Zizibonele Ukuba U-Obamacare Okhuseleko lwezeMpilo lweeNdleko
Ukunyamekelwa kwempilo kwathatha iipesenti ezi-4 zengeniso ngo-1960 xa kuthelekiswa nama-6 ekhulwini ngo-2013.
Kwakukho izimbini ezibini zokunyusa okukhulu: umgaqo-nkqubo welizwe kunye neenguqu zokuphila. Okokuqala, iUnited States incike kwi -inshurensi yempilo yabucala yangasese . Urhulumente wenze iiprogram ezifana ne- Medicare neMedicaid ukunceda abo bangena-inshurensi. Ezi nkqubo zavelisa isidingo seenkonzo zononophelo lwempilo. Oko kwabanika ababoneleli amandla okuphakamisa amaxabiso. Ucwaningo lweYunivesithi yasePrinceton lubone ukuba abantu baseMerika basebenzisa umlinganiselo ofanayo lwempilo njengabemi bezinye iintlanga. Bavele bahlawule ngaphezulu. Ngokomzekelo, amaxabiso esibhedlele ase-US angama-60 ephakamileyo aphezulu kunezo eYurophu. Imizamo kaRhulumente yokulungisa utshintsho lwempilo kunye nokunciphisa iindleko eziphakanyisiweyo esikhundleni.
Okwesibini, izifo ezingapheliyo, ezifana nesifo sikashukela nesifo senhliziyo, zande. Bajongene neepesenti ezingama-85 zeendleko zonyango. Phantse isiqingatha sabo bonke abaseMerika banomnye wabo.
Ziyabiza kwaye zinzima ukunyanga.
Ngenxa yoko, iipesenti ezi-5 ezidlulayo ze-populatio zidla iipesenti ezingama-50 zeendleko zonyango jikelele. Iipesenti ezingama-50 ezona zipheleyo ziphela kuphela iipesenti ezi-3 zenkcitho yezempilo.
Ininzi yezi zi gulane zizigulane zeMedare. Umsebenzi wezokwelapha wase-US wenza umsebenzi wobuqhawe wokulondoloza ubomi.
Kodwa kuza kwixabiso. Ukusetyenziswa kweMedare kwizigulane kunyaka wokugqibela wobomi ubukhulu obuphindwe kathathu ngaphezu komyinge. Ukunyamekela ezi zi gulane zibiza i-ezine yesine sebhajethi.
Kwiinyanga ezintandathu zokugqibela zobomi, ezi gulane ziya kwiofisi yegqirha ngamaxesha angama-29 ngomyinge. Kwinyanga yabo yokugqibela yobomi, isiqingatha siye kwigumbi lexakeka. Inxenye yesithathu ephezulu kwinqanaba lokunyamekela. Enye yesihlanu iyaqhubeka nokuhlinzwa.
Nkqubo kaRhulumente
Phakathi kowe-1960 no-1965, ukunyamekelwa kwempilo kwezempilo kwanda ngo-8.9 ekhulwini ngonyaka. Kungenxa yokuba inshorensi yezempilo yanda. Njengoko kubandakanya abantu abaninzi, imfuno yeenkonzo zononophelo zempilo zenyuka. Ngama-1965, amakhaya ahlawulwa ngaphandle kwe-pocket angama-44 ekhulwini kuwo onke amaxabiso enyango. Intshuwalense yezempilo ihlawulwe iipesenti ezingama-24
Ukususela ngo-1966 ukuya ku-1973, ukunyamekelwa kweenkonzo zempilo kwenyuka ngama-11,9 ekhulwini ngonyaka. I-Medicare ne-Medicaid ibenxibe abantu abaninzi kwaye bavumela ukuba basebenzise iinkonzo ezingakumbi zempilo. I-Medicaid yavumela abantu abadala ukuba bakwazi ukunyuka kwiindawo zokuhlala ezikhungayo. Njengoko ixabiso linyuka, kunjalo namanani. Ababoneleli bezempilo banike imali emininzi kuphando. Yakha ubugcisa obuninzi, kodwa bubiza, bubuchwepheshe.
I-Medicare yanceda ekwenzeni ukunyamekela esibhedlele.
Unyango lwezonyango oluphuthumayo libiza kakhulu, ngokwenza enye yesithathu yazo zonke iindleko zonyango eMelika. Ngo-2011, kwakukho ukuvakatyezelwa kwamagumbi angxamisekileyo kwezigidi ezili-136. Umangalisa kubantu abadala abahlanu basebenzisa igumbi lexakeka konyaka ngamnye.
