwata cheBBC chave chichiwanika, AHCA yakanga yatopfuura neKomiti YeNzira uye Means Means uye House Energy uye Commerce Committee; makomiti maviri akanga apfuura musayiri asi pasina ruzivo kubva kuBBCO. Dare reBumbiro reMari reHurumende reAHCA rakauya mazuva maviri mushure mekunge mabhii eBBC abudiswa, saka nyaya yevanhu vangarasikirwa nekugoverwa yaiva chikamu chekukurukurirana mukomiti iyoyo.
Musi waMarch 23, CBO yakatora zvakare AHCA zvakare kuratidza kuchinja kwainge kwawedzerwa, asi zvitatu zvimwe zvigadziriswa zvakawedzerwa munaMuvhuro neMeyi (izvi zvinorondedzerwa pasi apa zvakanyatsotsanangurwa). Nemhaka yekukurumidza kusvitsa kusvika pakvhota, Imba haina kutarisira kuti CBO ikwanise kubhadhara musarudzo wekupedzisira musati wavhota.
Pakupedzisira, chikwata cheBBC pamusangano wekupedzisira weAHCA wakabudiswa musi waMay 24, inenge mavhiki matatu mushure mokunge Temberi yakanga yatora mutemo. Idzo mbiri dzakambotanga dzave dzakaratidza kuti nhamba yevasiri vemuAmerica isingabatsiri yaizokura nemamiriyoni makumi maviri nemana makumi mana emakore gumi anotevera.
Mushure mokunge ichinyora zvigadziriswa zvitatu zvakawedzerwa munaEpril naMay, CBO yakaratidza kuti nhamba yevasiri vemuAmerica isingabatsiri yaizowedzera nemamiriyoni makumi maviri nemaviri vanhu mumakore gumi anotevera.
Saka zvigadziriswa zvakawedzerwa muna Epriv naMay zvakachinja kusarudzwa kwevanhu 1 mamiriyoni (vanhu vashoma mamiriyoni 23 vane inshuwarisi ne2026, kusiyana nemamiriyoni 24). Izvi zvinokonzerwa nehuwandu hwekuti mamiriyoni 4 evanhu vazhinji vachave nevanoshandira-kubhadharwa kwekugoverwa ne2026 pasi pegwaro rekupedzisira reAHCA (kusiyana nemuongorori wekare webhadharo), asi kuti vanhu vashoma mamiriyoni 3 vachave nehuwandu hwekugadzirwa kwemusika.
Mishandirapamwe yeBBCO iyo vanhu vazhinji vachava nehuwandu hwebasa rekushandira pasi pehurukuro ichangobva kuitika yeAHCA zvakananga nokuti vanotarisira kusarudzwa kwekutsvaga mumusika mumwe nomumwe kunoderera muhutano mune zvitsva zvinotsvaga maAWCA (MacArthur Amendment) kubva kune ACA yekudzivirira vatengi . Somugumisiro, vanotenda kuti vamwe vashandirwi vachapa kugoverana kweboka kune vashandi vavo, sezvo sarudzo dzevashandi mumusika usiri weboka huchava hwehutsika hwakanaka (mune zvitsva zvinoda kuregererwa, somuenzaniso, kuvhara kwekuberekwa kunogona kunge kusingazove kunobatsira pamapurogiramu ega emakethe, uye mapurogiramu eC CBO ayo anotasva vana vanogona kutengesa kudarika $ 1,000 / mwedzi).
23 Mamiriyoni Kurasikirwa: Ndiani uye Sei?
Kugadziriswa kwekupedzisira kweCOO yeAHCA ine mapeji makumi mana, uye inotsvaga mune zvinyorwa zvakasiyana-siyana, kusanganisira kubhadharwa kwebhizimusi kuve nemishonga yehutano yehutano yehutano, kushambadzika kwemisika, uye bhadharo yehurumende. Asi ngatitarisei nezvekuratidzwa kwekuti vanhu vane mamiriyoni 23 vangarasikirwa nekugoverwa kwemakore gumi anotevera. Ndivanaani vanhu ivavo, uye nei vachizorasikirwa nekuvhara?
