Ukulungiswa kwempilo kwezempilo kuye kwaba kwiindaba eziphantse kungekhona ukuyeka kuzo zonke i-2017, ngoko ke ukuba udidekile malunga noko kwenzekile kwaye kuya kwenzeka ntoni ngo-2018, ngokuqinisekileyo awuyedwa. Makhe sijonge oko kutshintshayo, yintoni ehlala efana, kunye nento onokuyilindela ngokwempilo yomshuwalense wakho ngo-2018.
Iinguqu eziphakanyisiweyo ezingenziwanga
Nangona zihloko ezize zikhona malunga nokulungiswa kwezempilo ngoncedo ngo-2017, uninzi lweenguqu ezicetywayo luye zabuna emdiliyeni.
UMthetho wezeMpilo we-American Health Care (AHCA) udluliselwe yiRephablikhi yaseMeyi ngoMeyi ngomzamo wokuphelisa uMthetho ojongene noNonophelo ongenakuncedo, kodwa iNguqulelo yeSenate, uMthetho weNgcaciso yokuThuthukiswa koKhathalelo (BCRA), awuphumelelanga ngoJulayi. Enyanisweni, iiSenethi zeRiphabhliki zazama ukugqithisa iinguqu zintlu ezahlukeneyo ze-bill- "skinny" ukuchithwa, uMthetho wokuBuyeliswa koLungelelwaniso lwe-Obamacare, kunye ne-BCRA-kwaye akukho namnye onokufumana inkxaso eyaneleyo yokupasa.
NgoSeptemba, ukulungiswa kweGraham-Cassidy-Heller-Johnson kwathathwa njengoluhlu olusandulweyo lwe-Senate lwe-ACA, kodwa impumelelo yalo yayibonakala ingathandabuzeki emva kokuba uSenathente uJohn McCain (R, eArizona) wamemezele ukuchasana kwakhe.
I-Senator Rand Paul (R, eKentucky) sele isichazele ukuchaswa, kwaye iiSenators uLisa Murkowski (R, Alaska) kunye noSusan Collins (R, Maine) bancike kwiinkcaso. NgoSeptemba 30 ngumhla wokugqibela we-Senate ukusebenzisa inkqubo yokuxolelana nohlahlo lwabiwo-mali eya kubavumela ukuba basuse ii-ACA ngamavoti angama-50 (kunye nevoti yokuphumula i-VE) kwaye ugweme i-filibuster.
Kwaye ukuba abathathu beRephabliki baseSenanethi bayichasa umlinganiselo, awuyi kudlula.
Ngoko nangona kukho imimiselo emininzi eyenziwe ngo-2017-kwaye iNdlu yadlulela uMthetho we-American Health Care Act-akukho namnye kuwo owenziwe.
Oko kuthetha ukuba i-ACA isasebenza ngokupheleleyo, kubandakanywa inkxaso-mali ye-premium , ukunciphisa ukwabelana ngeendleko (aka, inkxaso-mali yokwabelana ngeendleko), ukwandiswa kweMedicaid , igunya lomntu ngamnye, igunya lomqeshi , ukukhusela abantu abaneemeko zangaphambili , izibonelelo zezempilo , imigaqo yokulahlekelwa yonyango, kunye nokunye.
Inkxaso-mali yokwabelana ngeendleko iya kuqhubeka ukufumaneka ngo-2018, kungakhathaliseki ukuba urhulumente wesigqeba unikezela ngemali yabaxhasi-mali ukuba bawagubungele (umba wezimali unesizathu sokungaqiniseki okukhulu ku-2017). Ama-insurers kumazwe amaninzi afaka iindleko zokubonelela ngeendleko zenkxaso-mali kwiiprayimari eziya kubahlawula ngo-2018, kwaye ezo zi-premium eziphezulu ziyakuchotyiswa ngenxa yabaninzi ababhalise nge-premium inkxaso. Ukunciphisa i-mali-mali yokwabelana ngeendleko (okanye inkxaso-mali ye-premium) ingenziwa kuphela ngomthetho.
Utshintsho ngenxa yokuThengiswa kweMarike
Ngo-Apreli 2017, i-HHS yagqiba umgaqo- mgangatho wokuzinza kwemakethe owawucebise ngoFebruwari. Nangona ulawulo lwalujoliswe ngokuqinisekileyo ekuqiniseni imakethe yoshishino lomshuwalense, lungazange lucwangcise izinto ezimbini eziye zonakalisa ukuthengiswa kwemali nganye: ukungabi nokunyanzeliswa ngokuthe ngqo komsebenzi ngamnye (okwenene okanye obonwayo, njengoko impembelelo kusenabantu abancinci ababhalisa ukufikelela kunye nencipheko yengozi ebhetele emzimbeni jikelele), kunye nenkxaso eqhubekayo yokunciphisa iindleko.
