Ko Trump waOctober 2017 hutungamiri huchaita sei hunochinja hutano hwehutano?
Musi waOctober 12, 2017, Mutungamiri Trump akasayira mutemo mukuru "kusimbisa sarudzo yehutano nekukwikwidzana muUnited States." Mutungamiri wehutungamiri wakauya maawa mashomanana vasati vatungamiri veTrump vazivisa kuti mari yeAACA yekudhura kugoverwa mari (CSR) ichapera pakarepo , saka hazvishamisi kuti maitiro ehutungamiri wehutungamiri uye sangano reCRR rakagurwa dzimwe nguva rinongororwa.
Asi sezvo sangano reCSR rakagurwa raiva chiito chakajeka chakatanga kushanda pakarepo, mutungamiri wehutungamiri haana kuita chero shanduko mukati maro uye pachayo, uye zvinoguma zvichitora nguva yekugadzira. Mutungamiri wehurumende anongorayira masangano ehurumende akasiyana-siyana kuti "afunge nezvekugadzirisa mitemo" kuita shanduko dzakasiyana-siyana kumitemo inobata inshuwarhu yehutano yemazuva mashomanana, zvirongwa zvehutano hwehutano, uye hutano hwekubhadhara hutano (HRAs). Mitemo iyoyo inofanira kutora kuburikidza nehutano hwekuita-kutonga, iyo inosanganisira nguva yekutaura kwevanhu.
Ngatitarisei kuti izvo zvinoshanduka zvingave zvakadini, uye kuti zvingakanganisa sei inshuwarano yehutano.
Mishonga Yemazuva Ekupedzisira Youtano
Nguva yemazuva mashomanana, inshuwarisi yemazuva mashoma (STLDI) ndeyekuti zvinonzwika sei: inshuwarisi yehutano kuti iwe unogona chete kuchengeta kwenguva shoma. Asi urefu hwenguva iyo mumwe munhu angave achikwanisa kuva nekugoverwa kwenguva pfupi kwakapesana mumakore achangopfuura.
Nguva shomanana yehutano inshuwarhu haisi kutongerwa neAne Affordable Care Act. Saka avo vanofanirwa kubhadharwa vachiri kugoverwa pamabasa avo ezvehutano, mamiriro ezvinhu akambovapo asati avharwa, nguva yeupenyu uye gore rinoshandiswa mashoma majeko anoshandiswa, uye zvirongwa hazvifanirwi kuvhara mazano eAIDS ekukosha kwehutano .
Maitiro ekurasikirwa kurasikirwa (MLR) mitemo haashandisi kuronga kwenguva pfupi, naizvozvo hapana chikonzero chokuti huwandu hwepurayamisi hunoshandiswa pamashoko ekurapa.
Muchidimbu, zvirongwa izvi zvakafanana nenzira dzakawanda kune imwe yemapurogiramu makuru ezvokurapa ayo akanga ari kutengeswa mune dzakawanda nyika pamberi pegore ra2014. ACA inorambidza kutengeswa kwezvirongwa zvakadai mumutengo mukuru wezvokurapa wepamusoro wegore ra2014, asi Mitemo mitsva haishandisi kumiganhu yenguva pfupi.
Sezvo zvirongwa zvenguva pfupi zvakakwanisa kupfuurira kupa ruzivo kune vanhu vane hutano vane mitemo yakasimba pamigumisiro, uye nokuti zvirongwa zvisingagumi kwenguva refu, iyo mihorosiyamu inowanzove yakaderera zvakanyanya kudarika mari yakakwana yeAACA-inoenderana nemusika (zvose uye kunze-kuchinjana, semunhu mukuru wezvirongwa zvezvehutano zvinotarisirwa kutevera mitemo yakafanana kunze kwekutsinhanisa iyo inotevera mukati memuchengeterano).
Kusati gore ra2017, sarudzo yehurumende yeurongwa hwenguva pfupi yakanga iri kugoverwa kwaive nekureba kwemazuva 364. Dzimwe hurumende dzaive nemitemo yakasimba (vashomanana havabvumiri zvirongwa zvenguva pfupi, uye vamwe vakazvidzivirira kumwedzi mitanhatu), uye vatsigiri vakawanda vanogadzirisa zvirongwa zvenguva pfupi zvenguva pfupi kumwedzi mitanhatu muhupenyu, pasinei nekugadziriswa kunoitwa ne hurumende kana hurumende yehurumende.
Asi mune ruzhinji rwehurumende, pane zvishoma zvishoma zvirongwa zvenguva pfupi zvinowanikwa nehupenyu hwepedyo gore.
Kunyora muzvirongwa izvi kwakawedzera mushure mekugadziriswa kweAACA, sezvo vanhu vaitsvaga dzimwe nzira dzingabhadhara kuAACA-inoenderana nekuvhara. IAACA inoita kuti vanhu vawane mari yekupa mari yepamusoro , asi avo vane mari yepamusoro zvishoma pamusoro pezana 400 muzana yehurombo huri (kureva, vasingakwanisi kutenga rubatsiro rwemari yepayimusi) dzimwe nguva vanoona kuti zvirongwa zviripo kwavari zvinopfuura izvo zvavanowana bhajeti ichabvumira.