Utano hwezvehutano nyanzvi dzinowanzotaura zvakare kuti mamiriyoni evanhu aizorasikirwa nekugoverwa pasi peAHCA, uye kuti zvigadziriswa zvakawedzerwa kuti zvitsigire kutsigirwa muImba hazvingagadziri kukonzera kushandiswa kwemutemo. Mukupindura, Imba Mutauriri Paul Ryan (R, Wisconsin) akati, hongu, vanhu vashomanana vaizove nehuwandu kana pasina gwaro rehurumende rinoda kuti vanhu vazive. Kana vakamanikidzwa maererano nehuwandu hwevanhu vasingaverengeki ikoko vaizova pasi peAHCA, Ryan akatsanangura kuti "zviri kuvanhu," zvichiratidza kuti kurasikirwa kwekugoverwa kwaizova kuzvidira (kureva kuti, vanhu vangasarudza kuenda pasina kuvharwa kana kubviswa).
Izvi ndezvechokwadi, kune vamwe vanhu. Asi zvakawanda zvekurasikirwa kurasikirwa pasi peAHCA zvaizoitika apo inshuwarisi inenge isingagadziriswi.
Heino kuputsika kunotyisa kweavo vanorongedzwa kuti vasave vasina kuvimbiswa, uye nei:
Muna 2017, 4 Mamiyoni Vanhu Vanokonzerwa Nokudzingwa Kwemutemo Wega Mutemo
IAHCA yaizobvisa chirango chemunhu mumwe nomumwe, ichidzokorora kutanga kwe 2016. Somugumisiro, mapurogiramu eC CBO ane vanhu 1 mamiriyoni (ose ane ruzivo mumusika mumwe nomumwe, kusanganisira kugoverana) aizoderedza kuburitsa kwe 2017 pakati pemakore, kana uye apo mutemo unogadziriswa.
Pakazosvika 2018, mamiriyoni gumi nemana nekuda kwePamusoro yepamusoro uye chirango chekuregererwa
Pakazosvika gore ra2018, kuwedzera kwehuwandu hwevanhu vasina kuvimbiswa (maererano nekuenderera mberi kweAACA) kwaizokura kusvika mamiriyoni gumi nemana, uye muna 2012, iyo yaizokura kusvika mamiriyoni 19. ICBC inotarisa kuti vazhinji vevanhu ava vangadonha kugoverwa nokuti hakuzovi nemvumo yavanoda kuti ive nayo, asi kakawanda, kuchinja kwavo "kwokuzvidira" kuti ive isina uninsured kunouya nekuda kwekuwedzera kwekuwedzera.
Izvi zvingava kunyanya kuitika muna 2020 nekupfuura, apo mvumo yeAHCA inobhadhara mitero yeAACA (zvikwereti zveAHCA zvemitero zvichange zviduku kune vanhu vazhinji, kunyanya kune vanyori vanobhadhara mari vasingakwanisi kutakura mhirizhonga chekuwedzera kwekambani yekuwedzera kwekambani).
ICBC inofanotaura kuti mune zvinyorwa zvinoda kusunungura kubvumira zvirongwa zvekutengeswa pasina kuvhara yose yeAACA inobatsira hutano hunokosha, uye kubvumira vatsigiri vemisika kumunhu mumwechete kuti atsigire zvikwereti pazvenhau yezvokurapa apo vabvunzi vanopedzisira vaine mari, zvikwereti zvinogona kunge zvisingagoneki kune vanhu vane mararamiro aimbovapo uye nharaunda iripo.
Pakazosvika 2021, 21 Million People: Kuwedzera kweMedicaid Kusununguka Kunotamba Basa Guru
Kutanga muna 2021, nhamba yevanhu vanorasikirwa neMedicaid inopfuura kuderedzwa kwehuwandu hwevanhu vane mararamiro emisika. Kubvira ipapo kusvika mberi, kuderedzwa kwehuwandu hwevanhu vane Medicaid ndiyo inonyanya kukosha muhuwandu hwevanhu vane hutano hwehutano.
Izvozvo ndezvokuti AHCA inotadzisa kuwedzera kweAACA's Medicaid kutanga muna 2020. Kubvira panguva iyoyo, kuwedzera kuverengera kweMedicaid kwaizoguma, izvo zvinoreva kuti vana vasina vana vane mari kusvika 138 kubva muzana yehurombo huchazokwanisa kukwanise kunyora muMedicaid mari inowanikwa zvikuru hurumende yehurumende.
Vanhu vatove vakanyoresa kuwedzerwa Medicaid panguva iyoyo vaizoramba vakafukidzwa, asi kana mari yavo yakawedzera pamusoro pe 138 muzana yehurombo uhu, zvichikonzera kurasikirwa kwekukodzerwa kweMedicaid, havazokwanisi zvakare kunyoresa muMedicaid gare gare, kunyange kana mari yavo inodonha zvakare.
