Kuchinja kwehutano kwehutano kwave kuri nyaya yezvematongerwe enyika muU.S. kwemakore mazhinji, uye neTrute Administration panzvimbo, ramangwana reAne Affordable Care Act harina chokwadi. Chii chinoda sangano rimwe nerimwe? Ngatitarisei kuti mapurisa eDemocratic Party neRepublican Party angakanganisa sei inshuwarano yehutano.
Chimiro cheMutengo Wakatengesa Care Act
MaDemokorasi anowanzotsigira ACA, asi anoda kugadzirisa kukanganisa kwake uye kazhinji kuvandudza mutemo.
VaDemokorasi vakaratidza kuti inogona kuwedzera ACA kumativi eUnited States, uye vanoda kupa simba nyika kuti dzishandise innovation (i32 waivers) kuti dzigadzirise nzira dzavo dzehutano hwekugadzirisa hutano hwakanaka-kana huri nani pane-ikozvino. Vazhinji veMademokorasi vanotsigirawo kugadzirisa "ACIT" yemhuri yeAACA kuburikidza nekugadzirisa kukwaniswa kwekushandira-kubhadhara mari yekubhadhara pamitambo yemhuri panzvimbo pevashandi-pamba chete.
Trump uye vazhinji veRipublicans vanoda kubvisa ACA uye kutanga ne nzira itsva. Ikoko kunogona kunge kune kumwe kushanduka kuno pano; vaviri Republican Senators vakaunza mutemo munaJanuary 2017 iyo yaizopa nyika sarudzo yekuchengetedza ACA kana kuchinja kune imwe nzira.
Kuwedzera kweMedicaid
Medicaid kuwedzerwa ibwe rekona yeAAC uye nhoroondo dzechikamu chikuru chekuwedzera kwemaAmerica vane inshuwalhu yehutano.
IAACA yakadana Medicaid kuti iwedzere mumamiriro ose enyika, kupa hupfumi kuvanhu vane mari yemhuri kusvika 138 muzana yehurombo huno.
Asi Dare Repamusorosoro rakatonga muna 2012 kuti kuwedzera kweMedicaid kwaizova kukodzera kwehurumende, uye sekutanga kwegore ra2017, pakanga paine hurumende 19 dzisina kubvuma federal mari yekuwedzera Medicaid.
Muna 18 mune iyo nyika (zvose kunze kweWisconsin), kune dambudziko reMedicaid; vanhu vanosvika mamiriyoni 2,6 vakanamatira vasina ruzivo rweMedicaid kana kuti premium rubatsiro mune iyo nyika.
VaDemokorasi vanoda kudzvinyirira kuAACA's Medicaid kuwedzera mune zvinyorwa 19 izvo zvisati zvawedzera kuparidzirwa, uye zvinopesana nezvirongwa zvekuvhara mari Medicaid mari kune iyo nyika (block block zvinyorwa zvinosanganisira kubvisa purogiramu yehurumende inoenderana nemari inobva muhurumende Medicaid mari, uye panzvimbo pacho kupa hurumende mari yakatarwa yehurumende yemari yekushandisa sezvavanoona yakakodzera purogiramu yavo yeMedicaid).
VaRepublicans vanoda kubvisa ACA, iyo inosanganisira kubvisa Medicaid kuwedzera. Nzira yavo yakasarudzwa kuMedicaid ndiyo kubvumira, uye mapurati anotaura kuti vachapa nyika ruoko rune rusununguko rwekuvandudza Medicaid nechibvumirano-kupa chirongwa pasina michina. VaRepublicans vakagadzirirwawo neve-capita Medicaid zvikamu zvekutaura.
Health Savings Accounts
Health Maintenance Accounts (HSAs) ndeyekodhi dzakabhadharwa nemitero iyo vanhu vanogona kushandisa kushandisa mari yekubhadhara mari yemangwana yekutarisira utano. Iko kunofanana ne trifecta yekubhadhara mutero:
- Mari yaunoisa muakaiti yacho inotsvaga pamutero wako wekubhadhara (kana kuti iwe usati wateresa kana iwe uchipa muHSA yako kuburikidza nemari yekubhadhara).