Ngomnyaka we-1971, uMongameli uNixon waqalisa ukulawulwa kwexabiso lomvuzo ukuyeka ukunyuka kwamaxabiso . Ukulawulwa kwamanani entonophelo lwempilo kwenzile imfuno ephezulu. Ngomnyaka we-1973, i-Nixon egunyazisiweyo imibutho yokulondolozwa kwempilo ukunciphisa iindleko. Ezi zicwangciso ezihlawulwa ngokukhawuleza zanciphisa abasebenzisi kwiqela elithile lonyango. UMthetho we-HMO we-1973 wanikezela izigidi zeedola ngokuqalisa inkxaso-mali ye-HMOs. Kwakhona kwafuneka abaqashi ukuba banikele xa bekhona.
Ngowe-1973, uNixon washiya ngokupheleleyo izinga legolide . Njengoko ixabiso le dolaphu liye lahla, lenze ixabiso lokunyuka kwamaxabiso ephindwe kabini . Iindleko zonyango zonyango zenyuka ngezinga elifanayo.
Ukususela ngo-1974 ukuya ku-1982, amaxabiso okunakekelwa kwempilo aphakanyiswe ngama-14.1 ekhulwini ngonyaka ngenxa yezizathu ezintathu. Okokuqala, amaxabiso ahlawulelwe emva kokulawulwa kwemali yomvuzo waphela ngo-1974. Okwesibini, iCongress yamisela uMthetho woKhuseleko loNgeniso loMhlala-phantsi we-1974. Ikhuphe iinkampani ezivela kwimimiselo yerhafu kunye neerhafu ukuba zizinyango. Iinkampani zasebenzisa ezi zicwangciso ezincinci nezicwangciso. Okwesithathu, ukunakekelwa kwempilo ekhaya kwathatha, kukhula ngamaphesenti angama-32,5 ngonyaka.
Phakathi kowe-1983 no-1992, iindleko zonyango zonyuka zenyuka ngama-9.9 ekhulwini ngonyaka. ICongress yandise iMedicaid ukubandakanya abafuduki abangekho mthethweni, abantwana (ngokusebenzisa i-CHIP) kunye nabasetyhini abakhulelweyo. Iindleko zeziyobisi zonyango zenyuka ngama-12.1 ekhulwini ngonyaka. Amanani okunakekelwa kwempilo yasekhaya ayenyuka ngama-18.3 ekhulwini ngonyaka.
Phakathi kuka-1993 no-2010, amaxabiso aphakama ngama-6.4 ekhulwini ngonyaka. Ekuqaleni kwee-1990, iinkampani ze-inshorensi zempilo zazama ukulawula iindleko ngokusasaza ukusebenzisa ii-HMO kwakhona. I-Congress yazama ukulawula iindleko kunye noMthetho oHloniphekileyo woHlahlo lwabiwo-mali ngo-1997. Ngenxa yoko, iCongress yaxhomekeka kwimimiselo yokuhlawulwa kwiMithetho yoHlomelo loHlahlo lwabiwo-mali ngo-1999 kunye noMthetho woPhuculo loKhuselo kunye noKhuselo ka-2000.
Emva kowe-1998, abantu bavukela baze bafuna ukhetho olongezelelweyo kubanikezeli. Njengoko ixabiso liye landa kwakhona, ngokunjalo amaxabiso. Eli xesha, iinkampani zonyango zakha iindidi ezintsha zezilwanyana zonyango. Bavakalise ngqo abathengi kwaye benza isidingo esongezelelweyo.
Ngo-2003, uMthetho weModare Modernization wongezelela iMedareareli Part D ukujongana nokukhutshwa kwezidakamizwa. Kwakhona kwatshintsha igama le-Medicare Part C kwiprogram ye- Medicare Benevantage . Inani labantu basebenzisa izicwangciso eziphindwe kabini ukuya kwizigidi ezili-17.6 ngo-2016. Ezi ndleko zenyuka ngokukhawuleza kuneendleko zeMedare ngokwazo.