Pasi pemitemo yeAACA yezvino, vanhu vanofanirwa neMedicaid vanogona kunyoresa chero nguva, uye kune huwandu hwakawanda hwe "churn" muhuwandu hweMedicaid kuwedzera. Semuenzaniso, mushandi wekanguva uyo ane mari inogadzirisa inonyanya kukosha mukati megore inogona kuva Medicaid-yakakodzera chikamu chegore. Izvozvo zvakashandura shure uye zvichibva kubva pakuwedzerwa Medicaid kusvika kune avo vanoshandira-zvakatsigirwa kana kuti mumwe munhu aizotengeswa mumakethe haazobvumirwi kubvumirwa pasi peAHCA kubva muna 2020.
Nokufamba kwenguva, kuderedzwa kwehuwandu hwevanhu vane kubhadhara-kubhadharwa kunobatsirawo kukura, nekuda kwevanhu vakasarudza kusanyora (nokuti hapazovi nemhosva yemunhu mumwechete) uye nekuda kwevashandi vanosarudza kusapikira (nokuti uko kwaisazove kushandiswa kwevashandirwi chirango). Vazhinji vashandi vangangodaro vachienderera kugovera, asi, sezvo kuita saizvozvo inzira yakanaka yekukwevera nekuchengetedza vashandi vepamusoro. Uye chikwata cheMay CBO chinoratidza kudonha kwevanhu vanosvika mamiriyoni 3 vakafukidzwa nevanoshandira-zvirongwa zvakarongedzwa sekuma 2026-kusiyana nehotera re mamiriyoni manomwe raive rakataridzirwa mukutsvakurudza kwavo kwekare musayiri.
Pakazosvika 2025, Mamiriyoni 23, Kuramba Ari Pasi Iyoyo Kupfuura 2026
Mishonga ye CBO iyo muna 2025, paizova nemamiriyoni makumi maviri evanhu vasina kuvimbiswa muUnited States kupfuura zvaizove kana ACA yaizofanira kugara. Izvi zvinoramba zviripo kuburikidza ne2026, iyo ndiyo magumo ekufungidzira kwezvino.
Pamusoro pezvinhu zvinokurukurwa pamusoro apa, AHCA inogonawo kuchinja federal Medicaid mari kune imwe nzvimbo yekugovera kana kubhadharo, kubva muna 2020. Izvo zvakasiyana nezvinobudiswa zvakasununguka zvematongerwo enyika zvakapiwa nhasi. Chigumisiro chaizova mari yekuchengetedza hurumende yehurumende, asi pasi peMedicaid mari yehurumende sezvenguva inofamba. Kuti vatsigire, inotaura kuti ichange iine sarudzo yekushandisa mari yavo yakawanda paMedicaid, asi vazhinji vangamanikidzwa kuisa kukodzera kuitira kuti vadzivise mari.
AHCA Pakutanga Yakakundikana, Asi Yakadzoserwa uye Yakapfuura neImba
Vose veDemocratic lawmakers vave vachirwisana neAHCA kubva pakutanga, uye vazhinji vevaparidzi veRepublican vanga vatsanangurira nezvemutemo. Izvo zvinosanganisira vatsigiri veRepublican vanozvidya mwoyo pamusoro peMedicaid shanduko vanosiya zvavanenge vasati vasvikidzike, uye inosanganisira kure-right Republicans, kusanganisira House Freedom Caucus, avo vangada mushumo unobvisa zvachose ACA.
Munguva yeBhishopu yeHurumende Komiti inonzwa nezveAHCA, iyo yakaitika mushure mokunge chikwangwani cheBBC chikabudiswa, Mumiririri Tom McClintock (R, California) akataura kuti kuchinja kunoda kuitwa kuAHCA yeruzhinji rwemitero kuitira kuti kuchengetedza kushandiswa kunokwanisika kune vakanyoresa mari shoma (ikozvino mutero unoda kuti vanhu vave nemari inosvika kune $ 75,000, zvinoreva kuti munhu anowana $ 20,000 aizowana rubatsiro rwakafanana nemunhu anowana $ 70,000).
