Pakati pehurukuro dzekuvandudza AHCA, kusagadzikana kunowanikwa mumisika yemishuwarenzi
Apo Donald Trump akakunda sarudzo yezvematongerwo enyika munaNovember 2016, remangwana reAne Affordable Care Act (aka Obamacare) rakangoerekana risina chokwadi .
IAACA yakanga yakatarisana nezvipingamupinyi zvakapfuura, kusanganisira nyaya yepamusoro ye 2012 Supreme Court iyo yakawana mutemo wega wega wega wekugadzwa kwebumbiro rezvematongerwo enyika (asi kwete izvo zvinoreva kuti kuwedzera Medicaid kuitira kuchengetedza Medicaid iripo mari ), uye nyaya yeDare Repamusorosoro ra2015 umo ACA rubatsiro rwepayimari rwakanga rwakatemwa kuva mutemo mune imwe nyika.
Uye zvechokwadi, pakave neine tambo yekutonga kwepamutemo pamusoro pemutemo kubvira apo yakagadzwa. Hapana chimwe chezvikamu izvi zvemitemo chakanga chave chichimirira mukana chaiwo, zvakadaro, nekuda kweiyo-Mutungamiri weBotswana Obama vhoti.
Zvinhu zvakaratidzika zvakasiyana zvakanyanya kubva musi waNovember 9, 2016. Nehuwandu hweRepublican muzvikamu zvose zveCongress, uye Republican muWhite House iyo yakanga ichishandira pachikwata chokudzura ACA kunze kwemasuo, yakaonekwa kunge isina kumira iyo GOP kubva pakuita zvakanaka pamakore manomwe ezvivimbiso zvekubvisa ACA.
Asi ACA yakave yakanyatsogadzirwa muhutano hwehutano hwehutano, uye nhamba yevanhu vane inshuwarhu yehutano yehutano yakawedzera nekusvika mamiriyoni makumi maviri nekuda kweAACA (kunyanya kuburikidza nokuwedzera kweMedicaid uye kugoverwa kwemusika mumwe nomumwe, kunyange vamwe vachiri vaduku vanhu vakuru vakawana kugoverwa pasi pezvirongwa zvehupenyu hwevabereki vavo). Kudzokorora uye / kana kutora chikamu cheAACA kwakaratidza kuva chakaoma kudarika zvakatanga kuonekwa.
Chii Chakaitika Saka Zvakanyanya?
MunaJanuary, pamberi paTrump, Congress yakapfuura S.Con.Res.3, sarudzo yebhajeti yakagadziriswa nebhora pakugadzirisa kushandiswa kwemari-yeAACA. Sarudzo yacho yakatungamirirwa nevakuru vekomiti kuti vanyora musangano wekuyananisa waizoshandiswa kuparadza kana kuchinja zvikamu zveAACA izvo zvakananga kugadzirisa bhadharo yehurumende (kuyananisira mabhiriji inofadza-uchapupu, saka ivo vanongoda chete ruzhinji rushoma kudarika; , zvisinei, kune zvigadziro izvo zvinokanganisa bhajeti).
Zvikamu zvitanhatu zvekusava kwekuyananisa mitemo yakabatana neAACA yakaiswa pakutanga kwegore ra2017 , asi hapana kana mumwe wavo akafambira mberi pakuvhota. Bhiri rekuyananisa rakaguma kubva mukugadziriswa kwebhajititi yeJanuary-American Health Care Act, kana AHCA-yakatangwa mukutanga kwaMarch.
Asi mushure memazuva gumi nemasere ekukurukurirana kwakakurumidza uye kugadzirisa kwemazuva ekupedzisira, Trump uye House Speech Paul Ryan (R, Wisconsin) akatora maminitsi emitemo musati yatarwa neImba yeMuvhuro musi waMarch 24. Nguva pfupi mushure mekunge, Ryan akapa hurukuro pfupi yehurukuro panguva iyo akati ACA yakanga iri pano kuti igare kune ramangwana rakatarisika, uye kuti maRepublicans aizotamira kune zvimwe zvinhu pane zvavanoronga.
