BCRA Inochengetedza Zvimwe Zvikamu zveAHCA, asi Yakasiyana mune dzimwe nzira dzinokosha
Musi waJune 22, 2017, Senate yeUnited States yakabudisa musangano wehutano hwekugadzirisa hutano hwakange hwave hwakanyora zvachose mushure mekuvhara magonhi mumavhiki mashomanana kubva paImba yakapfuura America Health Care Act (AHCA) musi waMay 4. Kunyange iri ine nhamba yebhadharo imwe chete (HR1628 ), Senate inonzi ivo version ye Better Better Reconciliation Act (BCRA) ye 2017 . Bhiri iri rakachengetedza zvizhinji zveAHCA, asi rinewo zvimwe zvakasiyana-siyana.
Mumasvondo anotevera, Senate yakaunza zvishoma zvitsva zvakasiyana-siyana zveBBCRA, asi vakaramba vachinyora murairo pamutemo wepakati, pasina kambani yemisangano kana nhaurirano yebipartisan. Nhoroondo yekutanga, yakabudiswa musi waJune 26, yakabatanidza kudiwa kwekuenderera mberi, iyo yakanga isina kubatanidzwa muchirongwa chepakutanga (iwe unogona kuona zvose shanduro yemutemo pano). Zvimwe zvinyorwa zveBBCRA zvakatangwa musi waJuly 13 (chikamu-ne-chikamu chechikamu ), uye musi waJuly 20 (chikamu-ne-chikamu chechikamu ).
Senate yakataurirawo Obamacare Repeal Reconciliation Act (ORRA), iyo inongodzokorora mitemo iyo makamuri maviri aya akapfuura muna 2015 (HR3762) kubvisa zvimwe zvikamu zvakakura zveAACA. Mutemo iwoyo unowanzotumidzwa se "kudzokorora uye kunonoka" sezvo usina mhando yekugadzirisa ACA. Mutungamiri Obama akazvimutsira pakutanga kwegore ra2016, asi vamwe vateereri vemutemo muSeneti vanoda kufarira zvakare iye zvino Mutungamiri Trump ari muhofisi (uyu mutemo wakanga usina nguva shoma yekupfuura, zvichibva nekusavhiringidzika kwekuti vatsigiri veRepublicans muSeneti vakaratidza apo inouya kuzobvisa ACA isina kusimbiswa kwakasimba pamusana; yakaendeswa pasi pe senate yevhoti musi waJuly 27, uye yakakundikana 45-55).
IA BCRA yakaunzwawo pasi peSeneti musi waJuly 27, uye yakakundikana pavhoti 43-57. Senate ye 46 Democrats uye maviri Independents (avo vose avokodhi neDemocrats) vakasarudza kupikisana nechiyero, uye vakabatana nevapfumbamwe Republican Senators. Muchiedza chekupedzisira-chechi kupfuudza chimwe chimiro cheBobamacare kubviswa, GOP Senators akaunza kubviswa kwe "skinny" (Health Care Freedom Act) manheru manheru munaJuly 27.
Chiyero icho chakakundikanawo, 49-51 (Senatori Collins, Murkowski, naMcCain vakapikisana naro, pamwechete nevose veDemocrats uye Independents).
Zvakakosha kucherechedza, zvisinei, kuti Senate inogona kuramba ichisvitsa Mutemo weNyika kuti uongorore zvakare, uye zvimwe zvigadziridzo zviri kutaridzirwa zvinogona kushandiswa panzvimbo yevhesi yemutemo waipfuura neImba (iyi ndiyo nzira iyo Senate yakasarudza pa ORRA, BCRA, uye Health Care Freedom Act; vakaiswa sechigadziriswa kuti vatsigire mharidzo iripo yebhadharo).
Kunyange zvazvo BCRA haina kupfuura, hatizivi kuti sei kana ichashandurwa uye ichaongororwa. Saka ngatitarisei izvo Senate Republican yakanyora, uye kunzwisisa kuti inofananidzwa sei neAHCA iyo House Republicans yakapfuura (kuchengeta mupfungwa kuti makamuri maviri aifanira kubvumirana maererano nemutemo wekutevedzera / kutsiva ACA vasati vasvika anogona kuitumira kuna Mutungamiri). Tine zvinyorwa zvakawanda pamusoro peAHCA, kukubatsira kunzwisisa zvakawanda pamusoro peChirongwa cheDzimba rekugadzirisa utano hwehutano:
Saka ngatitarisei nzira iyo BCRA yakasiyana nayo neAHCA.
