2017 yaiva gore rinotambudza rehutano hwehutano hwekugadzirisa hutano, asi zvinenge zvose zveGOP-yakatungamirirwa kuedza kubvisa Mutengo Wekugadzirisa Mutemo (ACA, unowanzozivikanwa seOmbamacare) usina kubudirira. Hazvigoneki kuti rudzi rwekutsvaga uye kubhadhara zvikwereti izvo zvakatangwa muna 2017 zvichawanikwa zvakare muna 2018, asi remangwana reAACA nehutano hwehutano hwezvehutano zvisati zvava nechokwadi pasi peTrute Administration uye Republican Congress.
Imwe yenhau dzave dziri mberi uye pakati ndizvo zvinotangira zviripo. IAACA yakabvisa zvinyorwa zvezvechiremba muhutano hwehutano hwehutano hwevanhu uye hwediki, saka zvirongwa zveboka rimwe nerimwe uye zviduku zvino zvakapiwa kune vose vanoita zvisinei pasinei nenyaya yezvokurapa, uye pasina kuchinja kwemari kunobva pauri hwehutano.
Ichi chave chiitiko kune vanhu vane mamiriro ezvinhu akambovapo uye mabhizimisi maduku ane zvikwereti zvezvakawanda zvezvokurapa zvezvokurapa, uye zvinopawo rugare rwepfungwa kune vanhu vasati vambovapo, semamiriro ezvinhu ezvehutano angasimuka chero nguva, dzimwe nguva pasina yambiro.
Zviri nyore kuona kuti sei kugoverwa kwemamiriro ezvinhu akambovapo ave chimwe chezvinhu zvakakurumbira zveAACA. Asi zvakare chimwe chezvakagadzirirwa izvo zvakakonzera mari yekutengeswa kwemusika mumwe nomumwe. Kubhadhara mari yepamusoro kwepamberi kunokanganisa iyo mari yehuwandu hwevanhu vane ruzivo kuburikidza nekukwikwidzana, asi kune avo vasina kuwana rubatsiro (kusanganisira vose vanotenga mari kunze kwekugoverana), iyo miriyamisi inogona kunge iri mutoro unorema.
Nokudaro pasinei nekufarirwa kwemitemo yeAACA inoda zvirongwa zvehutano kuvhara mamiriro ezvinhu akagara, nyaya yacho inoramba ichikakavhiringidza. Mimwe yemitemo iyo vateereri veGOP vakakurudzira vaizodzoka zvakasiyana-siyana zveAACA dzekudzivirira mabhandi kune vanhu vane mamiriro ezvinhu akambovapo, uye zvakakosha kunzwisisa kuti izvi zvingashanda sei, kunyanya sezvo zvirevo zvepamutemo pamusoro pezvikamu izvi zvemurairo zvinowanzopa tsanga dzenzira yekuti vanhu vane mamiriro ezvinhu aimbovapo vangadai vakafukidzirwa.
IAHCA uye Zvirongwa Zvichiripo
Musi waMay 4, 2017, House Republican vakapfuura neAmerican Health Care Act (AHCA), uye vakatumira kuSeneti. IAHCA ndiyo yakagadzirisa sarudzo yeJanuary 2017 yakaronga maCommissional komiti kutora mitemo yekuyananisira kubvisa kushandiswa kwemari-yakabatana kweAACA (zvinhu zvakadai semari inobatsira , kuwedzera Medicaid , munhu mumwechete uye mushandi wemabasa ).
Kuyananisira mabhiriji kune mafirimu-uchapupu, saka vanongoda huwandu hushoma muSeneate. Asi ivo vanongogumira kune zvigadziro izvo zvinokonzera kushandiswa kwehurumende, uye naizvozvo haikwanise kutarisa zvinhu zvose zveAne Affordable Care Act. Nyanzvi dzepamutemo dzisina chokwadi kuti urongwa hwekuparadza hurumende yeAACA yakagara huripo huchabvumirwa kupfuurira muSénate seyano rekuyananisa.
Zvisinei, iyo MacArthur Amendment kuAHCA, yakawedzerwa muImba munaEpril mukuedza kukunda vamiririri vanochengetedza, vangadai vakaita saizvozvo. Sezvo zvakadaro, paive nekufungidzira kuti mutemo uyu unofanirwa kuchinjwa zvakanyanya kuitira kupfuudza Senate. Pakupedzisira, Senate Republicans yakaronga shanduro dzakasiyana dzakasiyana dzemutemo, iyo yose yakakundikana kupfuura ("kubvisa" kubvisa, " Better Care Reconciliation Act" , "Obamacare Repeal Reconciliation Act," uye Graham-Cassidy-Heller-Johnson kuchinja).
