Chirwere chevarwere 'Zvokudhura' Zvingawedzera pazasi kwe BCRA
Iyo shanduro yeSenate yehutano hwekugadzirisa kurapa kwehutano yakatangwa musi waJuly 20 yaizoguma nekudhura zvakanyanya zvakakwirira. Kutaura zvazviri, mapurojekiti eC Congressional Budget Office (CBO) ayo avhareji munhu anotsvaga pachirongwa chekuenzanirana ichave $ 13,000 muna 2026. Zvichida, izvi zvakakwirira kudarika zvavanoona nezvemahombekiti akawanda ayo achabvumirwa gore iroro kunze kwekuti chikwata chekuvhara kunze kwe-muhomwe mari inoshandiswa.
Zviri pachena, iyo inyaya iyo inoda rimwe basa rezvemitemo.
Munyika yose ya2017, imwe yenhau dzinokosha zvikuru dzeCongressal Republicans dzave dzichidhinda uye dzinotsiva ACA (Obamacare). Imba yacho yakapfuura neAmerican Health Care Act (AHCA) kutanga kweMay, uye yakatumira kuSeneti. GOP VaSenetin vakaungana musangano rekushandira pamwe kuti vashandure shanduro yavo yemutemo, yakanzi "Better Care Reconciliation Act" (BCRA), uye yakatanga kuitisa pakupera kwaJune. Senate Republicans yakabudisa shanduro yakarongedzwa yemutemo mushure memazuva mashomanana gare gare, ichibatanidza kuenderera mberi kwekuchengetedzwa kwezvinyorwa, izvo zvakanga zvisati zvasanganiswa mumutauro wavo wekare (iwe unogona kuona zvose shanduro yemutemo pano).
Zvinyorwa zvitsva zveBBCRA zvakatangwa musi waJuly 13 (chikamu-ne-chikamu chechikamu ), uye musi waJuly 20 (chikamu-ne- chidimbu chechikamu ). Pese iri sangano, Senate haina dare remisangano kana nhaurirano yebipartisan pamusoro pemutemo unorongerwa .
IABCRA yakasvika kuvhoti muSeneti musi waJuly 27 apo yakatsiviwa nemutauro muDzimba-yakapfuura musayiri. Yakakundikana nehombe yakadzika, 43-57. Seneti yakaramba zvakare "kubvongodza" (Health Care Freedom Act), iyo yaida kuti ive nzira yekuenda kumusangano wekomiti nehutungamiri hweHarare GOP.
Imba yeChishanu inogona kuwedzerwa zvakare kuSeneti kalendari kana uye apo vatungamiri veGOP vane mavoti ekupfuura shanduro yebhadharo. Kunyange zvazvo tisati taziva kuti chibvumirano-kana chiripo-chichapedzisira chasvika neRepublicans muSeneti, shanduro yaJuly 20 ye BCRA inotipa pfungwa yekuti sangano reSeneat republic inoda kuenda nehutano hwekugadzirisa hutano.
IBCRA iyo yeSeneti yakatora musi waJuly 27 yakanga yakafanana neyekare yemashandisirwo emutemo, asi yakasanganisirawo Cruz Amendment uye Portman Amendment. Hapana yevaya vakave vakatarwa neBBC, saka hatina nhamba chero ipi zvayo maererano nemagariro avo. The Cruz Amendment ingadai yakaita kuti vatsigiri vatsva vatengese zvirongwa zvekambani, kwete ACA-zvinoenderana chero bedzi ivo vakatengesa chirongwa chimwe chegoridhe, chirongwa chimwe chesirivha uye imwe chirongwa che "benchmark" pasi pemitemo ya BCRA, iyo inenge iine hutano hunokosha hwe 58 percent. The Portman Amendment yaizopa $ 100 mabhiriyoni kuitira kuti nyika dzishandise kuderedza mari yepamusoro yevatori venyika shoma, uye inopa humwe humwe hushanduko hwekushandisa Medicaid mari yekuderedza mari inenge isina mari yevashandi vashoma vanochinja kure kubva kuMedicaid kuenda kune pega pasi pe BCRA.