Kune vanhu ava, chero bedzi vaine hutano, hurongwa hwenguva pfupi hunogona kupa shanduro inobatsira kuti usasimbiswa.
Asi zvirongwa zvenguva pfupi dzine zvipingamupinyi zvakakomba (izvo vanhu vasingazivi nguva dzose kusvikira vangazviwana vachida kurapwa kwakanyanya), uye kana vanhu vane hutano vakasiya ACA-inoenderana nedambudziko rekuchengetedza kune dzimwe nzira, rinosiya zvose pangozi yezvirongwa zveAACA-zvinogadziriswa zvakanyanya kunyengera kune vanorwara, izvo zvinoguma mumisika isingagadziki.
Kunyange zvazvo vanhu vanovimba neshuwarisi yemazuva mashomanana vave vachizviisa pasi peAACA yekugoverwa chirango kubva mugore ra2014 (nokuti inshuwalhu yenguva pfupi haifaniri kutarisirwa kuti inokosha inokosha kugoverwa), Obama Administration yakasarudza kusimudzira mitemo uye inoita kuti inshuwarisi yenguva pfupi rinogona kushandiswa chete sezvarakanga rakatangwa: kuzadza mukana muduku pakati peimwe hurongwa hwehutano hwehutano, uye kwete sechigaro chenguva refu yehutano hwehutano inshuwarisi.
Saka vakagadzirisa mitemo mumagumo e 2016 (iyo yakatanga kushanda munaJanuary 2017 uye yakamanikidzwa kutanga munaEpril 2017) iyo inogadzirisa zvirongwa zvenguva pfupi kumwedzi mitatu munguva.
Hurongwa hukuru hweTrump hunogona kuunza mitemo mitsva inodzokorora mutemo we 2016 uye kudzorera mutemo wekare wakabvumira zvirongwa zvenguva pfupi kuti dzive nemakore makumi matatu nemakumi mana nemaviri. Asi vanhu vanovimba nemiganhu yenguva pfupi vaizove vachizviisa pasi pechirango cheAAC chavanogoverana, sezvo inshuwarisi yenguva pfupi ichiri kungofungidzirwa kunge isingabatsiri, uye naizvozvo kwete zvishoma zvishoma kugoverwa.
Pane zvinonetsa kuti kudzokera shure kwemitemo yezvigadziriswa zvenguva pfupi ichagadzirisa ACA-inoenderana nemusika. Asi vamwe vanoti vangangodaro vanochengetedza mitemo yakawanda yavakanga vatarisana gore ra2016, uye vamwe vangaita mitemo yakafanana kuitira kuchengetedza avo vaAACA-vanoenderana nemakambani makuru ezvokurapa.
Association Health Plans
Hurongwa hukuru hweTrump inoda kuti "kuwedzerwa kuwana" kune masangano ehutano hwehutano (AHPs), kuitira kuti mabhizimisi maduku abatanidzwe pamwechete uye awane kugovera kweboka rakakura (rakatengwa kubva kune inshuwarisi kana kuti kune inshuwarisi), panzvimbo yekuti bhizinesi rimwe nerimwe rizvitenge urongwa hweboka duku.
IAACA yakaisa mitemo yayo yakawanda pamusika mumwe nomumwe uye muduku. Kunyange zvazvo vashandi vakura (50+ vashandi) ndivo chete vanodiwa nemutemo kuti vape kugoverwa kune vashandi, kugoverwa kwemadiki mashoma kunogona kutengeswa zvakanyanya kudarika kugoverwa kunowanikwa kumapoka makuru.
Nokuda kwekuparidzira zvakakwana munaJanuary 2014 kana kuti gare gare, ACA inoda kuti mapeamisi mashoma emapoka ave akavakirwa chete kune vevashandi vezera, kushandiswa kwefodya, uye nzvimbo chaiyo-nzvimbo yehutano yeboka iri haigoni kushandiswa kugadzirisa mapeamisi. Uye mapoka maduku maduku anodiwa kuvhara kubatsira kweAAC inokosha yehutano . Hapana chimwe chezvidiwa izvi chinoshanda kune mapoka makuru emapoka (vazhinji vesangano guru rezvirongwa vanozvimiririra, asi izvo zvinodiwa neAACA hazvishandisi kwavari chero nzira).
Saka pfungwa neAHPs ndeyokutendera mapoka mashoma kuti aende pamwe chete kuti aumbe mapoka makuru, uye kudzivisa mamwe emitemo yeAACA mukugadzirisa. Asi nepo mubairo mukuru aine chido chakakosha pakuita kuti vashandi varo varambe vaine hutano uye mararamiro ayo ehutano akakwana zvakakwana kuti ave chikwata chekuunganidza uye chekuchengetedza, izvo zvingasava zvechokwadi kune sangano rehutano hwehutano.
