Ko Healthcare Kuchinja Kuchinja Ive Mutemo, Mutungamiri, kana Zvose?
Musi waJanuary 20, maawa mashure mushure mekugadzwa kwake, Mutungamiri Trump akasayira hurumende yakagadziriswa inotarirwa "kuderedza mutoro wezvematongerwo enyika weAffordable Care Act." Mutungamiri wehurumende anotaura kuti Hurumende yeTrump iri kutsvaga kubviswa kweAACA, asi kuti panguva ino, Trump inoda kuti mapurisa ehurumende ave seanoshandura uye ane hanya sezvaanokwanisa pakutevedzera zvigadzirwa zveAACA.
Mapurisa ehurumende anorayirwa kuti "avere, kurega, kupa mukana wekusunungurwa kubva, kana kunonoka kushandiswa kwe" chero urongwa hupi hweAACA hunogona kuisa mutoro wezvemari kana kutonga pane zvezvematongerwo enyika kana "vanhu, mhuri, vatsigiri vehutano, vatsigiri vehutano, varwere, vanogamuchira yehutano hwehutano, vatengi vehutano inshuwarisi, kana vaiti vezvigadzirwa zvemishonga, zvigadzirwa, kana mishonga "-kaizvoizvo munhu wose anobatanidzwa mune utano hwehutano.
Mukuwedzera, mutungamiri wehurumende anorayira masangano ehurumende kuti "awedzere kuchinja" kutaura kuti vanoda kufambisa zvirongwa zvavo zvakasiyana-siyana zvehutano nekuvandudzwa kwehutano.
Zvose Izvi Zvinorevei?
Kunyange zvazvo ACA pachayo inenge mapeji ane chiuru kwenguva refu, pane mapeji ane zviuru zvinyorwa zvehurumende mitemo-kunyanya kubva kuCMS / HHS uye IRS-iyo yakashandura uye yakatsanangura zvikamu zvakasiyana-siyana zvemurairo, uye yakagadzira mazano apo yaidiwa.
Zvimwe zvikamu zveAACA- sematambudziko ekuregererwa kwemashoko , uye zvakananga zvezvinoonekwa sekuchengetedzwa kwekuchengetedza -zvakagadzirirwa kune mamwe mazano ehurumende kuti aite zvakajeka mushure mezvo (nokuda kwechikonzero, ndicho chikonzero kuchengetedzwa kwevakadzi zvakadzivirira kusina kukonzerwa kusvikira muna 2011, pasinei nokuti ACA yakagadzwa muna 2010).
Kuchinja ACA pachako kunoda chiito cheCongress. Asi kushandura mitemo yakashandiswa nehurumende yehurumende inongoda hurumende itsva mitemo. Haisi seyo nyore sekurohwa kwepeni, zvakadaro. The Administrative Procedure Act, iyo yakave iri munzvimbo kubva kuma1940, inotungamirira kuti masangano ehurumende anoparidza mitemo.
Pamitemo yeHHS, mutemo wezvinyorwa unoparidzirwa, uye zvino pane nguva inoda kudiwa yevanhu. Pakupera kwemazuva ekutaura kwevanhu, HHS inoita zvisarudzo zvichienderana nemashoko evanhu uye inoparidza mitemo yekupedzisira, kusanganisira mashoko pamusoro pezvavakagamuchira uye mhinduro dzavo kumashoko iwayo. Saka mitemo mitsva haina kuitika usiku humwechete (kunyange zvakakosha kuziva kuti nzira yekugadzirisa hutungamiri inogadziriswa inogonawo kuchinja pasi peHurumende Inotungamirira).
Asi chaizvoizvo, Mutungamiri weTrump anoudza hurumende kuti dzive dzakanyanyisa sezvinobvira mukushanda kweAACA zvigadziro zvinokonzera mitero, chirango, kana mamwe mimwe mitoro. Nhau huru dzakagadziriswa nehutungamiri huri hutungamiri humwe hurumende uye humwe hutano hwematongerwo enyika hutungamiri hwehutano hwehutano hwehutano mune imwe nyika.
Iyo Mutevedzeri Wega
Mutemo wega wega unoda vakawanda vekuAmerica kuchengetedza hutano hwehutano inshuwarheni kana kutarisana nechirango pavanoshandisa mutero wavo unodzoka.