Somugumisiro, kuedza kwe 2017 kubvisa uye kusimbisa zvikamu zvakawanda zveAACA hazvina kubudirira. Vatongi veGOP vakabudirira mukudarika chirango chaAAC chavamwe chirango sechikamu chemutemo wavo wekutereta wakagadzwa muna December 2017, asi kudzokorora hakubatsiri kusvika muna 2019 ( kuchine chirango chekusabvumirwa muna 2018 ).
Nzvimbo dzakawanda dzeAACA dzinoramba dzisina kusimba kutanga kwegore ra2018, kusanganisira kupa kwaAACA kunoda kuti vatsigiri vadzivirire kuderedza mari yepamusoro yevashandi vanochera mari. Izvi zvinodhura-kugovana zvishoma (CSR) hazvisati zviri kubhadharwa zvakananga nehurumende yehurumende, asi zvikomborero zvichiri kuwanika kune vakanyoresa zvakakodzera.
Asi hutano hunochinja hukakavadzana huri kure, uye hazvina kunyatsojeka kuti yakawanda yeAACA inogona kubviswa kana kuchinjwa mumwedzi inotevera kuburikidza nemitemo yepamusoro uye / kana mitemo yakakura. Saka zvakakosha kunzwisisa kushandiswa kwekare kushandura mitemo pamusoro pezvakaitika kare, sezvo taigona kuona zvakafanana mune ramangwana.
The MacArthur Amendment
Muna Kubvumbi 2017, Rep. Tom MacArthur (R, New Jersey) akaunza shanduko kuAHCA yaida kutambira kutsigirwa kubva kune-ultra-Conservative House Freedom Caucus. Yakanga iri kubudirira, uye kutsigirwa kubva muChristian Caucus pakupedzisira kwakaunza mavhoti akakwana kuti AHCA ipinde muImba.
Iyo MacArthur Amendment ingadai yakarega nyika dzichitsvaka kusunungura-pasi pezvakaonekwa sechibvumirano chebvumirano-izvo zvingave zvakaita kuti vashandure huwandu hwekudzivirirwa kwevatengi veAACA:
- Vanhu vane mamiriro ezvinhu akambovapo kare vanozvinyora mumapurogiramu emakethe emagetsi nemusana wekuvhara (mazuva makumi matanhatu nemaviri mumwedzi 12 yapfuura) vangadai vakazviisa pasi pezvikwereti zvichienderana nehutano hwavo hwemwedzi kwemwedzi gumi nemaviri pasi peiyo mutemo mutsva. Pakanga pasina mamiro ekukwirira kwepamisiyamu idzi, izvo zvingave zvakaguma nekuvharidzirwa kusingabvumirwi kune vamwe vashanduri, zvichienderana nemanhoroondo ezvokurapa. Izvi zvingadai zvakave panzvimbo ye 30% yepamusoro yekuwedzera kwegore rimwe (zvisinei pasinei nenyaya yezvokurapa) iyo AHCA yaizoshandura apo mumwe munhu anenge atengesa misika achishandiswa mushure mekunge gwaro rakavhara.
- IAHCA yaida mari yepayimusi ingadai yakave yakapetwa katatu kune vakwegura (makore makumi mashanu nemakore makumi matanhatu nematanhatu) kupfuura kuvakuru vaduku. Iyo MacArthur Amendment ingadai yakabvumira nyika kuti dzisarudze ichi chiyero uye ipe imwe yakakwirira panzvimbo. Nekuona, ACA inogadzirisa chikamu kusvika ku3: 1, zvinoreva kuti vanhu vakwegura havagoni kukwaniswa kanopfuura katatu kupfuura vanhu vaduku.
- Iyo MacArthur Amendment zvakare ingadai yakaita kuti nyika dzitsvake kutsvaga kuchinja tsanangudzo yezvinodiwa zvehutano hunokosha . Izvozvo zvingareva kuti mamwe mabasa anobvunzwa kuvharwa pasi peAACA angasafanira kuvharwa mune dzimwe nyika kana AHCA yakagadzwa. Kune vanhu vane mararamiro aivepo, izvi zvaive zvakanyanya kunetseka, sezvo kurapa kwavo kwakakodzera kungave kusisati kwave kwakafukidzwa nenishuwarenzi. Pasi peAACA, zvikwereti zvehutano zvakakosha zvinongoda kuve zvakaputirwa nezvirongwa zveboka rimwe nerimwe uye duku, uye Medicaid. Zvirongwa zveboka rakakura hazvidiwi kuti zvivabate, kunyange vakawanda vachiita.
Chii Chiri Kusawirirana Nezve?
Kana wakatarisa VaRepublicans neDemocrats vachikakavadzana pamusoro peAHCA mushure mokunge kuiswa kweMacArthur Amendment, iwe unogona kunge wakaona Democrats achiti mutemo waizovhura maitiro ekuchengetedzwa kwemamiriro ekutanga, asi maRepublicans akati mutemo wakadzivirira vanhu zvakagara mazviri. Saka chaiva chii?
