Zvakaoma kunzwisisa kudarika kubviswa uye kushandiswa pakupedzisira zvinopindirana
Apo Donald Trump akakunda sarudzo yepurezidhendi munaNovember 2016, remangwana rehutano inshuwarheni muUnited States zvakangoerekana zvanyanya mu-limbo -apo vanhu vaitanga kuenzaniswa neCountable Care Act (aka, Obamacare).
Hapana mubvunzo kuti kushandiswa kweAACA kwaiva nematambudziko akawanda mumakore mashomanana apfuura, asi yakanga yasvika zvakanaka mumakore ekupedzisira 2016.
Nguva yechina yekunyora yakasununguka pamusika mumwe nomumwe (pane uye kunze-kushandiswa-kushandiswa ) yakanga iripo. Vashandi vakanga vava kupinda mugore ravo rechipiri kana rechitatu (zvichienderana nehukuru hwavo) hwekuteerera dare reAACA . Vanhu vaive vachinzwa mibvunzo pamusoro pehutano hwehutano hwehutano pamitero yavo yezvemitero, uye chirango chakanaka chevanhu vakanga vasina kuvimbiswa mukati megore.
Vanhu vakanga vashandura kuti mamiriro ezvinhu akagara asati aripo haasisiri chipingamupinyi paunenge uchitsvaga inshuwarhu yehutano, uye kuti kune vanhu vanotenga kugoverwa mumusika mumwe nomumwe, rubatsiro runowanikwa kuti hubvise mari, zvichienderana nemari inowanikwa ( izvi zvakabatsira kutarisa munda wekutamba kune vanhu vanozvitengera utano hwavo hwehutano inshuwarisi , sezvo vanhu vane vashandi-vanochengetedzwa nehutano inshuwarisi vaigara vachiine rubatsiro rwakakosha).
Zvino kamwe-kamwe, zvinhu zvose zvakanga zviri mumhepo. Mutungamiri Trump akasimbisa pachivimbiso chokuti aizodzinga ACA; purogiramu yake yepasiti yepaiti yakati, "Pazuva rimwe rekutonga kweTrump, tichakumbira Congress kuti itaure zvakakwana kubviswa kweObamacare."
VaRepublicans vakachengetedza hukuru hwavo muHarare uye Senate, uye vave vachitsvaga kubvisa ACA kubvira apo yakagadzwa muna 2010. Maitiro avo apfuura akanga ataderedzwa neMutungamiri weBotswana Obama puroti, asi iyo haisisiri chipingamupinyi pasi pekutonga kweTrump.
Kudzokorora ACA Haisi Semainyo Sezvo Inonzwika
Pakarepo musangano wekusimudzira 2017 wakatanga, Senator Mike Enzi (R, Wyoming), Sachigaro weSénate Budget Committee, vakataura sarudzo (SCRS 3) kuti vatange kurongedza ACA vachishandisa kuyananisira bhajeti.
Enzi sarudzo inopa mirayiridzo kumakomiti mana ekugadzira mitemo, kusanganisira kukanganisa kuderedza, iyo inofanira kuendeswa kuBurget Committee. Makamuri maviri eCongress akanga apfuura SCR 3 kusvika pakati paJanuary, uye congressional komiti dzave dzichishanda pane zvinyorwa zvekubvisa mitemo kubvira ipapo.
Congressional Republicans anoronga panguva iyoyo yaifanira kupedza mushure mekugadzirisa kubhadhara mushure pakarepo. Zvakatarisirwa ndezvokuti zvaizove zvakafanana neH HR3762, iyo yakapfuura kutanga kwegore ra2016 asi yakarambidzwa naMutungamiri Obama.
Kuti zvive zvakajeka, hazvina mavhoti aidiwa kupedza kubviswa kwakakwana kweAACA, sezvo izvo zvingada mavoti makumi matanhatu muSénate kuitira kukunda filibuster. Asi kubhadhara-iyo inotarisa chete mari yekushandisa-inogona kupfuura nehuwandu huri nyore, uye haisi pasi pehuwandu. Bhiri rekuyananisa rekubhadhara mari yeAACA inogona kupfuura ne 51 Senatori vachivhota nokuda kwayo, uye kune 52 Republican Senators muna 2017.