Uye kunyange zvazvo mushandi mukuru aifunga kwenguva yakareba pamusoro payo mazano anobatsira, hapana chakadzivirira bhizinesi duku kupinda muAHP apo vashandi varo vane utano, uyezve kudzokera kumusika weCAA-unoenderana nemusika unotevera kana icho chisarudzo chaifanira kuva chinonakidza zvikuru zvichienderana nemamiriro ezvinhu akachinjwa. Saka pane zvinonetsa kuti kuwedzera kwehuwandu hweAHPs kunogona kukanganisa kambani yeCAA-inoenderana nemakwikwi maduku nekukwevera madiki madzimai kubva kune ACA-inoenderana nemusika uye kuAHPs.
Health Artificial Arrangement Arrangements
Mutungamiri wehurumende anotumirawo mitemo mitsva ye "kuwedzera kushanduka uye kushandiswa kwe" hutano hwekubhadhara mari (HRAs). Iyo pfungwa, inonyanya, ndeyekubvumira vashandi kushandisa HRAs kubhadhara vashandi pamakambani emakambani emisika.
Vashandi vakashandiswa kuita izvi. Asi yakarambidzwa zvachose pasi pemitemo yekutanga yakanyorerwa kushandiswa kweAACA (kubvumidzwa kwaifambidzana nefambisi yakanaka: $ 100 zuva nezuva nemushandi kana mushandirwi achienderera mberi achibhadhara vashandi pamashandiro emakisi ega ega). Murairo wacho wakaderedzwa zvishoma ne 21st Century Cure Act, iyo yakatanga kushanda muna 2017 uye inobvumira vashandi vashoma (vashoma vanopfuura 50 vashandi) kuti vadzosere vashandi vemakambani ehurumende yemishonga yehutano yehutano kusvika kune imwe yakagara yakagadziwa madhora emari , vachishandisa HRAs.
Asi vashandirwi vaduku havakwanisi kupa ruzivo pane zvose pasi pe ACA, apo vashandi vakura vari. Uye iye zvino hapana purogiramu inobvumira vashandi vakawanda kubhadhara vashandi pamayero emakambani ega. Vashandi vane rusununguko kuwana chero rudzi rwehushuwarisi rwavanoda-kugamuchira chipo chavanoshandira che inshuwarisi yehutano hweboka, kana kutenga kugoverwa mumusika mumwe nomumwe-asi mushandirwi mukuru haagoni kubhadhara mari yega yega (pamwe chete, mushandi haakwanisi kuwana rubatsiro rwepayimusi mu iyo yemusika kana muridziri ari kupa zvisingakwanisi, inshumo inokosha yehutano inshuwarhu yehutano).
Hurongwa hutungamiri hweTrump inotarisirwa kuti huve nemigumisiro inorongwa inogona kuwedzera kushandiswa kwevashandi kushandisa HRAs kuti vadzosere vashandi 'pamakambani ekutengeserana pamusika, kunyange kana mushandi ane makumi mashanu kana kupfuura vashandi.
Izvo zvatisati tatiziva ndehuwandu hwemirairo yakarongwa. Ko chete ACA-inoenderana nekutaridzirwa inofungidzirwa yakakodzera kubhadharwa, kana kuti kunze kwezvakabatsiri (sezvirevo zvenguva shomanana zvataurwa) zvinokodzera here? Ko vashandirwi vakuru vaizoonekwa sevari kutevera basa revanoshandira (kureva kuti, izvo zvavanoda kupa kana kuti vangatofanira kubhadhara chirango) kana vakashandisa HRAs kuti vadzorere mari yemashandiro emakambani panzvimbo pekupa mapoka eboka?
Tichaona Rini Zvitemo Zvitsva?
Zvakawanda zvakasara kuti zvionekwe maererano nezvakanyatsorongedzerwa mumitemo inotevera. Mitemo yeAHPs uye inshuwarhu yehutano inshuwarisi inotarisirwa kurongedzwa mukati memazuva makumi matanhatu kubva musi wekutonga, saka tinofanira kuaona vasati vapera gore. Uye mitemo ine chokuita neHRA inotarisirwa kurongedzwa mukati memazuva makumi maviri, saka inofanira kuwanikwa kutanga kwegore ra2018.
Mushure mokunge mitemo yakarongwa ichinyorwa, pachava nehurukuro yevanhu musati yatanga kushanda, saka kana uine mhinduro kune vehurumende dzehurumende dziri kushanda panyaya idzi, iyo ichava mukana wako wekugovera.
> Sources:
> Dhipatimendi reMari; Dhipatimendi reVashandi; Dhipatimendi reHutano neHuman Services. Kunze kweZvibatsiro, Lifetime uye Zvikwereti zvegore negore, uye Nenguva Yenguva Yakawandisa Nguva Inoshuwarenzi . October 2016.
> White House, Office of the Press Secretary. Presidential Executive Order Kurudzira Utano hweHutano Nokukwikwidzana Munyika yose yeUnited States. Gumiguru 12, 2017.