Nenyanzvi, MacArthur Amendment yakati vanhu havagoni kurambwa kuparidzirwa maererano nemamiriro ezvinhu akambovapo. Ndicho chirevo chaRepublicans chaive chekutaura apo vaiti kuti mutemo waisanganisira kusati kwavapo maitiro ekuchengetedza. Dzimwe nguva ivo vakagadzirisa dambudziko racho vachiti vanhu vane mamiriro ezvinhu akambovapo vasati vaone chero njodzi inopesana chero bedzi ivo vachiramba vachienderera mberi.
Asi dhiyabhorosi ari mumashoko acho. Pasi peMacArthur Amendment, ndezvechokwadi kuti chibvumirano chakanga chisingave chakarambidzwa zvachose (icho chaiwanzoitika kune dzakawanda nyika pamberi peAACA, apo vanhu vaiva nemamiriro ezvinhu akatovapo kare uye vakashanda pamusana pekugadziriswa kwemusika). Asi vatsigiri vangave vakakwanisa kupa mari yepamusoro yepamitengo yakakwirira mumushamba wega wega muhurumende nemusununguko, kana vashandi vaive nemamiriro ezvinhu akambovapo uye vakanga vaona mukana wekugoverwa mumwedzi gumi nemaviri apfuura.
Izvozvo zvingave zvakanyatsoita kuti kuvharidzira kusakanganiswa. Saka kunyange zvazvo kushanda kwaisazobvumirwa, kubhadhara kwekodzero yekugadzira zvingadai isina kuitika. Isu tose tine "kuwanika" kune Lamborghinis. Asi izvi hazvirevi kuti tinogona kuva nevana va Lamborghinis.
Iyo MacArthur Amendment yakaunzawo kusanganisa maererano nezvinokosha zvehutano. Kana imwe nyika yakasarudza kusunungura mitemo inoshandiswa pamishonga yemishonga, somuenzaniso (chimwe chezvibatsiro zvehutano zvinokosha zveAACA), tingave taona zvirongwa zvisingavhiringidzi ruzere rwakakwana rwezita rechirwere nemishonga inokosha. Icho chinetso chakakomba kune vanhu vane mamiriro ezvinhu akambovapo anoda mishonga inodhura.
Saizvozvowo, kana nyika yakasarudza kuita kuti vana vawane rubatsiro rwekuberekera vana (ndiyo imwe yezvinodiwa zvehutano zvinokosha uye saka zvinotarisirwa pasi peAACA), vazhinji vevandi vezvematongerwoti mumusika mumwe chete havazombozvipi zvakare, sezvakange zvakaita nyaya pamberi pe ACA .
Nokudaro nepo maRepublicans aive akanyatsogadzirisa mukutaura kuti AHCA yakashandurwa ingadai isina kubvumira bhizinesi kuti varambe kushandiswa zvichienderana nemamiriro ezvinhu akambovapo, MacArthur Amendment zvachose ingadai yakaderedza kuchengetedzwa mumusika wega wevanhu vane mamiriro ezvinhu akambovapo. Uye semugumisiro wekugona kuchinja kune tsanangudzo yezvinodiwa zvehutano hunokosha, iyo inogona kunge yakawedzerwa mumusika unoshandiswa nevashandi pamwe chete.
Ndezvipi Zvimwe AHCA Angaita?
IAHCA ingadai yakabvisa chirango cheAACA chairo pamusana pekutanga kwa2016, kubvisa chimwe chezvinhu zvinokurudzira izvo zvino zvichengetedza vanhu vane utano muhombe yeinishuwarenzi (inishuwarenzi inoshanda chete kana paine vanhu vane utano hwakakwana mudziva kuti vaenzanise zvirevo zve vanhu vanoda ruzivo rwehutano). Asi kugoverwa kwaizoramba kuchivimbiswa-nharo, pasinei nenhoroondo yezvokurapa yemuiti.
[Cherechedza kuti chirongwa chemunhu mumwechete chakadzingwa muGOP mutero wekubhadhara wakagadzwa kumapeto kwegore ra2017, asi kudzokorora hakubatsiri kusvika muna 2019. Zvose zvekuedza kupedza uye kubvisa ACA muna 2017 zvakabatanidza kudzokorora mutemo wega wega, asi mutero wecaresi wakasimudza kunze kwekudzorerwa mune ramangwana panzvimbo.]