Akunjalo kuphela le micimbi engakhange ibhekiswe kumgaqo wokuzinza kweemarike, baye baqhubeka nokubangela ukungaqiniseki kweemarike ezizayo kwiinyanga ezizayo, kwaye baye badlala indima ebalulekileyo kuma-insurers abakhetha ukushiya imarike ekupheleni kuka-2017 okanye bafake iiprayimari eziphezulu kakhulu ngo-2018 kunokuba bahlawuliswe ngenye indlela.
Kodwa umgaqo-mgangatho wokuzinzisa imarike wajongana neminye imiba eminye, nangona kuncinci kuncinci kunomyalelo ngamnye kunye nokunciphisa ukwabelana ngeendleko. Olu tshintsho lusebenza ngokubanzi kubantu abathengayo ukuthengwa kwemakethe nganye, okanye ukutshintshiselana :
- Kwiinkoliso ezininzi, ukubhaliswa okuvulekileyo kuye kwafinyelelwa kwiiveki ezingaphezu kweeveki ezintandathu kwaye kuya kuqhutywa ngoNovemba 1 ukuya kuDisemba 15, kunye nezicwangciso zonke ziphumelela ngoJanuwari 1, 2018. Kodwa kukho iinguqu ezithoba ezenziwa ngurhulumente eziye zandisa ixesha lokugqibela lokubhalisa , ngoko Qinisekisa ukuba uyazi ukuba isebenza njani kwimeko yakho.
- Ukuba umgaqo-nkqubo wakho wanyulwa ngenxa yokungahlawulwanga kweprayimari ngo-2017 kwaye ubhalise kwakhona kunye ne-inshurensi efanayo (okanye enye i-insurer ene-nkampani yomzali ofanayo) ngexesha lokubhalisa okuvulekileyo, umgcini-mali uya kukwazi ukuba uhlawule lakho ixesha elidlulileyo- iiprimiyamu ezifunekayo phambi kokuba wenze i-coverage yakho entsha. Ngokuqhelekileyo, kufuneka kube yinyanga enye yee-premium ezifunekayo, ngenxa yokuba ii-premiums azihlawulwanga emva kokuba isicwangciso siphelile.
- Uluhlu lwexabiso lokuvunyelwene kwe-actuarial intlawulo nganye kwinqanaba lezetriki lokubhengezwa kwimakethi yecandelo ngalinye kunye nelincinci landisiwe. Izicwangciso zebhonze ziya kuba ne--4 / + 5 ububanzi, ngelixa igolide, kunye neeplatinum zicwangciso ziya kuba ne -4 / + 2. Izicwangciso zebhonze zinexabiso le-actuarial malunga nama-60 ekhulwini, isilivere malunga neepesenti ezingama-70, igolide malunga neepesenti ezingama-80, kunye ne-platinum malunga neepesenti ezingama-90. Kodwa ziyakwazi ukuhluka ngokuhambelana nemigangatho ye-minimus evumelekileyo, eye yawandiswa ngo-2018. Oku kuthetha ukuba kukho ukuhluka ngokubanzi kwesicwangciso esinye ukuya kwelinye kwinqanaba lezetriki, ngoko ke abantu kunye namashishini amancinci baya kufuna ukuthelekisa ngokucokisekileyo iinketho ezahlukeneyo ezifumaneka ngo-2018.
Ukunceda kunye nokuguquka kwenkcazo kumakethi athile kunye neentengiso ezincinci ziza kwenzeka njengoko zinako kwiminyaka edlulileyo, kunye nokulungiswa kwee-deductibles kunye ne-out-of-pocket limit, kunye neenethiwekhi zokubonelela kunye nezintlu zezilwanyana. Ungacingi ukuba isicwangciso owakuthatha kunyaka odlulileyo siya kuba yinto ekhethekileyo kuwe ngo-2018-soloko uqikelele ukuthelekisa ukhetho olukhoyo kuwe ngexesha lokubhalisa oluvulekile, kwaye wenze utshintsho xa kuyimfuneko.
Ukuncedisa ukuThengisa nokuBhalisa
Ukuba uhlala kwimeko engenazo i-inshurensi yempilo yomshuwalense kwaye uthembele endaweni ye-HealthCare.gov, unokwazi ukuba ukuthengisa, ukufikelela kunye nokubhaliswa kuncinci ngexesha lokubhalisa okuvulekileyo kubango-2018 kunokuba sele kudlulileyo.