Mutero Wemitero
The Affordable Care Act (ACA), kubviswa kwezviri pachena chinangwa cheNhengo neSenate zvigadziriswe, zvinosanganisira mitero yakasiyana-siyana yemitero kune veAmerica vane mari yakawanda uye makambani ekuchengetedza utano, pamwe chete nemitero yemitero inobatanidza munhu wacho mandate uye vashandi vashandi .
Mari inobva pamitero iyi inoshandiswa kugadzirisa hutano hwehutano uye kupa huri nani, kuwedzera kutengesa kugoverwa kune vanhu vakawanda. Mutemo wega wega isiriwo yekuita kuti vanhu vane hutano vakwanise kuchengetedza, uye mushandi wevashandi anoita kuti vashandi vakura vape zvipo zvepamusoro, zvisingakwanisi kubhadharwa kuvashandi venguva yakazara.
IAHCA inodzokorora mitero, uye shanduro dzekutanga dzeBBCRA dzakabvisa zvakare. Zvakare mapurogiramu eBCRA, asi, chengetedza miviri mikuru yemitero panzvimbo ino: Inenge 0.9 muzana yeMedare yebhadharo yepamusoro yebhadharo yepamusoro kune vanowana mari yakawanda, uye 3.8 muzana mari inowanikwa (kureva, inowanikwa mari) pamutero mukuru wemitero (kubvisa izvi Mitero yaizobatsira vanhu vanowana mari inenge mamiriyoni emadhora pagore).
IAHCA neBBCRA zvose zvinoguma nekuderedza mari yezvemari, kunyange zvazvo mabhiriro maviri ane purogiramu yakasiyana-siyana maererano nepamusoro apo mitero yakasiyana-siyana ingabviswa. Uye kuderedzwa kwehurumende yemari inoshandiswa zvishoma kudarika mune zvinyorwa zvekare zveBBCRA, sezvo ichichengetedza Medicare mitsva kune vanowana mari yakawanda (pamusoro pemakore gumi ari kuuya, kuchengetedza iyo miviri mitero inodzivisa kurasika kwe $ 231 mabhiriyoni mu federal revenue, maererano sangano reCongressal Budget Office rokuongorora BCRA ).
Kugadzirisa matanho emitero (mazhinji ayo aizoramba achishanda pasi pe BCRA), federal mari yeMedicaid uye mari yepayimari inowedzera zvakare.
Medicaid
Kunyanya Medicaid mari inoshandiswa kupa nguva yakareba kutarisira kune vakwegura vokuAmerica, nekupa vanachiremba vana vanotora mari shoma, vakadzi vane pamuviri, uye vanhu vane hurema (inenge zvikamu zviviri kubva muzvitatu zveimba yevanamukoti inoputirwa neMedicaid, uye inenge hafu yevana vose vanoberekwa muU.S. yakafukidzwa neMedicaid).
Pasi peAACA, Medicaid yakagadzirwawo kuti iwane vanhu vakakwana vanowana mari shoma. Zvose mbiri yeAHCA uye BCRA inodzorera kuwedzera kweMedicaid, uye inoshamisa kuderedza hurumende yeMedicaid mari. Kudzorera shure Medicaid kuwedzera kunowira pasi pechikamu chekudzora ACA (chinangwa chakataurirwa chezvino reRepublican health care reform), asi hurumende yose inoshandiswa mari yekuchera yeMedicaid inopfuurira kudarika ACA kubviswa.
Maererano nekuongorora kweCongress Budget Office (CBO), federal Medicaid mari inoshandiswa inoderedzwa ne $ 834 bhiriyoni pamakore gumi anotevera pasi peAHCA. Kuongorora kweJuly 20 CBO yeBBCRA inosvika $ 756 mabhiriyoni muMedicaid mari inoparadza kusvika muna 2026, asi zvinoshamisa kuti BCRA inoderedza Medicaid zvakanyanya kutanga muna 2025, saka kudengenyeka pasi pe BCRA kuchave kwakakura kudarika kudarika pasi peAHCA kana tikawedzera iyo kuongororwa kune imwe gumi (CBO yakaratidza kuti muna 2036, federal Medicaid mari inoshandiswa ichava 35 muzana pasi pasi pe BCRA kupfuura zvaizove kana ACA ichichengetedzwa).