BCRA (kunze kwePortman uye Cruz kuchinja) yakarongwa neCBC uye yakaongororwa nenyanzvi dzakawanda dzehutano hwehutano, saka tine pfungwa yakanaka yezvaizoita.The Portman Amendment zvingangodaro yakaguma nechepasi- muhomwe mari yekutanga, asi zvakakosha kuziva kuti mari yacho ingangodaro yakapiwa kwemakore manomwe; pakanga pasina kuenderera mberi kwekubhadhara mari mumutemo.
The Cruz Amendment ingangodaro yakaguma nemari yepamusoro yekutengesa mari kune ani zvake anotenga mapurogiramu asina kukodzera aizouya pasi pekushandurwa. Iko kuongororwa pasi apa kunobva pane zvikwata zveBBCO zveBBCRA. Sezvo Cruz nePortman kuchinjwa kwakanga kusina kuongororwa neB CBO, maitiro avo haana kubatanidzwa munyaya inotevera pamusoro pemari yekunze-ye-pocket.
Kunyange zvazvo BCRA ichishandura zvinhu zvakawanda zve inshuwarisi yega yega uye Medicaid, ngatitarisei ikozvino kuti ingakanganisa sei-ye-muhomwe mari (kuchengetedza mupfungwa kuti kunyange iyo shanduro chaiyo yebhadharo haina kupfuura muSeneti, imwe shanduro yacho rinogona kudzokera kuSeneti pasi).
Sangano Rinotungamirirwa neSenate Rinogadziriswa Sei?
Izwi rokuti "kunze kwehomwe" rinotsanangura zvose zvinotarisirwa vanhu kuti vashandise kana vachida kurapwa, mushure mokunge inshuwarisi yavo yakabhadhara chikamu chebhadharo. Hazviiti, zvisinei, zvinosanganisira mari yekubhadhara , iyo inofanira kubhadharwa mwedzi woga woga, pasinei nokuti unoshandisa chero kurapwa kupi zvako.
Nyaya pfupi ndeyokuti BCRA yaizoita kuti mari yepamusoro isati yakwana. Ngatitarisei kuti nei izvi zvaizoitika.
Pasi peAACA, zvirongwa zveboka rimwe nerimwe uye zviduku zvinofanira kuvhara mabasa akasiyana-siyana anoonekwa seanokosha hutano hwehutano , uye zvirongwa zvose (kusanganisira mapoka makuru emapoka) zvinofanira kuvhara zvinenge 60 muzana yehuwandu hwehutano hwehutano (izvi zvinoshanda kune huwandu hwehuwandu hwevanhu; huwandu hwemari inowanikwa kune mumwe munhu hunoenderana nehuwandu hwehutano hunotarisirwa nemunhu kupfuura gore rose). Ivhareji yezana remari iyo chirongwa chinowedzera chinonzi actuarial value (chinyorwa chokuti mumusika mumwe nomumwe, vatsigiri vanogona kutengesa zvirongwa zvinotyisa -izvo zvine kukosha kwezvinodiwa pasi pe 60 muzana-kune vanhu vashoma, kunyange zvazvo ACA premium rubatsiro isingashandisi kune avo zvirongwa).
Chirongwa chine kukosha kwezvinoenderana nemakumi matanhatu kubva muzana inosarudzwa seurongwa hwebhuroni munyaya ye inshuwarisi yehutano hwemunhu mumwechete uye shoma, uye inosangana nezvinodiwa pakupa "zvishoma kukosha" munyaya yeboka guru rekuvhara. Sezvo zvakaoma kumakambani einishuwarenzi kuti awane urongwa hwokugadzirisa kufanana chaizvo nehuwandu hwezvinodiwa, vatsigiri vanobvumirwa kushandisa 2 / + 2 de minimus range, saka urongwa hwebhandi hunotarisirwa hunogona kubva kubva 58 kusvika ku 62 muzana. Izvozvo zvakarongedzwa kuti zviwedzere kusvika ku2 / + 5 muna 2018, asi mitemo yakagadzirirwa muna April 2017 inoshevedza kuwedzera kweronze chirongwa che minimus range kusvika kune -4 / + 5. Saka pasi pemitemo yemazuva ano, zvirongwa zvendarira muna 2018 zvichabvumirwa kuti zvive nehuwandu hwe 56 kusvika ku 65 muzana yemari yekurapa.