Kuti vaite kuti vanhu varambe vachienderera mberi, mune dzimwe nyika dzisina kutsvaga kusunungurwa pasi peMacArthur Amendment, iAHCA yaizove yakatsigira kubhadharwa kwepamusoro kune vanhu vasina kuchengetedza zvinyorwa zvese. Kuvanyoresa mushure mekunge vanyori vekunyora kuzarura gore ra2018 (kureva,, chero munhu upi zvake anyoresa panguva yakanyoresa nguva yakakwana muna 2018, kana panguva yekunyora kusati yakasununguka muna 2019 uye kunze), vashandi vangadai vakaongororwa mapumendi 30 muzana kupfuura yehuwandu hwezinga kana vane kupera kwemazuva makumi matanhatu nemaviri kana kupfuura mukati memwedzi gumi nemaviri vasati vanyora. Iyo mihoro yepamusoro ingadai yakaramba iri panzvimbo yezvasara zveurongwa gore.
Zvakakosha kucherechedza kuti zvikwereti zvakakwirira zvaizoshanda kune ani zvake anyoresa purogiramu yemusika wega wega pamusana pepaburiro riripo. Hazvina mhosva kana munhu wacho anenge aine hutano kana anorwara. Nenzira, izvi zvinowanzoodza mwoyo vanhu vane hutano kubva pakunyora mushure mokunge vaine ruzivo rwekuvhara, uye vanogona kupfurikidza kushandura mapurisa emishuwarenzi kune vanotora zvirwere.
Will ACA Kuedza Kuedza Kuita Kudzokera Kumutemo weA-ACA Inishuwarenzi Here?
Recent Kaiser Family Foundation data inoratidza kuti 27 muzana yevanhu vasina kukwegura muUnited States vane mamiriro ekutanga asati avapo angaita kuti vasakanganiswa mumusika mumwe nomumwe kana tikadzokera kumagariro ekunyorwa kwezvokurapa akanga ari munzvimbo inenge imwe nyika yose pamberi pa2014 .
IAHCA yakanga isina kubudirira muna 2017, nokuti shanduro dzose dzeSeneate dzakakundikana kudarika. Asi kunyange kana AHCA yakanga yapfuura, haina kuenda kusvika pakudzorera zvinhu nenzira yaive isati yatanga ACA. Kunyange zvazvo kune vamwe vanyori vanochengeta mitemo avo vakaronga kuita saizvozvo , kudzokera kuchipatara chakakwana chekurapa mumakethe mumwe nomumwe ndechokugadzirisa mune zvematongerwe enyika.
Asi kunyange kana ACA yakagara yakachengetedzwa mamiriro ekudzivirira aifanira kubviswa, vazhinji veAmerica vacharamba vachichengetedzwa, nekuda kwemitemo iyo isati yasvika ACA. Ngatitarisei kuti vanoita sei:
Pre-ACA: Mitemo Yakasiyana-siyana Kubva Mududziro WeInishuwarenzi
Kune nzira mbiri huru dzekuAmerica kuwana inshuwalhu yehutano: Vashandi-vanobhadhara mari, Medicare, Medicaid, uye mutengo mumwe nomumwe. Iwe unogona kutarisira zvinhu zvakasiyana kune umwe neumwe wavo pasi pekutonga kweTrump .
Kana iyo ACA yaive yakagara yakachengetedzwa mamiriro ekudzivirirwa yaifanira kubviswa, izvo zvaizoitika hazvingasviki pamativi ose mana aya. Kuchinja kukuru kwakaitwa neAACA maererano nemamiriro ezvinhu aimbovapo aiva mumusika mumwe nomumwe, apo vanenge 7 kubva muzana veUnited States vanowana inshuwarhu yehutano hwavo.
HIPAA Yachange Ichiri Kuchengetedza Gulu Remazano Enrollees
HIPAA (Mutano Wemainishuwarenzi Kuzvigadzirisa uye Kuzvidavirira Mutemo) inodzokera kumashure mapfumbamwe-90, uye yakagara ichipa kudzivirirwa kwakakosha kune vanhu vanowana kugoverwa kubva kumushandi (anenge 49 muzana yevanhu vemuUnited States vane basa rakabhadharwa nevanoshandira). Kunyangwe kudzokorora kwakakwana kweAACA-kupesana nemutemo wekuyananisa saAHCA-hakuzobvisi zvirongwa zveHIPAA, saka vanhu vanozogoverwa kubva kuvashandirwi vavo vachange vachiri kugoverana nezvemamiriro ezvinhu akambovapo.
Asi pamberi peAACA, pasi pemitemo yeHIPAA, zvirongwa zvinoshandiswa nevashandi zvinogona kuita kuti nguva yekumirira isati yavapo yehuwandu hwehuwandu hwekuita (kunze kwekuberekwa, kutora chirongwa ichi chakagovera kubatsirwa kwevabereki) kana uyo akanyoresa asina kuchengetedza chinyorwa chinyorwa asati anyoresa muurongwa.
