I-Orump yo-Oktobha 2017 yolawulo oluchaphazelekayo ichaphazela i-inshurensi yezempilo?
Ngo-Oktobha 12, ngo-2017, uMongameli uTrump wasayina umyalelo olawulayo "ukukhuthaza ukhetho lokunakekelwa kwempilo kunye nokhuphiswano kwi-United States." Umyalelo olawulayo weza emva kweeyure ezimbalwa ngaphambi kokuba ulawulo lweTrump luchaze ukuba inkxaso ye-ACA yokunciphisa iindleko (CSR) iza kuphelisa ngokukhawuleza , ngoko akumangalisi ukuba umphumo wendlela yokulawula kunye nokuxhaswa kwezimali ze-CSR ngamanye amaxesha kudibaniswa.
Kodwa ngelixa i-CSR inkxaso-mali yayisisenzo esicacileyo esasetyenziswa ngokukhawuleza, umyalelo wesigqeba awuzange wenze nayiphi na utshintsho kwaye ngokwawo, kwaye iziphumo zayo ziza kuthatha ixesha lokuziphatheka. Umyalelo olawulayo ulawula nje i-arhente ye-federal ehlukeneyo ukuba "iqwalasele ukuphakamisa imimiselo" ukwenza iinguqu ehlukahlukeneyo kwimithetho ephathelene ne-inshorensi yexesha elifutshane, izicwangciso zezempilo kunye neenkqubo zokubuyiselwa kwempilo (i-HRAs). Le mi miselo iya kufuneka ihambe kwinkqubo eqhelekileyo yokwenza umthetho, equka ixesha lokubeka izimvo zoluntu.
Makhe sijonge ukuba zeziphi utshintsho, nokuba zinokuchaphazela njani i-inshorensi yakho yempilo.
Intsholongwane Yempilo Yesikhashana
Ixesha elifutshane elifutshane, i-inshurensi yexesha elide (STLDI) yinto efana neyo: umshuwalense wezempilo ukuba unokugcina kuphela ixesha elide. Kodwa ubude bexesha apho umntu kufuneka abe nako ukukhawuleza kwexesha elikhawulezileyo kuye kwaphazamiseka kwiminyaka yamuva.
Intsholongwane yezempilo yesikhashana ayigqithwanga nguMthetho woNonophelo ongenakuncedo. Ngoko ukufaneleka kwabafaki-sicelo ukuba kusetyenziswe imbali kusekho kwimbali yabo yonyango, iimeko ezingekaze zenziwe zingabhekiswa , i- maximal benefit benefits annuals iyasebenza, kwaye izicwangciso azidingeki ukuba zixhamle iinkonzo zezempilo ze - ACA ezibalulekileyo .
Imithetho yokulahlekelwa yonyango (MLR) imigaqo ayisebenzisi kwizicwangciso zexesha elifutshane, ngoko akukho mfuneko yokuba uninzi lweeprimimenti zichithwa kwiibango zonyango.
Ngamafutshane, ezi zicwangciso zifana nezindlela ezininzi kwezinye izicwangciso zonyango ezinkulu ezizithengiswa kwiindawo ezininzi phambi ko-2014. I-ACA ivimbela ukuthengiswa kwezicwangciso ezinjengelo lithile lonyango lokuqala lonyango njengango-2014, kodwa Imithetho emitsha ayisebenzi kwiiprogram zexeshana.
Ekubeni izicwangciso zexesha elifutshane ziye zakwazi ukuqhubela phambili ukunikezela ngokukhawuleza kuphela kubantu abaneempilo ezinemiqathango enqandekileyo kwiintlawulo, kwaye ngenxa yokuba izicwangciso zithintele ixesha elide, ama-premiums ahlala ephantsi kakhulu kuneepriyam exabiso elipheleleyo kwimarike eyanelisayo ye-ACA. (kokubili kunye nokutshintshiselana, njengento ebalulekileyo yezocwangciso zonyango kufuneka ukuba ilandele imithetho efanayo ngaphandle kokutshintshiselana abayilandelayo phakathi kwintengiso).
