Musi waDecember 22, 2017, Mutungamiri Trump akasaina Mutero Wemitero uye Jobs Act (HR1) mutemo. Mutemo uyu unosanganisira kuchinja kwakanyanya kumatare emutero weUnited States, asiwo unobvisa gore rinotambudza remutemo wehutano hwekuchinja. Iwe unogona kunge uri kushamisika kana GOP mari yemutero inogona kuchinja hutano hwako hwehutano, sezvo kubviswa kwe ACA kwave kuri chinhu chikuru kune veRepublican lawmakers uye Trump Administration.
Asi mutero wemutero hauna kusanganisira zvizhinji zvezvikamu izvo zvave zviri chikamu chekubviswa kweAACA kusati kwaitika muna 2017. Zvinoderedza mutongo wega wega wekutonga semwaka wa2019, asi mamwe ose eExpordable Care Act akasiiwa munzvimbo. Uye zvimwe kuchinja kwehutano hwehutano hwakanga hwakarongerwa kare mugore, sekushandura mitemo ine chokuita nehutano hwekuchengetwa kwenhoroondo (HSAs) haina kuiswa mubhadharo yemutero.
Kudzokorora Mutemo weMunhu Mumwechete
Mutero webhorosi unodzokorora mutemo wega wega kune we 2019. Nokudaro kune chirango chevanhu vasina kuvimbiswa muna 2018 (iyo chirango chichaongororwa apo mitero inodzoka inowanikwa kumavambo 2019). Izvi zvinopesana neGOP kuedza kubvisa chirango chemunhu mumwe nomumwe kare muna 2017, sezvo mabhiriro apfuura angadai akaita kuti kudzokorora kudzokezve. Pakupedzisira, mutero wemutero unochengetedza chirango chemunhu mumwechete panzvimbo yemakore ose apfuura, uye muna 2017 ne 2018.
Asi 2019 mutero wemitero yakatumirwa kumavambo 2020 haungasanganisi chirango chekusabvumirwa.
Kudzokorora chirango chinowirirana nebasa reAACA roga roga rave riri rinokosha kune Congressional Republicans, uye iyo mvumo pachayo ndeyechokwadi pakati pezvinyorwa zvisinganyanyozivikanwa zveAACA. Asi pasinei nekusafarirwa kwayo, ndeimwe yezvigadziro zvinobvumira kuti ACA ive yakanyanya kuve yakakurumbira-chikonzero chekutonga kushanda.
Chinhu chakavimbiswa-chinoreva kuparidzirwa kunoendeswa kune vose vanoita basa, pasinei nehuwandu hwezvokurapa. IAACA inoshandisa kushandiswa kwemagariro emunharaunda, izvo zvinoreva kuti zvikwereti zvepa insurer muzvikwata zvevanhu uye zviduku zvakasiyana chete zvichienderana nezera, kushandiswa kwefodya, uye zipcode. Pamberi peAACA, zvikwereti zvakare zvaive zvichibva pane zvinhu zvakadai sevakadzi uye nzvimbo yehutano.
Kuchinja mitemo kuitira kuti nhoroondo yezvechiremba haisati yaita basa mukukodzera kana premium yakave yakakurumbira. Asi zviri nyore kuona kuti vanhu vanogona kuedzwa sei kuti vaende vasina ruzivo kana vaine hutano, uye vanyoresa pavanorwara kana vachiziva kuti havagoni kurambwa-uye izvozvo zvingave zvisingagoneki. Nokudaro ACA yaisanganisira zvikamu zviviri zvekudzivirira izvi: Mutemo wega wega unotonga vanhu vanosarudza kuenda pasina inshuwarisi, uye mawindo mashoma ekunyora uye mazuva ekunyora akasiyana (kureva, haugoni kunyora chero nguva ipi zvayo yaunoda).
Kunyorwa kwakasununguka uye mahwindo ekunyora akasiyana-siyana zvicharamba zvisingashanduki, izvo zvinoita kuti zvive zvakaoma kuti vanhu vamirire kusvikira vanorwara kuti vanyora mune imwe yeruzhinji inshuwarhu yehutano yehutano (mushandirwi-akapiwa hutano hwehutano inshuwarheni ave achishandisa nguva dzekunyoresa pachena zvakare; vanhu havagoni kunyora nekuda kwerongwa hwehutano hwevanoshandira pavanenge vachida).
Asi kudzokorora hurumende yega yega kuchave nemagumisiro akaipa kune mumwe munhu wehutano inshumo yemushamba. Sangano reCongressal Budget Office (CBO) rakapiwa gore ra2027, kuchava nevamiriyoni 13 vashomanana vane inshuwarano yehutano kupfuura zvaizodai kana chirango chemurairo chakanga chiripo. Pakati pemamiriyoni gumi nemaviri mashoma ekuchengetedza, mamiriyoni mashanu angadai asina kuparidzirwa mumusika mumwe nomumwe. Uye ichi chikamu chinokosha chemusika mumwe nomumwe, uyo anofungidzirwa kune vanhu vanopfuura mamiriyoni 18 kubva muna 2017 (nokuda kwemaonero, mapurogiramu eC CBO anongova mamiriyoni maviri emamiriyoni 13 emadhora mashoma achava vanhu vangadai vakave nehupfumi pasi pevashandi vanotsigirwa zvirongwa zvehutano, uye vanhu vane mamiriyoni 158 vane ruzivo pasi pevaranda-vakatsigirwa zvirongwa).