Pasi peAACA, hurumende yehurumende ikozvino inopa 95 muzana yemari yekufukidza vanhu vakave vakakodzera kuMedicaid pasi pekuwedzera kweCAA . Izvo zvakagadzirirwa kuderera kusvika ku 90 muzana semakore makumi maviri nemakumi maviri, uye zvicharambira pane iyo yepamusoro kuenda mberi.
IAHCA haingabvumi kuti chero hupi hupi hutsva huwedzere kuwedzera Medicaid mushure meMarch 1, 2017, uye ichishandura kune imwe nyika inogara Medicaid inowirirana nehotera (pakati pe50 kubva kune 50 ne75 muzana; nyika dzine varombo dzinowanikwa mutsva mukuru) sa2021. Izvozvo zvingangodaro kugumisa mutsva weMedicaid kuwedzera kwekunyora, sezvo nyika dzichafanira kutsika zvisingabvumirwi nehuwandu hwemutemo.
IAHCA inoshandurawo Medicaid (iyo purogiramu yose, kwete chete ACA's Medicaid kuwedzera) kune imwe-capita mugove wehurongwa, pamwe nehuwandu hwemari kubva kune hurumende yehurumende inogadziriswa gore negore neCPI-Medical +1 (chiremba chinoshandiswa nevatengi mutengo index, pamwe chete chikamu chimwechete). Zvakakosha kuziva kuti Medicaid inowanzove yakarwara kudarika huwandu hwevanhu, saka nhamba yeCPI-yehutano haina kunyatsoratidzira kurapwa kwekurapa muhuwandu hweMedicaid.
Bhuku reBBCRA raizodzivirirawo Medicaid kuwedzera kuti inowedzera kusvika munaMarch 2017. Asi panzvimbo yekuchera federal mari yekuita Medicaid kuwedzera mune imwe chete kuenda, federal inodanana inodonha kusvika 85 muzana muna 2021, 80 muzana muna 2022, uye 75 muzana muna 2023. Kutanga muna 2024, yaizodzokera kune imwe nyika inogara Medicaid inofanirwa kuwandisa. Izvozvo zvinoreva kuti zvinoreva kuti hazvizoiti zvachose kurasikirwa nezvose zvakasimbiswa nehurumende mari inoshandiswa ikozvino inoshanda kuMedicaid kuwedzera kwehuwandu hwevanhu, asi pane dzakawanda dzinoti nyika inotonga ichagumisa Medicaid kuwedzera kana sangano rehurumende rinowira pasi pe90 muzana (Arkansas, Arizona, Illinois , Indiana, Michigan, New Hampshire, New Mexico, neWashington).
Bhuku reCRARA raizoshandura Medicaid kune imwe nzvimbo yekugoverana, asi panzvimbo yekugadzirisa zviyero neCPI-Medical + 1, BCRA ingongogadzirisa neCPI-Medical kuburikidza ne2024, uye neCII nguva dzose (kwete yezvokurapa) kutanga muna 2025. CPI-Chiremba inowanzo nhamba yakakura kudarika yose CPI, sezvo mari yezvechiremba inowedzera kukurumidza kupfuura dzimwe mari. Kakawanda CPI inogona kunge isina kunaka, iyo inogona kuita kuti gore-kupfuura-gore federal Medicaid mari ichekwe . Saka zvinoreva kuona zvakaderera muhurumende yavo yeMedicaid mari kana nguva dzichienda pasi pe BCRA.
Icho Chinodiwa Kuti Uchengetedze Utano Inishuwarenzi
IAACA inoda vanhu vakawanda kuchengetedza utano hwehutano inshuwarheni kana kutarisana nemutero webhasi. Kune runyorwa rukuru rwekuregererwa kwechirango , asi IRS yakarondedzerwa kutanga kwegore ra2017 kuti mamiriyoni matanhatu ematare emitero akanga aongororwa anenge madhora mazana matatu emadhora muzvikwereti nokuda kwekusabatsirwe muna 2015.
IAHCA uye BCRA vose vanobvisa chirango, kudzokera shure kusvika pakutanga kwe 2016. IAHCA inotsiva iyo gore rimwechete, 30 muzana kuwedzera pamaripo yevanhu vane mukana wekupararira kwemasvondo makumi matanhatu kana kupfuura mumwedzi 12 yapfuura (kana, sezvinotsanangurwa pasi apa, nyika inogona kusarudza kubvumira vatsigiri vekuchengetedza mapeamamiro munhoroondo yezvokurapa apo vaverengi vane mukana wekugoverwa).
