Ko da tare da ACA Sashe na 1557, yana da rikitarwa
Dogayen daidaitattun halayen Amurkawa masu wucewa sun kasance mai zuwa, amma Dokar Kulawa ta Kasa (ACA) tana ci gaba da daidaitawa a kiwon lafiya . Sashe na 1557 na ACA ya hana nuna bambanci a kan wasu dalilai da dama don kowane "shirin kiwon lafiyar ko aikin" wanda ke karɓar kowane taimakon kudi na tarayya.
Amma wannan ba yana nufin cewa duk waɗanda aka sanya su ba su sami damar shiga duk wani likita da suke bukata.
Sashe na 1557 na ACA
ACA Sashe na 1557 ya kasance tun daga shekarar 2010, amma dai kawai wasu sassan layi ne, kuma ainihin ma'anar yanayi. Don tabbatar da bukatun da ba a ba da izini ba, Sashen Harkokin Kiwon Lafiya da Harkokin Dan Adam (HHS) da kuma Office for Civil Rights (OCR) sun buga dokoki na 362 na karshe don aiwatar da Sashe na 1557 a watan Mayu 2016.
Sashe na 1557 ya hana nuna bambanci bisa ka'idodin da ke gudana-Dokar 'Yancin Lafiya, Title IX, Dokar Age, da Sashe na 504 na Dokar Amincewa - waɗanda sun riga sun saba da yawancin jama'ar Amirka (watau shekaru, rashin lafiya, tsere, launi, asalin ƙasar da jima'i). Sashe na 1557 na ACA ya shafi waɗannan ka'idojin rashin nuna bambanci game da tsare-tsaren kiwon lafiya da kuma ayyukan da ke karɓar kudade na tarayya.
A karshe mulki, HHS da OCR sun bayyana cewa ainihin jinsi "na iya zama namiji, mace, ba, ko hade namiji da mace." Kuma mulkin ya haramta haramtacciyar tsare-tsaren kiwon lafiya da ayyukan da ke samun tallafin tarayya daga nuna bambanci ga mutane bisa ga jinsi ko jima'i.
Sashe na 1557 ya shafi kowane kungiya da ke bayar da sabis na kiwon lafiya ko inshorar lafiya (ciki har da kungiyoyi masu zaman kansu na tsare-tsaren kiwon lafiyar ma'aikata) idan sun sami duk wani taimakon kudi na tarayya don inshorar lafiya ko ayyukan kiwon lafiya.
Wannan ya hada da asibitoci da sauran wuraren kiwon lafiya, Medicaid , Medicare (ban da Medicare Sashi na B ), tsare-tsaren kiwon lafiyar dalibai , Shirin Kulawa da Lafiya na Yara , da masu insurers masu zaman kansu da suka karbi kudade na tarayya (ciki harda tallafin da aka yi a musayar kasuwancin su; wannan shari'ar, dukan tsare-tsaren insurer dole ne ya dace da Sashe na 1557, ba kawai tsarin su na musanya ba).
Ƙungiyoyi waɗanda dole ne su bi Sashe na 1557 ana kiransa "abubuwan rufewa."
Yawancin tanadi na karshe mulki ya faru a ranar 18 ga watan Yuli, 2016, amma idan akwai canje-canje a tsarin tsarin kiwon lafiyar, za'a iya jinkirta har zuwa farkon shekara ta farko da zata fara ko bayan Janairu 1, 2017 Saboda haka tsarin kiwon lafiyar wanda yake da shekara ta shekara mai zuwa daga watan Agusta zuwa Yuli ba zai yi amfani da canje-canjen da ake buƙata a cikin mulkin karshe har zuwa watan Agusta na 2017.
An yi amfani da OCR tare da aiwatar da Sashe na 1557, kuma suna yin hakan tun 2010. Tun da farko dai ana iya magance laifuka da kuma tilasta yin amfani da su a kan kararraki, kuma an yarda da mutane su nuna rashin adalci a cikin kotun tarayya a karkashin Sashe na 1557.