Chero bedzi munhu wacho ainge aramba achienderera mberi kwenguva refu kwemwedzi gumi nemaviri pasina chinyorwa chemazuva makumi matanhatu kana kupfuura, mamiriro ezvinhu akambovapo akanga akavharwa pakarepo sezvo kugoverwa kwega kwega kwakazobudirira. Asi kana uyo akanyoresa aine chikamu pakuparidzirwa kwemazuva anopfuura makumi matanhatu asati achinyorera muurongwa hunoshandiswa nevashandirwi, urongwa hunogona kuisa nguva yekumirira kusvika mwedzi gumi nemaviri nekuda kwezvinoitika.
IAACA yakabvisa urongwa uhwu. Pasi peAACA, mamiriro ezvinhu aimbovapo anowanikwa pane chirongwa chega chega chinoshandiswa nevashandirwi, uye kune vose vasina- grandfathered (uye vasina- grandmothered ) mararamiro emisika yemakethe, nokukurumidza kana kuwanikwa kwevanhu pasi pesarudzo kunoshanda.
IAACA yakarambidzawo vatsigiri vekuchengetedza madiki mapoka ekubhadhara mari yakadzama yakabva kune vevashandi vezvechiremba. Kubatanidzwa kweboka duku kwaive kwakatogadziriswa-nyaya pasi peHIPAA, asi vatakuri vanogona kupa mari yepamusoro yepuraimari kuti ipe mapoka nehutano hwehurombo hwehutano. Apo kamwe ACA yakatanga kushanda, izvi zvakarambidzwa, uye mapeamendi mashoma emapoka aigona kungotarirwa pamazana emakore, nzvimbo, hutano hwemhuri, uye kushandiswa kwefodya.
Kana iyo ACA yakabviswa uye kushandiswa kusina kubatanidza urongwa hwokudzivisa nguva yekumirira yezvakaitika kare, mitemo yaizodzokera nenzira yaive iri pamberi pegore ra2014. Vanhu avo vakaramba vachienderera mberi havangave nenguva yekumirira yekare yakagara mamiriro ezvinhu paanosangana neurongwa hwehutano hwevashandi. Asi vanhu vane ruvengo muhuwandu hunogona kuve pasi pekumirira kwemazuva ekugara akambovapo. Uye mapoka madiki ane vashandi mune utano husina hutano angasangana nezvikwereti zvepamusoro zvakakwana kupfuura mapoka madiki ane vashandi vane utano.
Asi AHCA haizove yakabvisa zvinyorwa izvi zveAACA (kuchengeta mupfungwa kuti yakanga iri bhiriyano rekuyananisa, uye rakange risingagumi pane zvingashandurwa). Pasi peAHCA, kurambidzwa kwezvakaitika kare kune nguva yekumirira nguva yekushandira zvikwereti zvingadai zvakaramba zvichiri kushanda, uye mapeamendi mumakambani maduku madzimai haazove akazvidzivirira pane hutano hweboka revanoshandira.
Medicare uye Medicaid Vachaenderera Kuvhara Mamiriro Ezvinhu Anotangira
Medicaid uye Medicare vanovhara mamiriro ezvinhu akambovapo. Iko kune zvimwe zvipfeko zveMedare, zvisinei, izvo hazvinei neAACA:
- Munyika dzakawanda, vanhu vanyoresa muurongwa hweMedigap mushure mekunge vanyoro yavo yokunyora yewindo (uye vasina ruzivo kune imwe yenhepfenyuro yeMedigap yakanyoreswa yakakwana) inowanikwa pasi pekunyorwa kwechiremba. Basa ravo rinogona kurambwa, vanogona kupiwa chirongwa nepamusoro-kudarika-yepamusoro-purogiramu, kana mutakuri anogona kuisa mamiriro ekutanga akagara akamirira.
- Mune zviitiko zvakawanda, kana iwe wapedza-stenti-stenal renal chirwere (ESRD), haugoni kunyoresa ku Medicare Advantage .
Kunyange zvazvo ACA isina kuchinja chero chinhu pamusoro pehutachiwana huripo huripo huri pasi peMedricare uye Medicaid, yakanyanyisa kuwedzera kusvika kune Medicaid. Nhamba yekubhabhatidzwa kwaMedicaid / CHIP yakawedzera nevanhu vanodarika mamiriyoni 17 kubva pakupera kwa2013, tichida zvikuru kuwedzera kweAACA yemitemo yekufanirwa kweMedicaid.
Pamberi peAACA, Medicaid (iyo yaisanganisira kugoverwa kwemamiriro ezvinhu akambovapo) yaive yakawanikwa mune dzakawanda inotaura nezvevakadzi vasina pamuviri vane mimba nevana, vamwe vabereki vane mari shoma kwazvo, pamwe chete nevagari vepasi vasina mari vakagadzikana uye / kana vakwegura.
Pasi peAACA, 31 States uye District of Columbia vakawedzera Medicaid kuvanhu vose vakuru vane mari yemhuri kusvika 138 kubva muzana yehurombo, iyo inodarika madhora 16,700 mumari yegore rimwe chete muna 2018.