Ngaphambi kowe-2017, inkcazo yesigqeba sesicwangciso sexeshana sasisigxina esinexesha elide ukuya kwii-364 iintsuku. Amanye amazwe anemithetho ethandekayo (abambalwa abavumeli izicwangciso zexesha elifutshane kuzo zonke, kwaye ezinye zazinciphisa ukuya kwiinyanga ezintandathu), kwaye abaninzi abaqinisekisayo banciphisa izicwangciso zabo ezifutshane zangexesha elifutshane kwiinyanga ezintandathu ngexesha, kungakhathaliseki ukuba ziguquguquke urhulumente okanye urhulumente wephondo.
Kodwa kuninzi lwamazwe, kukho ubuncinci izicwangciso zexesha elifutshane ezifumanekayo kunye nexesha eliphantse kunyaka.
Ukubhalisa kulezi zicwangciso kwandiswe emva kokuba amalungiselelo e-ACA aqalise ukusebenza, njengoko abantu befuna ezinye iindlela ezinokuhlawuleka kwi-ACA. I-ACA yenza ukuthengwa komntu ngamnye onokufanelekela ukufumana inkxaso-mali ye- premium , kodwa abo abanemivuzo engaphantsi kwe-400 kwinqanaba le-intlupheko (okt, abanakufumana inkxaso-mali ye-premium) ngamanye amaxesha bafumanisa ukuba izicwangciso ezifumanekayo zingaphezu kwazo uhlahlo lwabiwo-mali luza
Kuba bantu, xa nje bephilile, icebo lesigxina lisexesha elifutshane linokuthi linikeze enye indlela efanelekileyo yokungaqiniseki.
Kodwa izicwangciso zexesha elifutshane zineengxaki ezinkulu (ukuba abantu abahlala besazi malunga nelokuba bafumana uncedo lokhathalelo olunzulu), kwaye xa abantu abanempilo beshiya i-ACA-efanelekileyo yokukhusela umngcipheko ngokubhekiselele kwezinye iindlela, kushiya yonke Igalelo lomngcipheko wee-ACA-ezicwangcisiweyo zicwangcise kakhulu kwiibhalisi ezigulayo, ezikhokelela kwimarike engaqinisekanga.
Nangona abantu abathembele kwi-inshorensi yexesha elifutshane baye baxhomekeke kwisigwebo soxanduva lwabiwo lwe-ACA ukususela ngo-2014 (ngokuba i-inshorensi yesikhashana ayifumwanga njengobuncinci bokubambisana), u-Obama Administration wanquma ukuphakamisa imimiselo nokuqinisekisa ukuba i-inshorensi yesikhashana ingasetyenziselwa kuphela njengoko yayijoliswe ekuqaleni: ukuzalisa i-gap emfutshane phakathi kwezinye iinjongo ze-inshorensi yezempilo, kwaye kungekhona njengomntu ohlala endaweni ende kwi-inshorensi yempilo yangempela.
Ngoko bafezekisa imigaqo ngasekupheleni kwe-2016 (eyaqala ukusebenza ngoJanuwari 2017 kwaye yafuneka ukuba iqale ngo-Apreli 2017) inqwenela izicwangciso zexesha elifutshane kwiinyanga ezintathu kwixesha.
Umyalelo olawulayo weTrump unokubangela ukuba imimiselo emitsha eya kugqithisela umgaqo we-2016 nokubuyisela umthetho owangaphambili owawuvumela izicwangciso zexesha elifutshane ukuba zibe neentsuku ezingama-364. Kodwa abantu abathembela kwizicwangciso zangexesha elifutshane baya kuqhubeka bexhomekeke kwisigwebo soxanduva lwabiwo lwe-ACA, njengokuba i-inshurensi yesikhashana iyakuthi ithathelwe ingqalelo ngaphandle kwenzuzo, kwaye ngoko ke ayifumanekanga inkcazo ebalulekileyo.
