Chigamulo cha Federal District Court chikhoza kuyika pachiwopsezo kuperekedwa kwa inshuwaransi kwa njira zopitilira 50 zovomerezeka, mayeso ndi chithandizo | Goodwin

maziko a bungwe

Pansi pa Affordable Care Act, mapulani azaumoyo amagulu ndi opereka inshuwaransi yazaumoyo akuyenera kupereka inshuwaransi yaumoyo potengera malingaliro ochokera kwa akatswiri azaumoyo. Magulu omwe aphatikizidwa ndi awa:

  1. Zinthu zozikidwa paumboni kapena mautumiki omwe ali ndi “A” kapena “B” mumalingaliro apano a USPSTF;
  2. Makatemera omwe ali ndi malingaliro ochokera ku Advisory Committee on Immunisation Practices (ACIP) ku Centers for Disease Control and Prevention (CDC);
  3. Chisamaliro chozikidwa paumboni ndi mayeso a makanda, ana, ndi achinyamata, monga momwe zaperekedwa ndi malangizo athunthu othandizidwa ndi Health Resources and Services Administration (HRSA); Ndipo the
  4. Kufikira zomwe sizinafotokozedwe kale ndi malingaliro a USPSTF mu Gulu Loyamba, chisamaliro chodzitetezera ndi kuwunika kwa amayi monga momwe zaperekedwa ndi malangizo a HRSA.

USPSTF imapangidwa ndi mamembala odzipereka odziyimira pawokha omwe atumikira zaka zinayi ndipo ali ndi chidziwitso chopanga malingaliro azachipatala. 42 USC § 300gg-13. Mwalamulo, USPSTF iyenera kukhala “yoima palokha komanso, momwe zingathekere, osakakamizidwa ndi ndale”. ID. § 299b-4(a)(6). Mkulu wina wa US Department of Health and Human Services (HHS), mkulu wa Agency for Health Care Research and Quality, ali ndi mphamvu zogwira USPSTF, koma wotsogolera kapena mlembi wa HHS sangathe kuwunikanso malingaliro a USPSTF.

ACIP mofananamo ndi bungwe lolangiza, koma limapereka malipoti kwa mkulu wa CDC ndipo ilibe lamulo lodziimira palokha. HRSA ndi bungwe mkati mwa HHS.

nkhani zakumbuyo

Otsutsa pamlanduwo anali ndi makampani awiri ndi anthu asanu ndi mmodzi omwe anali ndi udindo wopereka chithandizo cha inshuwaransi yaumoyo kwa ena, kapena akuyang’ana kuti adzipezere okha chithandizo. Otsutsawo adatsutsa zofunikira zitatu za kufalitsa malinga ndi malingaliro ochokera ku USPSTF, ACIP, ndi HRSA: (1) chilolezo cha chithandizo cha PrEP kwa anthu omwe ali pachiopsezo chotenga kachilombo ka HIV, malinga ndi ndondomeko ya USPSTF; (ii) udindo wopereka katemera wa HPV kwa ana onse azaka zapakati pa 11-12 (ndi kubwezera kwa okalamba), monga momwe ACIP imalimbikitsa; ndi (3) udindo wopereka chithandizo cha kulera kwa amayi onse omwe ali ndi mwayi wobereka, monga momwe HRSA imalimbikitsa.

Woweruza O’Connor adagamula mokomera boma pazovuta zomwe ACIP ndi HRSA zikukumana nazo, ndipo adagwirizana ndi katemera wa HPV ndi ntchito zakulera. Koma USPSTF, komabe, Woweruza O’Connor adagamula mokomera odandaulawo, ponena kuti bungwe la USPTSF likuphwanya ndime yosankhidwa m’malamulo a federal, chifukwa mamembala a USPSTF amagwiritsa ntchito mphamvu monga “olamulira a United States” koma sanasankhidwe pansi. ndondomeko yofunikila mwalamulo. Woweruza O’Connor adatsimikiza kuti mamembala a USPSTF ndi “ogwira ntchito” ku United States chifukwa (1) ali ndi maudindo nthawi zonse – kuwunika kafukufuku, kukonzanso malingaliro, ndi kupereka malipoti ku Congress ndi mabungwe a federal; ndi (2) ngakhale amatchedwa “maupangiri,” malangizo a USPSTF ali ndi mphamvu yalamulo, chifukwa amatanthauzira kuchuluka kwa inshuwaransi yazaumoyo. Justice O’Connor adanenanso momveka bwino kuti mamembala a USPSTF ndi akuluakulu “ofunikira”, omwe ayenera kusankhidwa ndi pulezidenti ndikuvomerezedwa ndi Senate. Koma Woweruza O’Connor adanenanso kuti ngakhale mamembala a USPSTF atakhala oyenerera kukhala “otsika” maofesala, njira yakusankhidwa kwawo sikuloledwa. Pomaliza, poganizira zofuna za USPSTF pazandale, Woweruza O’Connor adatsimikiza kuti Mlembi wa HHS sakanatha “kukonza” vuto lachigamulo povomereza malingaliro a USPSTF pambuyo pake, monga momwe Mlembi wa HHS adachitira ndi malingaliro a ACIP ndi HRSA.

Payokha, Judge O’Connor ananenanso kuti udindo wa PrEP unalemetsa kwambiri odandaulawo kuti azitsatira zikhulupiriro zawo zachipembedzo, motero akuphwanya lamulo la Religious Freedom Restoration Act. Iye adatsimikiza kuti, mosasamala kanthu za ubwino wonse wa PrEP, boma linalephera kusonyeza kuti “liri ndi chidwi chobisika chokakamiza makampani achipembedzo apadera kuti apereke mankhwala a PrEP popanda kugawana ndalama komanso popanda zipembedzo”.