Asi pane zvakawanda zvisingabvumirwi kumutemo . Zvimwe zvacho zvinotsanangurwa zvakajeka mumashoko eAACA, asi mamwe-kunyanya, izvo zvakakosha zvinokodzera sekunetseka-zvakasara kusvika kune HHS kugadzirisa.
Pasi pemutungamiri weTrump, Dhipatimendi reHutano neHuman Services rinogona kusarudza kuwedzera kukodzera kwekusununguka kwematambudziko, zvichiita kuti vanhu vazhinji vaende vasina uninsured vasina kutarisana nemutero wekubhadhara kuti vaite saizvozvo (chokwadi, kuenda kune uninsured ndiro dambudziko guru rinoenda kure kunze kwemutero wemutero; kana iwe usina kuvimbiswa uye uchida kurapwa, iwe uri wega nokuda kwezvikwereti zvezvechiremba, uye iwe unogona kusakwanisa kuwana kutarisirwa pane zvose kunze kwekuongorora kuongorora / kugadzikana kuti makamuri ekukurumidzira anodiwa kuti ape ).
Kana hurumende yega yega ichibviswa ( kuburikidza nemitemo ) kana kuti yakasununguka (kuburikidza nehutungamiri hwehutano huchibva kuhutungamiri hwehutungamiri) munguva yemberi iri pedyo, humwe hutano hwehutano hutengesheni hunogona kugadziriswa . Mitero ingangodaro ichikwira zvakanyanya kusvika muna 2018, uye vamwe vatakuri vangave vasarudza kusununguka pamusika mumwe nomumwe.
Asi kudzokorora kana kuporesa hurumende yega yekutanga munguva yeTrump yaizozadzisa chikamu chemupiro wemhiko yaakaita kuti abvise iyo ACA (Obamacare), uye inosvika kune vanhu vasingadi mutemo wega. Kujekesa, kunyange zvazvo hurumende yega yega ndiyo imwe yezvikamu zviduku zvakakurumbira zveAACA, iyo chikamu chinokosha chehutano inshuwarheni hupi inopa kugoverwa kwemamiriro akambovapo, ayo ACA inodawo. Iwe haugoni kuva nehuwandu hwemamiriro ezvinhu akambovapo asi pasina imwe nzira yekuita kuti vanhu varambe vakafukidzwa pavanenge vakagwinya, panzvimbo pokumirira kusvikira vanorwara kuti vanyora.
State Flexibility in Health Care Reform
Nyika dzave dziine humwe hutsika huri pasi pe ACA: 1332 waivers inobvumira nyika kutora nzira itsva yekushandura ACA, chero bedzi inotevedzera kune zvakasiyana-siyana zvinotarirwa muAACA. Hawaii yakanga ichangobva kupiwa 1332 waiver iyo inobvumira hurumende kuti irege kuva nebhizinesi rehutano hwehutano inshuwarheni, sezvo Hawaii inenge yakatova nesimba rakashandiswa-rakatsigirwa nehutano hwehutano hurumende yakagadzwa nehurumende.
Uye dzimwe nyika dzakashandisa 1115 waiver kuti iwedzere Medicaid kuwedzera nekugadzirisa kwakasiyana kubva pakuwedzera kweMedicaid inonzi muAACA. Asi pasi pe Obama Administration, CMS yakaramba kubvumira zvimwe zvekuchengetedza zvakanyatsorongeka zvakakumbirwa mune zvimwe zvinokwana 1115 waiver zvido.
Semuenzaniso, hurumende dzakawanda dzakaronga basa rinofanira kuitwa kuti vanhu vakuru vave nekodzero yekuwedzera Medicaid (zvinoreva kuti vaifanira kunge vachishanda, vachishingaira mubasa rekutsvaga basa, muchikoro / kudzidzira basa, kana kutarisira vana vanovimba kuronga kugamuchira Medicaid mibayiro). Muzviitiko zvose, CMS yakaramba zvirongwa zvakadaro, uye yakangobvumira mapurogiramu ekudzidzira mabasa ekuzvidira kuti aiswe. Asi pasi peHurumende yeTrump, taigona kuona nyika dziri kusarudza kuwedzera Medicaid (nokudaro kugamuchira mari yakawedzerwa yehurumende yehurumende yavo yenyika Medicaid) nebasa rinodiwa rinobvumirwa neCMS.