Ukuthembela kwesizwe kwi-inshorensi yempilo yabucala yabucala yabashiya abantu abaninzi bengenawo ugqirha wezempilo. Ngo-2009, isiqingatha sabantu (46,3 ekhulwini) abasebenzisa isibhedlele bathi bahamba ngenxa yokuba babengenayo enye indawo eya kuyo yoncedo lwempilo. I-Treatment Emergency Medical and Labor Labor Act yafuna izibhedlele ukuba zinyange nabani na obonise kwindawo yokuphucula. Ezi zigulane ezingagqithwanga zibiza izibhedlele i-$ 10 billion ezidlulayo ngonyaka. Izibhedlele zadlula le ndleko kwiMedicaid.
Izifo ezingapheliyo
Isizathu sesibini sokunyuka kweendleko zempilo yintlupheko yezifo ezikhuselweyo. Ezi zimbini ezibangelwa ukufa kukuba zizifo zentliziyo, umhlaza, isifo esingapheliyo sokuphazamiseka kwemiphunga kunye ne-stroke. Izifo ezingapheli zibangele bonke. Bangakwazi ukuthintelwa okanye bahlawulwe ngaphantsi ukuba baphathe xa bebanjwe ngexesha. Izinto ezinobungozi zesifo senhliziyo kunye nezibetho ezingenasondlo kunye nokukhuluphala. Ukutshaya ngumngcipheko womhlaza wemiphunga (uhlobo oluqhelekileyo) kunye neCOPD. Ukunyameka kwimeko yengozi kwezinye iindlela eziqhelekileyo zomhlaza.
Ezi zifo zibiza i-$ 7,900 nganye. Ezi zihlandlo ezihlanu kunomntu onempilo. Iindleko eziqhelekileyo zokuphatha isifo sikashukela, umzekelo, ngu-$ 26,971 kwintsapho. Ezi zifo kunzima ukulawula ngenxa yokuba izigulane zidinwa ngokuthatha amachiza athile. Abo banqumlayo bazifumanisa kwigumbi lokuxakeka ngeentliziyo, izibetho kunye nezinye iingxaki. (Umthombo: "Impembelelo yezifo ezingapheliyo kwiNyango yezeMpilo," kwiMpilo eseMpilweni, 2014.)
Indlela i-ACA yanciphisa ngayo iindleko zokuNyuka kwezeMpilo
Ngama-2009, ukunyuka kweendleko zempilo kwandise isabelomali. I-Medicare neMedicaid ixabisa i-$ 676 yezigidigidi. Yiyo 10,4 ekhulwini yebhajethi. Iintlawulo zerhafu zifikelela kuphela kwisiqingatha se-Medicare kwaye akukho nenye yeMedicaid. Le nto ebizwa ngokuba yimfuneko yokuchithwa kwemali yayiquka iimpesheni zenkampani kunye nabasemagunyeni, inhlalakahle kunye nomdla kumatyala. Yadla iipesenti ezingama-60 zebhajethi yesigqeba .
Okubaluleke nakakhulu, ukuthatha umhlala-phantsi kwi-Baby Boomers kuya kuba ngaphezu kwe-Double Medicare ne-Medicaid iindleko ngo-2020. Njengoko iindleko zonyango zonyuka zikhawuleza kunokukhula koqoqosho, irhafu yentlawulo kunye ne-Trust Fund iya kugubungela ngaphantsi nangaphantsi. Ngo-2030, i-Trust Fund iya kubhatyiswa, kwaye irhafu iya kuhlawula kuphela i-48 ekhulwini yeendleko.
Iindleko zempilo ze-Federal ziyingxenye yesabelomali esisimfuneko . Oko kuthetha ukuba kufuneka bahlawulwe. Ngenxa yoko, badla inkxaso- mali yezinto ezihlawulelwayo, ezifana nokukhusela , imfundo okanye iSebe lezoBulungisa.
Esi sizathu esinye sokuba iCongress ivumelekile kwi- Obamacare . Kwakudinga iinkampani ze-inshorensi ukubonelela ngononophelo wokukhusela . Yayiphatha imeko engapheliyo ngaphambi kokuba ifune unyango lwezonyango eziphuthumayo. Kwaye kwanciphisa intlawulo kwi-Medicare Benevantage insurers.
Ukususela ngo-2010, xa uMthetho woNonophelo ongenakunqunyulwa usayinwe, iindleko zonyango zempilo zenyuka ngama-4.3 ekhulwini ngonyaka. Ifezekise injongo yayo yokunciphisa izinga lokukhula kweenkonzo zempilo.