Asi kunze kwezvirongwa zvinotangisa zvinotaurwa, zvirongwa zvebhandi ndezvishoma zvishoma maererano nezvisayenzi zvinogona kupa. Chirongwa chekufananidzira, icho chinowanzove chakanyanya kufarirwa nevanyori, chirongwa chesirivha, icho chine kukosha kwezvinoenderana neanenge makumi manomwe kubva muzana. ACA premium rubatsiro inosungirwa kumutengo weurongwa wehupfumi , uye ACA kugovana-kugovera rubatsiro kunowanikwa chete kana vanyoresa vachitora purogiramu yesirivha.
Kuchengeta zvose izvi mupfungwa, ngatitarisei zvino zvakatemerwa BCRA. Pakati pese, kune zvimwe zvikamu zvechibharo icho chinozobatsira kukura kunze kwehomwe mari:
- Nyika dzichakwanisa kuponesa mitemo maererano nemhando ipi inofanirwa kuve yakabatanidzwa mumakambani emumwe nemapoka maduku, uye ndezvipi zvinobatsira zviri pasi peAACA kunze kwemahombekombe uye kurambidzwa kwoupenyu hwose uye gore rose mazuzo maximums pamisika yose , kusanganisira boka guru rezvirongwa.
- Pakazosvika 2026, zvirongwa zve "benchmark" zvaizotanga kubva pakugadzirisa zviyero zvinokwana madhora 5 000 kusvika pakugadzirisa zviyero zve $ 13,000 . (cherechedza kuti kana ACA inoramba iripo, mari inosvika madhora 5 000 inowanikwa inowanikwa muna 2026 inoshanda kune vanhu vasina kukodzera kugoverana mari dzekubhadhara mari ; kune munhu ane mari inosvika madhora 26 500 muna 2026, mapurogiramu eC CBO anowanzokwanisa kubviswa ngangova madhora mazana mana chete kana vakanyoresa purogiramu yekufananidza, sezvo ACA inobhadhara mari inobhadhara mari inoita mari yepamusoro inodhura zvakanyanya kutengesa kune vanyori vanoita mari shoma).
- Kugovana-kugoverana kwezvikwereti kwaizobviswa ne BCRA, zvichiita kuti vanhu vakawanda vane mari shoma (yakataurwa pamusoro apa, mari yeAACA inobhadhara mari inobhadhara mari inotapudza mari inoshandiswa kubva ku $ 5,000 kusvika ku $ 800 kuti munhu awane mari 175 muzana yehurombo huri muna 2026 ... asi chete kana ACA uye mari yekugoverana mari ichiripo munzvimbo).
Kunyange zvazvo mapurogiramu eC CBO kuti chirongwa chine kukosha kwezvikamu makumi mashanu nemakumi mashanu nemasere (58%) chinogona kubhadharwa $ 13,000 ne2026, vanofungidzirawo kuti mari inenge isingabvumirwi nehuwandu hwezvokudya (in-network) ichava $ 10,900 pasi iyo yakagadzirwa iye zvino inoshandiswa kusarudza kuti yakawanda yakagamuchirwa kunze kwehomwe inokwira gore negore . Icho chimiro hachina kuchinjwa muBBCRA, asi izvi zvakajeka kusagadzikana kunofanira kutaridzirwa kana BCRA yaifanira kushandiswa. Chaizvoizvo, mutemo unoda kuti zvirongwa zvigadziriswe zvive nezvikwereti zvakanyanya zvokuti hazvibvumirwi kutengeswa.
