I-inshorensi yempilo ejongene noJob ishintshe phantsi kwe-Obamacare
Ngenxa yokuba amaninzi amalungiselelo kaMthetho woNonophelo ongenakuncedo asebenza kumakethi athile, imakethi ye-inshorensi exhaswe ngumqashi ngamanye amaxesha ayishiywa ngaphandle kwengxoxo. Kodwa i-inshorensi yempilo exhaswe ngumqeshi yindlela eqhelekileyo yokufikelela kwi-US. Kuphela malunga nama-6% aseMelika ayenokuthengwa kuthengwa kwiimarike ngamnye ngo-2014, ngokuchasene no-49% oye wabhalwa ngumqeshi.
Imarike yempilo yomshuwalense yempilo ihluke kakhulu namhlanje kunokuba yayingaphambi kokuba uMthetho woNonophelo ongenakunceda (aka, Obamacare) uphunyezwe. Nangona utshintsho aluzange luchazwe kwiimarike ze-inshurensi yempilo (ngokukodwa kwimarike yeqela elikhulu), kukho iinkalo ezininzi ze-ACA ezisebenza kwizicwangciso zempilo abantu abafumana ngayo abaqeshi babo.
Abaqeshi amakhulu bayadingeka ukuba banikeze ngokukhawuleza
Ngaphambi kuka-2014, kwakungekho mfuneko yokuba abaqeshi banikela i-inshurensi yempilo kubasebenzi babo. Uninzi lwabaqeshi abakhulu lanikezela nge-coverage, kodwa loo nto yayiyikhethayo. Umqeshi we-ACA wabelane ngokubonelela ngemfanelo (umqeshi wegunya lomqeshi) kufuna abaqashi abaneminyaka engama-50 okanye ngaphezulu abasebenzela ixesha elizeleyo ukuba banikeze i-inshurensi yempilo enokuhlawulela kubasebenzi babo abasebenza okungenani iiyure ezingama-30 ngeveki.
Imfuno yayifanele iqalise ukusebenza kubo bonke abaqeshi abaqala ukususela ngo-2014 kodwa ilibazisekile kuze kube ngu-2015 kubaqeshi abanabasebenzi abayi-100 okanye ngaphezulu, kuze kube ngu-2016 kubaqashi abanabasebenzi abangama-50 no-99.
Isigunyaziso somqeshi sithetha ukuba abaqeshi kufuneka banikezele ngokukhawulelana okuhlangabezana nexabiso elincinci kwaye kuthathwa njengexabiso elifanelekileyo kumqeshwa. Nangona kunjalo, " intsapho ye-glitch " ithetha ukuba kwezinye iimeko, i-coverage ayikwazi ukuhlawulelwa kubaxhomekeke kubaqeshwa.
Zonke izicwangciso kufuneka zikhuphe iindleko ze-pocket
Ngo-2016, zonke izicwangciso zezempilo ezingenakuzaliswayo kufuneka zikhuphe iindleko ze-pocket kwi-$ 6,850 ngamnye, kunye ne-13,700 zamawaka kwintsapho.
Kwaye izicwangciso zentsapho kufuneka zibe nemigangatho engaphandle kwee-pocket ezingagqithanga i-$ 6,850 . Iindleko zokunciphisa iindleko ze-pocket zisebenza kwizicwangciso zeqela kunye nezicwangciso ezizimeleyo, ngoxa nje zingakhange zizalwe (izicwangciso ezazisetyenziswa xa i-ACA isayinwe kumthetho ngoMatshi 23, 2010).
Ayikho imingcele yeli dolophu kwizibonelelo zempilo ezibalulekileyo
I-ACA ichaza ishumi "iingeniso zezempilo ezibalulekileyo" ekufuneka zifakwe kuzo zonke izicwangciso zeqela elincinci kunye namancinci (kwiindawo ezininzi, iqela elincinci lichazwa njengabasebenzi abafikelela kuma-50). Ukuba usebenzela umqeshi ongenabasebenzi abangaphezu kwama-50 kunye nomqeshi wakho obhalise kwisicwangciso ukususela ngoJanuwari 2014, isicwangciso sakho sezempilo sibandakanya iintlawulo zempilo ebalulekileyo ngaphandle kwemida yeli doladi malunga nokuba isicwangciso esiza kuhlawula njani ezo zinzuzo kunyaka okanye ngaphezulu lonke ixesha unako ukukhutshwa.
Ukuba usebenzela umqeshi omkhulu (kwiindawo ezininzi, abasebenzi abangaphezulu kwama-50; kodwa kwezinye iindawo, abasebenzi abangaphezu kwe-100), isicwangciso sakho sezempilo asikwazi ukusibekela zonke iinkonzo ezibalulekileyo zempilo, njengoko kungadingeki ukwenza njalo phantsi ACA. Kodwa kukho naziphi na izibonelelo eziyimfuneko ezibalulekileyo zezempilo, isicwangciso asiyikunyanzelisa umlinganiselo wonyaka okanye i-dollar umyinge wendlela yokuhlawula ezo zibonelelo (ezininzi izicwangciso zeqela zibandakanya uninzi lwezibonelelo zempilo ebalulekileyo, ingakumbi ngoku iqela elikhulu kufuneka ukuba banikeze ubuncinane ubunani).