Shin ACA ta buƙaci masu shayarwa don rufe Jigilar Harkokin Jinsi?
Kodayake tsarin karshe na Sashe na 1557 yana da cikakkun bayanai kuma musamman haramta hana nuna bambanci dangane da ainihin jinsi, bazai buƙatar manufofin inshorar kiwon lafiya don "rufe duk wata hanya ta musamman ko magani ga kulawa da alaka."
Har ila yau, dokoki ba su hana wani abu mai rufewa daga "yin amfani da ka'idodi masu tsaka-tsakin da ke jagorancin yanayin da zai ba da cikakken ɗaukar hoto ga dukkan ƙa'idodinsa a cikin hanyar da ba'a yi ba." A wasu kalmomi, dole ne a bayar da aikin likita da kuma matakai a cikin hanyar rashin nuna bambanci, amma babu wani takamaiman takaddama cewa masu sayarwa sun kulla wasu hanyoyin kula da kiwon lafiya na transgender, koda kuwa idan aka dauke su da lafiya.
OCR ya bayyana cewa idan wani mahaluki ya yi ko ya biya wani aiki na musamman ga wasu daga cikin mambobinta, ba zai iya amfani da jinsi ko jima'i ba don magance wannan hanya zuwa ga wani mutum mai karuwa. Alal misali, idan mai insurer ya rufe mahaifa don hana ko magance ciwon daji a cikin matan aure, sai ya yi amfani da ka'idojin tsaka-tsakin, da rashin nuna bambanci don sanin ko zai rufe magunguna don magance dysphoria jinsi .
Kuma ainihin jinsin baza'a iya amfani dashi don ƙaryar da magani wanda yake da mahimmanci, koda kuwa ya dace da nau'in jinsin mutum.
Alal misali, ba za a iya hana namiji mai karuwa ba don hana shan magani don ciwon daji na ovarian bisa ga gaskiyar cewa ya gano namiji.
Amma batun ya zama rikitarwa. Kafin jagoran da aka bayar a cikin Dokar 1557 na ƙarshe, akwai jihohin 17 da suka hana masu sayen lafiya daga ciki har da barkewar hanyoyi don kulawa da ƙwayar cuta, da jihohi 10 da suka hana irin wannan barkewa a cikin shirin su na Medicaid. A karkashin mulkin karshe, an haramta mahalli a cikin kowace jihohi ta amfani da cirewar rufe bargo don ƙin yarda da dysphoria jinsi, kuma dole ne suyi amfani da hanyoyi marasa nuna bambanci idan sun yanke shawarar ko za a rufe hanya.
Duk da yake yayin da Sashe na 1557 ya zama babban mataki ga daidaito a kiwon lafiyar Amurkawa, bazai buƙatar ɗaukar hoto ba don sake jima'i da jima'i na likita.
Shin Shin Shirye-shiryen Asibiti na Kiwon Lafiya Kashe Bayyanawa na Jinsi?
Ko da yake Sashe na 1557 ya kasance tun daga shekara ta 2010, hukuncin karshe bai zo ba har sai shekaru shida bayan haka, kuma masu bada shawara na kiwon lafiya da masu samar da kayan aiki suna aiki don warware bayanai. Musamman ma a bayyane cewa hukuncin karshe a kan Sashe na 1557 baya buƙatar masu sayarwa su rufe duk wani matakan da ya dace-ko da idan an yi la'akari da su da mahimmanci - har yanzu suna da yalwacin wuri.
Healthcare.gov ya ba da bayani game da yadda za a bayar da rahoto game da jima'i a kan aikace-aikace don ɗaukar hoto a cikin sha'anin inshora na kiwon lafiya a jihohin da suke amfani da Healthcare.gov, kuma ya bayyana yadda za a gudanar da rahoton nuna bambanci.
Tun shekara ta 2014, Medicare ya rufe aikin tiyata mai mahimmancin jima'i , tare da yanke shawara akan yanke shawara ta hanyar kararrakin da ya shafi likita. Ma'aikatar Veterans Affairs (VA) ta ba da shawara ta kawar da dakatarwar da ta yi na tsawon lokaci don biyan bashin jima'i ga 'yan tsohuwar Amurka.