- Mari iri munhoroondo inowedzera musero-isina.
- Iwe hausati ubhadhara pamari kana iwe uchibvisa, chero bedzi iwe uchiushandisa kubhadhara mari yakakodzera yezvokurapa (vamwe vanhu vanoshandisa aya maakaita seMutambo IRA, sezvo mari inogona kubviswa nokuda kwezvinangwa kunze kwemari yezvechiremba pasina chirango pashure pemakore makumi matanhatu nemashanu. Asi mumamiriro ezvinhu akadaro, kuregera kunenge kuri pasi pemutero wenguva dzose).
Ikozvino IRS mitemo inobvumira vanhu vane HSA-vakakodzera High Deductible Health Plans (HDHPs) kuti vabatsire kune HSA, uye kune mitezo yemiganhu: Muna 2017, mari yakawanda yaunogona kuisa kune HSA inodarika $ 3 400 pamunhu, kana $ 6 750 kana Hupenyu hwako hweHDHP ndewemhuri.
Kunyange zvazvo HSAs chokwadi chiri chinhu chakakosha chekubhadhara mari yemazuva ano yekuchengetedza utano-uye kubhadhara mitero inokosha-tinofanira kugara tichiyeuka kuti rubatsiro rwavo chete rwunowedzera kusvika kumunhu uye kukwanisa kubhadhara kambani. Sezvo vakadaro, vanowanzofarirwa nevaya vane mari yakawanda.
VaDemocrates havana kurongedza chero kuchinja kukuru kune mitemo yemazuva ano iyo inotarisira Maintenance Savings Accounts.
Republicans, kune rumwe rutivi, funga HSAs kuti inogona kunge inogona kugadziriswa kwehutano sarudzo. Mutsara wekutanga peji yehutano yeTrump panguva yemushandirapamwe wakataura kuti " Dzorera uye ushandure Obamacare neAalth Savings Accounts ." Vakaronga kushanduka kwakasiyana-siyana, kusanganisira mirefu yakakura yemipiro (zvichida yakabatana neHDHP yakabviswa), mitemo shoma kune avo vanogona kupa mukana weHSA, nemimwe mitemo yakasununguka maererano nezvokuti mari yeHSA inogona kushandiswa sei pasina mitero kana chirango.
Zviviri zvezvikwereti zvakatangwa neRepublican Senators munaJanuary 2017 zvakadudzira kuchinja kunosanganisira HSAs: Patient Freedom Act inoshandura HSAs kuRoth HSAs (zvipo zvingasazobviswa, asi kukura kwaizova kusingabhadhara mutero, uye kuregererwa kwezvokurapa kwaizova mutero -kusununguka), uye yaizowedzera muganhu wemugove. Bhuku reObamacare Replacement Act raizobvisa miganhu yemipiro zvachose, uye raizobvumira HSAs kushandiswa nevanhu vasina HDHPs.
Premium Subsidies uye Affordability
Izvi zvinonyanya kukosha munguva yemitengo yemishonga yemishuwarenzi yehutano uye kugona kwave kuri mumusika mumwe nomumwe , uko maitirwo akawedzerwa zvinotyisa kusvika muna 2017. Mumwe mutengesi chikamu chiduku zvikuru chevanhu, zvisinei, uye kuwedzerwa kwekuwedzera kwave kwakanyanyisa kudarika vanhu vakazara.
VaDemokorasi vave vakaronga nzira dzakasiyana-siyana dzekugadzira uye kuchengetedza mari. Zvinosanganisira kubhadharwa kwemitero kune vanhu vane mari yekudarika mari yepamusoro inodarika 5 kubva muzana yemari yavo, nekuwedzera mari yepamusoro kuti vaone kuti hapana munhu anofanira kubhadhara kupfuura 8.5 kubva muzana yemari yekubhadhara mari, iyo inogona kubvisa "nzvimbo yekubatsira" iyo ikozvino kune vamwe vakanyoresa.
