Ngaba i-Obamacare yokutshintshwa iya kukhusela abaxhamli be-Medicare?
Umthetho woNonophelo olungabonakaliyo, u-Aka Obamacare , awugcini nje ukuzisa i-inshurensi kwizigidi zabantu baseMelika ngokusebenzisa indawo ye-Intshumo yeMpilo ye-Intshuwalense kodwa iphinde yandise iMedicaid kumazwe amaninzi. Abantu abangenakho ukufumana i-inshurensi yempilo babefikeleleke ngokutsha. Yiyiphi ininzi abantu abayilibalayo, nangona kunjalo kukuba le nkqubo nayo yaba nefuthe elibi kwi-Medicare .
Umthetho ubhekene nokuchithwa ngo-2017 yi-Republican Congress. Nangona kunjalo, ukutshitshiswa akuzange kwenzeke, ubuncinane bengekho.
Isicwangciso esithatha indawo ye-Obamacare kufuneka siqale siqwalasele indlela uMthetho woNonophelo ongenakuncedisa uthintela ngayo i-Medicare. Emva koko kufuneka liqwalasele indlela eliza kulungisa ngayo (okanye ingaba liya kulungisa) loo mfuno kunye nomthetho omtsha.
CMS Innovation Centre
Ukuba asitshintshi, asiyi kukhula. Amacandelo e-Medicare kunye neMedicaid (CMS) Isikhungo soNxibelelwano saba khona phantsi koMthetho woNonophelo ongenakuncedwa kwaye ubhekisela kwiindlela zokubonisa imbuyekezo entsha kunye neendlela zokunakekelwa kwezempilo ukuze kungabi ngcono kuphela umgangatho wokunyamekela kodwa ukunciphisa iindleko ze-Medicare, Medicaid , kunye neNkqubo ye-Intshumo yezeMpilo yabantwana (CHIP) .
Makungabikho mpazamo. I-CMS isetya isigaba yonke ishishini lomshuwalense. Ukuba i-CMS ifunyenwe into esebenzayo, abaqinisekisi bamashishini abazimeleyo baqinisekisile ukujoyina isizathu.
Ukususela ekuqalisweni kwayo, iimodeli ezingaphezulu kwe-30 zokuhlawula ziye zacetyiswa kwaye zahlolwa.
I-Centre ye-CMS Innovation ibhekiselele kwimibutho yokunyamekela ingxelo kunye neentlawulo ezikhokhwayo njengeendlela ezahlukeneyo zokuhlawula unyango lwempilo. Ukutshintshwa kwi-pay-to-service (ugqirha zentlawulo nganye kwinkonzo ngamnye) ukuhlawula-umgangatho (ugqirha uya kubuyiselwa ngokusekelwe kwiziphumo zokunakekelwa kwekhwalithi) kuyaqhubeka.
Iingxowa ezili-30 zeentlawulo ze-Medicare ngoku ziqhutywe ngale ndlela.
Iinkqubo zonyango lwempilo ziye zaphucula umgangatho kwizigidi zabantu baseMerika. Isicwangciso soPhando oluPhezulu oluPhezulu sivumele ukuba ukwandiswa kolondolozo lwangundoqo kwiindawo ezithile ukuzuza abo bafuna. Isicwangciso sokuQinisekisa esiPhezulu esiSisigxina (ESRD) sokuQala iNkqubela kuphuculwe ukufikelela kwenkathalo kubantu abano-dialysis . Ukuqala Okuqinileyo koMama kunye namaNtsana kunciphise ukuzalwa kwangaphambi kokuzalwa kwaye iingxaki zesikhathi eside kwiintsapho ezintsha. Inkqubo Yokukhusela iSifo Sikashukela iphumelele kangaka iya kwandiswa lonke ilizwe ngo-2018.
Ngaba i-Obamacare yokutshintshwa iya kuphelisa le nkqubo? Ukutshintshwa kwe-Obamacare kufuneka kuqwalasele indlela eya kuba nefuthe ekukhuleni kwexesha elizayo, kokubili kumgangatho kunye nangeendleko.
