Ingaba i-BCRA Impact iyakuthinteka njani kunye ne-Out-of-Pocket Costs?

Isabelo sabathengi seendleko eziya kukhula phantsi kwe-BCRA

Inkokhelo ye-bill ye-bill ye-bill yezinto zokuvuselela ukunakekelwa kwempilo eyenziwa ngomhla we-20 Julayi yayiza kubangela ukuxothwa okuphezulu. Enyanisweni, iiprojekti ze - Congressional Budget (CBO) iiprojekti eziqhelekileyo ezichithwe kwisicwangciso-mali esiyiyo-mali ziza kuba yi-13,000 zamawaka ngo-2026. Ngokucacileyo, oku kuphakamileyo kunokuba kuqwalasele inani elingaphezulu kwe-pocket eliya kuvunyelwa loo nyaka ngaphandle kokuba ifomula yokukhupha iindleko ze-pocket ishintshiwe.

Ngokucacileyo, loo mcimbi oza kufuna omnye umsebenzi owongezelelweyo womthetho.

Kuyo yonke i-2017, enye yeembambano ezibalulekileyo kwiCongress Republic Republican iye yachithwa yatshintsha i-ACA (i-Obamacare). INdlu yadlulisela uMthetho we-American Health Care Act (AHCA) ekuqaleni kukaMeyi, kwaye uyithumela kwi-Senate. I-GOP uSenamente yadibanisa iqela lokusebenzela inxaxheba ekuqulunqeni ingqungquthela yabo yowiso-mthetho, obizwa ngokuba nguMthetho weContain Reconciliation Act (BCRA), kwaye wazisa ngasekupheleni kukaJuni. IiRiphabhlikhi zaseRephabhliki zanikezela inguqulo ehlaziyiweyo yomthetho ngeentsuku ezimbalwa emva koko, kubandakanywa imfuno eqhubekayo yokukhawulela, eyayingazange ifakwe kwinguqulo yabo yangaphambili (ungabona zombini iinguqulelo ze-Bill ye-Senate apha).

Iinguqulelo ezintsha ze-BCRA zaziswa ngoJulayi 13 ( isishwankathelo sesebe -sigaba), kwaye ngoJulayi 20 ( isishwankathelo sesebe-sigaba) .Konke inkqubo, i-Senate ayinakho ukuvalelwa kwekomiti okanye ingxoxo yebipartisan malunga nomthetho ohlongozwayo .

I-BCRA yafikelela kwivoti kwi-Senate ngoJulayi 27 xa itshintshelwa ngolwimi kwi-bill-passed pass bill. Yiphumelele kumgama osemazantsi, 43-57. I-Senate iphinde inqatshelwe "i-skinny" Act (i-Health Care Freedom Act), eyayijoliswe ukuba ibe yindlela yokufikelela kwikomidi yenkomfa kunye nobunkokeli beNdlu ye-GOP.

Umthetho-mali weNdlu unakho ukongezwa kwikhalenda yeSenate ukuba kwaye naxa iinqununu ze-GOP zinamavoti ukupasa i-Senate version yowiso-mthetho. Nangona singayazi ukuba yiyiphi isivumelwano-ukuba nayiphi na-ekugqibeleni iza kufumaneka ngamaRiphabhliki kwi-Senate, inguqulelo ye-20 ye-BCRA isinika ingcamango apho iiphabliki zeSenethi zifuna ukuhamba kunye nokulungiswa kwezempilo.