Uyu muenzaniso mumwe chete; kune zvizhinji zvehutano hwekushandura kwehutano pamusoro pekuti republican rehurumende dzehurumende dzinopikisana neBritain Administration, uye chirongwa chekutonga kwaTrump chinovapa nzira yakajeka yekugadzirisa kuchinja nenzira yavo pachavo. Nzvimbo yeVamiririri veMinnesota yakaparidzira mutemo munaJanuary 2017 iyo yaizobvumira inshuwarisi yehutano yekutengesa zvirongwa pasina zvigaro zvakasiyana-siyana zvakavharwa izvo zvino zvinowira pasi pemuraira wezvakagamuchirwa zvinokosha zvehutano. Iyo Minnesota Senate yakaramba chikamu icho chemurairo, zvisinei, uye haina kuitwa. Asi kana mutemo wakafanana waifanira kugadziriswa nedzimwe nyika dziri kuenda mberi (kufunga kuti ACA pachayo haina kubviswa) iyo nyika inoda 1332 waiver kuti iite. Obama wekutonga haaizombobvumira zvakadai, asi Hurumende yeHurump inonyanya kuita saizvozvo.
Zvakakosha kuziva pano kuti chimiro cheMedicaid pachako chinogona kuchinja pasi peHurumende yeTrump uye pakupedzisira ACA kuchinja mitemo. Vatongi veRipublican vari kukurudzira kushandura purogiramu yekudzivirira zvipo kana zvikamu zvepamusoro-soro, panzvimbo yezvinoenderana nekugadzirisa kusinganisa kwehurumende iyo hurumende inoshandisa kubhadhara Medicaid.
Chii Chinoitika Pashure?
Inenge zvinhu zvose zvichiri kukwira mumhepo maererano nezveramangwana rehutano hwekugadzirisa. ACA kudzokorora mitemo ikozvino iri kunyorwa neine congressional komiti. Vadzidzisi vemitemo vasati vashandura zvakapoteredza nzvimbo, kunyange zvazvo pane zvakawanda zvataurwa pamusoro petafura (kusanganisira zvimwe zvange zvichichangobva kubudiswa mu 2017 musangano wekutonga, seCassidy-Collins musayiti).
Mashoko anobva kuHurumende yeTrump yaive yakawandisa uye yakasiyana-siyana maererano nehutungamiri hwehutungamiri huchagadziriswa sei, asi ikozvino iyo yakawanda yevatungamiri veTurmende vakagamuchirwa, chiito chekutonga maererano nehutungamiri hunogona kunge chiri kuuya.
Dzimwe hurumende dzichatora nyaya mumaoko avo, dzichishandisa mitemo yekuchengetedza zvimwe zvikamu zveAACA munzvimbo iyo pasinei nekuchinja kwehuwandu hwematongerwo enyika. Semuenzaniso, zuva rakatevera Trump rakasaina sarudzo yakakura, New York yakazivisa mitemo yehurumende yekuchengetedza kusvika kune zvisingabhadharwi mari yekudzivirira uye mishonga-inobatsira kubvisa pamuviri kune zvirongwa zvehutano zvehurumende.
Nokuda kwenguva iyo, hapana chakachinja pamusoro pehutano wehutano inshuwarisi kana mitemo inodzora inshuwarisi yehutano. IAACA ichiri panzvimbo, iwe unofanirwa kuramba uchichengetedza, zvirongwa zvehutano hazvigoni kushandisa zvinyorwa zvekurapa kana kusabhadhara kugoverwa kwemamiriro ezvinhu akambovapo, uye kubhadhara mari yepamusoro (ie premium tax credits) ichiripo mukutengeserana kukubatsira kuti uwane rubatsiro.
> Sources:
> Centers for Medicare neMedicaid Services, Center for Consumer Information and Insurance Oversight. Chikamu 1332: State Innovation Waivers.
> Cornell University Law School, Legal Information Institute. 5 US Code Code Administration Procedure.
> HealthCare.gov. Verengai Mutengo Wakanaka Wenyu. Nyaya Yakazara yeChinakatika Care Care Act uye Reconciliation Act.
> Medicaid.gov. Panenge Chikamu 1115 Waivers.
> The White House, Office of the Press Secretary. Executive Order Kuderedza Zvemari Mutoro Wenharaunda Yekutengesa Care Act Pending Repeal.