Zvinofadza kuti shanduro yeBBCRA yakabudiswa musi waJune 22 haina kutora chikamu chekuparadzwa kwechinhu chero chipi zvacho. Ingadai yakangodzokorora, uye haina kuisa chero urongwa hwekukurudzira vanhu kuti varambe vachienderera mberi.
Asi kazhinji pakarepo, pakanga pane runyerekuro kuti rumwe rudzi rwekutsvaga kwekutsvaga kudiwa kunogona kuwedzerwa pane imwe nguva yakatevera, uye shanduro itsva yemutemo yakabudiswa musi waJune 26, iyo inosanganisira kuenderera mberi kwekuchengetedza zvinodiwa (unogona kuona nechemberi makopi eJune 26 neJune 22 maBhaibheri eBBCRA pano; chikamu chetsva pamusoro pekuvhara nekuenderera mberi chinotangira papeji 135 yeJune 26 version). Kuenderera mberi kwekudiwa kwekuchengetedza kwakave kwakachengetwa mune zvinyorwa zvekare zveBCRA.
Pasi pekuvandudzwa kweBBCRA, vanhu vaifanira kuramba vachienderera mberi kana kutarisana nekugona kwenguva yekumirira vasati vawane kugoverwa mune imwe yehutano inshuwarheni yemusika. Heino maitiro aizoshanda:
- Vanhu vane nguva yakazara yekuvhara (kureva, mukati memwedzi gumi nemana yapfuura, vakanga vasina mukana wekugoverwa kwemasvondo makumi matanhatu kana kupfuura) vaizogona kunyora panguva yekunyorwa kwakasununguka kana nguva yekunyora inokosha , uye nguva dzakagadzirwa zvakanaka (yekutanga ye mwedzi unotevera kana mwedzi wechipiri unotevera, zvichienderana nekunyoresa zuva).
- Vanhu vasina kuenderera mberi vanoverengera avo vanozonyora panguva yekunyorwa kwakasununguka kana nguva yekunyora inokosha ichave pasi pemwedzi mitanhatu yekumirira vasati vapihwa.
- Vanhu vasina ruzivo rwakapfurikidza vanonyora kunze kwekunyora kwakasununguka uye pasina nguva yekunyora yakadzama vaifanira kumirira gare gare kwemwedzi mitanhatu yekumirira kana kutanga kwegadziriro inotevera gore risati rasvika risati rasvika (nekunyora munaFebruary pasina imwe nguva yokunyora inokosha inogona kureva kuti kugoverwa kwako kwaizotanga kushanda musi waJanuary anotevera).
- Vanhu vane mararamiro emusika mumwe nomumwe mushure mezuva risati rasvika purogiramu yavo yevatengesi vese yekuita basa haizovi pasi pemwedzi mitanhatu yekumirira, kunyange dai vaine mukana wekugoverwa mugore rapfuura (somuenzaniso, munhu anonyora panguva yekunyora kusununguka, zvichienderana nemwedzi mitanhatu yekumirira, uye ozoona chiitiko chakakodzera nguva pfupi mushure mokunge chirongwa chitsva chikaitika, chikwanisa kuchinjira kune chirongwa chitsva munguva yekunyorwa kwekunyanya kuenzaniswa pasina nguva yekumirira, kunyange kana kuparara kwake kwepakutanga kwaive kuchiri mumwedzi 12 yekupedzisira).
- Vana vatsva nevana vachangobva kugadzirirwa havazovi pasi pekumirira chero bedzi ivo vakanyoreswa mukati memazuva makumi matatu ekuberekwa kana kubvumirwa (nyora kuti ACA inopa vabereki vemazuva 60 kuti vanyore mwana achangoberekwa kana kuti achangobva kugamuchira mwana).
Essential Health Health Benefits
IAACA inoda kugoverwa kwezvakakosha zvehutano kune vose vasiri vekuru , vasati vakura, mapoka evanhu uye mapoka maduku. Zvinonyanya kukosha zvehutano zvakakosha kuti zvive zvakafukidzwa pane zvirongwa zvekuwedzera kweMedicaid.
IAHCA haina kuchinja hutano hunokosha huri hurumende, asi huchabvumira nyika kuti dzitsvake hurumende iyo inogona kujekesa hutano hunokosha huri munyika.