I-HHS yabhengeze ekupheleni kukaAgasti ukuba baya kuba bancitshiswe isabelomali sokuthengisa kwi-HealthCare.gov ukuya kwii-10 ezigidi zezigidi kulo nyaka, ukusuka kwi-$ 100 yezigidi ngonyaka odlulileyo. Baye baqaphela ukuba babeza kunciphisa uhlahlo lwabiwo-mali lweprogram ye-Navigator, obonelela ngoncedo lwabantu ngabanye abakwii-state ukuba abaqhubeki nabo. Ukutshintshiselwa kombuso kuxhasa iiprogram zabo ze-Navigator, kwaye uhlahlo lwabo lwabiwo-mali aluchaphazeli ngolu hlobo lwabiwo mali.
Izicwangciso zempilo kwimakethi nganye ziye zanciphisa iikomishoni zeekhredithi kwiinkcukacha zorhwebo nganye kwiminyaka embalwa edlulileyo, ekupheliseni ngokupheleleyo kwezinye iimeko. Oku kubangelwe inxalenye enkulu kumgangatho ongeyona inzuzo yemarike nganye kubagcini-bhintsi abaninzi, ngoku ukuba i-ACA iguqule imigaqo; abanye abatshutshisi baye banquma ukuba abafuni ukuhlawula abathengi ukuba bazise ishishini ekugqibeleni lilahlekelwa ngumnini-inshurensi. Iikhomishini ngokuqhelekileyo yindlela ephela yokuthengiswa kwabadayisi, ngoko abanye abathengi baye bakhetha ukuba bangasebenzi kunye nokuthengwa kwemakethi nganye ngenxa yokuba abanako ukukwazi ukusebenzela ngaphandle kwamahhala.
Konke oku kuthetha ukuba imarike nganye yabhalisa kwezinye iindawo zelizwe inokufumanisa ukuba akukho ncediso lwababhaliso olufumanekayo njengoko lusetyenziswa. Kuya kubakho uncedo olukhoyo, kodwa abhaliseleyo baya kufuna ukucwangcisa phambili kwaye bangalindeli ukugcina umgca wokugqibela wokugcina ukuba umzuzu wokugqibela uza kufika ngokukhawuleza kwiinkalo ezininzi kulo nyaka kunokuba kwenzeke kwiminyaka edlulileyo.
Kwakhona kubonakala ukuba i-HealthCare.gov, i-portal yokubhalisa i-portal esetyenziswe ngabantu base-39, iya kuba phantsi ukulungiswa okucwangcisiweyo kwi-Chunk enkulu yeeCawa ezininzi ngexesha lokubhalisa okuvulekileyo ukuwa, kunye nobusuku ngosuku lokuqala lokubhalisa, ngoNovemba 1. Le ntshukumo ephikisanayo, kwaye iyakwazi ukuguquka phambi kokubhaliswa okuvulekileyo. Kodwa okwangoku, abantu abaneendlela zokuthengisa emakethe kuya kuba bubulumko ukucwangcisa ukubhalisa okanye isicwangciso sokutshintsha ukuthatha ixesha elide kunokuba kuqhelekileyo kulo nyaka.
Ukubhalisa iiPlatform kunye nokuCwangcisa ukuFumaneka
Ukuba unomsebenzi kumashishini athile, ekuthengeni okanye ekutshintshisweni, ungadinga ukukhetha isicwangciso esicwangcisiweyo ngo-2018 ngenxa yesikhorensi sakho ephuma kwimarike, okanye unokufumanisa ukuba unokufikelela kwizicwangciso ezintsha ngenxa yomshuwalense ongena kwimarike kwindawo yakho (nolu uluhlu lwezikhulu eziphambili kunye nokungena).
Nangona kukho intetho eqhubekayo yeeklasi "ezingenalutho" ngo-2017, zonke iindawo ezisemaphandleni kweli lizwe zine-inshurensi enye edibeneyo ukuze inikezele nge-2018 inzuzo kwintsebenziswano phakathi koSeptemba. Oku kusenokutshintsha, kodwa kuyaphawuleka ukuba kuwo wonke umbuso apho kwakukho amabalo okuqala ngaphandle koomatshini abonelelwe ukunikezela ngokukhawuleza ngo-2018, abaqhankqalazi baye baqhubela phambili ukuzalisa amabala angenanto (oku kwenzeka e-Ohio, eWisconsin, e-Nevada, eVirginia, e-Indiana , EKansas, eMissouri naseWashington).