I-BCRA ukuba iNkundla yeSenate iqwalaselwe ngoJulayi 27 yayifana neenguqulelo zangaphambili zebhilikhi, kodwa iquka i-Cruz Amendment kunye ne-Portman Amendment. Akunjalo kulawo afunyenwe yi-CBO, ngoko asikho na manani ngokwefuthe labo. I-Cruz Amendment yayiya kubavumela abaqhankqalazi ukuba bathengise iiplani ezicetywayo, ezingezizo ze-ACA-njengoko ziye zathengisa ubuncinane isicwangciso segolide esinye , isicwangciso esisodwa sesilivere kunye nesicwangciso esisodwa "sesicwangciso sokumisela" phantsi kwemithetho ye-BCRA, eya kuba nexabiso le-actuarial 58 pesenti. I-Portman Amendment iya kubelwa i-$ 100 yezigidigidi ukuze amazwe asetyenzise ukunciphisa iindleko ze-pocket kubhalisi abafumana imali encinane, kwaye iza kunika iinguqu ezongezelelweyo zokusebenzisa i-Medicaid iimali zokunciphisa iindleko ezingaphandle kwee-pocket zokubhalisa abaphantsi. kude neMedicaid ukuya kwirejista yangasese phantsi kwe-BCRA.

I-BCRA (ngaphandle kohlengahlengiso lwePortman ne-Cruz) iye yafumana i-CBO kwaye yahlaziywa yiinkcenkcesho ezininzi zempilo yezempilo, ngoko ke sinengcamango entle yintoni igalelo layo eliza kuba ngayo. I-Portman Amendment yayiza kubangelwa ukuhla Iindleko zepokhethi ekuqaleni, kodwa kubalulekile ukuqaphela ukuba imali yayiza kubonelelwa kuphela iminyaka esixhenxe; bekungekho inkqubo yokuxhasa ngemali emthethweni.

I-Cruz Amendment yayiza kubangela iindleko eziphezulu ezingaphandle kwe-pocket kubani na abathengi izicwangciso ezingenakuqhelana eziza kuvela phantsi kwesihlomelo. Uhlalutyo olungezantsi lusekelwe kwi-CBO yokulinganisa i-BCRA. Ekubeni izilungiso ze-Cruz ne-Portman azizange zilandelwe yi-CBO, impembelelo yabo ayifakiwe kwiingxoxo ezilandelayo malunga neendleko ezingaphandle kwe-pocket.

Nangona i-BCRA ingatshintshela iinkalo ezininzi ze-inshurensi yabucala kunye neMedicaid, makhe sijonge ngoku ngokuthi kuya kuthintela njani iindleko ze-pocket (kugcinwe ingqalelo ukuba ngelixa le nguqulelo yebhilizi ayizange idlule kwi-Senate, enye inguqu inokubuyiselwa kwisantya seSenethi).

Ngaba uMthetho weBhili ye-Senate wawuchaphazela njani iindleko zePocket?

Igama elithi "ngaphandle kwe-pocket" lichaza zonke iindleko abantu abafanele bahlawule xa befuna unyango, emva kokuba inkampani yabo yomshuwalense ihlawule isabelo sayo. Nangona kunjalo, akubandakanyi indleko zeeprimiyam , ezifuneka zihlawulwe rhoqo ngenyanga, kungakhathaliseki ukuba usebenzisa nayiphi na inonyango.

Ibali elifutshane kukuba i-BCRA iya kubangela iindleko eziphezulu ezingaphandle kweefowuni. Makhe sibone ukuba kutheni kwenzeka oko.

Ngaphantsi kwe-ACA, zonke iiplani zeqela kunye namancinci kufuneka zibandakanye iintlobo zeenkonzo ezithathwa njengezibonelelo zezempilo ezibalulekileyo , kwaye zonke izicwangciso (kubandakanywa izicwangciso zeqela elikhulu) kufuneka zibandakanye ubuncinane ama-60 ekhulwini kwiindleko zonyango zempilo (oku kusebenza Umlinganiselo ophantsi, ipesenteji yeendleko ezigqityiweyo ngamnye zixhomekeke kwisixa sempilo enyamekayo umntu ebudeni bonyaka). Umyinge wepesenti weendleko ezicwangcisiweyo zibizwa ngokuba yi-actuarial value (inqaku lokuba kumashishini athile, abaqinisekisayo bangathengisa izicwangciso ezinobungozi -bokuba banexabiso le-actuarial elingaphantsi kwama-60 ekhulwini-kubantu abancinci, nangona inkxaso-mali ye-ACA engenakusetyenziswa cwangciso).