VaDemocrat vakagadzirirawo "chirongwa chevanhu vose" hurongwa hwehutano hwakanga huchikwikwidzana nehutano hwehutano inshuwarisi vanotakura mukuedza kuburitsa mutengo, uye kukwanisa kwevanhu vane makore makumi mashanu nevekare vanotenga muMedare, izvo zvino zvinopa kugoverwa kutanga apo vanhu vanosvika 65 .
Democrats anodawo kupa hurumende simba rekuvhara kuwedzera kwehuwandu hunoonekwa seisina kukodzera. Parizvino, kuva ne "sarudzo yekubudirira kwehuwandu" chirongwa, hurumende-kana hurumende yehurumende-inongofanira kuongorororodzwa mitengo yakatarwa uye kuongorora kana vakarurama kana kwete. Asi kunze kwekunge hurumende yakagadza mitemo inovabvumira kudzivisa maitiro asina kukodzera, hapana chakavakwa-mugadziriro yeiyo. Zvinofanira kuonekwa, zvisinei, kuti mitemo yemazuva ano yekurasikirwa kwemitemo inoda bhizinesi kuti vatumire kudzokera kune nhengo kana maitirwo ehurumende anodya zvinodarika makumi maviri kubva muzana yemarikiti; izvi zvinogadzira zvimwe zvidziviriro zvakadzivirirwa pamutengo wekutengesa kwechinangwa chekutyaira purogiramu kana hutungamiri hukuru.
VaRepublicans vakagadzirira kubvumira vanhu kuti vabvise zvakakwana zvikwereti zvemishonga yehutano yehutano pamitero yavo, iyo inogona kuderedza mari chaiyo yekugoverwa. Zvikwereti zvemishonga yehutano yehupfumi yemari inobhadharwa nevashandirwi ikozvino inobhadharwa kusati yateresa, uye vanhu vanozvishanda vanogona kudhara miriyamu yavo.
Asi vasiri vashandi vanozvidzivirira vanotengesa hutano hwavo hwehutano havakwanise kutora zvimiridzo zvavo panguva ino kunze kwekuti ivo vaite zvido zvavo. Kana vachiita itemize, vanobvumirwa chete kubvisa mari yezvechiremba-kusanganisira zviyero- izvo zvinodarika 10 muzana yemari yavo . Izvi hazvinyanyobatsiri kune vanhu pane mitemo yezvino yevashandi-vanobhadhara inshuwarisi uye vanhu vanozvishanda.
VaRepublicans vanodawo kutendera vanhu kutenga hutano hwehutano muhutano hwehurumende kuitira kuti kuwedzera kukwikwidzana uye kuburutsa mutengo. Zvisinei, hazvina kujeka kana vatsigiri vangave vachida kuwedzera nzvimbo dzavo dzekugadzirisa nzvimbo, nekuda kwezvinetso zvinosanganisira nekuvaka nhare munzvimbo itsva.
Panewo mibvunzo pamusoro pekutonga kwekutonga, sezvo kuiswa kwemazuva ano kunobvumira hurumende yehurumende yeInishuwarenzi yehurumende kutonga zvirongwa zvose zvinotengeswa munharaunda iyoyo (kunyange zvazvo makambani einishuwarenzi anowanzotarisirwa kune imwe nyika), zvinoreva kuti vatakuri vanofanira kuchinja kugoverwa kunopiwa humwe hurumende hunoenderana nehumwe hurumende mitemo. Kana iyo mitemo yekudzora yakabviswa nokuda kwenyika dzisati dzaitika uye ACA yaiparadzaniswa panguva imwe chete, kuchengetedzwa kwevatengi zvingangoderera sekuti vatsigiri vangazosarudza kugarisa muhurumende nemitemo ine mireza.