Iyo BCRA hainawo kuchinja hunodiwa hutano hunokosha pahurumende, uye haisanganisi mhando yehurumende yekuregererwa inorondedzerwa muAHCA. Asi inobvumira kuti inotaura zvakakwana kufambiswa kweAACA's 1332 waivers. Aya "mafungiro ekudzivirira" anobvumira nyika kuti iwane nzira dzakasiyana-siyana dzehutano hwehutano hwehutano (Hawaii ikozvino ndiyo nyika chete inobvumirwa 1332 waiver pasi pe ACA).
IAACA ine mitemo yakasimba yemitemo yekuchengetedza vatengi kusimbisa kuti vanhu vanovhara pasi vane 1332 waiver zvakanaka chete, vanofukidza vanhu vashomanana, uye hazvikoshi kudarika zvingadai pasina kunze kwekuregererwa. IAACA inodawo 1332 waivers kuti ive bhajeti-isati yarerekera hurumende yehurumende, uye ichi chinodiwa chinochengetwa ne BCRA. Asi kubatsirwa kwevatengi kunobviswa, kunotsiviwa nechinangwa chokuti nyika inongorondedzera kuti vaizoita sei "kuwedzera kukwanisa kusvika kune zvakakwana, kupedza mapurogiramu evhareji, nekuwedzera kuverenga." Saka hurumende inogona kukwanisa kuchinja mitemo inobatsira yehutano uchishandisa 1332 waiver pasi pe BCRA, sezvo pakanga pasina chinhu chinodiwa kuti kugoverana kunoramba kuri kwakakwana pasi pekuregererwa sezvazvakanga zvakaita kare.
Shanduro yaJuly 13 ye BCRA yakasanganisira Cruz Amendment (yakanyorwa naSenator Ted Cruz, weTexas). Iyo Cruz Amendment haisati yave yakatarwa neCBC, uye hazvisi pachena kana vatungamiri veSeneti vachironga kuisanganisira iyo shanduro yemutemo inouya nechisarudzo (kana izvozvo chaizvoizvo zvichiitika).
The Cruz Amendment yaizobatsira zvikuru pakuparidzirwa kwehutano hunokosha. Inobvumira vatsigiri vekutengesa kutengesa mapurogiramu asina kukodzera chero bedzi ivo vachitengesa imwe chete chirongwa chesirivha, chirongwa chimwe chegoridhe, uye imwe chete 58 muzana actuarial value plan ( iyi inenge iri chirongwa chekufananidzira pasi pe BCRA ). Zvichienderana nemitemo yehurumende, Cruz Amendment yaizobvumira vatsigiri vekuchengetedza kuti vasachengetedze mitemo yezvino yehutano ine chokuita nehutano hwehutano, kusanganisira hutano hunokosha huripo.
Chikamu cheZviitiko Zvichiripo
IAACA inoda kuti boka rimwe nerimwe neboka duku rive nehupenyu hwekugadziriswa-nharo, pasinei nenyaya yezvokurapa.
IAHCA inobvumira nyika kuti dzitsvake hurumende inoshandiswa nevatsigiri vehurumende, nokuda kwehumwe urongwa hwegore, zvikwereti zvepabhesi munhoroondo yezvokurapa kana uyo anenge akakumbira aine mukana wekugoverwa kwemasvondo makumi matanhatu kana kupfuura mukati memwedzi 12 yapfuura. Vatsigiri vangave vasingagoni kukanganisa kushanda zvakakwana maererano nehuwandu hwezvokurapa (sezvavaigona munharaunda dzakawanda pamberi pegore ra2014), asi vaizokwanisa kupa mari yepurayamisi yakakwirira-pasina cheji-iyo yaizoita kuti kuvharidzira kusakanganiswa kwevanhu vane pre- mamiriro ezvinhu aripo uye gaka riripo.
Bhuku reBCARA rinochengetedza kuti ACA inotarisirwa-zvinodiwa uye inharaunda yevanhu, izvo zvinoreva kuti vanhu havagoni kupiwa mhosva yakawanda maererano nenyaya yavo yezvechirwere. Asi nekuda kwezvinhu zvinowanikwa 1332 zvakasununguka, nyika dzichakwanisa kujekesa hutano hunodiwa, zvichiita kugoverwa kusingadziviriri vanhu vane mamiriro ezvinhu akambovapo. Semuenzaniso, kana zvirongwa zvehutano zvisingafaniri kuvhara zvakasiyana-siyana zvemishonga yemishonga uye mamiriro ako epanguva yakavapo inoda madhiragi anodhura, chokwadi chokuti mamiriro ezvinhu akambovapo "akafukidzirwa" haasi kuzobatsira.