Uye musi waMarch 19, Mutungamiri Ryan akati zvikwereti zveAHCA zvinoshandiswa kugadziriswa kuti zvive nezvisingakwanisi zvevanhu vari mumakore makumi mashanu nemakumi matanhatu. IAHCA inoda kutora chikwereti chakakura chekubhadhara mutero kune vakwegura vakwegura, asi mutemo unobvumira vatsigiri vekubhadhara kuti vatengese vanhu vakwegura vakanyore kashanu kana kupfuura vaduku vanyori (kunze kwehutano hwezvino 3: 1), uye zvikwereti zvinoti zvitsva zvinodiwa hazvizove zvakakwana kuchengetedza kuvhara kwevanhu vari mumakore avo makumi mashanu nemakumi matanhatu nemapato mashoma uye ari pakati.
Mutungamiri weAmendment yakawedzerwa kuAHCA musi waMarch 20 yakanga iri kuedza kuwana vatongi vemapurisa vakawanda, uye zvimwe zvigadziriswe zvakaitwa mumugumo wokupedzisira mukutungamirira kusvika kuvhoti yakatanga kurongwa musi waMarch 23 uye yakadzoserwa kusvikira March 24. Zvakanga zvisina kukwana, zvisinei, uye shure kwemaawa mana ekukakavadzana paImba pasi musi waMarch 24, mutemo uyu wakabviswa maminiti vasati vote.
Nguva pfupi mushure mekunge, Mutungamiri Ryan akapa hurukuro yezvepanhau panguva iyo akati ACA icharamba ichishanda kune ramangwana rakatarisika, uye avo vemuRepublican lawmakers vaizoenderera pane zvimwe zvinhu pane zvavanoronga.
Manzwiro iwayo akanga ari nguva pfupi, zvisinei, uye nevhiki yekutanga munaEpril, mutemo wakadzoka patafura uye pasi pekutaurirana. Asi pakanga paine kukanganisa kwakakosha pakati peNyika Freedom Caucus uye vaRepublicans vane mwero.
Iko Freedom Caucus inoda kubvumira nyika kuti dzisabvise zvinodiwa zvehutano zveAACA, uye bvumira vatsigiri vekuchengetedza vatsigiri kuti vabhadhare vanhu vanorwara vanorwara kupfuura vanyori vane hutano hwakanaka (izvo zvaiwanzoitika pamberi peAACA, asi ACA yakarambidza tsika iyo, zvichibvumira kuti mitengo ienzane chete zvichienderana nezera , zip code, uye fodya). VaRepublican Republic, kune rumwe rutivi, vanonetseka kuti kubvumira vatsigiri vekubhadhara mari kune vakawanda vanorwara vanozobvisa zvachose kuchengetedza kweAACA kune vanhu vane mamiriro ezvinhu akambovapo, iyo ndeimwe yezvakagadzirwa zvakanyanya zveAACA.
Zvinhu Zvitatu Zvichivandudzwa Zvakanga Zvichisanganisira muTatuk CBO Score
Musi waApril 6, House Republicans yakaunza kuchinjwa kwaAHCA (yakatsanangurwa mune mamwe mashoko pano). Chigadziro chacho chaifanira kukwana $ 15 mabhiriyoni muhurumende yezvemari pamakore mapfumbamwe (2018 kusvika 2026) ye "purogiramu isingaoneki yekugoverana nengozi." Iko kushandurwa kwemaji mapeji mana chete uye inosiya zvakawanda zvemashoko kusvika kumitemo yeCMS iyo ichazobudiswa pane imwe nguva inotevera.
Asi zvakakosha, inenge iine hurumende yehurumende inotora zvikwereti zvinodhura zvakanyanya mukuedza kuderedza zvikwereti zvese. Vanhu vane zvikwereti zvinodhura vanoramba vachifukidzwa nemapurogiramu mamwe emishuwarenzi sevamwe vanhu vose (asi zvinopesana nekutengeswa kuti vaparadzanise padzimba dzepamusoro), asi hurumende yehurumende inenge ichitora zvimwe zvinetso kubva kune vanotakura inshuwarisi apo nhengo dzinoda kuwedzera kurapwa. Nokudaro "zvisingaoneki" chikamu, sezvo nhengo dzisingagoni kuona kusiyana kupi maererano nehuwandu hwekuparidzira kwavo kana kuti zvido zvavo zvinoshandiswa sei.