Asi manzwiro iwayo akanga ari nguva pfupi, zvakadaro. Pakuvamba vhiki inotevera, Ryan akataura kuti AHCA yakadzoka patafura. Imba yeRobert Caucus, boka rakachengeteka reVamiriri veRuban Republic, pamwe chete nevamwe vateereri pamagumo ekuchengetedza kwemitambo, vakange vashandura zvikuru pfungwa yekudzora ACA, uye havana kuda kusiya zvakakurumidza kudaro.
Sei IAHCA Yakakundikana Nguva Yokutanga Yakapoteredza?
VaRepublicans vane ruzhinji muHarare, asi kana vanopfuura 22 vaRepublican vakaputsa mauto pamwe neboka ravo, chiyero chaisazopfuura.
Panguva yekuratidzwa kwaMarch pamusoro peAHCA, kwaive neve 33 vaRepublicans vakange vasina kutsigira mutemo (Democrats aipikisana nenyika yose).
Asi avo 33 vaRepublicans vakanga vasina kubatana mumaonero avo; vakanga vane zvikonzero zvakasiyana zvikuru zvekupikisa AHCA. Pakupera kwekugadzirisa kwemasangano, Freedom Caucus nhengo dzakatenda kuti mutemo uyu hauna kuenda zvakakwana mukudzura ACA, iyo yavanoda kuona zvachose kubviswa (mutemo wekuyananisa haungakwanise kubvisa zvachose ACA, asi Freedom Caucus nhengo dzaida mari yekusungirirwa kana yakasimba se HR3762, iyo yakabvumidzwa neMutungamiri Obama muna 2016).
Uye pamagumo akawandisa emitambo yacho, vateereri vemitemo vakazvidya mwoyo pamusoro pekuona kweBBCO kuti vanhu vasina kubatsirwa vaizokura nemamiriyoni makumi mana nemakumi maviri mumakore gumi anotevera pasi peAHCA, uye nezveAHCA kuchinja kuMedicaid nekuwedzera Medicaid mari.
Chii Chiri Kuitika Nenguva Dzose 2?
Pakuvamba kwaEpril, House Republicans, nechisimba chakasimba neVamishandi veMutungamiri Mike Pence, uye Munyori weHHS Tom Price, vakaonekwa sevari pamusana pokusunungura mitemo yavo yakashandurwa, asi vachiri kutaurirana pamusoro pekuchinja kwaizobatanidzwa.
Dambudziko rakagumuchirwa kubva pakuti kupesana kweRepublican mukutanga kokufamba-kwese kwakauya kubva kuongorori uye nevanhu vari kumagumo ekupedzisira kwezvematongerwe enyika. Kuchinja kwakatangwa kunofadza hurumende yeChristian Caucus ine chokwadi chekuparadzanisa vatsigiri veZimbabwe, uye pamwe chete.
Pakutanga, vatungamiri vePence nevatongi vemuRwanda vanga vachipa sarudzo yekuisa mvumo yekuregererwa iyo inoti ichakwanisa kushandura kugadzirisa zvinodiwa zveAIDS nezvehutano uye ACA inorambidza kubhadhara mari yemishonga yehutano yehutano kune avo vanoita zvekurapa. Rusununguko Caucus nhengo dzinoda kuti hurumende dzikwanise kutsanangura mazano avo ehutano hunokosha, kuitira kuti kuderedza kuwanda kwezvinofanira kuvharwa nehutano hwehutano. Vanodawo kubvisa tsika yemazuva ano yehutano uye vanorwara vanorwara vachibhadhara mapeamendi akafanana.
Pasi peAACA, premiums inogona kusiyanisa zvichienderana nezera (ine chikwata che3: 1 chevanhu vakwegura vakanyorwa nevaduku vaduku), kushandiswa kwefodya (kusvika ku 1.5: 1 chiyero), uye zip code. Asi nhoroondo yezvokurapa yevashandi haisi chikamu chekuenzanisa.
Kusati gore ra2014, makambani einishuwarenzi ehutano muhurumende dzakawanda inogona kuongorora nhoroondo yezvechiremba yevashandisi uye kushandisa iyo ruzivo kugadzirisa mapeamendi. Vanokwanisawo kuramba zvirongwa zvakananga kana mamiriro ezvinhu aimbovapo akanga akakomba zvakakwana. Kuchinja kunenge kuri kupiwa kweAHCA hakuzobvumiri vatsigiri vadzivisi kuti varambe vachipfurikidza maererano nehutano hwehutano, asi vatsoropodzi vakati kana zvikwereti zvingave zvakanyanya kuwedzera kune avo vanorwara, zvinenge zvichinyatsoratidza kuti ACA inodzivirira vanhu vane mamiriro ekutanga. Izvi zvinonyanya kuitika kana hurumende yaifanirawo kugadzirisa zvinodiwa zvehutano zveAACA, sezvo munhu anenge achitsvaga aigona kuwana kuti mamiriro avo akambovapo ari "akavharwa" asi urongwa hahupi hunobatsira munharaunda yaunoda yekutarisira.