Ngo-2010, urhulumente waxela ukuba iindleko ze-Medicare ziza kuphakama iipesenti ezingama-20 kwiminyaka emihlanu nje. Oku kuvela kwi $ 12,376 ngomzuzi-mali ngo-2014 ukuya kwi-14,913 ye-2019. Kunoko, abahlalutyi babethukisiwe xa befumanisa ukuba ukuchitha imali kuye kwehla nge-$ 1,000 ngomntu ngamnye, ukuya kuma-11,328 ngo-2014. Kwenzeke ngenxa yezizathu ezine ezicacileyo:
- I-ACA iyanciphisa iintlawulo kwi-Medicare Benevantage providers. Iindleko zababoneleli zokulawula iAng A neB zazikhuphuka ngokukhawuleza kuneendleko zikaRhulumente. Ababoneleli 'abakwazi ukulinganisa amanani aphezulu. Kunoko, kubonakale sengathi bawongamela urhulumente.
- I-Medicare yaqalisa ukukhupha imibutho yokunyamekela, ukuhlawula iintlawulo kunye neentlawulo ezisekelwe kwixabiso. Ukuchitha imali ekunakekeleni esibhedlele kuye kwahlala okufanayo ukususela ngo-2011. Ingxenye yesizathu sokuba oku kufundwa kwezibhedlele kuye kwawa ngama-150,000 ngonyaka ngonyaka we-2012 no-2013. Leyo yezinye izibhedlele zihlawulwa xa zigqitha imigangatho. Kwaphumela ekwenzeni ukwandisa ukwenziwa komgangatho kunye nokunyamekela kokunyamekelwa kwezigulane.
- Abanikezeli bemali ephezulu bahlawula ngaphezulu kwiirhafu zerhafu yeeMedare kunye neeNgqungquthela ze-B kunye ne-D. Kwakuthetha ukuba i-premium ye-Medicare Part B eyayihlawuliswa kubo bonke abantu ingahlala kwisilinganiso sayo samanje se-$ 104.90 ngenyanga. Ngaphezulu, khangela i- Obamacare Taxes .
- Ngo-2013, ukulandelwa kweemfuno ze-Medicare kunciphisa iintlawulo ze-Medicare ngamaphesenti amabini kubaboneleli kunye nezicwangciso.
Ngokusekelwe kule mizila emitsha, ukusetyenziswa kweMediare bekucetywayo ukuba kukhule ngama-5.3 ekhulwini ngonyaka phakathi kuka-2014 no-2024.
Iindleko Zonyango Lwempilo Ngonyaka
| Unyaka | Ukusetyenziswa kweMpilo kaZwelonke (iibhiliyoni) | Ukukhula kweepesenti | Indleko Ngomntu | Isiganeko |
|---|---|---|---|---|
| 1960 | $ 27.2 | N / A | $ 146 | Ukubuyisela |
| 1961 | $ 29.1 | 7.1% | $ 154 | Ukuzibuyisela kuphelile |
| 1962 | $ 31.8 | 9.3% | $ 166 | |
| 1963 | $ 34.6 | 8.6% | $ 178 | |
| 1964 | $ 38.4 | 11.0% | $ 194 | I-LBJ yaqala iMedare neeMedicaid |
| 1965 | $ 41.9 | 9.0% | $ 209 | |
| 1966 | $ 46.1 | 10.1% | $ 228 | IMfazwe yaseVietnam |
| 1967 | $ 51.6 | 11.9% | $ 253 | |
| 1968 | $ 58.4 | 13.3% | $ 284 | |
| 1969 | $ 65.9 | 12.9% | $ 318 | |
| 1970 | $ 74.6 | 13.1% | $ 355 | Ukubuyisela |
| 1971 | $ 82.7 | 11.0% | $ 389 | Ulawulo lwexabiso lomvuzo |
| 1972 | $ 92.7 | 12.0% | $ 431 | Stagflation |
| 1973 | $ 102.8 | 11.0% | $ 474 | Umgangatho weGolide uphele. HMO Act |
| 1974 | US $ 116.5 | 13.4% | $ 534 | ERISA. Ulawulo lwexabiso lomvuzo luphelile. |
| 1975 | $ 133.3 | 14.4% | $ 605 | Imali engama-6.9% |
