Senate Shanduro Inogona kunge yakanyatsosiyana
Musi waMay 4, 2017, Imba yeVamiririri yakapfuura neAmerican Health Care Act (AHCA) uye yakatumira kuSeneti. Pangopera chiyero ichi, imba yeRwanda Republican yakabatana naPresident Trump, Vachigaro wePurezidhendi Pence, uye Munyori weHHS Tom Price pamhemberero pa White House. Asi iAHCA ichiripo mune ramangwana risina chokwadi.
Imba yevhoti yakauya mushure memavhiki mashomanana ekubvumirana nekugadziriswa kwakagadzirirwa kutambira kutsigirwa kubva kune vamiriri veRepublican vaipikisa AHCA munaMarch.
Vhiki masere chete musati gwaro racho risati rasvika muImba, hutungamiri hweRepublican hwakanga hwauisa pamberi pevhoti yakarongwa muna March, apo zvaiva pachena kuti pakanga pasina hutsigiro rwakakwana kuti hupfuure.
VaDemokorasi vanopesana nenyika yose, uye kunyange zvazvo veRepublicans vane ruzhinji muImba, kana vanopfuura 22 vamiriririri veRepublican vanopesana nemutemo, haungapfuuri. MunaMarch, paive nevashoma makumi matatu nemaviri vaRepublican vanopesana neACHA. Asi apo vhoti yakauya kutanga kweMeyi, 20 chete veRepublicans vaivhota zvinopesana nemutemo, uye yakapfuura nevhoti imwe chete kuti irege (217-213; yaida 216 kuti ipfuure).
Hazvisi pachena kana Senate ichapedza kubviswa kweAACA, uye kana ikaita, ingave makamuri maviri achakwanisa kubvumirana pane kubvumirana kunochengetedza zvimwe zvikamu zveAHCA.
The Impact of the Current Bill
IAHCA yakaziviswa zviri pamutemo muHarare musi waMarch 20, uye yakapfuura mushure memavhiki manomwe gare gare.
Munguva iyoyo yakave nehuwandu hukuru hwekuchinja kuburikidza nekugadzirisa. Chimwe chezvinhu zvinopesana nezvakaitwa neHarare yakasarudzwa ndeyokuti yakauya pamberi pevasina kubatana neChristian Congressional Budget Office (CBO) yaive nenguva yekuongororwa mushure mekubhadharwa mushure mekuita basa rayo.
Gwaro reCBC rakaronga chikwereti mukati meMarch, uye zvakare mazuva mashoma gare gare mushure mekunge vateereri vezvemitemo vakawedzera kuchinjwa kwemabiko kumutemo.
Izvo zvakaratidzwa mumatambudziko acho maviri ndezvokuti AHCA yaizoguma nemamwe mamiriyoni makumi maviri nemasere asina kuvimbiswa muUnited States muna 2024 . Asi bhizimusi rakagadziriswa rakarongedzwa kuderedza kupera kwehurumende nema $ 150 mabhiriyoni chete mumakore gumi ari kuuya, kusiyana ne $ 337 mabhiriyoni ekuderedzwa kwakarongwa nokuda kwekutanga kweAHCA.
Mushure mechikamu chechipiri cheBBC, House Republican yakawedzera matatu makuru ekuchinja kweAHCA:
- Kuvandudzwa kwekugadzira "chirongwa chisingaoneki chokugoverana nengozi" iyo inogona kupa $ 15 mabhiriyoni muhurumende yehurumende kubatsira kubhadhara mari yezvikwereti chikuru muhutano hwehutano inshuwarheni.
- The MacArthur Amendment, iyo inobvumira kuti nyika dzisarudze kune dzimwe dzekudzivirirwa kwevatengi ve ACA. Nyika dzingasarudza kubvumira vatsigiri vekusimudzira chikwata chepayero yezera remakore yepamusoro pamusoro pe 5: 1 cap yakagadzwa neAHCA, inodzokorora maitiro eAAC anokosha ehutano , uye shandisa nhoroondo yezvokurapa kuti ione mari yevashandi avo vakawana mukana wekugoverwa mune zvekare gore.
- IUpton Amendment , yakataurira zuva risati rasarudzwa Vhesi kuti ripfuure AHCA, raida kuvhara mafungiro eRepublicans nezvemaitiro eMacArthur Amendment. IUpton Amendment inopa $ 8 mabhiriyoni muhurumende yezvemari (ye 2018 kusvika muna 2023) inoshandiswa kukanganisa mamwe emakambani ekutanga ayo vanhu vane mamiriro ezvinhu akambovapo avo vanogona kuwana mune zvisarudzo zvinosarudza kubvumira vatsigiri vekuchengetedza mapiamisi panhau yezvokurapa apo vatsva chikamu chiripo.