Kuma wannan taƙaitacciyar daga Aetna misali ne mai kyau game da yadda masu kula da lafiyar masu zaman kansu zasu iya ɗaukar wasu nau'o'in jituwa tsakanin maza da mata, amma ba duka ba.
Yayin da aka aiwatar da tsarin karshe na Sashe na 1557, akwai yiwuwar karin tsarin kiwon lafiyar da ake son ɓoye a gefen haɗarin jima'i. Jami'ar Vanderbilt ta sanar a watan Yunin 2016 cewa za su fara daukar nauyin farfadowa na maza a kan tsarin kiwon lafiya na dalibai, da kuma birnin Portland, Maine za su fara rufe lafiyar lafiyarsu a watan Janairu 2017.
Har ila yau, a cikin watan Yunin 2016, Hukumar Kundin Kasuwancin Cincinnati, ta amince da su, don kada su kara wa] anda suka ha] a da shirin haya. Masu binciken da aka yi la'akari da su sun hada da kiwon lafiyar transgender, aikin tiyata, da kuma kula da rashin haihuwa. Ɗauren ɗakin karatu yana ɗaukar hoto ta hanyar Anthem, kuma mai ɗaukar hoto yana ba da mai ba da zaɓi wanda magajin ɗakin karatu zai iya saya don rufe kiwon lafiya na transgender.
Amma ɗakin ɗakin karatu ba a ɗauke shi ba ne a karkashin sashi na 1557 na ACA, domin aikin kasuwancin su ba shine samar da lafiyar lafiya, asibiti na kiwon lafiya, ko ayyukan kiwon lafiya ba. Kamar yadda irin wannan, su ne misalin wani kungiya wanda bazai bin ka'idojin Sashe na 1557 ba tare da nuna bambanci a amfanin asibiti na kiwon lafiya ba.
Wani mai kula da namiji wanda ke aiki don lafiyar lafiyar San Francisco ya yi masa aiki a watan Yuni 2016 akan rashin nuna bambanci, saboda tsarin lafiyar asibiti ba ya rufe magani ga dysphoria. Kusan duk asibitoci an rufe ɗakunan a ƙarƙashin Sashe na 1557, amma asibiti ya yi iƙirarin cewa tsarin kiwon lafiya na ma'aikata ba nuna bambanci ba ne saboda ba ya keta "cututtukan mutum" a gaba ɗaya (ba tare da nuna nuna bambanci game da ma'aikatan transgender ba).
Shari'ar ta yi jayayya cewa jima'i dysphoria ba halin mutum ba ne, amma batun ya nuna gaskiyar cewa Sashe na 1557 har yanzu yana ba da izini ga ɗan ƙaramin ra'ayi, fassarar tarar da kararraki.
Wannan batu zai iya fuskantar maganganu na shari'a a cikin shekaru masu zuwa, musamman don tabbatar da cewa yawancin kiwon lafiyar ACA ba sun hada da kiwon lafiya na transgender ba, kuma gaskiyar cewa dokar 1557 ta karshe ba ta buƙatar buƙatar kiwon lafiya don rufewa hanyoyin kiwon lafiya da suka shafi jigilar jinsi, ba tare da buƙatar likita ba.
> Sources:
Ma'aikatar Lafiya da Ayyukan 'Yan Adam, Nukasuwa a Shirye-shiryen Lafiya da Ayyuka , tasirin Yuli 18, 2016. Samun shiga 6/22/16.
Cibiyar Kasa ta Tsakanin Tsarin Mulki, Sanin Hakkinku: Medicare. Samun shiga 6/22/16.
Ma'aikatar Shari'a na Amurka, Taron Farko na IX na Saurin Harkokin Ilimi na 1972, Samun damar 6/22/16.
Ma'aikatar Wakilan Amurka, Ƙaddamarwar Kariya da Tsaro da Dokar Kulawa, Kamar yadda aka gyara ta ranar 1 ga Mayu, 2010 . Samun shiga 6/22/16.