Kutsigirwa kwepa Premium, kugovana-kudhura mari, uye kuwedzera kweMedicaid zvingave zvisingabviswi nemutemo wekuyananisa. Saka dai ACA mitero yakafanana neyemushandi wekutonga chirango, chirango chemunhu mumwe nomumwe, uye zvinhu zvakadai semutero wemichina yezvechiremba uye Cadillac Tax yet-to-be-implemented.
Bhiri rekuyananisa haringazokwanisi kuderedza zvikamu zvisina kushandiswa-zvinoshandiswa zveAACA, sezvakavimbiswa-nyaya inoshandiswa (pasinei nenyaya yezvokurapa), hutano hunobatsira , nekubvumira vechidiki kuti varambe vari muzvirongwa zvehutano hwevabereki vavo kusvikira vava nemakore 26 Asi kana ACA ichitsvaga, zvikamu zvakasara zvayo hazvizopona kunze kwekunge mamwe matongerwo emutemo akatorwa kuti agadzikane pamusika we inshuwarisi.
Chii Chinouya Nezvekupedzisira?
Congressional Republicans dzakatamhanya nekukurumidza kutanga chirongwa chekubvisa ACA kuburikidza nokuchirasa, asi hachisati chabatana nechinangwa chekugadziriswa. Nhengo dzeGOP dzakawanda dzekugadzirisa ACA dzakagadziriswa mumakore mashomanana apfuura, kusanganisira House Speaker Paul Ryan " Inzira Yakanakisisa" , uye Tom Price ekugonesa Patient First Act ye 2015 (HR2300)-iyo yakakosha kukosha apo Mutengo wakasarudzwa kutungamirira HHS pasi pekutonga kweTrump (Senate yakasimbisa kusarudzwa kwake muna February 2017).
Zvinoratidzira zvinowanzova nehuwandu hwepfungwa dzakafanana, saka tine pfungwa yakajeka yekutungamirirwa umo Congressional Republicans inoda kuenderera mberi.
Zvikwereti zvitsva zvitsva zvakatangwa mumavhiki ekutanga emusangano we 2017 wekutonga, kazhinji hutevera maitiro akawanda akafanana akataurwa muzvakaitika kare zveRepublican nezvehutano hwekugadzirisa zvirongwa. Asi hapana kana mumwe wavo akawana rubatsiro rwebipartisan kana kunyange rubatsiro rwakakwana kubva kuRepublican side yevhiri.
Muchidimbu, tsanangudzo chaiyo yezvingazogadzirisa ACA haisati yavapo. Vamwe veAmerica vari nani pasi peAACA, uye vamwe vari kuipa, asi hapana kana mumwe wavo akawana mukana wekuona kunyatsogadziriswa. Uye zvichida kunyanya kukosha kwezvose, inshuwarhu yehutano yehutano uye hutano hwemakambani haazive kuti chii chinotevera.
Vatungamiri veChishanu vakataura kubva pakutanga kuti hapazovi nekushaikwa kwekutaura. Kunyange zvazvo vakagara vachitaura kuti chirongwa chavo ndechokubvisa ACA nokukurumidza sezvinobvira, havana vavariro yekuita kuti kudzokorora kuite basa pakarepo. Kuzononoka kwemakore maviri kusvika mana kukanganisa kushandiswa kunenge zvichida, zvinoreva kuti vanogona kuvhota kuti vadzidzise ACA mumavambo-pakati pa20177, asi kubviswa kunotora nguva imwe pakati pa2019 na2021.