MacArthur Amendment yakakunda pamusoro pekuchengetedzeka kweHarare Freedom Caucus, uye Upton Amendment yakagutsikana zvakakwana kutsigirwa kubva kuRepublicans zvakaderera kuti mutemo uyu wakakwanisa kukwanisa kukunda muImba.
Asi apo vateereri vemutemo muImba vakapfuura mutemo uyu, vakanga vasati vava kuziva kuti mari yavo yaizoita sei pamutengo usingabatsiri, kana pamashandisirwo enyika. Vakatora mubhadharo maawa mashomanana mushure mokutaura kugadziriswa kwekupedzisira, uye zvakatora CBO inenge vhiki nhatu kuti vapedzise zvikwata zvavo pamutemo wekuvandudzwa.
Mhinduro yekuvandudzwa: 23 Mamioni Mashoma Insureds; $ 119 Bhiriyoni muDaficit Reductions
Musi waMay 24, CBO yakabudisa kuongororwa patsva kweAHCA, kuverenga kwezvikamu zvitatu zvitsva.
Vakagumisa kuti shanduro yakashandurwa yeAHCA (iyo yakanga yapfuura paImba inenge masvondo matatu apfuura) yaizoita kuti vanhu vane mamiriyoni 51 vasina kuvimbiswa ne2026, kubva pamamiriyoni 28 pasi pe ACA. Kuwedzera ikoko kwemamiriyoni makumi maviri nemaviri asina kuvimbiswa kwakadukusa kudarika kuwedzerwa kwekare kwemamiriyoni makumi maviri nemashanu vakawedzera vasina kuvimbiswa, asi ichiri chiitiko chinotyisa maererano nehuwandu husina kuvimbiswa.
Iyo yakarongedzwa maBBC mapurojekiti ayo ekuderera kwehurumende achaderedzwa ne $ 119 mabhiriyoni pasi peAHCA (kudukusa kuduku kudarika zvakambotaurwa $ 337 mabhiriyoni uye $ 150 mabhiriyoni iyo CBO yaifungidzira munaMarch).
IAHCA muSeneti: Ichapedza Test Byrd here?
VaRepublicans vane ruzhinji muSeneti zvakare, asi mararamiro avo akawandisa mumakamuri iwayo. Kune makumi maviri nemaviri Republican muSeneate, pamwe chete neRemocrats neVaviri Independents, avo vaviri avo vekkucus neDemocrates. Sezvo AHCA iri musarudzo yekuyananisa, inogona kupfuura nehuwandu huzhinji muSénate, panzvimbo yekutora mavhoti makumi matanhatu.
Asi izvi zvinoreva kuti kana vanopfuura vaviri vaRepublican Senators vanoramba chiyero, hachizoperi (Vachigaro wePurezidhendi Pence anogona kukanda vheti-breaker vote kana chikamu chekupedzisira chiri 50-50). Izvi zvinoreva zvakare kuti mademocrats haakwanisi kudzora mhedziso yemutemo; Va Democrat vose muSeneti vanogona kuvhota kwete, pamwe chete neRepublican imwe kana mbiri, uye inenge ichiri kupfuura.
Icho chikonzero chokuti AHCA iri musarudzo yekuyananisa inoreva kuti ine mitemo chaiyo yainofanira kutevedzera. Kuyananisira mabhiriro kunogona kungogadzirisa nyaya dzinobatsira zvakakwana kushandiswa kwehurumende. I Byrd Rule inodzivisa Senate kubva pakufunga "nyaya yakanyanyisa" (kureva, zvinhu zvisingaiti zvakakwana kushandiswa kwemari) sechikamu chebhadharo rekuyananisa.
Pakava nenharo huru pamusoro pekuti MacArthur Amendment yaizopfuura ne Byrd Rule test; iyo inogona kuguma kuiswa pachena neSeneti nokuti haisati yasangana nemuedzo wezvinhu zvinogona kubatanidzwa musangano rekuyananisa. Mune mamwe mazwi, Senate paramende, Elizabeth MacDonough, angataura kuti mutauro uri muMacArthur Amendment unoda kuti vhoti 60 dzipfuure, kupfuura 51; saka inofanira kubviswa pamutemo, sezvo Senate Republican isingakwanisi kuwana mavhoti makumi matanhatu ekudzinga ACA.