Iintengiso ze-inshorensi aziyikutshintsha ngo-2018. Zonke iindawo ezisebenzisana ngazo ngo-2017 ziya kuqhubeka zenza njalo ngo-2018, kwaye onke amazwe asebenzisa i-HealthCare.gov ngo-2017 uya kuqhubeka nokwenza njalo. Amazwe angama-12 kuphela anamaqonga abo obhaliso; abanye-kuquka amazwe kunye nokusebenzisana ngokubambisana, ukutshintshisana kwamanye amazwe, kunye nokutshintshisana kwamanye amazwe usebenzisa i-platform-federal-konke ukusebenzisa i-HealthCare.gov.
Nangona kunjalo, abathengi kwiindawo ezininzi banokufumanisa ukuba kulula ukubhalisa "ngokutshintshiselana" kwisayithi lomthengisi webhubhu le-third party, njengoko urhulumente wesigqeba uvumela " ummeli wendlela yokubhalisa ngokuthe ngqo " eqala ukuwa okuya kuphelisa umnxeba wabafake izicelo buyela emuva nakwi-website yomthengisi kwi-HealthCare.gov. Abathengi baya ku funeka benze i-akhawunti kwi-HealthCare.gov, kodwa baya kukwazi ukugqiba yonke inkqubo kwinkqubo yomthengisi wewebhu.
Kwaye ukuba uthengisa iqela elincinci kwintsebenziswano, unokubona ukungafani, njengoko i-HealthCare.gov ishintshile ekusebenziseni inkqubo yobhaliso oluchanekileyo kumashishini amancinci. Ukutshintshwa kwe-inshurensi yezempilo yincinci akuzange ibe yinto ekhethekileyo, kodwa kunjalo; amaninzi amashishini abhalisele ukutshintshiselana-ngokuthe ngqo kubatshutshisi-ukususela ekuqaleni.
Utshintsho ngenxa ye-Trump's Executive Order kwi-ACA
Ngosuku lwakhe lokuqala kwi-ofisi, u-Presiden Trump wasayina umyalelo olawulayo ojoliswe "ekunciphiseni umthwalo wezoqoqosho woLondolozo lweMonde kunye noMthetho ojongene noNonophelo ojongene noThathaka." Ngelo xesha, ukulindela phakathi kweCandelo loLawulo lweTrump kukuba i-bill ye-ACA yokuchithwa iya kuhanjiswa kungekudala, engazange ifike.
Kodwa ulawulo olulawulayo luyalela i-arhente ye-federal ukuba ibe yinto elula njengokuba kunokwenzeka- nangaphandle kokumisela umthetho-xa ugxininisa amalungiselelo e-ACA.
Igunya lomntu ngamnye, elifuna abaninzi baseMerika ukuba bahlale bekhuseleko lwe-inshorensi yezempilo okanye bajongane nesohlwayo serhafu, kuye kwaba yinto yokucinga ngokuqhubekayo ukususela kwisigqeba sokulawula. Ukucaca, isigunyaziso ngasinye sisekhona ngo-2017 , kwaye kubonakala ukuba kuya kuba njalo ngo-2018. Uninzi lwee-bills zokutshitshiswa kwe-ACA ezenziwa yiRiphabhulikhi kwiCongress ziye zazisa ngo-2017 (kuquka uGraham-Cassidy-Heller-Johnson ibhilikhwe) yayiya kuncitshisa isigwebo somntu ngamnye kwi-$ 0, ukubuyela emva kokuqala konyaka we-2016. Kodwa akukho nanye yalezo zikolo eziye zenziwe.
Kwimiba yezeMpilo, uTim Jost wabika ngo-Agasti ukuba ngokuqinisekileyo isigunyaziso somntu sisenyanzeliswa yi-IRS, nangona amahemuhemu aphikisanayo, kwaye i-website ye-IRS ithi nakuba kukho umyalelo olawulayo, " amalungiselelo omthetho we-ACA asebenzayo de utshintshwe yiNgqungquthela, kwaye abahlawuli berhafu bahlala bebophekile ukuba balandele umthetho kwaye bahlawule oko batyala.
Nangona kunjalo, i-IRS iye yavumela abantu ukuba bafake iintlawulo zerhafu 2016 entwasahlobo ka-2017 engayiphenduli umbuzo malunga nokuba i-filer yayine-inshurensi yempilo ngo-2016 . Baye bavumela ukuba ngo-2014 no-2015, kodwa babezimisele ukugatya ezo ntlawulo ngo-2016, kwaye bafune ukuba zonke iifayile ziphendule umbuzo. Baye baphenduka inkqubo kweso sitshintshi emva kolawulo lukaMongameli uTrump, kwaye baqhubeka bemkela ukubuya "ukuthula" okungazange kuthethe ukuba ngaba iifayile zerhafu ayinayo i-inshorensi yezempilo.