Kana ACA ichizobviswa uye kushandiswa kwacho hakusi kwakasimba, mamiriyoni evanhu avo iye zvino vane Medicaid vanogona kurasikirwa nekwaniso yekuwana kugoverwa. Vaizokwanisa kutenga kutengesa mumusika mumwe nomumwe (zvichida ane rudzi rwekubhadhara mutero), asi izvo zvingasava mari yepamusoro kune avo vane mari shoma. Kana vaizove vasina kuvimbiswa, mamiriro avo ezvinhu akambovapo akanga asingazogoni kuvharwa, uyewo hapana chero kurapwa kwavasingatarisirwi vangave vachida.
IAHCA yaida kubhadharwa kwekunyora pakuwedzera muMedicaid kubva muna 2020, uye kuchinja Medicaid kune imwe nhengo yekugovera kana kubhadharo pane pane ikozvino yakasununguka sangano rinoshandiswa sangano rinoshandiswa nhasi.
Izvozvo hazvina kuitika, asi Hurumende yeTrump yatanga kutora nzira yakasiyana yekuderedza kuverengwa kweMedicaid nekudzikinura mitemo pamusoro pevaya vanoti vanogona kutsvaga mishonga yavo yeMedicaid (Medicaid inobhadharwa pamwe chete nehurumende nehurumende, saka inotaura ruoko rukaita mamwe emitemo). Zvinhu zvakadai sekushanda zvinodiwa uye hupenyu hwehupenyu hwehupenyu hwakanga husingabvumirwi pasi pe Obama Administration, asi huri kubvumidzwa kana kuonekwa neTrute Administration. Pakupedzisira, chinangwa chekutonga kweTrump nevatongi veGOP ndechokuti vave nevanhu vashoma vakaputirwa neMedicaid. Zvinosuruvarisa, hakuna mufananidzo wakajeka wekuti vanhu ivavo vanofanira kuwana sei kumwe kugoverwa, uye vazhinji vangangova vasina kuvimbiswa vasina kuwana maMedicaid.
Mamiriro Ekutanga Anotarisana neMunhu Mumwe Chega
Sezvinorondedzerwa pamusoro apa, AHCA-pamwe neMacArthur Amendment-ingadai yakazadza zvimwe zvekare zvakagara zviripo zvidziviriro zvakasikwa neAACA.
Kunzwisisa kuti maitirwo akaita sei kare akashandiswa pre-ACA chikamu chakakosha chekunzwisisa kuti sei ACA yaive yakakodzera pakutanga, uye chii chinogona kuvepo kana kusati kwavapo kwekuchengetedzwa kwemamiriro ezvinhu kuchinjwa.
Kubatanidzwa mumushamba wega woga mune zvese kunze kwechishanu zvakange zvichishandiswa kunyorwa pasi pamberi pegore ra2014, apo ACA yakarambidza iyo tsika (mumwe wekutengeswa kwemusika ndiyo mutengo waunotenga iwe-kuburikidza nekutsinhanisa kana kusagadzikana - kusanganisa pane kuigamuchira kubva kumushandi ).
Kune vanhu vanodarika mamiriyoni 17 vane hupfumi mumusika mumwe nomumwe. Vakawanda vavo vakanga vatotengesa pamakambani kare pre-ACA, asi vamwe vakangokwanisa kuwana ruzivo apo mitemo yaAACA yakatanga uye vatakuri vakanga vasingachakwanisi kuramba zvikwereti zvichienderana nevanoshandiswa nehutano hwehutano.
Chiremba pasi pekunyora chaireva kuti mumwe nemusika mutengesi yemishonga inshuwalano yehutano yakabatanidza mapepa mazhinji emibvunzo pamusoro pevashandi vezvechiremba. Kuvharidzirwa kukodzera kwakatsigirwa nemhinduro, uye kuvanhu vakabvumirwa kunyoresa pasinei nemamiriro avo aimbovapo, mapeamisi aiwanzokwirira kupfuura mazinga akaenzana.
Mamiriro ezvinhu aimbovapo aisanganisira kunyanya chero kurapwa kwechiremba. Kunyanya kuwandisa, kuwedzera cholesterol kana kuwedzerwa kweropa, nhoroondo yekushanyira chiropractor ... zvose zvakaongororwa nevanyori vezvokurapa kuti vaone kana munhu anenge akakumbira akakodzera kugoverwa, uye kana zvakadaro, pamutengo upi.
IAACA yakashandura zvose izvozvo. Pamusana pemusika wega, mitemo yeAACA yakagara iripo yaiva mutambi-mutambi. Kuramba kushandiswa uye kuwedzera mihorosiyamu pamusana pezvokurapa zvakaitika kwakave chinhu chekare, sekuita kwakagara kwavapo kune nguva yekumirira.