Kubata pamuviri uye Kubvisa pamuviri
Izwi rokuti kubvisa pamuviri rinoshandiswa makumi matatu nemaviri muRepublican Party Platform, asi kanowanika katatu muDemocratic Party Platform. GOP inoita kuti zvive zvakajeka kuti vanoda kuparadza yose federal mari yehurumende dzakadai sePlned Parenthood dzinopa rubatsiro rwekubvisa pamuviri. Uye nepo Democratic Party inofunga kuti "kubvisa pamuviri kwakachengeteka kunofanira kuva chikamu chekuchengetedza kwakakwana kwehutano hwevakadzi nevakadzi," GOP "yakasimba zvakasimba" kubvisa pamuviri. Trump yakagamuchira maitiro akafanana nekubvisa pamuviri .
I Hyde Amendment yave iri munzvimbo kubva muna 1976, uye inorambidza kushandiswa kwemari yehurumende kubhadhara pamuviri munguva dzakawanda. Kunyange zvazvo Democratic Party Platform ichidaidza kubviswa kweHyde Amendment, Republican Party Platform inoda kukosha kwayo uye "kushandiswa kune hurumende, kusanganisira Obamacare."
VaDemocrates vanowedzera kutsigira kweAACA kuti hurongwa hwehutano hwehutano hunofanirwa kuvhara kubhadhara pasina kugovera mari, uye vatungamiri veDemocratic vakakwanisa kubatsira pakuita zvekudzivirira kwepabonde kune-in-counter.
I Republican Party Platform inopikisa makiriniki anochengetedza chikoro anopa mishonga yekudzivirira, uye anoramba pfungwa yekubvumira "mishonga yekurapa ine simba" inotengeswa pamusoro pe-counter. Asi Trump yakataura kuti inobvumidza kubvumira kutengesa kwekudzivirira kwemishonga pasina mushonga.
Zvirongwa Zvichiripo
IAACA yakachinja chiso chemushuwarisi hwehutano hwega kuburikidza nekuita kuti ive yakagadziriswa-dambudziko munyika dzose, pasinei nemamiriro ezvinhu akambovapo. Mapoka ehutano ehutano hwezvehutano akanga atofanirwa kuvhara mamiriro ezvinhu akambovapo, asi aikwanisa kuisa mamiriro ekutanga akachengetwa mamiriro ekumirira asati asvika 2014 (kuti ave pachena, bhizimisi vaibvumirwa kukwereta vashandi mapeamendi makuru mumatunhu mazhinji zvichienderana nezvenhoroondo yezvakaitika zveboka, asi vamwe vashandi havana kukwanisa kurambwa kubva purogiramu yeboka nekuda kwezvakaitika kare.
Iye zvino sezvo ACA yakashandiswa, mamiriro ezvinhu aimbovapo anowanikwa pane zvirongwa zvose (kunze kwemakisi ega ega akange aine zvirongwa) pasina nguva yekumirira. Vashandi vanogona kunge vachiri kumirira kwemazuva makumi mapfumbamwe asati agadzirisa, asi kana ikangoita, mamiriro ezvinhu akambovapo akavharwa pasina nguva yekumirira.
VaDemokorasi vanoda kuchengetedza ACA, kusanganisira zvigadziro zvinodzivirira vanhu vane mamiriro akambovapo.
Zvimwe zveRepublican zvigadziro zvinoda kubviswa zvakakwana kweAACA, izvo zvinoreva kuti mamiriro ezvinhu akambovapo aigona zvakare kubvumira inshuwarisi kuti irege kupararira mumusika mumwe nomumwe, kana kuisa nguva yekumirira mumusika weboka. Zvimwe zveRepublican zvinorayirwa zvinoda kuti kuchengetedza kuchengetedzwa kwevanhu vane mamiriro akambovapo.