Ukuvinjelwa kwama-maxums enzuzo ebomini kwizibonelelo ezibalulekileyo zempilo kusebenza nakwizicwangciso ezininzi. Kwaye ukuvinjelwa kwama-maxum enzuzo yonyaka yemisebenzi ebalulekileyo yezempilo kusebenza kwizicwangciso ezixhaswe ngumqeshi.
Akukho zonyango ezibhaliweyo kwiiplani zeqela elincinci
Ngaphambi kowe-2014, abo bango-inshurensi babeza kusekela i-premium yeqela elincinane kwimbali yonyango jikelele yeqela lezonyango nangona ezinye iindawo zithintela okanye zithintela lo mkhuba. Ukususela ngo-2014, i-ACA inqatshelwe abathwali be-inshorensi yezempilo ukususela kwimbali yonyango yeqela lezonyango ukufumana iiprayimari. Kwiindawo ezininzi, oku kusebenza kubaqeshi abanabasebenzi abangama-50 okanye abambalwa.
Zonke izicwangciso ziquka ukukhutshwa komama
Ukususela ngo-1978, izicwangciso zempilo ezixhaswe ngumqeshi e-US ziye zafuneka ukuba zibandakanye ukukhutshwa komama ukuba umqeshi unabasebenzi aba-15 okanye ngaphezulu kwaye bakhetha ukubonelela nge-inshurensi yezempilo. Kwaye ngo-19 uthi, imimiselo yayisetyenziswe ngaphambi kokuba i-ACA idinga ukukhutshwa komama kwiiplani zeqela elincinane nangona umqeshi unabasebenzi abangaphantsi kwe-15.
Kodwa ukunakekelwa kwababelethi ngenye yeenzuzo ezibalulekileyo zezempilo ze-ACA, oku kuthetha ukuba ifakwe kuzo zonke izicwangciso ezintsha zeqela kunye nezincinci ezithengiswa ukususela ngo-2014. Ezi zizaliswe kwizikhewu apho apho iqela elincinci kakhulu (abasebenzi abangaphantsi kwe-15) abazange kufuneka unakekele ukunakekelwa kwababelethi ngaphambi ko-2014. Akukho myalelo wabaqeshi kubaqeshi abanabasebenzi abangaphantsi kwama-50. Kodwa ukuba amaqela amancinci akhetha ukunikezela ngokubhengezwa kwabaqeshwa babo, isicwangciso ngoku siya kubandakanya ukunakekelwa kokubeleka kuwo onke amazwe.
Izikhathi zokulinda azikwazi ukudlula iintsuku ezingama-90
Xa umqeshwa ezimisele ukufumana inkxaso phantsi kwesicwangciso esixhaswe ngumqeshi, ixesha lokulinda ukuqala ukufikelela kwincwadi angeke lidlule iintsuku ezingama-90 (eminye imithetho isebenzayo kwiimeko apho abasebenzi kufuneka basebenze inani elithile leeyure okanye bafumane isigaba esithile somsebenzi ukuze kulungiswe ukufaneleka ukufikelela).
Izingane zingakwazi ukuhlala kwizicwangciso zabazali de i-26 ubudala
Ukususela ngo-2010, zonke izicwangciso zempilo ziye zafunwa ukuba zivumele abantwana ukuba bahlale kwisicwangciso somzali de bafike kwi-26. Oku kusebenza kwizicwangciso ezixhaswe ngumqeshi kunye nezicwangciso ezizimeleyo, kwaye kusebenza nakwizicwangciso ezininzi. Akukho mfuneko yokuba abantu abaselula babe ngabafundi okanye bathembele kubazali babo ukuze bahlale kwi-inshurensi yabo yezempilo.
Inkathalo yokukhusela ikhutshwe ngekhululekile
Ukunyamekela kokukhusela ngenye yeenzuzo ezibalulekileyo zezempilo ezifakwe kuzo zonke izicwangciso zeqela kunye namancinci phantsi kwe-ACA. Kodwa kuyafuneka ukuba ihlanganiswe kwizicwangciso zeqela elikhulu kunye nezicwangciso ezizimeleyo ezizisebenzisayo ezisetyenziselwa umlawuli wesithathu (izicwangciso ezininzi zikhululekile kumyalelo wokunakekelwa kokukhusela). Kukho uluhlu olubanzi lweenkonzo ezigqityiweyo ngaphandle kweendleko kwisigulane phantsi kwegunya le-ACA lokuncedisa ukukhusela.