Mukuwedzera kune AHCA, zvimwe zvikamu zvakawanda zveAACA kubviswa / kushandura mitemo zvakatangwa nevatongi veGOP mugore ra2017. Vakawanda vavo vakadana kuchengetedza ACA yekudzivirirwa kwevanhu vemazuva ano.
Asi kana iyo ACA inotarisirwa kuti nyaya yacho isati yakachengetwa, pane nzira mbiri dzinokosha dzekugadzirisa mamiriro ezvinhu akambovapo akange akabatanidzwa mune dzakawanda zvezvirongwa zvakaiswa mumakore mashomanana apfuura: dzimba dzakawanda dzinotyisa kana kuti "kuenderera mberi" , kana maviri.
Zvose izvi zvakabatanidzwa muMasimba ekurapa varwere vekutanga, yakataurirwa naT. Tom Price (R, Georgia), uyo akasimbiswa neSeneti munaFebruary 2017 kuva Munyori weHutano neHuman Services (Mutengo wakasiyiwa mushure mekunge muna 2017, pakati pemishumo inoti akashandisa jets pachake pane nzvimbo dzebhizimisi dzebhizimisi kuitira bhizimisi rake kufamba). Zvose izvi zvinowanikwawo mune imwe nzira yakanakisisa, chirongwa chekugadzirisa hutano hunobudiswa neHarare Republican munaJune 2016.
Mvura Dzakakwirira
Zvizhinji zveRepublican nezvehutano hwekugadzirisa zvirongwa zvekurarama nazvo zvakasanganisira kudzokera kumadzimba akakwirira ekusimbisa vanhu vasingakwanisi kuwana ruzivo mumusika mumwe nomumwe (mumakumbirwo anosanganisira kuenderera mberi kwekugadzirisa zvigadziriswa, dzimba dzepamusoro-ngozi dzinoda kuvhara vanhu vasingaiti kuchengetedza kunopfuurira, uye avo vane nguva yakagara iripo inokosha zvakakwana zvokuti havakwanise kuwana mishonga inonyorwa pasi pezvinyorwa).
Dzimba dzepamusoro-ngozi dzakasimbiswa mumatunhu makumi matatu nemakumi matatu nemakumi mapfumbamwe. Asi kukanganisa kwakawanda kwekuisa pangozi yemuenzaniso muenzaniso waiva chikamu chechikonzero icho ACA chaidiwa pakutanga. Zvirongwa izvi zvaiwanzova zvekutengesa, uye kazhinji zvaive nezvakawanda zvekubuda kwehombodo uye zvishoma zvoupenyu huwandu hunobatsira. Mukuwedzera, dzimwe dzimba dzakaipisisa dzaifanira kukonzera kuverengwa kwemakore pamusoro pemakore ekuda kwebhadharo.
Nzvimbo dzepamusoro-pangozi dzakapedzisira kushanda apo pakavimbiswa-imwe nyaya yekutengeswa kwemari yakatanga kuwanika muna 2014. Asi mamwe maitirwo anove achiri nehutachiona hwemvura yakawanda. Nekubhadhara mari yakakwana, nzvimbo dzakakwirira-panjodzi dzinogona kuva sarudzo yakasimba inofambira mberi. Asi pasina mari yakakwana, hazviiti kuti vangave vakabudirira zvakare kupfuura zvavakanga vari mumakore zvichiita kushanda kweAACA.
IAHCA ingadai yakapa hurumende mari yezvematongerwo enyika kuti ishandise pamadzimba akakwirira, asi ingadai yakashandisawo kune mamwe mazai emagetsi ekugadzirisa. Uye nyanzvi dzakawanda dzakaona kuti kubhadhara mari yakawanda yakadzika muAHCA haizove yakakwanira kubvumira dzimba dzepamusoro dzine ngozi kuti dziite zvakanaka.
Continuous Coverage
Pasi peAACA, kuparidzirwa kunovimbiswa nyaya, nguva. Hazvina basa kuti wakave usina uninsured sei paunenge uchinyora, uye hazvina basa kuti ndezvipi zvawakagara uripo (asi iwe unogona kunyora chete panguva yekunyora yakasununguka gore negore, kana panguva yekunyora kunokosha kana iwe vanoona chiitiko chinofanirwa).
Pasi pemhando dzakasiyana-siyana dzeGOP dzekugadzirisa mazano anoshevedza kuti kuenderera mberi kugoverwa, pfungwa yacho ndeyokutarisa zvimwe zveHIPAA kudzivirira kumusika mumwe nomumwe. Vanhu vanoramba vachienderera mberi (kana vari muchirongwa cheboka kana chirongwa chavo pachavo) vanogona kukwanisa kupinda muurongwa hutsva pamutambo wepamusoro, pasinei nemamiriro ezvinhu akambovapo (kureva, asina kunyora pasi pezvokurapa).