Kuti vanyatsogadzirisa maRepublicans, imwe sarudzo yave ichitenderera. Izvo zvingaita kuti nyika dziwane rubatsiro rwekugadzirisa hutano hunokosha hwehutano uye yeAACA's premium age ratio (saka vakwegura vakwegura vaizobhadharwa kusvika kanomwe kudarika vaduku vaduku, pane katatu), asi hazvizobvumiri mari yepuremu kuti iite vanoshingaira 'vezvechiremba.
Nenguva yaEpril 5, kupesana pakati pezvisarudzo zviviri kwaita kuti hurukuro dziparare, kwechinguva. Imba Rusununguko Makomiti eCaucus haadi kupfuurira pasina chivimbo chekuti ichakwanisa kubvumira inshuwarisi kuti adzokere kuchishandisa chinyorwa chekurapa kuti agadzire zvikwereti, sezvo vachifunga kuti ichi ndicho chinhu chikuru chekuderedza mitero yehuwandu hwevanhu (kureva, avo vasina mamiriro ezvinhu akambovapo).
Uye kune rumwe rutivi rwemitambo, vanhu veRepublicans vane mwero vanotenda kuti kudzokera kumishandirapamu inobva mune zvakaitika mune zvezvokurapa ingangodaro inopedza kuchengetedza kweAACA kune vanhu vane mamiriro ezvinhu akambovapo, iyo ndiyo imwe yemitemo yakakurumbira zvikuru.
Vatsigiri vemitemo vakagadzirira kushandisa mari yakagoverwa muAHCA yezvematongerwo enyika kuti agadzirise matanho emishuwarenzi, uye pane kuisa kune kunzvimbo dzekushambadzira dzemvura yakakwirira . Iyi dzimba dzakawanda dzinogona kuvhara vanhu vane mamiriro ekutanga asati aripo avo vari kutengeswa mumusika wega wega kana zvikomboti zvikaenderana nehuwandu hwehutano hwehutano. 35 inotaura kuti yaiva nemadzimba akakwirira pamberi peAACA, uye ivo vaiwanzobhadhara mari. Kudzoka kumadzika akakwirira semugadziro kunokakavadzana uye kunoda mari yakawanda kupfuura iyo dzimba dzakagamuchirwa munguva yakapfuura.
Ndekupi Kwatinobva Kubva Iko?
Kunyange zvazvo Trump naPence vakanyora kuti chibvumirano chiri kuuya nokukurumidza, nhaurirano inoonekwa kunge iri kure nekupfuura, uye hapave kusina huripo huripo huri huripo huripo huripo huripo huripo huripo huripo huripo huripo hweAHCA. Kukurukurirana kunogona kupfuurira mushure mekupedzisira kwegore, asi zvingave kuti pane izvo zvisingakwanisi zvepakati pepakati pemigumo yese yeRepublican delegation kubvumirana nenzira inoenda mberi.
Kana mitemo isingapfuuri kupedza kana kuchinja ACA, icharamba iri mutemo wenyika. Kunyange zvakadaro, ramangwana ravo rinonyanya kuvimba nezviito izvo Trump Administration inogona kutora.
Vatsigiri vanove vachicherechedza mwedzi yakawanda yavanoda kuona mamwe mararamiro ekugadzirisa mararamiro anoiswa munzvimbo ino kuitira kuti varambe vachipa kugoverwa muna 2018. Two Insurers-Humana, uye Wellmark yaIowa-vakatotaurira kuti havazobatanidzi mu ACA- mumwe mutengesi mumwe chete unoenderana negore rakatevera, uye vamwe vanogona kutevera kana vachifunga kuti pane kusava nechokwadi kwakanyanya maererano nezvinoitika zvinotevera.