| 1976 | $ 152.7 | 14.6% | $ 688 | Imali engama-4,9% |
| 1977 | $ 173.9 | 13.8% | $ 777 | Imali engama-6.7% |
| 1978 | $ 195.3 | 12.4% | $ 865 | Imali engama-9.0% |
| 1979 | $ 221.5 | 13.4% | $ 971 | Imali engama-13.3% |
| 1980 | $ 255.3 | 15.3% | $ 1,108 | Ixabiso lemali kwi-12.5% |
| 1981 | $ 296.2 | 16.0% | $ 1,273 | Amaxabiso aphakanyisiweyo |
| 1982 | $ 334.0 | 12.8% | $ 1,422 | Ukuzibuyisela kuphelile |
| 1983 | $ 367.8 | 10.1% | $ 1,550 | Ukunyuka kweRhafu kunye nokusetyenziswa kwemali |
| 1984 | $ 405.0 | 10.1% | $ 1,692 | |
| 1985 | $ 442.9 | 9.4% | $ 1,833 | |
| 1986 | $ 474.7 | 7.2% | $ 1,947 | Ukunqunyulwa kweRhafu |
| 1987 | $ 516.5 | 8.8% | $ 2,099 | NgoMvulo ngoMnyama |
| 1988 | $ 579.3 | 12.2% | $ 2,332 | Ixabiso eliphakanyisiweyo eliphakamileyo |
| 1989 | $ 644.8 | 11.3% | $ 2,571 | Inkathazo ye-S & L |
| 1990 | $ 721.4 | 11.9% | $ 2,843 | Ukubuyisela |
| 1991 | $ 788.1 | 9.2% | $ 3,070 | Ukubuyisela |
| 1992 | $ 854.1 | 8.4% | $ 3,287 | |
| 1993 | $ 916.6 | 7.3% | $ 3,487 | IiHMO |
| 1994 | $ 967.2 | 5.5% | $ 3,641 | |
| 1995 | $ 1,021.6 | 5.6% | $ 3,806 | Ixabiso eliphakanyisiweyo eliphakamileyo |
| 1996 | $ 1,074.4 | 5.2% | $ 3,964 | Ukuhlaziywa kweentlalo |
| 1997 | $ 1,135.5 | 5.7% | $ 4,147 | UMthetho oHloniphekileyo woLwabiwo-mali |
| 1998 | $ 1,202.0 | 5.8% | $ 4,345 | I-LTCM |
| 1999 | $ 1,278.3 | 6.4% | $ 4,576 | BBRA |
| 2000 | $ 1,369.7 | 7.1% | $ 4,857 | BIPA |
| 2001 | $ 1,486.8 | 8.5% | $ 5,220 | 9/11 ukuhlaselwa |
| 2002 | $ 1,629.2 | 9.6% | $ 5,668 | Imfazwe kwiSibetho |
| 2003 | $ 1,768.2 | 8.5% | $ 6,098 | UMthetho weModare Modernization Act |
| 2004 | $ 1,896.3 | 7.2% | $ 6,481 | |
| 2005 | $ 2,024.2 | 6.7% | $ 6,855 | Umthetho weBhanki |
| 2006 | $ 2,156.5 | 6.5% | $ 7,233 | |
| 2007 | $ 2,295.7 | 6.5% | $ 7,628 | |
| 2008 | $ 2,399.1 | 4.5% | $ 7,897 | Ukuthatha ixesha lokunciphisa iindleko. |
| 2009 | $ 2,495.4 | 4.0% | $ 8,143 | |
| 2010 | $ 2,598.8 | 4.1% | $ 8,412 | ACA isayinwe. |
| 2011 | $ 2,689.3 | 3.5% | $ 8,644 | Iingxaki zematyala |
| 2012 | $ 2,797.3 | 4.0% | $ 8,924 | Inkcazo yezimali |
| 2013 | $ 2,879.0 | 2.9% | $ 9,121 | IAAA irhafu |
| 2014 | $ 3,026.2 | 5.1% | $ 9,515 | Exchanges ivuliwe . |
| 2015 | $ 3,200.8 | 5.8% | $ 9,994 | |
| 2016 | $ 3,337.2 | 4.3% | $ 10,348 |
(Umthombo: "IiNkcitho zeMpilo zeSizwe eziNkcazo kuquka neSabelo se-GDP, i-CY 1960-2016," amaziko e-Medicare kunye neenkonzo zeMedicaid. " Umyinge wexabiso loNyaka ," i-Balance. " Imbali yokuchitha imali eMelika, ngo-1960-2013 , "Amasebe e-Medicare kunye neenkonzo zeMedicaid, ngoNovemba 19, 2015." Ukunyamekelwa kweMpilo yase-US: Ngubani ohlawulayo "I-California Care Care Foundation, Disemba 2015.)