Gare gare munaEpril, MacArthur Amendment yakaiswa mukuedza kukwidza mavhoti kubva muDare reCaucus Caucus. Nzira iyo yakashanda, uye Freedom Caucus yakatsigira AHCA mushure mokunge MacArther Amendment yakawedzerwa. The Amendment inopa nyika chisarudzo chekuita zvimwe zvekudzivirirwa kwevatengi ve ACA. Mune dzimwe nyika dzinotsvaka kusunungurwa,
- Vanhu vane mamiriro ezvinhu akambovapo kare vanotenga kugoverwa mumusika mumwe nomumwe vanogona kubhadhara mapuramiki akakwirira achienderana nemamiriro ezvinhu akambovapo kana aine mukana wekugoverwa kwemazuva masere makumi matanhatu mumwedzi gumi nemaviri asati abatanidzwa.
- Izvo zvinodiwa neAACA zvinokosha zvehutano zvinogona kuiswa patsva, zvichiita kuti kuvharwa kwakanyanya kunopihwa kune vanhu uye mapoka maduku mukati mehurumende. Kubvira sezvo ACA inorambidzwa munguva yehupenyu uye gore negore zvigaro zvigaro, pamwe chete nekuderera kwezvinenge zvisingabhadharwi nehomwe, zvinongoshanda kune zvakakosha zvehutano, tsanangudzo shoma inokosha yehutano inoshandiswa inotsanangurwa inogona kuderedza kuvharidzirwa kweAACA kuchengetedzwa kwevanhu vari mubasa guru boka rekusika uyewo.
- IAHCA inobvumira vanyori vekare kuti vabhadharwe kudarika kashanu kana kupfuura vaduku vanyoresa mumusika mumwe nomumwe uye muduku. The MacArthur Amendment kune AHCA inobvumira nyika kuti iise chiyero chiri pamusoro pechiyero (nokuda kwemaonero, ACA inoitora pa3: 1). Izvo zvakakwirira chikamu ndechekuti, vanhu vakwegura vakanyora vacharemerwa, uye vaduku vaduku vanyori vachapiwa mhosva.
Rimwe shanduko, yeUpton Amendment , yakawedzerwa kuAHCA musi waMay 3, manheru asati apera muImba. IUpton Amendment yaiva mhinduro kune zvinonetsa izvo MacArthur Amendment yaizochengetedza kudzivirirwa kwevanhu vane mamiriro ezvinhu akambovapo.
Inopa $ 8 bhiriyoni pamakore mashanu kuti zvipi zvese zvinoshandiswa kugadzirisa mari yakakwirira iyo inogona kutakurwa nevanhu vane hutano hwakagara huripo hunova neruzivo rwekugovera uye dzinoda kutenga chirongwa mumusika mumwe nomumwe. Izvi zvinofadza VaRepublicans vakakwana kuti AHCA ipinde muImba, asi kune zvinonetsa zvinoramba zvichiitika kuti mari yakawanda yakanyanya kuderera kuti ipe kudzivirirwa zvakakwana kune vanhu vane mamiriro ezvinhu akambovapo (CBO yakasimbiswa muna May yavo kuongorora $ 8 mabhiriyoni ichave isina kukwana mari).
IC CBO yakanga isati yapera kugadzirisa zvinhu zvitatu zvitsva zvigadziriswa panguva iyo House yakasarudza paAHCA. Izvi hazvishamisi, zvichipiwa kuti Upton Amendment yakawedzerwa maawa mashoma vasati vote. Asi kutarisira kwaiva kuti AHCA yakagadziriswa yaizoguma ichikonzera tsananguro inoshamisa muzinga risina kuvimbiswa, kubvira panguva yaro yose yakaderera.
Zvechokwadi, mapurogiramu eC CBO ayo akashandurwa shanduro yeAHCA ichaita kuti vanhu vane mamiriyoni 51 vasina kuvimbiswa vawane 2026, kunze kwemamiriyoni 28 kana tikaramba tichiine ACA.
> Sources:
> Congressional Budget Office, American Health Care Act, March 13, 2017.
> Congressional Budget Office, IAmerican Health Care Act neMutungamiriri weAmendment , March 23, 2017.
> Congressional Budget Office, HR1628, IAmerica Health Care Act, inodhura mari , My 24, 2017.
> C-Span, Budget Komiti Yakagadziriswa Nechirongwa Chinotarisirwa Mutemo Kudzokorora Bhiri, Chikamu 2, March 16, 2017.
> Imba GOP, IAmerican Health Care Act (inosanganisira zvinyorwa zvinyorwa zvepa bill).
> House.gov Chirongwa cheMutungamiri weAmerica Health Care Act, Kuchinja Kwematongerwo , March 20, 2017.
> House.gov Chirongwa cheMutungamiri weAmerica Health Care Act, Kuchinja Kwemishonga , March 20, 2017.