Kuti ishandise nzira yekuyananisa, Senate ichadawo chikwata kubva kuCBC pane shanduro yavanokumbira; kuvhota pasina chikwata, sezvakaitwa neDzimba, haisi yekusarudzwa kwebato rekuyananisa, sezvo kukonzerwa kwebhadharo yezvematongerwo enyika inofanira kuva yakawanda yakazivikanwa.
Senate Kunyora Bhuku Ravo Ravo. Ndezvipi Zvakawanda zveSvondo Version Vachazvichengetedza?
Zuva rimwechete iyo AHCA yakapfuura muImba, zvinyorwa zvemashoko zvakatanga kutaurira kuti Senate yakanga iri kuronga kunyora ivo pachavo mari panzvimbo yekugadzirisa imba iyo. Nokukurumidza pashure pacho, Senate Republicans yakashuma boka revanhu vanosvika 13 raizoshanda musangano weSeneti, uye yakatsanangura kuti mutemo ungangodaro wakanyorwa uri woga, panzvimbo yekutarisana nemanzwiro evanhu uye mahofisi emakambani.
Asi iyo yakawanda yeIndaneti version yeSeneti ichachengetedzei? Uye iyo Imba ichabvumirana here nekusiyana kwakagadzikana pakati peDzimba neSeneti zvinyorwa?
Mumavhiki mushure mekunge MacArthur Amendment yakawedzerwa muimba kuti ikunde vaRiphabliki vanochengeteka muChechi iyoyo, pakanga pane nharo huru pamusoro penyaya yekudzivirira vanhu vane mamiriro ezvinhu akambovapo. Izvi zvakatova hurukuro yekutaurira Jimmy Kimmel, uyo akashandisa nyaya yemwanakomana wake achangoberekwa kutsvaga kwemoyo kuratidza kukosha kwekuvhara mamiriro ezvinhu akambovapo asi pasina.
Nemhaka yokuti mutauro weMacArthur Amendment haungatenderwi neByrd Rule, kushaya simba kwekuchengetedzwa kwevanhu vane mamiriro ezvinhu akambovapo kungasaita kuti ive yeSeneate version yemutemo. Sénata Susan Collins (R, Maine) ataura pachena kuti haazobatsiri imba yeAHCA, kana chimwe chikwereti chinokonzera mamiriyoni makumi maviri evanhu vasina kuvimbiswa, kana kuti 850 muzana yepumusoro inowedzera kune vakwegura vane mari yakaderera (CBO mushumo pamusoro peIndaneti version yeAHCA inoratidza kuti kune munhu ane makore 64 anowana $ 26,500 / gore, mushure mekubhadhara mari yemabhadharo ichawedzera kubva pa $ 1,700 / gore pasi peAACA kusvika $ 16,100 / gore pasi peAHCA mumasangano anochengetedza ACA kuchengetedza vatengi, uye $ 13,600 muhurumende dzinoshandisa ACA kuchengetedza vatengi; chero nzira, kuwedzera kusingagoneki).
Asi kune dambudziko rakakura riripo-rimwe risina kugamuchira kunyatsoteerera sezvakakodzera apo nguva yeAHCA yaiva mumba. IAHCA yaizoshandura Medicaid yehurumende inoshandisa $ 834 mabhiriyoni mumakore gumi anotevera, maererano nehuwandu hweBodO yekuongorora.
Kuchengetwa kunobva kumativi maviri akasiyana-siyana: Curtailing ACA's Medicaid kuwedzera (hapana rimwe remakore 19 risati rawedzera Medicaid rinogona kusarudza kuita kudaro, uye rinotaura kuti rakawedzera kugoverwa hakuzokwanise kunyoresa vatsva vatsva pazera rekuwedzera chekubhadhara mari yehurumende mushure mekupera kwe 2019), uye kushandura huwandu hweMedicaid yemari kubva kune yakagadziriswa inoenderana nekugadzirisa hurongwa hwekuvhara zviyero kana ma-capita allotments. Zvose zvinosarudzwa zvingaguma nehurumende dzine madiki pasi Medicaid mari pamusoro penguva refu.
Nyaya yeMedicaid inogona kunge yakanyanya kuva chigumbuso muSeneti. Kune huwandu hweRipublican senator-kusanganisira dzimwe kubva kune dzimwe nyika dzakagadzirisa Medicaid-iyo yakaratidza kunetseka pamusoro pekuderedza kwaAHCA kuFedicaid federal uye mari iyo inogona kuva nevakatarisa avo vanovimba neMedicaid, kusanganisira zvose Medicaid kuwedzera uye tsika dzeMedicaid.
Chii Chinoitika Kana Senate Inopedza Its Own Version?