Chikonzero chekunonoka kudzokorora kushandiswa ndechokupa vateereri mukana wekushandura tsanangudzo yekubhadhara mari, kuifambisa, uye kuva nenguva yekuwana zvikamu zvose panzvimbo iyo kuti zviitwe panguva imwe chete neAACA kubviswa. Rep.Chris Collins (R, New York), uyo ari nhengo yeboka reTrump Transition, akati pakutanga kwaJanuary 2017 kuti mutemo wekugadzirisa hurumende ungangotanga kuitwa munaJune kana munaJuly 2017. Akadzokorora zvakare kuti hapana chinogona kuchinja nezvehutano zvirongwa muna 2017 kana kuti 2018, asi vakati kudarika kwekupedzisira kweAACA kwaidiwa nokuti vateereri vanga vachironga kupedza zvinhu zvakadai se "mutero wemichina yezvokurapa, mutero wehutano hwehutano pamakambani ehurumende yehurumende, mushandi wevashandi, mushandi wevashandi [achitaura nezve mumwe mandit]]. "
Imba Mutauriri Paul Ryan (R, Wisconsin) akati anotarisira kubviswa kwevhoti kuti zviitike muna March kana Aprili, asi Mutungamiri Trump, uyo aimbove achitaura pamusoro pekubviswa kwevhoti pakupera kweJanuary, ambotaurwa pakutanga kweFebruary kuti kubviswa kuvhota hakugone kuitika kusvikira muna 2018.
Ndezvipi Zvinhu Zvinotaurirwa
Mharidzo iyo Congressional Republican yakabudisa inofadza kune vakawanda veAmerica:
- Dzorera ACA, asi kwenguva yakareba kuitira kuti vanhu varege kurasikirwa nehuwandu hwavo pavanenge vakamirira kuchinja.
- Chirongwa chinotsiviwa chakaitwa nevatongi chichava nani kupfuura ACA (kunyange pasina kuona mutemo chaiwo, vanhu vangotora shoko ravo nokuda kwayo), uye izvo zvicharongwa kuti zviitike panguva imwe chete nekubviswa kweObamacare, pasina gap pakati.
- Kamwe kubviswa kweimwe yemitero yeAACA, kusanganisira mushandi wevashandi uye chiremera choga, izvo zvese zvave zvisingafarirwi.
Zvazviri Chaizvo Zvinoreva
Izvozvo zvinonzwika zvakanaka. Asi patinotarisa pasi pe hood, pane zvishoma zvishoma zvisingakoshi. Dare reCongressal Budget Office rakaratidza kuti dare reAACA nemishandiro evanhu, pamwe neCadillac Tax, inounza $ 297 mabhiriyoni mumari kubva muna 2016 kusvika muna 2025. Izvo zviwanikwa zvinoshandiswa kubatsira kubvisa mari yeAACA, iyo inosanganisira kudyidzana kwehurumende pamusoro pekubatsira mari uye Medicaid kuwedzera.
Kana izvo zvikwereti-izvo zvinobudisa zvikamu zveAAC zviri kubviswa munguva pfupi iri mberi, zvinogona kuguma kuve zvipingamupinyi zvemari kuti varambe vachipa rubatsiro nekuwedzera kweMedicaid.
Asi pane zvimwe zvinetso zvakakomba zvinogona kusimuka kana Congress inosarudzwa nokukurumidza kubvisa ACA (kunyange nekumhanya kunonoka kushanda) uye zvino kumirira mwedzi yakawanda kuti itaure mutsigiri wemitemo. Zvimwe zviviri zvakakosha ndezvokuparadzwa kwehutano hwehutano inshuwarisi uye zvichida kuti mari yekutsiva isingatombopfuuri.
Iwe Unorevei, "Kuparara Kwehutano Wehutano Inishuwarenzi"?
Nguva yekunyora yakasununguka kwekugoverwa kwe 2017 yakangoguma, asi inshuwarisi yevatano vehutano vatove yakanyanya kufunga nezvekugadzirira kwe 2018. Kune vatakuri vanoda kupa zvirongwa munzvimbo yemusika (facilitally-facilitated marketplace) (kureva, HealthCare.gov) muna 2018, mitengo uye zvirongwa zvokugadzirisa inofanira kuendeswa musi waMay 3, 2017 mune dzimwe nyika apo hurumende yehurumende inotora chirongwa chekuongororwa kwezvikwereti (Missouri, Oklahoma, Texas, uye Wyoming), uye neJuly 17 mune dzimwe nyika.