Isicwangciso esinomlinganiselo we-actuarial we-60 ekhulwini sichongiwe njengesicwangciso sobhedu kwimeko ye-inshurensi yezempilo yomntu ngamnye neyincinci, kwaye ihlangabezana neemfuno zokubonelela "ixabiso elincinci" kwimeko enkulu yeqela. Njengoko kunzima kumaqumrhu e-inshorensi ukufumana isicwangciso sokudibanisa ukulingana kunye nexabiso elinikeziweyo le-actuarial, i-insurers ivumelekile ukusebenzisa i--2 / + 2 ye-minimus range, ngoko ke ixabiso lexabiso lexabiso le-bronze liyakhula ukusuka kuma-58 ukuya kuma-62 ekhulwini. Oku kwacetywa ukunyuka ukuya kwi--2 / + 5 ngo-2018, kodwa imigaqo ephelelwe ngo-Apreli 2017 ukubiza ukwanda kwenkqubo yebhedu ye-minimus range, ukuya kwi -4 / + 5. Ngoko phantsi kwemithetho yangoku, izicwangciso zobhedu ngo-2018 ziya kuvunyelwa ukuba zihlawule umyinge wama-56 ukuya kuma-65 ekhulwini kwiindleko zonyango.

Kodwa ngaphandle kwezicwangciso eziyingozi ezikhankanyiweyo ngasentla, izicwangciso zobhedu zingabonakali ubuncinane ngokubhekiselele kwizinto abaqinisekisayo abanokuzenza ngazo. Isicwangciso sokulinganisela, esivame ukuba sithandwa kakhulu ngababhalisi, isicwangciso sesilivere, esinexabiso le-actuarial malunga nama-70 ekhulwini. Izibonelelo ze-premium ze-ACA zibophelelwe kwiindleko zesicwangciso sesilivere, kunye ne- ACA-ukwabelana ngeendleko zenkxaso-mali zifumaneka kuphela xa ababhalisile bekhetha izicwangciso zesilivere.

Ukugcina konke oko kwingqondo, makhe sijonge kwiimfuno ze-BCRA. Ngokubanzi, kukho imiba emininzi yebhili-mali eya kunceda ukwandisa iindleko ze-pocket:

Nangona iiprojekthi ze-CBO isicwangciso esinexabiso le-actuarial lama-58 ekhulwini liza kuhlawula i-$ 13,000 ngowe-2026, kwaye iphinda iphrojekthi ukuba iindleko ezingenakuvunyelwa ngaphandle kwee-pocket (eziyimfuneko zezempilo, in-network) ziya kuba ngu-10,900 ifom yangoku ekhoyo isetyenziselwa ukuchonga ukuba ubuninzi belikhupha elivumelekileyo liphuma kunyaka ngamnye . Leyo fomyula ayitshintshi kwi-BCRA, kodwa ngoku kucacileyo kuyona ukungafani okuya kuphendulwa ukuba i-BCRA iya kuphunyezwa. Okubalulekileyo, umthetho ubiza iiplani zokumisela eziza kuba neenzuzo kangangokuba abaza kuvunyelwa ukuba bathengiswe.

Ukuphucula iiNzuzo zezeMpilo ezibalulekileyo = Iindleko eziphezulu zamagulane

I-BCRA iya kuvumela ukuba, ngokusetyenziswa kwenkqubo ye-1332 yeiver-existant-but with restrictions few and restrictions instead of ACA implemented-to change the definition of benefits for health. Ngoko, ummandla unakho, umzekelo, ukuba isigqibo sokuthi ukukhulelwa komama akusisona nzuzo ebalulekileyo yezempilo, kwaye abaqinisekisi abayi kusayi kubakhokelela kwizicwangciso zempilo ezintsha (kuloo mzekelo, iiplani zeqela elincinci kunye nabasebenzi aba-15 okanye ngaphezulu baya kubandakanya ukukhulelwa komama, ngenxa yomthetho oye wahlala iminyaka emashumi).