Ubuqhetseba, inkunkuma kunye nokusetyenziswa kakubi
Ukukhwabanisa, ukuchithwa kunye nokusetyenziswa gwenxa kuqhutywe kwiinkonzo zempilo, ukuhlawula abakhokhi berhafu ngokukhawuleza. Umthetho ononophelo loNonophelo uthathe amanyathelo okunciphisa oku kusebenzise kakubi nokubuyisela imali leyo kwinkqubo ye-Medicare. Yenza njalo ngokuqinisa uMgudu woPhuculo lwe-Medicare Fraud Strike Force.
I-Medicare Fraud Strike Force yasungulwa ngo-2007 kwaye isebenza ngekhonsathi kunye neSebe lezoBulungisa, i-Federal Bureau of Uphando, i-Ofisi yoMhloli-Jikelele, kunye nokuthotyelwa komthetho.
Ukusebenza kwizixeko ezilisithoba kwilizwe lonke - iBat Rou Rouge, eLouanaana; EBrooklyn, eNew York; Chicago, Illinois; EDallas, eTexas; Detroit, Michigan; Houston, eTexas; Miami, eFlorida; ELos Angeles, eCalifornia; kunye neTampa, eFlorida - iMicrosoft Fraud Strike Force igcine iphrogram ngokuphindwe kabini njengoko yenzayo ngaphambi kokuba uMthetho woNonophelo ongenakunqunyiwe wenziwe ngo-2010.
Ukususela ngoJuni ka-2016, iinzame ze-Medicare Fraud Strike Force zenze ukuba kubekho izigwebo ezi-2,522. Kwimbali enkulu kunazo zonke kwimbali ye-Task Force eyenziwa ngoJuni ngo-2016 xa abantu abangama-301, abaneminyaka engama-61 kubo babebaqeqeshi bezonyango abaneemvume, bahlawuliswa ngenjongo yokwenza ubuqhetseba bempilo, ukutshalwa kwemali kunye nokutshintshwa kwezazisi .
Ulwaphulo-mthetho lwazo lwalubalelwa kwizigidi ezingama-900 zezigidi kwiingxowa zobuxoki.
Ukuguqulwa kokunakekelwa kwempilo ekuqhubekeni phambili kufuneka kuqhubekele ukuthatha injongo kulabo bazama ukusetyenziswa kakubi kwenkqubo. Kuya kuba yindlela kuphela yokugcina iindleko kulabo abayidinga kakhulu.
IiRhafu zokuBala iSibhedlele
Wonke umntu uyavuma ukuba ukunakekelwa kwezibhedlele kufuneka kube ngumgangatho ophezulu. Ubomi bentlalo kunye nenhlalakahle kuxhomekeka kuyo. Umthetho ojongene noNonophelo ojongene noThathaka uthathe amanyathelo okubangela izibhedlele ukuphucula umgangatho wabo wokunyamekela. Baye benza njalo ngokuvavanya ukuba abantu babedluliselwa esibhedlele kangangeentsuku ezingama-30. Ukugqitywa esibhedlele, bacinga ukuba, kuya kuba yinkcazo yokuba isibhedlele yayingakhange ilungiselele ukunakekelwa komntu ngaphambi kokuba ikhutshwe.
Inkqubo Yokunciphisa Ukufunda, eyenziwe phantsi koMthetho wokuNakekelwa ongenakunqwenelekayo, ngokubhekisele kwi-admission ye- heart attack , ukuhluleka kwentliziyo , ukunyuka kwesifo se- pneumonia , ukuguqulwa kwamadolo / ukuguqa, kunye nokugula okungapheliyo kwipimon (POP) . Izibhedlele ezazinamabanga aphakamileyo okufundwa kule ndawo zihlawulwa ngepesenti yokuhlawula kwiintlawulo zabo zeMedare.