Kukho iinkxalabo ezibuyisela imimiselo kwiiprogram zexeshana ezifutshane ziza kuzinzisa i-ACA. Kodwa ezinye iimeko ziyakuthi zigcine imithetho engaphezulu yokubaluleka ebeyenayo ngaphambi kowe-2016, kwaye abanye banokufumana imimiselo efanayo ukuze bakhusele i-ACA-efanelekileyo yemarike yonyango.
IziMpilo zoMbutho
Iifowuni zokulawula zeTrump "ukukhulisa ukufikelela" kwizicwangciso zezempilo (Association of AHPs), ukwenzela ukuvumela amashishini amancinci ukuba ahlangane kunye nokufumana igalelo elikhulu leqela (kuthengwa kwi-insurer okanye kwi-insured), kunokuthenga nganye ishishini icebo leqela elincinci.
I-ACA imisele ininzi yemithetho yayo kwiimakethe zeqela kunye namancinane. Nangona abaqeshi abakhulu (abasebenzi abangama-50 + kuphela bafunwa ngumthetho ukuba banikeze ukunika ingxelo kubasebenzi, ukuxhaswa kwamaqela amancinci angayithengwa kakhulu kunokuba kufikeleleke kumaqela amakhulu.
Ukuze kufikelelwe ngoJanuwari 2014 okanye kamva, i-ACA idinga iiprayimari zeqela elincinci ukuba zisekelwe kuphela kwixesha labasebenzi, ukusetyenziswa kwecuba kunye nendawo yokuhlala-yonke imeko yezempilo yeqela ayikwazi ukusetyenziswa ukufumana iiprayimari. Kwaye izicwangciso zeqela elincinci zifuneka ukuba zibandakanye iingenelo zezempilo ze - ACA ezibalulekileyo . Ayikho yale mfuneko ifake kwiiplani zeqela elikhulu (ininzi yeeplani zeqela elikhulu kakhulu zizinkxaso-mboleko, kodwa ezo mfuneko ze-ACA azizisebenzisi naluphi na uhlobo).
Ngoko ingcamango nge-AHPs kukuvumela amaqela amancinci ukuba aqoke ngokubambisana kunye nokwenza amaqela amakhulu, kwaye aphephe ezinye zeemigaqo ze-ACA kwinkqubo. Kodwa ngelixa umqeshi omkhulu ufumana inzala eqinisekisiwe ekuqinisekiseni ukuba abasebenzi bayo bahlala besempilweni kwaye iinzuzo zezempilo zabo zinamandla ngokwaneleyo ukuba zibe zixhobo eziqinileyo zokuqashwa nokugcinwa, ezingenakuyinyaniso kwiziko lempilo.
Kwaye nangona umqeshi omkhulu ekufuneka acinge ngexesha elide malunga nesicwangciso saso sonke isibonelelo, akukho nto ikhusela ishishini elincinci ukuba lingene kwi-AHP ngelixa abasebenzi balo bephilile, baze babuyele kwi-ACA-imakethe yeqela elincinci elincinane emva komhla xa olo khetho luya kuba luncedo ngakumbi kwiimeko ezitshintshileyo. Ngoko kukho ukukhathazeka ukuba ukwandisa ububanzi be-AHPs bunokubangela ukuba i-ACA-imakethe yeqela elincinci lihambelane ngokutsala amaqela amancinci aphilileyo kwiimakethe ezihambelana ne-ACA kunye ne-AHPs.
Izilungiso zeMpilo yeNtlawulo
Umyalelo olawulayo ubiza imimiselo emitsha "yokwandisa ukulungelelanisa nokusebenzisa" amalungiselelo okubuyiselwa kwempilo (ii-HRAs). Ingcamango, ngokukodwa, kukuvumela abaqeshi ukuba basebenzise ii-HRAs ukuze babuyiselwe abasebenzi kwiipalamama zethenge.