Vanhu vanozosiya kugoverwa kwavo pasina mvumo kunowanzove vane hutano, sezvo vanhu vanorwara vanowanzoita chero chavanotora kuti varambe vachiverenga. Ikoko kunotamira kune rimwe dambudziko rinowedzera dambudziko rinowedzera mubhadharo epamusoro, iyo inotungamirirawo vanhu vane utano hwakanaka kubva mumusika.
Kakawanda, CBO inofungidzira kuti miriyamu yemumwe mushambadziro yemusika ichakura nekuwedzera kwe10 muzana pagore, kupfuura pamusoro pemari yavanenge vakura kudai mutemo wega wega wakaramba uripo.
Asi CBO inotaurawo kuti mumwe mushambadziro yemusika "ucharamba wakasimba mune zvese zvenyika mumakore gumi ari kuuya." Nemamwe mashoko, vanotenda kuti nzvimbo dzakawanda dzenyika dzicharamba dziine inshuwarisi dzichitsvaga kutengeswa kwemisika, uye nhamba yakakwana yevakanyoresa kuchengetedza zvirongwa zvakasimba. Izvi zvinokonzerwa, kunyanya chikamu, kunyanya kuti rubatsiro rweAACA rwekutanga huri kukura kuti hurambe huchikwirirana nezvikwereti. Saka kunyange zvazvo kubviswa kwehurumende yega yega kuchaita kuti purogiramu iwedzere kuwedzera, rubatsiro rwekubhadhara mari ruchatowedzerawo zvakanyanya sekudiwa kuti uchengetedze mitero yekambani pamatengo akakwana.
Kune vanhu vanowana rubatsiro rwekutanga, iyo inosanganisira mhuri yevana inokwana $ 98,400 muna 2018, kuwedzera kwepurayamisi kuchagadziriswa nekuwedzera kwekubhadhara mari. Asi kune vanhu vasina kuwana rubatsiro rwemari yepamusoro, kugoverwa mumusika mumwe nomumwe kunogona kuwedzera kusinganzwisisiki mumakore anotevera. Zvakakosha kunzwisisa kuti zvipo zvekutora matanho okusatira mari uye / kana HSA (kana iwe uchitenga chirongwa cheHSA-yehutano yakakodzera ) ichaita kuti kuderedzwa kwakaderedzwa mari yakaderedzwa (ACA-yakadaro; kwete yakafanana neyogara iri MAGI), uye iyo inogona kuita kuti iwe uwane chikwereti chekubhadhara mari-premium-hurukuro nemubhadhara wezvemitero usati wafunga kuti hauna kukodzera kubhadhara mari.
Asi kazhinji, kuwedzera kwekutanga kunokonzerwa nekubviswa kwehutongwa hwemunhu mumwe nomumwe kucharova vanhu vanotenga mumusika mumwe nomumwe uye havakodzeri kuwana rubatsiro rwepayimusi (kureva, avo vane mari yemhuri inopfuura 400 muzana yehurombo huri, ivo mumutauro weMedicaid, kana kuti hauna kukodzera kubatsirwe nekuda kwemhuri inobwinya ). Uye kunyange zvazvo mishonga yeCOO iyo yemakethe imwe neimwe icharamba yakasimba mune dzimwe nzvimbo dzenyika, pangave pane dzimwe nzvimbo iyo mumwe mutengesi unongoputsika, uye hapana bhizimisi inopa kugoverwa. Izvozvo zvaizofanira kutongwa pane imwe nyaya-ne-nyaya, zvichida nehurumende uye / kana mutemo wenyika. Asi icho chiitiko chinogona kana kuti chisingazoitiki.
Migumisiro Pamushandirwi-Inotsigirwa Health Insurance
Vakawanda vasiri vakura vekuAmerica vanowana inshuwarhu yehutano kubva kune avo vashandi, uye mutero webhorosi haugadziri chinhu chero chipi zvacho pamusoro pevashandi vanochengetedzwa nehutano hwehutano. Mushandi wehurumende acharamba achishanda , sezvinozoita mitemo yakasiyana-siyana iyo ACA inotarisa kune zvirongwa zvehutano zvinoshandiswa.
Zvinyorwa zvakasiyana-siyana zveAACA zvakabvunzwa kare muna 2017 zvingadai zvakabvisa zvose zvinotarisirwa nemunhu uye mushandi wevashandi, asi mutero webhorosi unodzokorora hurumende chete. Saka vashandi vakuru (makumi mashanu kana kupfuura vanoshanda nguva yakazara yakaenzana) vacharamba vachida kugovera hutano hwehutano kuvashandi vavo venguva yakazara.