Nemhaka yokuti Senate Republicans inofanira kusungira inenge nhengo dzese dzadzo-kurasikirwa kupfuura zvinopfuura zviviri-kuitira kuti vapedzisire shanduro yavo yeAHCA, ndima inenge isina chokwadi. Asi chii chinozoitika kana sarudzo yeSeneti iri kugadzira mapurisa makumi matanhatu emavhoti (kusanganisira yevhesi yevheti-breaker vovhota neMutungamiriri weMutungamiri)?
Nemhaka yekuti Senate iri kunyora mitemo yavo, uye nekuda kwezvinonetsa kuti MacArthur Amendment haigoni kutevedzera neByrd Rule, uye nekuda kwekuti vazhinji veRepublican Senators vakaratidza kushushikana pamusoro peNyaya yeChinyorwa inopindirana neMedicaid, ichokwadi chaicho icho House neSeneti zvikwereti zvichange zvakasiyana zvikuru.
Kana izvozvo zvikaitika, komiti yemusangano ichaumbwa, inoumbwa nenhengo kubva kuImba uye Senate. Basa ravo richagadzirisa kuwirirana pakati pemari mbiri uye kugadzira mushumo wegore. Kubvira ipapo, iyo imba neSeneti inofanira kupupurira mushumo wegore, iyo inogona kukwikwidzana nevateereri vemutemo asi isina kuchinjwa .
Kana zvose imba neSeneti dzichipfuura mushumo wehurukuro, inotumirwa kumutungamiriri wenyika kuti ataure. Mutungamiri Trump anogona kunge achisayina chero chikwereti chakapiwa kwaari chinodzokorora kana kuchinja zvimwe zvikamu zveAACA. Hazvina chokwadi, zvisinei, kunyange mapoka maviri eCongress achakwanisa kubvumirana pane chiyero chekutumira kumutungamiri.
Zvinogoneka kuti vateereri vane chido chokuderedza zvimwe zveAACA-a campaign campaign kune vazhinji vavo-zvichaita kuti vavhote pamutemo wavanenge vasingatsigire zvakakwana.
Kune rumwe rutivi, House Freedom Caucus yakaramba kutsigira kwaAHCA munaMarch, uye haina kubvumirana kuvhota mushumo kusvikira MacArthur Amendment yakawedzerwa, zvichibvumira kuti nyika dzisunungure mitemo ine chokuita nehutano hunobatsira uye kugoverwa kwepamberi -mamiriro ezvinhu aripo. Ungada Freedom Caucus ingada here kubvumirana nemushumo unogona kuita musangano unobvisa kuti kuchinja? Zvichida, asi isu hatigoni kutaura zvakasimba.
Shoko Rinobva
Kunyange zvazvo hutungamiri hweMahofisi uye Mutungamiri weTrump akapemberera chikamu cheAHCA muImba, mutemo unenge une nzira yakareba yekuenda. Kana Seneti ichipfuura, iyo inogona kunge yakasiyana zvikuru neIndaneti version, uye hapana chivimbo chekuti makamuri maviri anozobvumirana nekukanganisa kuchazodiwa kuti kuyananisi mabhiriro maviri.
Nokuti nguva iripo, ACA inoramba iri mutemo wenyika. Inishuwarenzi yehutano mumusika mumwe nomumwe ichiri kutendwa-dambudziko munharaunda dzose, pasinei nenyaya yezvokurapa ( zviitiko zvinokodzera zvinotarisirwa kuti zvinyore kunze kwekunyoresa pachena). Kubhadharwa kwepa Premium , zvichibva pamari inowanikwa uye mari yekugoverwa munharaunda imwe neimwe, ichiripo mune imwe shanduko yehurumende, uye kuwedzerwa kweMedicaid hakuchinji mumatunhu 31 uye DC uko yakawedzerwa. Zvinotarisirwa neAACA kuchengetedza ruzivo kana kutarisana nemitero yemitero zvakare zvichiri kushanda, uye zvichava kusvikira mutemo waitwa kuti uubvise.
> Sources:
> Congress.gov. HR1628, American Health Care Act ye 2017. Yakagadzirwa March 20, 2017.
> Congressional Budget Office, American Health Care Act . March 13, 2017.
> Congressional Budget Office, American Health Care Act , March 23, 2017.
> Congressional Budget Office, HR1628, American Health Care Act , May 24, 2017.
> Hall M; uye Bagley N, Kuita Sense ye "Invisible Risk Sharing" Health, April 12, 2017.
> US House of Representatives, Komiti Yemitemo, Chidimbu cheByrd Rule.