Eroding Essential Health Health Benefits = Kuwedzera Kwezvinhu zvevarwere
IA BCRA inobvumira kuti, kuburikidza nehutano hwaive huripo 1332 -iiver-asi nemiganhu shoma shoma uye zvirindiro kupfuura ACA zvashandiswa-kuchinja tsanangudzo yezvinodiwa zvehutano hunokosha. Saka hurumende inogona, somuenzaniso, kusarudza kuti kuvhara kwekuberekwa hakusi iko kwekukosha kwehutano hwehutano, uye vatsigiri havachafaniri kuifukidza pane zvirongwa zvehutano zvitsva (nokuda kwechiitiko ichocho, boka duku rezvirongwa nevashandi vanenge 15 kana kupfuura vangaramba vachibatanidza kubata pamuviri, nekuda kwemutemo wakanga uripo kwemakumi emakore).
Kana zvirongwa zvichibvumirwa kutengeswa pasina zvimwe zvezvinobvumirwa zvinobvumirwa, vanhu vanoda zvirongwa izvi vachatarisana nepamusoro-soro yezvokubhadhara mari, sezvo vaisazova nehutano hwehutano hwehutano hwemamwe mabasa. Zvinhu zvakadai semishonga inorayirirwa, utano hwepfungwa / kushandisa zvinodhaka, uye kuchengetwa kwekuberekwa ndezvese zvinhu zvisingagoni kuvharwa mune zviti zvinosarudza kujekesa zvikwereti zvakakosha zvehutano pasi pe BCRA.
Zvakakoshawo kunzwisisa kuti kubhadharwa kweAACA munguva yehupenyu nemiganhu yekubhadharwa kwegore negore , pamwe chete nekodzero yemutemo pamatengo ekubuda kwemahomwe, inoshanda chete kune zvinokosha zvehutano-izvi zvinoshanda kumapurogiramu evanhu nemapoka maduku, pamwe chete zvirongwa zvikuru zvevaridzi. Saka kana hurumende yaizoderedza huwandu hweshumiro inowanikwa pasi pehutano hunobatsira maambura, vatsigiri vangave vachiri kupa humwe ruzivo rwemashumiro iwayo, asi havazodi kuti vabhadhare mari yekusungirirwa kwemari, uye ivo vaizokwanisa kuisa upenyu hwegore uye gore negore kubatsirwa kwemashandiro avo vanga vasati vafunga nezvehutano hunokosha hwehutano.
BCRA Inotsigira Ichabatanidzwa neBronze Plans Panzvimbo yeSirivha
IA BCRA yaizoenderera mberi kupa rubatsiro rwekubhadhara mari inenge ichinyatsotaridzirwa kuAACA premium rubatsiro, asi kwete seyakasimba. Vaizongowedzera kune vanhu vanowana 350 muzana yehurombo huno, panzvimbo yeAACA ye 400 muzana (nokuda kwekutsvaga, iyo yepamusoro mari yepamusoro yekubhadhara mari yemhuri yevana kubva muna 2017 urombo huchava $ 86,100, pane $ 98,400) . Vaizodawo vanhu vakwegura (mune dzimwe nguva, vachiri vaduku sevana 40) vane mari yepamusoro inenge 250 muzana yehurombo huripo kubhadhara chikamu chikuru chemari yavo yepurogiramu yekuenzanisa.
Asi zvichida zvinonyanya kukosha, rubatsiro rweBBCRA premium ruchabatanidzwa kune chirongwa chinokwana 58 muzana chinotarisirwa kukosha (panzvimbo yezvino zvigadziriswa zvesirivha, izvo zvinotaridzika zvinokosha zve 68 kusvika 72 muzana).