Asi vashandi ivavo havachazogadziriswa ne IRS kana vakundikana kuchengetedza kuparidzirwa. Nokudaro CBO inotanga kuti muna 2027, kune vanhu vanenge 2 mamiriyoni vashomanana vane ruzivo rwakabhadharwa nevanoshandira kunze kwekunge kwaizove kana mutemo wega wega wakanga uripo. Asi kazhinji, kuderera uku kuchabva kune vashandi vanowedzera kupiwa kwevashandirwi avo, sezvo vashandi vacharamba vachipa kugoverwa kuitira kuti vadzivise zvinogona kutongerwa pasi pehurumende yevashandi.
HSA Mipiro neMitemo isina kuchinjwa
Nhoroondo dzekuchengetedza hutano (HSA) dzinobvumira vanhu vane HSA-vanofanirwa zvirongwa zvehutano zvakakosha (HDHPs) kuti vaise mari yekutora mari isati yasvika kuti vawane mari yekuchengetedza hutano hwavo mune ramangwana ( kana kuti vanoshandisa seye reta retirement ). Vatongi veRepublican vave vachifunga nezvekuedza kuwedzera HSA kuburikidza nekuwedzera miganhu yemipiro uye kubvumira mari kuti ishandiswe kubhadhara mari yemishonga yehupfenyuro yehutano. Munguva pfupi yapfuura, vatongi veGOP vave vachitsvaga kuderedza chirango chekugadziriswa kweChinhu Chine Mariki Chakatengeswa chakatemerwa pazvikwereti zvisiri zvekurapa mari isati yava nemakore 65.
Zvimwe kana zvese izvi zvakagadziriswa mune zvakasiyana-siyana zveAACA kubhadhara mabhizimisi avo vatongi veGOP vakafunga muna 2017 . Asi hapana mumwe wavo akazviisa muHarare Cuts uye Jobs Act. GOP vateereri vangafunga nezvemimwe mitemo muna 2018 kuita shanduko kuHSA, asi kwenguva iyo iri, hazvina kuchinja.
Mipiro yemiganhu yegore ra2018 inokwana madhora 3,450 kune vanhu vasina kugoverwa kwega pasi peHDHP, uye $ 6 900 kune avo vane mhuri yekuvhara. Kunezve chikamu chemazana makumi maviri kubva muzana kubva pamakore makumi maviri nematanhatu kana mari isingashandisirwi mari yekurapa, uye mari yemishonga yehutano yehutano haigoni kubhadharwa neHSA-mari, kunze kwekubhadharwa kwekambani yeCOBRA, miriyamu inobhadharwa paunenge uchinge uchitambura , uye premium yeMedare Parts A, B, uye / kana D.
Kuchenesa Mari Dhepodhi Zvichava Zvishoma muna 2017 uye 2018
Kurapa kwekurapa kune mutero kunotorwa, asi kana bedzi pavanopfuura 7,5 muzana yemari yaunowana. Yakave iine 7.5 kubva muzana, asi ACA yakashandura iyo kusvika 10 muzana mune imwe nzira yekuchengetedza mari. Vanhu avo vaiva 65 kana kupfuura vakabvumirwa kuramba vachishandisa 7.5 kubva muzana kusvika pamagumo e 2016, asi 10 percent threshold yainge yasarudzwa muna 2017 yevose vateresi.
Mukuedza kukonzera mutero wevatero kune vatengi, Senator Susan Collins (R, Maine) akakurudzira kusundira kudzokera kune 7.5 muzana. Pakupedzisira, mutero wecaresi waisanganisira kuchinja uku, asi ndeyechinguva. Kubva muna 2017 ne2018, vateresi vemitero vanogonazve kubvisa mari yezvechiremba inopfuura 7,5 kubva muzana yemari yavo. Asi kutanga muna 2019, iyo 10 muzana inoshandiswa ichashanda, uye chete mari yezvechiremba inopfuura chikamu ichocho ichava mutero inobviswa.
> Sources:
> Congress.gov. HR1 - Mutemo wekugadzirisa kuyananiswa maererano nemazita II uye V echisarudzo chakaenderana nehuwandu hwemari > gore re2018. Kuiswa murairo 12/22/2017.
> Congressional Budget Office. Kudzokorora Muhuisi Wehutano Hwehutano Mutezo: Anokurudzirwa Muchidimbu . November 2017.
> Kaiser Family Foundation. Enzanisa zvirevo zvekugadzirisa zvakanakira Care Act.
> Kaiser Family Foundation. Utano Inishuwarenzi Inoshandiswa yeVanhu Vose. 2016
> Mark Farrah Associates. Muchidimbu Tarisa Mushandi Wehutano Wehutano Inotengesa Misika. July 19, 2017.