Mukuwedzera, BCRA inokonzera mwedzi mitanhatu yekumirira kune ani zvake anonyora muhuwandu mushure mekunge agona kupararira kwemazuva anopfuura 63 mukati megore rakapera. Saka munhu uyo anofamba asina kuvharidzirwa aisazokwanisa kuwana kugoverwa kwemwedzi mitanhatu, kunyange kana iye aifanira kunyora panguva yekunyora kusununguka. Izvozvo zvaizova zvakakosha zvikuru kune ani zvake ane mamiriro ezvinhu akambovapo kuti arambe achivhara nguva dzose.
Zvikwata zvekutanga zvichibva paInrollee's Age
IAACA inobvumira bhizinesi kuti vabhadhara vanhu vakwegura vakanyorwa kusvika katatu kanopfuura makumi maviri nemakumi maviri. Asi rubatsiro rwemari inowanikwa muAACA runobva pane pfungwa yokuti mamiriyoni emadhora (mushure mekutsigira) anofanira kuenzana kune vanhu vane mari yakaenzana (kusvika 400 muzana yehurombo huri nani, pamusoro apa iyo rubatsiro rweAACA harusipo). Saka apo zvikwereti zvakakwirira kune vakwegura vakwegura, rubatsiro rwema premium hukuru kune vakwegura vakwegura kuitira kuti vakwanise kubhadhara mari yakakwirira.
IAHCA inobvumira vatsigiri vekutengesa kubhadhara vakanyoresa vakwegura katatu zvakanyanya sezvavanotarisira makumi maviri nemakumi maviri (makumi maviri nemakore) vakanyoresa (kana imwe yakawanda kana nyika dzichisarudza kuibvumira). Mutemo uyu waizopa rubatsiro rwemakore ekuwedzera ruzivo rwakakura kune vakwegura vakwegura, asi kwete nekukwanisa kuvhara musiyano muzvikwereti. Vanhu vakwegura vaizoguma vachibhadhara mari yakawanda zvikuru mumapurayamisi kupfuura vanhu vaduku, kunyange mushure mokunge rubatsiro ruchishandiswa.
IA BCRA yaizobvumira vatsigiri vekuchengetedza mabhadharo kuti vabhadharwe vanhu vakwegura vashanu kunyanya sezvavanorayira vaduku vanyori. Kubhadharwa kwepa Premium kwaizove kwakakura kune vanhu vakwegura, asi kwete nekukwanisa kukanganisa mari yepamusoro, uye mutemo unonyanya kusanganisira urongwa hunoita kuti vanhu vakwegura vabhadhara chikamu chikuru chemari yavo mumitambo yekubhadhara.
Premium Subsidies
IAACA inopa rubatsiro rwepayimusi inowanikwa mukuchengetedza purogiramu yeurongwa hwekutsvaga (yechipiri-yakaderera-yakawanda mari yeurongwa) munzvimbo imwe neimwe pamutengo unodhura. Izvozvo zvinoreva kuti rubatsiro rwakakura mune nzvimbo umo kugoverwa kunodhura, uye kukuru kune vanhu vakwegura. Zvikwereti zvepamberi pasi pe ACA hazviwanike kune vanhu vane mari iri pasi pehurombo-sezvo vachifanirwa kuva neMedicaid panzvimbo-uye havakwanisi kune ani naani ane pamba yemhuri inopfuura 400 muzana yehurombo huri (hweimba yechina, iyo $ 97,200 muna 2017).
IAHCA ine purogiramu yakapedzisira kubatsiri iyo inongoratidzika maererano nezera, uye hazvirevi kuti iyo miriyamisi yakakwirira kwazvo mune dzimwe nzvimbo dzenyika kupfuura kune vamwe. Uye sezvakataurwa pamusoro apa, kushandiswa kwemazuva-kare kubhadharo yepamusoro yepakutanga hakungabvumi kukanganisa zvikwereti zvakakwirira zvekuti vanhu vakwegura vaizobhadharwa. Asi HHCA rubatsiro inogona kuwanika kune vanhu vane mari yakawanda (inowanikwa yakazara kuna avo vane mari kusvika kune $ 75,000 kune munhu mumwe chete uye $ 150 000 kune vakaroorana vakaroorana, uye vanobudiswa pamusoro pezera iroro), nokudaro vachiwedzera rubatsiro rubatsiro rwakanyanya kupfuura chikamu chepakati kupfuura mari yeAACA.
