Amalungiselelo e-ACA kwabemi baseMerika kunye namaAlaska
Umthetho ojongene noNonophelo ongenakunqwenelekayo-aka Obamacare - unikezele abantu abaninzi baseMelika baseMelika nabaseAlaska abanamathuba okufumana i-inshorensi yempilo. Ngokwe- US Census data , kukho izigidi ezi-5.2 zaseMelika kunye namaAlaska aseMelika. Ukususela ngo-2009 ukuya ku-2011, phantse i-30% yazo yayingaqinisekisiwe-xa kuthelekiswa ne-17% yabantu bonke base-US.
Abantu baseMerika kunye namaAlaska abaNtu banokufikelela kwiinkonzo zempilo zamahhala ezibonelelwa ngamaziko e-Indian Health Service (IHS), kodwa iindawo ze-IHS zihlala zihlala kufuphi neendawo zokuhlala, kwaye ngaphezu kwekota ezintathu zamaNative aseMerika kunye namaAlaska aMhlali abahlali kwiindawo zokugcina okanye kwilizwe. Nangona iindawo ze-IHS zendawo, i-Ofisi yoKwazisa i-Government iye yabona ukuba unyango lwezempilo oluyimfuneko aluhlali lufumaneka ngexesha elifanelekileyo.
Ngezizathu ezahlukahlukeneyo, abantu baseMelika nabama-Alaska abaNtu bafumana iziphumo zempilo ezihluphekileyo ngokubanzi kunabantu base-US ngokubanzi. Ukujongana nokungalingani kwempilo, kunye nomgudu wokunciphisa izinga elingenakuqinisekiswa phakathi kwabemi baseMelika kunye namaAlaska, ama-ACA afaka amalungiselelo anokwenza ufikeleleko lufikeleleke kwaye unonophelo oluthile lufikeleleke kubantu baseMelika nabama-Alaska.
Ukwabelana ngeendleko ezincinane
Ukwabelana ngeendleko ngumlinganiselo wemali ukuba izigulane kufuneka zihlawule iinkonzo zabo zonyango.
Ngaphantsi kwe-ACA, iindleko ezingapheliyo ze-pocket zilinganiselwa kuma-6,850 ayi-$ 6,850 omnye umntu ngo-2016, nangona izicwangciso zempilo zinokuthi zibe nemida engaphantsi, kwaye zikwazi ukuguquguquka ngokweenqanaba lokuba zenze njani ukwabelana ngeendleko zisebenzisa i-copays, iinqununu, kunye ne-coinsurance.
Kubantu baseMelika kunye namaAlaska, azinamalungiselelo akhethekileyo malunga nokwabelana ngeendleko:
- Kubantu baseMelika nabama-Alaska Abemi kunye neengeniso zomakhaya ukuya kwi-300% yezinga lehlwempu (malunga ne-$ 60,000 kwiintsapho ezintathu, okanye i-$ 75,000 kwintsapho yeentathu e-Alaska), akukho mali yokwabelana kwiiprogram ze-inshorensi zempilo ezithengwa ngokutshintshiselana . Ii-premiums zenyanga (iindleko ze-inshorensi ngokwazo) mazihlawulwe, nangona inkxaso-mali ye-premium ingahlawulela ingxenye ebalulekileyo yeendleko, kuxhomekeke kwimali engenayo. Kodwa xa kunikezelwa unyameko, ayikho i-copays, i-deductibles, okanye i-coinsurance.
- Kubo bonke abantu baseMelika nabama-Alaska Abemi abhalisa kwisicwangciso sezempilo ngokutshintshisana-kubandakanywa ababhalisa kunye neengeniso zemizi ngaphezu kwe-300% yezinga lehlwempu - akukho ukwabelana ngeendleko (i-copay, i-deductible, i-coinsurance) nayiphi na inkathalo yezempilo efumaneka kwi-IHS okanye isizwe, okanye kumboneleli onikwe isivumelwano kunye ne-IHS.
Ubhaliso lwabho ngonyaka
I-ACA ifake umgaqo wokubhalisa okuvulekileyo kwimarike yomshuwalense yempilo. Ngaphambi kuka-2014, i-inshurensi yempilo nganye yayingathengwa nanini na ngexesha lonyaka, kodwa abafaki-zicelo kwiindawo ezininzi babefanele babe nempilo ukuze bavunyelwe ukufumana ingxelo.
Ngaphantsi kwe-ACA, wonke umntu unako ukufumana ingxelo, kungakhathaliseki ukuba imbali yonyango.
Kodwa urhwebo-nkonzo kukuba i-inshurensi yezempilo iyabonakala ngokubanzi ngexesha lokubhalisa okuvulekileyo (ngo-2016, ukubhaliselwa okuvulekileyo kwaqala ngoNovemba 1, 2015 kwaye iyaqhubeka ngoJanuwari 31, 2016). Emva kokubhalisa okuvulekileyo, i-coverage ingathengwa kuphela ngabantu abafumana iziganeko ezifanelekileyo ezibangela ixesha lokubhalisa olulodwa .