Woweruza O’Connor sanasankhebe kuti mankhwala oyenera ndi ati malinga ndi zigamulo zake pa USPSTF ndi PrEP. Maphwandowa akuyembekezeka kupereka chidule cha chigamulo cha Jaji O’Connor m’masiku akubwerawa.

Kodi chisankho chopereka inshuwaransi yazaumoyo ndi zisankho zina za USPSTF zikutanthauza chiyani?

Sizikudziwikabe kuti chigamulo cha Judge O’Connor chikhala chotani pa USPSTF komanso udindo wa PrEP. Udindo wa PrEP ukhoza kutsatiridwa. Kwa USPSTF, boma likambirana za chithandizo chomwe chimasiya malingaliro ena a USPSTF momwe alili. Koma poganizira mawu a Justice O’Connor onena za ufulu wodziyimira pawokha wa ndale wa USPSTF ndi ulamuliro wochepera wa trustee wa HHS pokhudzana ndi USPSTF, ndizovuta kuwona njira yopita patsogolo pomwe malingaliro a USPSTF am’mbuyomu – komanso momwe amakhudzira thanzi la boma kapena lachinsinsi. chisamaliro Kuphunzira – ayi. amakayikira.

Gawo lina lofunikira laulamuliro wa USPSTF limaphatikizapo kulipira kwa Medicare pamayeso oyeserera momwe mulibe phindu la Medicare. Mwachindunji, Medicare Patient and Provider Improvements Act ya 2008 (PL 110-275) (yomwe imadziwika kuti “MIPPA”) idavomereza Medicare, kudzera munjira yake yowunikira dziko lonse, kuti ikwaniritse mayeso odziletsa omwe sagwera pansi pa gulu la Medicare. . , malinga ngati mfundo zitatu zakwaniritsidwa: (a) ntchito yopewera yomwe ikuyembekezeredwayo ndi “yoyenera komanso yofunikira popewera kapena kuzindikira matenda kapena kulumala msanga (ndiko kuti, muyezo wa Medicare); (b) ntchito yopewera “ndikoyenera” kwa omwe adzapindule ndi Medicare, ndipo (c) chithandizo chodzitetezera chimalandira malingaliro a USPSTF a Gulu A kapena B a USPSTF. Kuphatikiza pa mfundo zina zomwe zatulutsidwa mu chenjezoli, sizikudziwikanso ngati chisankho cha Judge O’Connor chikanakhala zotsatira zilizonse zotsatila pazisankho zam’mbuyomu zomwe zidatsogolera ku Malangizo A. kapena B kapena kutanthauza chigamulo choletsa malingaliro otere.

Chigamulochi chingakhalenso ndi zotsatira za ndondomeko za thanzi labwino (HDHPs). Kuti munthu akhale woyenera kupereka zopereka zomwe amakonda misonkho ku HSA, IRS imafuna kuti munthuyo azilipidwa ndi HDHP. Kuti muyenerere HDHP, ndondomeko yaumoyo imafunidwa ndi IRS kuti ikhale yochepetsera chaka chilichonse. Nthawi zambiri, HDHP singapereke phindu lililonse kwa membala membala asanakwaniritse kuchotsera kwawo pachaka. Ndime 223(c)(2) ya Internal Revenue Code imapereka chosiyana ndi malire awa pa HDHPs omwe amalola “kulipira dola yoyamba” pazithandizo zina zodzitetezera, kuphatikiza zinthu zozikidwa paumboni kapena mautumiki omwe ali ndi mlingo wa A kapena B Malingaliro apano. United States Preventive Services Task Force. Othandizira a HDHP akuyenera kuwunika momwe chigamulochi chikukhudzidwira ndi milandu ina iliyonse yotsatiridwa popereka chindapusa cha dola yoyamba pazinthu ndi ntchito potengera ma ratings a US Preventive Services Task Force.

Ngati Woweruza O’Connor apereka chigamulo chomwe chimalepheretsa malingaliro onse a USPSTF chifukwa mamembala a PSTF sanasankhidwe ndi malamulo, chigamulocho chikhoza kukhala ndi zotsatirapo zazikulu pamakampani a inshuwalansi ya umoyo, kwa opereka chithandizo kufunafuna zowunikira zodzitetezera, komanso kwa opanga. zoyesa zodzitetezera. USPSTF pakadali pano ili ndi malingaliro opitilira 50 “A” kapena “B”, omwe amafotokoza zinthu monga khansa, thanzi la mano, thanzi lamaganizidwe, kuthamanga kwa magazi, komanso kunenepa kwambiri. Ngati Woweruza O’Connor HHS alamula kukhazikitsidwa kwa malingaliro a USPSTF – mpaka momwe malingalirowa ali ndi zotsatira zomangirira ma inshuwaransi, Medicare ndi Medicaid – zitha kukhala ndi tanthauzo lalikulu pakuperekedwa.

N’zokayikitsa kuti Woweruza O’Connor angakhale ndi maganizo omaliza pa mlanduwu. Atazindikira momwe oimbira mlanduwo angachitire moyenerera zonena za odandaulawo pokhudzana ndi USPSTF ndi PrEP, boma la feduro ndi odandaula (mpaka pomwe ataya mfundo zawo zokhudzana ndi ACIP ndi HRSA) atha kuchita apilo zigamulo za Judge O’Connor khothi la United States. Adandaula ku Chigawo Chachisanu. Boma likhoza kupemphanso kuti chigamulo cha Woweruza O’Connor chikhalebebe poyembekezera kuchita apilo.

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