MuRepublicans zvigadziro izvo zvingazobvisa maAAA anovimbiswa nhaurirano, pane dzimwe nheyo dzekuvandudza dzimba dzepamusoro-pangozi dzemvura kuti dzishandise vatengi vane mamiriro akambovapo. Trump akatiwo mari yake yekutsvaga (sekubvumira kutengeswa kwezvirongwa kumativi ose enyika) inogona kubvumira vatakuri kuti varambe vachivhara mamiriro ezvinhu akambovapo pasina mirairo inoda kuti iite, asi pane uchapupu hushoma hunenge huri zvechokwadi.
Prescription Drug Costs
VaDemokorasi vanoda kuvhara mwedzi wose kunze kwehomwe mari inoshandiswa nemishonga (izvo zvinotarisirwa apa ndezvokudhura kwezvinhu zvinodhaka zvinodhaka, izvo zvinowanzovharwa ne coinsurance-chikamu chemari-panzvimbo yepa copays yakazara; mamwe maitiro atotorerwa kunze -pocket mari yezvinyorwa).
VaDemokorasi vanodawo kugumisa " kubhadhara kunonoka ," (mutsika inochengetedza mari shoma-generic drugs kunze kwemusika). Nzvimbo yepamberi iyi inosanganisira kubvumira kutengeswa kwemashoko kubva kune dzimwe nyika, nekusimudza kurambidzwa kweMedarere ikozvino kutengesa mitengo yezvinodhaka nemishonga inogadzira mishonga.
I Republican Party Platform haina kutarisa mimwe mitemo kunze kwechirevo chekupararira kweapioid uye kuedza kuronga kushandiswa kwezvinodhaka zvinodhaka. Panguva yemushandirapamwe, Trump akati aida kutaurirana mari nekambani yemishonga, uye kubvumira kutorwa kwemishonga yakaderera kubva kune dzimwe nyika. Zvisinei, chinzvimbo chake pakutaurirana nezvemishonga yemishonga chakanga chachinja nekupera kwaJanuary.
Mumwe Mutemo
Mutemo weAACA mumwe nomumwe (munhu oga akagoverwa kutarisira) inoda vakawanda vekuAmerica kuchengetedza hutano hwehutano inshuwarheni kana kutarisana nemutero wemutero. Vatsigiri vanosimbisa kuti iyi ndiyo nzira chete inotsigirwa-iyo hutano hwehutano huripo, uye ruzivo rwakawanda runotanga kutsigira kudai.
MaDemocrates anowanzosimbisa mutemo wega.
VaRepublicanism vanorwisana naro, kunyange, pakutanga kwegore ra2016, Trump akazviratidza kuva achifarira. Akakurumidza kuchinja mamiriro ake, achicherechedza kuti anotsigira zvakakwana kubviswa kweAACA, kusanganisira iyo imwe mvumo.
Mutongo wega wega ndeimwe yezvinokakavadzana zveAACA, uye chirango chinosangana nacho chinogona kubviswa nebhadhibha-uchapupu hwekuyananisa. Izvozvo zvinogona kukonzera kusagadzikana muhutano hwehutano hutengesheni, zvisinei, uye nyaya yacho ichiri kuongororwa nevatongi vezvemitemo, nechinangwa kubva kumabhizimisi einishuwarenzi nevatsigiri vevatengi.
> Sources:
> Barnett JC, Vornovitsky MS. Dare rekuverenga reUnited States, Health Insurance Coverage muUnited States: 2015 . Yakabudiswa muna September 2016
> Blumberg LJ. The Urban Institute. Sales of Inishuwarenzi Inosanganisira State Lines, June 2016.
> Centers for Medicare neMedicaid Services, Center for Consumer Information and Insurance Oversight. Chikamu 1332: State Innovation Waivers
> Garfield R, Damico A. Kaiser Family Foundation, The Coverage Gap: Uninsured Varombo Vakuru muDzimwe Dzisina Kuderedza Medicaid - An Update. Musi waJanuary 21, 2016.