Akucaci ukuba i-IRS iya kutshintsha isimo sayo kulo mbandela ongena kwixesha lokufakela irhafu ekuqaleni kowe-2018, kodwa akunakwenzeka ukuba baya kuthi, banikezwe umyalelo olawulayo weTump.
Iqela Elikhulu, i-Medicare, kunye neMedicaid: Iinguqu eziqhelekileyo zonyaka Zenza isicelo
Uninzi lweengxoxo zengxelo yokunakekelwa kwempilo ngo-2017 zijolise kwiimarike zodwa, ixabiso lemarike yeqela kunye neMedicaid. Kodwa njengoko kuphawuliwe ngasentla, ininzi yale mpikiswano ayiphumelelanga naluphi na utshintsho oluthile. Kubantu abafumana i-inshorensi yabo kubaqeshi abakhulu, i-Medicare, okanye iMedicaid (ithathelwe ndawonye, ininzi loluntu), utshintsho lwe-2018 luya kuba luhlobo olufanayo lweenguqu ezenzeka ngonyaka.
Ukuvulwa kobhaliso lwe-Medicare Benevantage kunye ne-Medicare Part D kuqhutywa ngo-Oktobha 15 ukuya kuDisemba 7, kunye neenguqu zonke ngoJanuwari 1, 2018. Izicwangciso zangoku ziza kutshintsha ngo-2018-njengokuba zenza unyaka ngamnye-ngoko kubalulekile ukuba ababhalise ukuba bathathe ixesha ngexesha lokuvula ukubhalisa ukuthelekisa iindlela ezahlukeneyo ezikhoyo kwaye ukhethe lowo oza kufeza ngokufanelekileyo iimfuno zabo kunyaka ozayo.
Kuyafana neenjongo ezixhaswe ngumqeshi. Uninzi lwabaqeshi livule ukubhaliswa ekuwa, kunye neenzuzo zenguqu zintshintsho ngoJanuwari 1. Ukuba isicwangciso sakho sineenguqulelo zonyaka ozayo, okanye ukuba kukho iindlela ezintsha ezifumanekayo kuwe, ukubhaliswa okuvulekileyo kuya kuba yithuba lakho lokutshintsha zakho iingenelo ukuba ukhetha ukwenza njalo.
Akukho nanye kweziphakamiso zokunakekelwa kwempilo ezinxulumene neMedicaid zenziwa ngo-2017, oko kuthetha ukuba ukufaneleka kuya kuqhubeka ngo-2018 ngokukodwa ngokungatshintshi ukususela ngo-2017, kubandakanywa ne-ACA's Medicaid. Akukho zizwe ezintsha ezandise ukulungeleka kweMedicaid ngo-2017, ngoko ke amanqanaba okufumana umvuzo wokunyuswa kwamaMedicaid ahlala afana nawo aqala ekuqaleni konyaka. Ukuba ufumana isicelo esivela kwi-agency yakho ye-Medicaid agunyazisiweyo ukuba ubuyekeze ukufaneleka kwakho kweMedicaid, uya kufuna ukunikezela ngamaxwebhu afanelekileyo ngokukhawuleza ukuba uphephe ukuphazamiseka.
> Imithombo:
> Cassidy.Senate.gov. Umbhalo wesiHlomelo 543 ku-HR1628 (i- Graham-Cassidy-Heller-Johnson isilungiso kuMthetho wezeMpilo waseMelika ). Ukwaziswa ngoSeptemba 13, 2017.
> Amasebe e-Medicare neeNkonzo zeMedicaid. Ikamva le-SHOP. I-CMS ihlose ukuvumela amaShishini amancinci kuma-SHOPs usebenzisa i-HealthCare.gov ngakumbi Ukunyaniseka xa ubhalisa kwi-Healthcare Coverage . Meyi 15, 2017.
> Isebe Lempilo Neenkonzo Zoluntu. Isiqinisekiso soMonde kunye noNonophelo ojongene noNonophelo olungabonakaliyo: I-Market Stabilization . Epreli 2017.
> INkonzo yeNgeniso yangaphakathi, Ukunikezelwa kweMfanelo yoBuntu ngabanye.
> WhiteHouse.gov, i-Ofisi yoNobhala woLwazi. Umyalelo oLawulayo ukunciphisa Umthwalo wezoQoqosho woKhuselo lweMonde kunye noNonophelo ojongene noNonophelo ojongene noThathaka oluLungileyo. NgoJanuwari 20, 2017.