Ukususela ngo-2012, izinga lokufunda ngokubhedlele kwisibhedlele liye lahla. Ukuhlaselwa kwentliziyo kuhla kweepesenti ezingama-2,8, izinga lokungaphumeleli kwentliziyo ngama-2,8 ekhulwini, kunye ne-pneumonia rates ngama-1.5 ekhulwini ukususela ngo-2007 ukuya ku-2014. Umbuzo, enoba, ukuba ngaba akunjalo ngokwenene kubonakalisa uphuculo lokunyamekela kwekhwalithi. Kukho ukukhathazeka ukuba izibhedlele ziyakwazi ukuphepha izigwebo ngokubeka abantu "ngaphantsi kokubonwa" ngokuchasene nokuzifunda njengezigulane.
Ngomthetho ojongene noNonophelo ongenakunciphisa, iNkqubo yokuNcitshiswa kweeRejista ingahamba. Ngethemba, kuya kuqhubeka, okanye iinzame ezintsha zokujongana nomgangatho wokunyamekela abantu abafumana kwizibhedlele.
Icandelo D iDonut Hole
I-Medicare Ingxenye D yaba khona phantsi koMongameli uGeorge W. Bush xa uMthetho weModare Modernization Act wenziwa ngowama-2003. Abaxhamli bafumana inzuzo kwiCandelo D izibonelelo zonyango ezisetyenziswayo ngo-Januwari 2006 kunye ne-cavesat eyodwa. Umthetho wawuquka "umgodi wokungena," umgca wokufumana umxhasi owawufuna i-Medicare abaxhamli ukuhlawula iipesenti ezingama-100 kwi-pocket kwimithi yabo emva kokuba kunye nesicwangciso sabo seCandelo D sichithe inani elithile lemali kunyaka owenziwe.
I-Obamacare yanceda ukunciphisa iindleko ezingaphandle kwee-pocket .
Okokuqala, ixoxisana nabahlawuli beendleko bangakuhlawula ngamachiza akho. Abakhi begama loBenzi, ngokukodwa, babeza kunika iziyobisi zabo kwi-50% yexabiso lokunciphisa ngelixa ubenesidongxongo.
Okwesibini, u-Obamacare wehlile ubuninzi obuya kuhlawula ngaphandle kwe-pocket ngokufuna iCandelo D liceba ukuhlawula isahlulo esincinci seendleko zamachiza ngexesha lomgodi. Ubungayihlawula ngaphezulu ukuba uya kuphuma ngaphandle kwendawo yokungena, kodwa ukugcinwa kubalulekile. INdlu yeNdlu iNgxelo ithi ukulolonga kuye kwazuza abantu abangaphezu kwezigidi eziyi-8, kubasindisa ngaphezu kwe-11.5 billion ukusuka ngo-2010.
Okwesithathu, isixa sakho isicwangciso sokuhlawula amayeza akho siya kunyuka ngokukhawuleza kude kube yilapho igalelo lokuvalwa livalwe ngokupheleleyo ngowe-2020. Kulula nje, uya kuhlawula iiprayimari zakho eziqhelekileyo, ukuhlawula imali, ukukhutshwa kweemali, kunye nokunye.
Umngxuma we-donut wawuya kubuya kunye no-Obamacare ukutshitshiswa. Ngomuthi weziyobisi ubiza ngaphezu kwexesha elide, impembelelo kubantu abadala baseMerika kuya kuba nzima. Ukutshintshwa kwe-Obamacare kuyakufuneka kuthathele ingqalelo ukuqinisekisa ukuba abantu banokufikelela kumayeza abayidingayo.
Iinkonzo zoKhenketho
I-Obamacare iphinde iphinde iphuculwe ukuhanjiswa kweenkonzo zokukhusela. Ngethuba nje ugqirha wakho wamkela isabelo , oku kuthetha ukuba wavuma kwiShedyuli yoTywala yeMagqirha ye-Medicare, ezo nkonzo zokukhusela aziyi kuphinda zifune i-copayment okanye i-coinsurance. Babeza kunikwa kuwe mahhala.