Asi vanhu vane ruzivo muhuwandu huchava pasi pezvikwereti. Pfungwa iyi ndeyokukurudzira vanhu kuti varambe vachienderera mberi vachienderera mberi vasingashandisi kumutemo weAACA asingadikanwi.
Mune hurumende iyo haina kutsvaga kuregererwa pasi peMacArthur Amendment, AHCA ingadai yaisanganisira kubhadhara mari yepamusoro yevanhu vasina kuchengetedza kuenderera mberi. Zvinyorwa zvemari zvingadai zvakashanda zvakaenzana, kune vose vane hutano uye vanorwara vanoshanda.
Izvi zvakasiyana nehupfumi hunopfuurira hunoita kuti vatsigiri vashandisi vashandise zvinyorwa pasi pezvokurapa apo vatsvaki vanyoresa kutevera chikamu chiripo. Ndiyo nzira iyo ingadai yakashandiswa pasi peAHCA mune zvinyorwa zvitsvaga kutsvaga kuita saizvozvo. Mune dzimwe nyika, vanhu vane hutano vane ruzivo rwekugoverwa vangadai vakwanisa kunyora mune imwe pese yekutengeserana nemakero nemazinga akaenzana. Asi vanhu vane mamiriro akambovapo (iyo inonyanya kurongwa) vangadai vari pasi pehurukuro yakakwirira zvakanyanya kana vakashanda pamusana pekugoverwa kwemakwenzi pasina nhoroondo yekuenderera mberi kwekugoverwa mugore rapfuura.
Ndinofanira Kunetseka Here?
Zvichida, kunyange zvichienderana nehutungamiri hwehutano hunochinja hutano hunotora. IAACA haisisiri pasi pekufungisisa, asi chimwe chinhu chakafanana chinogona kuiswa muna 2018 kana gore rinouya, kunyanya kana veRepublicans vachichengetedza hukuru hwavo muCongress mushure megore ra 2018 pakati pemakore ekupedzisira.
Shanduro yeAHCA iyo yakapfuurira imba yacho yaizove yakakanganisa vanhu vane mamiriro ezvinhu akambovapo avo vaida kugoverwa mumusika mumwe nomumwe. Izvo zvaivawo zvinetso mumagariro ekuti zvinodiwa zvehutano zvakakosha zvingadai zvakaderedzwa, zvichiita kuti zvive zvakaoma kuti vanhu vane boka duku varonga kuwana ruzivo rwemamiriro avo ezvinhu akambovapo.
Uye kunyange mumusika mukuru wemapoka, zvirongwa zveAACA zvinorambidza mararamiro ehupenyu uye gore rinoshandiswa huwandu hwemari uye zvinogadzirisa kunze kwemari zvinoshandiswa zvinongoshanda kune zvinokosha zvehutano (izvo zvisingadi kuiswa pasi pezvirongwa zveboka guru, asi kana zviri-uye zvinowanzo-mararamiro eupenyu / gore rose kubhadhara kubhadhara uye chikwata chiri kunze kwehomwe mari inoshandiswa). Saka kana zvikwereti zvakakosha zvakakonzerwa zvakare, vanhu vane zvirwere zvekurapa zvinowanzoenderera mberi vanogadzirisa zvirongwa zvingashandurwa zvakare .
Muna 2017, vatongi veRipublican vakati kakawanda vakati AHCA yaizoenderera mberi kudzivirira vanhu vane mamiriro ezvinhu akambovapo, kunyange zvazvo izvo zvisiri zvechokwadi. Nguva yemberi yehutano hwekushandura kwehutano inoramba ichionekwa, uye kunetseka pamusoro pemamiriro ezvinhu akagara aripo ndeyechokwadi. Asi kwenguva iyo iri, hapana chakachinja pamusoro pekubatsira kwehutano hunokosha nekugoverwa kwemamiriro akambovapo.
> Sources:
> Congressional Budget Office, American Health Care Act, March 13, 2017.
> HealthCare.gov, Grandfathered Health Insurance Plans.
> Kaiser Family Foundation, Health Insurance Coverage ye Total Population. 2016.
> Kaiser Family Foundation, Pre-existing Conditions uye Medical Underwriting muIvidual Insurance Market Pamberi paAACA. December 12, 2016.
> Kaiser Family Foundation, Kaiser Health Tracking Poll-June 2017: ACA, Replacement Plan, uye Medicaid. June 23, 2017.
> United States Dhipatimendi reMabasa, Health Benefits Coverage Under Federal Law. Svondo 2014.
> United States Dhipatimendi reMabasa, Utano Hwokuchengetedzwa Kwemutemo Mutemo uye Kuzvidavirira Mutemo (HIPAA) Kusarudzwa Kwehutano Hwehutano Uye Kusarudzwa Kwekutsvaga Zvaunoda FAQ.