Abaqeshi basebenzisa ukukwazi ukwenza oku. Kodwa yayivalwe ngokupheleleyo phantsi kwemimiselo yokuqala eya kubhalwa ukuphumeza i-ACA (ukuvinjelwa kwakuhamba kunye nentlawulo ephezulu: $ 100 ngosuku ngomsebenzi ngamnye ukuba umqeshi uyaqhubeka nokubuyiselwa kwabasebenzi kwiimali-mali zamashishini ngamnye). Umngcipheko wancincizwa ngu-21 we-Century Cures Act, owaqala ukusebenza ngowama-2017 kwaye ivumela abaqeshi abancinci (abasebenzi abangaphantsi kwama-50) ukuba babuyisele iimali-mali zee- inshurensi zempilo kwiimarike zempilo nganye ukuya kwi-dollar yangaphambili.
Kodwa abaqeshi abancinci abafunwa ukuba banikeze ukugqithiswa kuzo zonke phantsi kwe-ACA, ngoxa abaqeshi abakhulu. Kwaye akukho nalungiselelo evumela ukuba abaqeshi abakhulu bahlawulele abasebenzi kwiipalamama zethenge. Abasebenzi bakhululekile ukufumana naluphi uhlobo lwe-inshurensi abayithandayo-ukwamkela isibonelelo somqeshi wabo we-inshurensi yezempilo, okanye ukuthengwa kwemali kumntu ngamnye-kodwa umqeshi omkhulu akakwazi ukuhlawula umrhumo ngamnye wemakethe (ngokuchaseneyo, umqeshwa akakwazi ukufumana inkxaso-mali ye-premium kwiimarike zomntu ngamnye ukuba umqeshi unikezela ngexabiso elithengekayo, ubuncinci bomshuwalense wezempilo yeqela).
Umyalelo wokulawula weTrump kulindeleke ukuba ube nomgaqo-nkqubo ophakanyisiweyo onokunyusa ukuguquguquka kwabaqeshi ukusebenzisa ii-HRAs ukubuyiselwa kwabasebenzi kwii-premium zorhwebo, nokuba ngaba umqeshi unabasebenzi abangama-50 okanye ngaphezulu.
Into esingazaziyo ububanzi bemimiselo ecetywayo. Ingaba kuphela i-ACA-coverage engqinelanayo iya kuthathwa njengelungelo lokubuyiselwa, okanye ingahlawulwa ngaphandle (njengezicwangciso zexesha elifutshane)? Ngaba ngabaqeshi abakhulu babeza kuthatyathwa ngokuthobela igunya lomqeshi (oko kukuthi, imfuneko yokuba banikezela ngokukhawuleza okanye mhlawumbi kufuneka bahlawule isohlwayo) ukuba basebenzise ii-HRA ukuze babuyisele iipresimesi zorhwebo nganye kunokuba banikezele ukuxhaswa kweqela?
Siya kuvela nini iMimiselo emitsha?
Uninzi luhlala lubonakala ngokubhekiselele kwinto ephakanyiswayo kwimimiselo ezayo. Imimiselo ye-AHPs kunye ne-inshorensi yempilo yexesha elifutshane ilindeleke ukuba iphakanyiswe zingakapheli iintsuku ezingama-60 ukusuka kumhla wokulawula, ngoko kufuneka sibone ngaphambi kokuphela konyaka. Yaye imimiselo malunga nee-HRA ikulindeleke ukuba icetywe zingadlulanga iintsuku ezili-120, ngoko kufuneka zifumaneke ekuqaleni kuka-2018.
Emva kokuba imimiselo ecetywayo ipapashwe, kuya kubakho ixesha lokubeka izimvo zomphakathi ngaphambi kokuqalisa ukusebenza, ngoko ke ukuba unempendulo kwi-arhente ye-federal esebenza kule miba, iya kuba yithuba lakho lokwabelana ngalo.
> Imithombo:
> Isebe leNondyebo; KwiSebe lezeMisebenzi; ISebe lezeMpilo kunye neNkonzo zoLuntu. Izibonelelo ezingeNye, iiNkcazo zokuPhila kunye neNyaka, kunye neNkxaso-mali yexesha elifutshane elifutshane . Oktobha 2016.
> INdlu ye-White, i-Ofisi yoNobhala woLwazi. UMyalelo oLawulayo woMongameli oKhuthaza ukhetho lwezeMpilo kunye noKhuphiswano kwi-United States. Oktobha 12, 2017.