Iinkonzo zokukhusela ezikhuselekile ezigqitywe yi-Medicare ziquka:
- Ukutyelela koNyaka
- Uhlolo loxinzelelo lwegazi
- Ukuhlola umhlaza wesisu ( mammogram )
- Ukuhlolwa komhlaza wesibeleko (umlomo we-Pap smears kunye nokuhlolwa kwe-papillomavirus (HPV)
- Ukuhlolwa komdlavuza weColon (ukuhlolwa kwegazi okwenyama, i-colonoscopy, sigmoidoscopy)
- Ukucima ukunyanzeliswa
- Ukuhlolwa kwePilid
- Ukuhlolwa komhlaza weprotate (i-prostate-specific antigen)
- Izifo (umkhuhlane, i-pneumococcal)
Ezinye iinkonzo-esiswini esiswini, ukuhlolwa kwesifo sikashukela, ukuhlolwa kwesifo se- hepatitis C, ukuhlolwa kwe-HIV, ukuhlolwa komhlaza wemiphunga, ukuhlolwa kwe- osteoporosis , kunye nokuvavanya izifo ezithathelwana ngesondo-kuya kukhululeka kodwa zifumaneka kuphela kubantu ababhekwa njengengozi enkulu. Ukuhlolwa komhlaza weColon ngesigxina se-DNA uvavanyo luya kubhekiswa kuphela ukuba loo mntu wayengozini.
Ukunciphisa iindleko zokuxhamla kwabadala abakwazi ukuzigcina bephilile okanye ezinokubangela ukuba unyango lwangaphambili lwezifo ezinzima lubhekiselele. Ndiya kuthetha nokuba iphakamisa imiba yokuziphatha. Masingayikhohlwa ukuba isifo esiphezulu sisona xa sifunyenwe, kubiza kubiza ukunyanga. Ukutshintshwa kwe-Obamacare kufuneka iqwalasele imiphumo yempilo kunye neendleko zexesha elide kulabo abazibandakanyayo.
ILizwi
I-Ofisi engabandakanyeli i-Ofisi yeBlujethi ye-Congressional ihlolisise iimpembelelo ze-Obamacare ichithwe kwaye ixelwe ukuba imali yokusetyenziswa kweMedricare iya kunyuka ngama-dollar ayi-802 yezigidi ngaphaya kweminyaka eyi-10. Isicwangciso esinyango sokunakekelwa kwempilo kuya kufuneka sibe neyona nto inokubangela ukuba kubekho ukulingana.
Ingxaki yokuguqulwa kwempilo ayikho nje kwezopolitiko kodwa ihlawuliswe ngokomzwelo. Enoba ungakholelwa kwiimfanelo zoMthetho woNonophelo ongenakunceda, kufuneka uqonde ukuba zeziphi izibonelelo zonyango eziza kutshintshwa ngokutshitshiswa komthetho. Kuza kukuxelela ukuba uza kujonga nini xa ukuguqulwa kwe-Obamacare okungenakupheka kufikeleleka.
> Imithombo:
> Boccuti C, uCasillas G. Efuna iSibhedlele seZibhedlele ezimbalwa: I-Programme Yokunciphisa iSibhedlele se-Medicare Hospital. http://kff.org/medicare/issue-brief/aiming-for-fewer-spital-u-turn--medicare-hospital-read--uction-program/. Ipapashwe ngoSeptemba 30, 2016.
> Imiphumo yoHlahlo lwabiwo-mali kunye nezoQoqosho ngokuPhinda uMthetho woNonophelo ojongene noNcedo. Iwebhusayithi yeHhovisi leNgxowa-mali yeCongress. https://www.cbo.gov/publication/50252. Ishicilelwe ngoJuni 19, 2015.
> Imimiselo ephambili yoMthetho woNonophelo ongenakuncedo Ngonyaka. ISebe lezeMpilo leSebe lezeMpilo yaseMzantsi Afrika. https://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca-by-year/index.html. Ukuhlaziywa ngo-Agasti 13, 2015.
> I-Medicare yoBuqhetseba. I-Ofisi yoMhloli-Jikelele-Isebe lezeMpilo neNkonzo ze-US. https://oig.hhs.gov/fraud/strike-force/.
> Iinkonzo zokuPhepha nokuCoca. Medicare.gov. https://www.medicare.gov/coverage/preventive-and-screening-services.html.