IA BCRA inoronga hurongwa hwekubatsira huri hwakafanana neAACA, asi nehumwe humwe hunokosha. Kutanga muna 2020, rubatsiro rwaizove ruwanike kune vanhu vane mari kubva ku3-350 muzana yehurombo huripo, kusiyana ne100-400 muzana yehurombo huri pasi pe ACA. Izvozvo zvingave, muchirevo, kubvisa chirwere cheMediciaid chazvino , sezvo rubatsiro runogona kuwanika kune vanhu vane mari iri pasi pehurombo huri munyika dzisina kuwedzera Medicaid.
Asi kugoverwa kunowanikwa kune vanhu vane mari yakaderera kunenge kusina simba rakanyanya kudarika kugoverwa kwakapiwa neMedicaid kana kuti ikozvino ACA zvirongwa. Izvi zvingava zvechokwadi kunyanya mushure mekudhura-kugoverana kuderedza kudyidzana kunobviswa muna 2020 sehupi hwe BCRA. Uye kune vanhu vari kumucheto wokumusoro weAACA yemazuva ano, rubatsiro runogona kubviswa kuvanhu vane mari pakati pe 350-400 muzana yehurombo. Kana mutemo uyu wakanga uri kushanda muna 2017, zvinoreva kuti mhuri yevana yaizogona kukwanisa kubhadharwa mari yepayimusi ine mari ye $ 85,050 panzvimbo ye $ 97,200 (federal paurombo nhamba nhamba dzinoshandurwa gore rega rega, saka avo vakagadzirwa vachasiyana kana apo BCRA inotonga inoshanda).
Uye BCRA yaizobatanidza rubatsiro kune hurongwa hutsva hwekuenzanisa, iyo inogona kuvhara mavhareji ezana makumi mashanu ehutano hwehutano hwehuwandu hwehuwandu hwevanhu. Nokutaura, rubatsiro rweCAA premium runosungirirwa kurongwa hwekufananidzira hunovhara muvhareji we68-72 muzana yezvinoshandiswa zvehuwandu hwevanhu. Izvi zvinoreva kubhadhara uye kubhadhara kwemahomwe mari inenge yakakwirira zvikuru pasi pe BCRA.
Kune vanobva kune dzimwe nyika, BCRA inogonawo kugadzirisa rubatsiro rwekubhadhara mari kune " vatorwa vakakodzera ," izvo zvinoreva kuti vanhu vashandi venguva pfupi uye vhiki dzevadzidzi havachazokwanisi kubhadhara mari, sezvo vari pasi pe ACA .
Kutenga-Kugoverana Kubatsira
IAACA inopa rubatsiro rwekugovera mari mari yekuderedza mari yekunze-ye-pocket iyo inonyorera mari yepamusoro. Vanhu vane mari yepamusoro kusvika 250 kubva muzana yehurombo hukodzero vanofanirwa kugoverwa kunowanzobatanidza kugovana-kugoverana mari, chero bedzi pavanosarudza chirongwa chesirivha.
IAHCA yaizobvisa mari yekugoverana mari kune mushure me 2019. Asi zvinonzwisisika, iyo hainawo kukodzera mari yekuvabatsira panguva iyi. Kugovera-kugovera rubatsiro kunosanganisira nyaya inopomerwa inopomerwa neHarare Republic Republic muna 2014, nekuda kwekuti rubatsiro rwacho haruna kumbogadziriswa neCongress. Pakave nekusava nechokwadi kwakanyanya pamusoro pekubhadhara mari mari yekugoverana muna 2017, uye zviri kuita kuti vatsigiri vese vatsigire zvikwereti zvepamusoro zve 2018 kupfuura zvavanoita kudai paive nekuzvipira kwakasimba kubva kuhurumende yehurumende kubhadhara mari yekugoverana mari.
IA BCRA yaizobvisawo mari yekugoverana mari dzinoshandiswa shure kwegore ra2019. Asi inonyatsotarisa mari yekubhadhara pakati penguva ino. Izvi zvichabatsira kuderedza kusava nechokwadi kwekuti inshuwarisi inotarisana mumusika mumwe nomumwe, kunyange kubviswa kwekubhadhara mari kwekubhadhara shure kwegore ra2019 kuchaita kuti vanhu vane mari shoma vasakwanise kuwana hutano hwakanaka.