Ukuba izicwangciso zivunyelwe ukuba zithengiswe ngaphandle kwezibonelelo ezigunyaziwe njengamanje, abantu abafuna loo nkonzo baya kubonakala bejongana neendleko eziphezulu eziphezulu ze-pocket, kuba bebengayi kuba ne-inshorensi yempilo yezo nkonzo. Izinto ezinjengezilwanyana zonyango, unyango lwempilo yengqondo / ukusetyenziswa kakubi kweziyobisi, kunye nokunyamekelwa kokubeletha zizinto zonke ezingenakukugqitywa kwizinto ezikhethiweyo zokuhlaziya izibonelelo zezempilo ezibalulekileyo phantsi kwe-BCRA.

Kwakhona kubalulekile ukuqonda ukuba ukuvinjelwa kwe- ACA kwixesha lokuphila kunye nemingcele yonyaka , kunye nekhondo yomthetho kwiindleko ezingaphandle kwee-pocket, kusebenza kuphela kwiimfuno zezempilo ezibalulekileyo-oku kusebenza kwiiplani zeqela kunye namancinci, kunye izicwangciso zomqeshi omkhulu. Ngoko ukuba i-state yayinokunciphisa inani leenkonzo eziwela phantsi kweemfuno zezempilo eziyimfuneko, i-insurers isenokuthi iqhubeke negalelo lezo nkonzo, kodwa abayi kufunwa ukuba bathathe imali yokubhalisa imali yabo ngaphandle, kwaye babeza kuba nako ukunyanzelisa i-maximums yokufumana i-lifetime kunye nonyaka yonikezelo ngeenkonzo ezingakhange ziqwalasele iimfuno zezempilo ezibalulekileyo.

Iimali ze-BCRA ziya kufakwa kwiiplani zeBronze endaweni yeSiliva

I-BCRA iya kuqhubeka nokubonelela ngeenkxaso-mali ze-premium eziza kutyunjwa ngokukhululekile kwiinkxaso-mali ze-premium ze-ACA, kodwa kungekhona njengamandla. Baya kufikelela kuphela kubantu abafumana iipesenti ezingama-350 zezinga lobuhlwempu, endaweni ye-ACA ye-400 ekhulwini (ngokubhekiselele, i-cap engenayo engenayo yokufumana inkxaso ye-subsidy kwintsapho emine esekelwe kwi-2017 ubuhlwempu iya kuba yi-$ 86,100, endaweni ye-$ 98,400) . Baya kuthi bafune abantu abadala (ngamanye amaxesha, njengabancinci njengama-40) ngenzuzo engenayo malunga neepesenti ezingama-250 zentlupheko yokuhlawula ipesenteji enkulu kwinzuzo yazo.

Kodwa mhlawumbi okubaluleke kakhulu, inkxaso-mali ye-BCRA iya kuxhunywa kwisicwangciso nge-58% yexabiso le-actuarial (endaweni yezicwangciso zesilivere zangoku, ezixabiso lexabiso eliphakathi kwama-68 ukuya kuma-72 ekhulwini).

Ngoko ukuqala ngowe-2020, isicwangciso "esiqhelekileyo" siza kuba nexabiso le-actuarial elilingana nelo langoku le-al-level-level-ladder. Kuhlalutyo lwabo lwe-BCRA , i-CBO iyaphawula ukuba kuzo zonke izicwangciso zesilivere zangoku, i-deductible engama-dollar ayi-3,600, ngelixa isicwangciso sebhasi esiphakathi sinokudityaniswa ngama-6,000. Kodwa izithintelo kunye neendleko zokuphela kwee-pocket ziphakama kunye nokunyuka kwamayeza. Kuhlalutyo lwabo ngo- Julayi 20 lwe -BCRA, iiprojekti ze-CBO eziqhelekileyo ezichithwayo kwizicwangciso zokumisela phantsi kwe-BCRA ziya kuba yi-$ 13,000. Kwaye kwakhona, kunokuba ube ngumgangatho ophantsi kwizinga, ezi ziza kuba zicwangciso zokulinganisela.