Kana ACA ichibvisa mitemo yakatopfuura nepfungwa iyoyo, asi kushandiswa kwacho hakuna kuiswa uye / kana kupfuura, hutano hwehutano inshuwarheni huchange huri kutarisana nekusava nechokwadi kwakanyanya maererano neurongwa hwavo hwekureba.
Izvo zvakaenzana nevatakuri kana pasina chakaitika zvachose maererano nemitemo-kusanganisira kubvisa mitemo-nenguva iyo mitero uye zvirongwa zvinofanira kuiswa. Vakatakura vanoziva kuti zvinhu zvose zviri mumhepo, izvo zvinodzokorora zviri patafura, uye izvo zvinotsiviwa hazvina chokwadi.
Vamwe vatakuri vanogona kuenda mberi uye kuisa mahara uye zvirongwa zve 2018 (zvinowanzove nezvikwereti zvakakwirira zvavaizouya kunze kwekusava nechokwadi panguva ino yakapoteredza pamusika mumwe nomumwe). Asi vamwe vanogona kusarudza kuti kusava nechokwadi kune ngozi yakawandisa, uye kungosarudza kubuda kugoverana kana kumusika wega wega pamagumo e 2017.
Kana iyo mvumo yega yega ichibviswa asi kugoverwa kuchiri kuve kwakagadziriswa-muna 2018, zviri nyore kuona kuti nei vatsigiri vangave vachikanganiswa nepfungwa yekuenderera mberi kupinda muchikwata. Kana zvakadaro, zvingava zviri nyore kupfuura kare kuti vanhu vane hutano vaende pasina ruzivo, uye nzvimbo dzekuisa njodzi dzaizoramba dzichienderera mberi kune vanotora zvirwere, zvinoreva kuti vatsigiri vangave vachida kuti vasazobatana zvachose, kana kuti kubatanidzwa nezvikwereti zvakakwirira zvikuru.
Mutungamiri weTrump akataura kuti ivo vachave vachiraira mitemo inotarisirwa kugadzirisa hutano hwehutano inshuwarheni, asi inoramba ichionekwa kana mitemo ichange yakawanda kuchengetedza vatsigiri vekambani ye 2018, uye kudzivirira zvikwereti kubva pakukwira zvinoshamisa.
Kune vazhinji vehutano vehutano, mutengesi mumwe nomumwe ichinyanya chiduku chebhizimisi ravo rose. Zakawanda zvebhizimisi ravo zvinowanzobatanidza zvirongwa zvemapoka (kana kuita sevatariri vezvikwata zvekuzvipira zveboka guru), zvirongwa zve Medicare Advantage, uye zvirongwa zvekutarisira Medicaid. Kubuda mumusika mumwe nomumwe haisi chisarudzo chavanotora zvishoma, asi hachisiwo chisarudzo chinogona kukanganisa basa ravo rose munguva refu.
Kana Kushandurwa Kusati Kwakambopfuura
Imwe dambudziko nekudhinda ikozvino (nekukurumidza kushandiswa) uye zvino kushanda pakugadzirisa kushandiswa ndeyokuti kushandiswa hakugone kubuda pasi. Zvichida Congress haigoni kubvumirana pamusoro pekugadziriswa kwekugadziriswa, kana zvichida haigone kuita kuti nhamba idzi dziite basa maererano nemari yehurumende panzvimbo yekugadzirisa.
Sezvakaratidzwa nehurefu, hutsvene hwekukakavadzana uye kudarika ACA kumashure muna 2009/2010, zvakajeka kuti kuwana chibvumirano pamusoro pehutano hutsva hwekugadzirisa kurapa kwehutano hakuzovi nyore.