Imba v. Mutengo: Mutengo Wekugoverana Mutsigiri Mhosva
Nhengo dzeAACA dzinobhadhara mari dzinowirirana iye zvino dzinotongwa (House v. Price, yaimbova Imba v. Burwell) yakaiswa nePublic Republicans muna 2014. Vaiti vezvemitemo (iyo inowanzobatanidza Tom Price, uyo aireva muDeorth 6th District in The House yapfuura kuti asarudzwa neTrump kuti atungamirire HHS, uko iye zvino ari mumiririri munyaya yacho) anotaura kuti mari yekugoverana mari-mari inotambirwa mari, sezvo mari yakanga isina kupiwa nemitemo. Sutu yavo yakanga yakakodzera, uye mutongi wedare reruwa akatonga mukuda kwavo muna May 2016.
Bhuku reAmerica Obama rakakumbirisa, izvo zvakachengetedza kugadzirisa-kugovera rubatsiro rwekubhadhara runoenderera kune vatsigiri vehurumende panguva ino. Zvadaro mushure mokunge Trump ichikunda sarudzo, House Republican vakakumbira kuti nyaya yacho igare yakabatwa apo ivo vakaronga ramangwana reAACA. Mamiriro ehupfumi anowanikwa mumatare musi waMay 22.
Kana House Republican inodonhedza nyaya yacho, kana kana Congress inosarudza kupedza mutemo kuti iwane mari yekubhadhara mari mari, House V. Mutengo unotadza huchapera. Kune rumwe rutivi, kana Hurumende yeTrump yaizobvisa kukwidza kwekuti Obama Administration yakatanga, mutengesi mumwe nomumwe waizova nokuparara kwakapararira (vatsigiri vepamberi vane chinyorwa chekudzivirira chikwata muzvibvumirano zvavo ne HealthCare.gov zvinovabvumira kuti vabve kugoverana kana zvichida -kuwana rubatsiro rwakabviswa).
Kuiswa Kwemisika Kuedza
MunaFebruary 2017, HHS yakaronga kuchinja kwehutungamiri hunoenderana nekugadzirisa pamusika wega. Asi panguva imwecheteyo, zuva raTrump rimwe rinotungamirirwa nehurumende kuti rive rakanaka mukushanda kwavo kweAACA rine zvakasiyana.
Semuenzaniso, IRS yakanga yakaronga kuva yakasimba zvakanyanya maererano nemaitiro avakatarisa kudzokera kwemitero muna 2016 maererano neurongwa hweAACA mumwe nomumwe. Asi kutevera chirevo chekutungamira, vakadzoka nzira pamusoro pazvo, uye vari kugadzirisa kudzoka nenzira imwecheteyo yavakaita mumakore apfuura . Chinhu chipi nechipi chinoshumira kuderedza simba romumwe munhu pakupedzisira chinowedzera kusimbiswa kwemisika yemishuwarenzi, sevanhu vashoma vanopinda muhutano.
Chii Chinotevera?
Panguva ino, ramangwana reAACA uye 2018 mumwe munhu wehutano inshuwarheni yemusika yakawanda kwazvo mumhepo. VaRepublican lawmakers neVhite House vari kushanda kuti vadzosezve AHCA, asi hazvizivikanwe kana vachizokwanisa kuita kudaro. Kunyange kana ACA ichiramba yakasimba, zvisinei, kubudirira kwemisika yemishuwarenzi inoda mitemo yakagadzikana, mari yakakwana, uye nzvimbo yakachengeteka yakawanda. Hatisati taziva kuti zvose izvi zvinodedera sei pamwedzi inoverengeka inotevera.
> Sources:
> Congress.gov, HR1628 - American Health Care Act we 2017. 115th Congress (2017-2018).
> Congress.gov. S.Con.Res.3. 115th Congress (2017-2018)
> Congressional Budget Office Inotarisirwa Mutengo, American Health Care Act , March 13, 2017. (pamwe kuchinjwa kurongwa musi waMarch 23, 2017)
> Dhipatimendi Rezvoutano uye Human Services, Mushonga Kudzivirirwa uye Anogadziriswa Care Care Act, Market Market , chiziviso chekugadziriswa kunoitwa. February 2017.
> Garrett, Bowen; Gangopadhyaya, Anuj; Urban Institute, Ndiani Akawana Health Insurance Coverage Pasi pa ACA uye Vari Kupi ? December 2016.