Okwangoku, iiplani zesilivere zilolu hlobo olugqithiseleyo kakhulu lolwazi. Ngo-2017, kwabangama-9.65 yezigidi zabantu ababhalise kwizicwangciso zempilo nge-HealthCare.gov, izigidi ezi-7.1 ezikhethiweyo zesilivere. Ukuba aba bantu bafuna ukugcina amanqanaba abo okwangoku phantsi kwe-BCRA, kuya kufuneka bahlawule inxalenye enkulu yeeprayimari, kuba inkxaso-mali ye-premium iya kugxininisa ukugcinwa kwemali engapheliyo encinci kwipesenti ezifumanekayo zemali yabhaliso.

Ukuba endaweni yoko, bayakhetha ukuthenga izicwangciso ngeepriyamu ezenziwe zifikeleleke ngezimali ze-BCRA, ziya kuphelisa ngeendleko eziphezulu kakhulu ezingaphandle kweefowuni ukuba kwaye xa zifuna ukusebenzisa i-coverage.

Ukuxothwa kweeNkxaso-mali zoLuntu ngeeNkcitho = Iindleko zePokota eziPhakamileyo

Izibonelelo zenkxaso-mali ze-ACA zifumaneka kuphela xa ababhalisile bekhetha izicwangciso zesilivere kwaye banemivuzo yekhaya engadluli kuma-250 ekhulwini kwintlupheko. Kodwa kwi-7.1 yezigidi zabantu abakhethile izicwangciso zesilivere kwi-HealthCare.gov ngo-2017, ngaphezu kwezigidi ezi-5.7 zathengile izicwangciso ezibandakanya ukunciphisa iindleko. Ezi ncediso zihlala zinciphisa iinqununu zokunciphisa eziphantsi kweedola ezi-1 000, ukwenza ukuba unyango lwezempilo lufikeleleke kubantu abangenakukwazi ukuwufumana-nangomshwalense wezempilo.

Kodwa i-BCRA, njenge-AHCA, iya kuphelisa imali-mali yokwabelana ngeendleko emva ko-2019. Oku kuthetha ukuba abantu abakwaziyo ukwenza izicwangciso ze-deductibles ze-$ 0 okanye i-$ 500 babeya kubhekana neentengo ze-$ 6,000 okanye i-$ 7,000. Kwaye ngo-2026, iiprojethi ze-CBO ezi ziza kukhula ziza kufikelela kwi-13,000 zamawaka (kwakhona, ekucingeni ukuba umlinganiselo wokubala i-maximum-of-pocket limit limits ishintshelwe ukuvumela i-BCRA ukuba iphunyezwe).

Nangona inkxaso-mali yokwabelana ngeendleko ikhona ukuba ibhalise kunye neengeniso ukuya kuma-250 ekhulwini kwintlupheko, zibonelela ngenzuzo kubantu abanemali engenayo ukuya kuma-200 ekhulwini lobuhlwempu (okwangoku malunga ne-$ 24,000 ngomntu omnye, kodwa ubuhlwempu nqanaba likhuphuka ngonyaka). Laba bantu baya kulungele ukufumana uncedo lwe-premium phantsi kwe-BCRA, kodwa izicwangciso eziza kubakho kubo-kwaye zithengwa ngemali-mali ziza kudla, kwiimeko ezininzi, isiqingatha somvuzo wabo. Kwaye kubantu abanemali engaphantsi kwinqanaba lentlupheko, i-deductibles iya kuba yimivuzo engaphezulu yonyaka.

Isiphumo, ngokubhekiselele kwi-CBO, ukuba abantu abafumana imali abaphantsi baya kuhamba ngaphandle kwe-inshurensi yezempilo, kunokuthenga i-coverage efuna ukuba bahlawule inxalenye enkulu yengeniso yabo ukuze bahlangabezane ne-deductible.