Uye chii chinoitika kana vasingakwanisi kuwana chinhu chipi nechipi chakapfuura maererano nekugadzirisa? Muchiitiko ichocho, kubhadhara chikwereti chaizoramba chiripo, nekuzadzisa kushanda kwakagadzirirwa 2019 kana kuti gare gare. Uye kana pasina chinhu chiripo kuti chigadzirise, mararamiro ekudengenyeka anotsanangurwa pamusoro apa aizotonyanya kushamisa, sezvo mamwe maitiro eAACA (akadai akachengetedzwa-issue coverage) achange achiripo, asi vamwe (semutungamiri mumwe nomumwe uye rubatsiro rwepayimusi) yaizobviswa.
Pakati pevanhu vane mamiriyoni makumi maviri nemakumi matatu vangangodaro vanorasikirwa neinishuwarenzi kana ACA yakabviswa uye isati yatsiviwa nechinhu chakafanana zvakasimba. Hurumende yeBongress yeBongress inofungidzirwa munaJanuary 2017 kuti vanhu vanosvika mamiriyoni 18 vangarasikirwa nekugoverwa mugore rokutanga mushure mekunge musangano wakafanana neH HR3762 wakapfuura, uye kuti nhamba yevanhu vanorasikirwa nekugoverwa ingadai ichikura kusvika mamiriyoni makumi maviri nemakumi anopfuura gumi.
Trump Inoti Chirevo Chinozofanana
Pakati pemhirizhonga pamusoro pezvikamu zviviri zvemutemo zvichitanga mwedzi yakawanda pasina, Several Republican senators vakatanga kutaura kusava nechokwadi pamusoro pesarudzo. Randi Paul (Kentucky) Lamar Alexander (Tennessee), naTom Cotton (Arkansas) vose vakataura kuti zvingava nani kutarisa kubviswa kwevhoti kusvikira kugadziriswa kurongwa kuripo. Pane chiitiko chiduku asi chiri kukura kuti kudzokorora pakarepo kubhadhara hakukwanisi kupfuura kana kugadzirisa mitemo isati yagadzirira kuenda panguva imwe chete.
Munguva yehurukuro yehurukuro yaJanuary 10, Trump yakati mabhiriro ekubvisa uye kutsiva ACA yaizobudiswa "zvichienderana panguva imwechete" mushure meRep Price inotsigirwa kutungamirira HHS (Mutengo wakatsigirwa musi waFebruary 10). Trump yakanyora zvishoma, ichiti "Zvichava zvikamu zvakasiyana-siyana, iwe unonzwisisa, asi zvingangodaro zviri pazuva rimwechete kana kwevhiki imwe chete, asi zvichida zuva rimwe chete.
Izvozvo zvinomanikidzira zvakanyanya kune vateereri vemitemo kuti vauye pamwe chete vachipoteredza hurongwa hwekugadzirisa nokukurumidza sezvinobvira, asi izvo zvingave zviri nyore kutaura pane kuita. Nokuti ikozvino, remangwana reAACA rinoramba riri mumhepo. Asi apo pundits achitaura pamusoro pokuti hapana chinetso ne "kubvisa uye kunonoka" nokuti chirongwa ichi chitsva chinozoguma chichitsvaga sezvakangoitwa neAACA, gara mupfungwa kuti yakaoma zvakaoma kupfuura izvozvo.
> Sources:
> Congress yeUnited States, Congressional Budget Office. Yakavandudzwa Budget Projections, 2015 kusvika 2025 . March 2015.
> Dhipatimendi Rezvoutano uye Human Services. 2018 Tsamba kune Vashambadziri muMusika weChechi. December 16, 2016.
> DonaldJTrump.com. Healthcare Reform. 2016 mushandirapamwe.
> Price, Tom, US House of Representatives. Kupa Mwoyo Mwoyo Murefu First Act wegore ra2015. May 11, 2015.
> United States Senate Komiti yeBhujiro. Senate Kutanga Nharo pamusoro peUbamacare Kudzoka Kugadziriswa. January 3, 2017.