Saka kutanga muna 2020, chirongwa che "standard" chichange chiine kukosha kwezvinoenderana nekusvika kwepasi-kwe--makero emarongerwo emarongerwo. Mukuongorora kwavo BCRA , CBO inocherechedza kuti pasi pemari yehupfumi iripo, inowanikwa deductible inosvika madhora 3,600, asi purogiramu yegoridhe yakarongeka inokwana madhora 6 000. Asi zvinodzvinyirira uye zvachose kunze kwehomwe mari inowedzera nehuwandu hwezvokurapa. Mukutsvakurudza kwaJuly 20 kweBBCRA, mapurogiramu eC CBO ayo anowanzogadziriswa kwezvirongwa zvepakati pe BCRA angave $ 13,000. Uye zvakare, panzvimbo pokuva iyo yakaderera pasi pamakamuri, izvi ndizvo zvaizova zvirongwa zvekufananidzira.
Pari zvino, zvigadziri zvesirivha ndezvinyanyozivikanwa zvikuru zvekugovera. Muna 2017, kubva mamiriyoni 9.65 mamiriyoni avo vakanyoresa zvirongwa zvehutano kuburikidza neHealthCare.gov, 7.1 mamiriyoni akasarudzwa esirivha zvirongwa. Kana vanhu ava vachida kuchengetedza mararamiro avo ezvino pasi peBBCRA, ivo vachabhadhara chikamu chikuru chezvikwereti, sezvo rubatsiro rwema premium rucharongwa kuchengetedza huwandu hushoma hwekuvhara kusvika kune mari inodhura yeinorlees 'mubhadharo.
Kana pane kudaro, vanosarudza kutenga zvirongwa nezvikwereti zvemari zvichitengwa zvakakwana nezvikwereti zveBBCRA, dzichaguma nepamusoro-soro kunze kwemari yekutengesa kana uye kana pavanenge vachishandisa kushandisa kwavo.
Kugadziriswa Kwekubhadhara-Kugoverana Kubatsiri = Kunoshamisa Kubuda Kwemahomwe Kwemari
Iyo ACA inobhadhara mari yekubhadhara inowanikwa apo inyorese inosarudza zvirongwa zvesirivha uye ine mari yemhuri isingapfuuri 250 muzana yehurombo huno. Asi pakati pevanhu vanokwana mamiriyoni 7.1 vakasarudza zvirongwa zvesirivha kuHealthCare.gov kwegore ra2017, vanopfuura mamiriyoni 5,7 vakatenga zvirongwa zvinosanganisira kugovana kudhura. Izvi zvinowanzopedza chiyero chinoderedzwa kusvika pasi pe $ 1 000, zvichiita kuti utano hwakwanise kubudikanwe kune vanhu vasingadi kuti vawane mari-kunyange nehutano inshuwarhu.
Asi BCRA, yakafanana neAHCA, inogona kupedza mari yekugoverana mari yakawanda mushure me 2019. Izvi zvinoreva kuti vanhu avo vari kukwanisa kuronga zvirongwa zvinodheredzwa zve $ 0 kana $ 500 vangangotarisana nezvikwereti zve $ 6,000 kana $ 7,000. Uye muna 2026, mapurogiramu eCBCO ayo anoderedzwa achakura kusvika ku $ 13,000 (zve, achifunga kuti chiyero chekuverenga zviyero zvakasununguka kunze kwechikwata chinogadziriswa kuitira kuti BCRA ishandiswe).
Kunyangwe kugoverana-mari-kugoverana mari inowanikwa kuti inyorese nemari kusvika kune 250 muzana yehurombo huripo, inopa zvakanyanya kubatsiro kune vanhu vane mari yepamusoro kusvika 200 muzana yehurombo huri (ikozvino inenge madhora 24 000 kune mumwe chete, asi urombo Nhamba inomuka gore negore). Vanhu ava vacharamba vachikwanisa kubhadhara rubatsiro rwepamberi pasi pe BCRA, asi zvirongwa zvaizovapo kwavari-uye zvakagadziriswa ne-premium rubatsiro-zvingadai zvakaderedza zvingadya, kakawanda, hafu yemari yavo. Uye kune vanhu vane mari iri pasi peurombo hwehurombo, iyo inobviswa zvishoma inogona kunge yakanyanya kupfuura inowanikwa gore negore.