Ukutshintshwa ukusuka kwiMedicaid ukuya kwi-Private Insurance = i-Out-of-Pocket

I-BCRA iya kuphelisa ngokukhawuleza inkxaso ye-federal finance echaza ukuba njengamanje ifikelela kwiindawo zokunyusa abantu baseMedicaid . Kwakhona kuya kuguqula inkxaso-mali ye-Medicaid rhoqo kwimimandla ekhoyo ngoku evulekileyo ukuya kwisiqingatha somntu ngamnye oza kuthi ekugqibeleni abe ne-indexed index index (edla ukunyuka kancinci kuneendleko zeMedicaid).

Isiphumo, ngokwemiqathango ye-CBO, iya kuba ukunciphisa i-$ 756 yezigidigidi kwi-federal Mederationid yokuchitha imali kwiminyaka elishumi ezayo, ngokuchitha imali ngo-2026 ibekwe malunga neepesenti ezingama-26 ngaphantsi kunokuba kube phantsi komthetho wangoku. I-CBO iphinde ishicilele uhlalutyo olongezelelweyo , uqikelele ukuba inkxaso-mali ye-Medicaid ye-2036 iya kuba ngamaphesenti angama-35 ngaphantsi kunokuba ibe phantsi komthetho wangoku.

Isiphumo salo lonke kukuba ngowama-2026, kuya kuqikelelwa abantu abayizigidi ezili-15 kwiMedicaid kunokuba bekuya kuba phantsi komthetho wangoku, kwaye ukungafani kuya kuqhubeka kukhula kwiminyaka elishumi ezayo.

Abantu abagqitywa yiMedicaid banomthwalo kuphela weendleko zokuphuma ngaphandle kweefowuni. Uninzi lwabantu abayizigidi ezili-15 luya kuba yi-uninsuredured ukuba lulahlekelwe ukufikelela kwi-Medicaid. Kodwa abo batshintsho kwi-inshurensi yempilo yabucala (mhlawumbi bencediswa inkxaso-mali ye-premium) baya kubhekana neendleko eziphezulu eziphezulu. Oku kuyinyani ngokwenene kunikezelwa ukuxothwa kwe-BCRA yokunikezelwa kweendleko zenkcitho, kunye nokuba izicwangciso zeenjongo zokubaluleka ziza kuba nexabiso le-actuarial ye-58 ekhulwini. I-13,000 deductible ayikho into enokwenene kumntu ohlala entlupheko okanye nje ngaphezu kwehlwempu.

> Imithombo:

> Amasebe e-Medicare neeNkonzo zeMedicaid, i-2017 Indawo yokuThengisa ukuBhaliswa kwexesha lokuBhaliswa kweeFayile.

> I-Ofisi yeBhajethi yeCongressal. HR1628, uMthetho woNxibelelwano woNxibelelwano olungcono lwe-2017. NgoJuni 26, 2017.

> I-Ofisi yeBhajethi yeCongress, Ixabiso lokulinganisa. HR1628, uMthetho wezeMpilo waseMelika ka-2017, njengoko udluliselwe yiNdlu ngoMeyi 4, 2017 . NgoMeyi 24, 2017.

> I-Ofisi yeBhajethi ye-Congressional, ixabiso lokulinganisela, > HR 1628, uMthetho woNxibelelwano woNxibelelwano olungcono ngo-2017: Uhlengahlengiso kwiNdawo yesiThili [ERN17500], njengoko kuthunyelwe kwiWebhusayithi yeKomiti yeKomiti yeBethi-mali ngoJulayi 20, 2017. Julayi 20, 2017.

> Isebe lezeMpilo kunye neNkonzo zoLuntu, isiKhuseli soMonde kunye noMthetho woNonophelo ojongene noThathaka; Uzinzo lweMarike . Ngo-Apreli 13, 2017.

> I-Register Register, iSebe lezeMpilo kunye neNkonzo zoLuntu. Ukhuseleko lomonde kunye noMthetho woNonophelo ojongene noThathaka; Isaziso seNzuzo yeeNzuzo kunye neParameters yokuhlawula i-2018; Izilungiso kwiiNyanga zokuBhalisa eziKhethekileyo kunye neNkqubo yokuCwangciswa kwabasebenzisi. Disemba 22, 2016.