Vanhu Vangani Vaizorega Kuwanda?
Pasi peAHCA, CBO inofungidzira kuti nhamba yevanhu vasina kuvimbiswa vaizokura nemamiriyoni makumi maviri nemakumi maviri nemaviri . Izvi zvinosanganisira vanhu vanoshoma mamiriyoni gumi nemana vane Medicaid, vanhu vanosvika mamiriyoni matanhatu vashoma pamushamba (kwete cheboka), uye 3 mamiriyoni evanhu vashoma nevashandi-vakabhadhara inshuwarisi.
Pasi peBBCRA, CBO inofungidzira kuti nhamba yevanhu vasina kuvimbiswa vaizokura nemamiriyoni makumi maviri nemakumi maviri nemaviri muna 2026. Izvi zvinosanganisira vanhu vashoma mamiriyoni 15 vane Medicaid, uye vanhu vanomwe mamiriyoni vashoma vane huwandu hwemisika.
Ndekupi Kwatinobva Kubva Iko?
Kusiyana kwakarondedzerwa pamusoro apa hakusi kuwandisa kwemashoko, asi kutarisa zvinhu zvakawanda izvo vatengi vanoona kana mutemo waifanira kushandiswa.
Hatisati taziva kuti Senate ichapedzei-kana chero chinhu-maererano nehutano hwekugadzirisa hutsika panguva yegore ra2017. Mutungamiriri weTrump akanganisa zvakananga vateereri nemararamiro avo nekurasikirwa kwevashandirwo-vanobhadhara utano hwehutano inshuwarheni kana vasingapfuuri mutemo kubvisa (uye zvichida kutora) ACA ( pano ndiyo tsanangudzo yekuti nhengo dzeCongress nevashandi vavo vanowana sei inshuwarano yehutano hwavo ). Trump zvakare akatyisidzira kubvumira Obamacare "kukumbira" kuburikidza nekuchera zvaanotaura se "bhailouts" kumakambani einishuwarenzi (chaizvoizvo, arikutaura nezvekubhadhara mari yekubhadhara mari, iyo inongova hurumende yehurumende inobhadhara vatsigiri vekupa mari yakawanda vanyori vanobhadhara mari; hazvirevi kubhadhara mari).
Senators Lindsey Graham, Bill Cassidy, naDean Heller vaudza shanduko inogona kuchinja yakawanda yehurumende yekushandisa pasi pe ACA yekuvhara zvipo zvehurumende. Iyo yaizochengetedza zvimwe zvekudzivirirwa kwevatengesi veAACA, asi yaizobvisa hurumende yega yega inoda kuti vanhu vatenge kutengesa. Hazvinyanzwisisiki panguva iyi kana izvo zviyero zvichange zvichitsigira zvakakwana kutsigira musangano wehutano hwehutano hwehutano hwakanaka zvakare pasi peSeneti kune imwe vhoti.
Kwekunge nguva iripo, hapana chakachinja, kunyange humwe hutano hwemishurensi yemisika inotarisana nekusava nechokwadi kwakanyanya uye kupesana neTrute Administration yekutya kukuru kwekutendera Obamacare "kukumbira." Izvi zvinonyanya kupa chokwadi kuti kune nzira dzokuti Hurumende yeTrump inogona kuparadza mutengesi mumwe nomumwe pasina Congressional action.
Sources:
> Congressional Budget Office, HR1628, American Health Care Act ye 2017, Kuongorora Mari . May 24, 2017.
> Congressional Budget Office, HR1628, Mutemo Wakawedzerwa Kuyananisa Reconciliation we 2017, Kuongorora Mari . June 26, 2017.
> Congressional Budget Office, HR1628, Bhuku Rakanaka Rokuyananisira Reconciliation ra20177: Kuchinjwa kwechimiro cheMutevedzeri [ERN17500], sezvakatumirwa paIndaneti yeDare reSenate muBurget musi waJuly 20, 2017 . July 20, 2017.
> Kaiser Family Foundation. Chirongwa cheMedziso reMedical Medical Percentage (FMAP) yeMedicaid uye Multiplier.
> Senate Budget Committee, Mharidzo yeHR1628, Mutemo weBang Care Reconciliation Act we 2017 . June 22, 2017.
> United States Department of Labor, Bureau of Labor Statistics. Kuenzanisa Mutengo Wekuchinja Kurapa muCPI.