Kodwa amaMelika aseMerika kunye namaAlaska aseMelika awanalo kuphela ukubhalisa ngexesha lokubhalisa okuvulekileyo, kwaye abadinga iziganeko ezifanelekileyo. Banako ukubhalisa nanini na, unyaka-wonke (ngokutshintshana kuphela; ukubhaliswa kwe-year round does not apply exchange-exchange). Kwiinkoliso ezininzi, i-coverage iza kusebenza yokuqala yokuqala kwinyanga elandelayo kubhaliso ukuba ngaba bayabhalisa nge-15 yenyanga leyo, kunye neyokuqala kwinyanga yesibini elandelayo kubhaliso oluzaliswe emva kwe-15 yeenyanga (eMassachusetts, Rhode Island, kunye Uhulumeni waseWashington konke kuvumela ukubhaliswa - kunoma yimuphi umfaki sicelo-ukuba ugqitywe ngokukhawuleza njengoko i-23 yesi-nyanga yokulungiselela ukuphumelela ngenyanga yokuqala kwinyanga elandelayo).
Akukho sihlwayo sokungaqiniseki
Ngaphantsi kwe-ACA, kukho isohlwayo sokungaqiniseki . Kubalwa kwimbuyekezo yentela, kwaye isebenza kunoma ubani ofuna ukuba afake ibuyiselo engazange aqinisekiswe kunyaka odlulileyo kwaye akazange afanelekele ukukhululwa kwesohlwayo.
Kodwa amaMelika aseMerika kunye namaAlaska aMazwe angamalungu esizwe esaziwayo (okanye ngubani na onokufumana ukunakekelwa nge-IHS) akhululwa kwisihlwayo. Bayakwazi ukufumana ukuxolelwa kwabo kwi-exchange okanye kwi-IRS xa befake iifom zabo zerhafu (le fom isetyenziselwa ukucela ukuxolelwa, kumazwe angama-38 asebenzisa i-Healthcare.gov).
Kuye kwaba nentsholongwane ephawulekayo yokufumana amaMerika aseMelika kunye namaAlaska abhalise kwizicwangciso zempilo ngokusebenzisa i-ACA exchanges. Kodwa imingeni ihleli ngokubhekiselele kwizinto zokusebenza, imfundo yabathengi, kunye nakwezinye iimeko, ukungathembeki kurhulumente wephondo. Nangona ubunkokheli bobuhlanga beye basebenzela ukusabalalisa igama lokubhalisa kwimpilo ngokubambisana kwe-ACA kunenzuzo kubemi baseMelika kunye namaAlaska, azinaso isohlwayo samalungu omthonyama abakhetha ukuhlala bengagqithwanga.
UMthetho woPhuculo lwezeMpilo waseNdiya
UMthetho woPhuculo lwezeMpilo waseNdiya, ohlawula i-IHS, wadluliselwa yiNgqungquthela ngowe-1976 kwaye wagcina wagunyazwa ngowama-2000. Kodwa i-ACA ivuselele ngokusisigxina uMthetho woPhuculo loLondolozo lwezeMpilo waseNdiya, kwaye yongezelela iinkonzo ezongezelelweyo , kuquka iinkqubo zokunakekelwa kwempilo yengqondo nokuziphatha, kunye neenkonzo zonyango lwexesha elide.
Ukwandisa iMedicaid
Ngo-2014, izinga lobuhlwempu phakathi kwabemi baseMelika kunye nabakwa-Alaska abahlali be-28.3%, xa kuthelekiswa ne-15.5% kubo bonke abantu base-United States. Amanani aphezulu kunamahlwempu phakathi kwamaMerika kunye namaAlaska aseMelika (aphakamileyo kunamanye amaqela eentlanga) enza ukuba i-ACA's Medicaid kwandiswe ngokubalulekileyo.
I-ACA ibiza ukuba ukwandiswa kweMedicaid ukugubungela bonke abantu abadala abaneengeniso zomzi ukuya kwi-138% yezinga lehlwempu (abantwana sele behlanganiswe kumanqanaba aphezulu aphezulu ngenkqubo yentlangano yeNkcazo yeMpilo kunye ne-Child Health Insurance Programme), kwaye urhulumente wesigqeba uya kuhlala ehlawula ubuncinane i-90% yeendleko zokunyusa iMedicaid.
Kodwa iNkundla ePhakamileyo yagweba ngo-2012 ukuba amazwe angaphuma ekunyuseni iMedicaid, kuze kube ngoku, ama-19 athi awanako ukwandisa i-Medicaid coverage.
Kwisixhenxe (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, naseMzantsi Dakota), abantu baseMelika nabama-Alaska Abemi baquka okungenani ama-3% abantu bonke. Kuloo mazwe, yonke i-Oklahoma kunye neSouth Dakota yandisa iMedicaid.
Kodwa ngaphezu kwesiqingatha sabo bonke abantu baseMelika nabama-Alaska bahlala kwiindawo ezisixhenxe (Alaska, North Carolina, Texas, New Mexico, Oklahoma, California, nase-Arizona). Kulawo mazwe, iNorth Carolina, iTexas, ne-Oklahoma azizange zandise iMedicaid. Kuphela nje kwezo zintathu zithi, kukho abantu abayizigidi ezili-1.1 kwi-gap yokukhawulela, inombolo ngokuqinisekileyo ibandakanya abanye baseMelika baseMelika.
Abantu abasemgangathweni wokufihla abavumelekanga kwi-Medicaid kuba i-state ayinakwandisa ukufaneleka, kwaye ayifanelekanga ukufumana inkxaso-mali ye-premium kushintshi kuba inkxaso ayifumaneki kubantu abanomvuzo phantsi kwelihlwempu (ekubeni babefanele babe nokufikelela kwiMedicalid esikhundleni).
Nangona ukwandiswa kweMedicaid kuye kwabangela impembelelo enkulu ekuqinisekiseni amaNative aseMelika kunye nabakwa-Alaska, aba bahlala phantsi, oku kusebenza kuphela kwiindawo apho iMedicaid iye yanda.