Chigumisiro, maererano neBBCO inoratidzira, ndeyekuti vanhu vane mari shoma vanogona kunge vachida kuenda pasina inshuwalhu yehutano, pane kutenga kugoverwa kunoda kuti vabhadhara chikamu chikuru ichocho chemari yavo kuti vasangane nehurukuro.
Kuchinja kubva kuMedicaid kusvika kuInishuwarensi Yepamusoro = Kubuda Kunze kwePocket
IA BCRA ichapedza zvishoma nezvishoma kufambiswa kwehurumende mari iyo inotaura kuti ikozvino inofanirwa kuvhara Medicaid kuwedzera kwevanhu. Izvi zvinogonawo kuchinja nguva dzose Medicaid mari yekubhadhara kubva pamusangano wayo wakasununguka kusvika kune imwe yenyika imwechete iyo yaizopedzisira yakanyorerwa kumutengo wekutengesa (iyo inowanzosimudza zvishoma nezvishoma kupfuura Medicaid mari).
Chigumisiro, maererano neBBCO maitiro, chichave kuderedzwa kwe $ 756 mabhiriyoni muhurumende Medicaid kushandiswa kwemakore gumi anotevera, nekupedza muna 2026 kunotarirwa kuva ne 26 muzana pasi kudarika zvaizova pasi pemutemo wezvino. IC CBO yakabudisawo kuongororwa kwakawedzerwa , inofungidzira kuti federal Medicaid mari ye2036 ichava 35 muzana pasi kudarika zvaizove pasi pemutemo wezvino.
Mugumisiro weizvi zvose ndezvekuti muna 2026, kuchave nekufungidzirwa vanhu vanoshoma mamiriyoni gumi nemashanu paMedicaid kupfuura pane zvaizova pasi pemutemo wezvino, uye kusava nekupararira kucharamba kuchikura mumakore gumi anotevera zvakare.
Vanhu avo vakafukidzwa neMedicaid ndivo vanongotarirwa chete nemazita emadhora emari. Vakawanda vevanhu vane mamiriyoni gumi nemashanu vanenge vachingova vasina kuvimbiswa kana vakarasikirwa nekuwana ku Medicaid. Asi avo vanochinjira kune hutano hutano inshuwarisi (zvichida nekubatsirwa nehutano huripo) huchasangana nehupamhi hwepamusoro hwekunze kwemari. Izvi ndezvechokwadi zvakapiwa kupa kubviswa kweBRARA kudhura-kubhadhara mari, uye kuti zvirongwa zvekuenzanisira zvichave nehuwandu hunokosha hwe 58% chete. I $ 13,000 inotsvaga haisi yechokwadi kune munhu anorarama muurombo kana zvishoma pane urombo.
> Sources:
> Centers for Medicare neMedicaid Services, 2017 Market Market Open Open Period Public Use Files.
> Congressional Budget Office. HR1628, Better Care Reconciliation Act we 2017. June 26, 2017.
> Congressional Budget Office, Kuongororwa Kwezvinhu. HR1628, American Health Care Act ye 2017, sekupfuura neImba musi waMay 4, 2017 . May 24, 2017.
> Congressional Budget Office, Kutarisirwa Kwemari, > HR 1628, Mutemo Wakawedzerwa Kuyananisa Rechidhiyo we 2017: Chichigadziriswa muChiratidzo cheMutevedzeri [ERN17500], sezvakatumirwa paIndaneti yeDare reSenate muBurget musi waJuly 20, 2017. July 20, 2017.
> Dhipatimendi Rezvoutano uye Human Services, Mutevedzeri Kudzivirirwa uye Anogadziriswa Care Care Act; Market Stabilization . April 13, 2017.
> Federal Register, Department of Health and Human Services. Murwere Anodzivirirwa uye Anogadziriswa Care Care Act; HHS Chinyorwa cheBatsiro neZokubhadhara Zvikamu zve 2018; Kugadziriswa Kunyoresa Kwemazuva Akazotevera uye Mutengi Akashandiswa uye Akarongeka Zvirongwa Purogiramu. December 22, 2016.