Amanyathelo amaninzi aphumelele okanye aqhubela phambili ama-1332 Waivers
Icandelo 1332 loMthetho woNonophelo ongenakunceda uvumelekile ekudalweni kwe-1332 yeivers. Ukuba ivunyiwe nguRhulumente we-federal, ama-1332 waivers avumela amazwe ukuba aguqule okanye atshintshe amalungiselelo ahlukeneyo e-ACA ukuze asebenzise indlela entsha yokujonga utshintsho lwezempilo. Kodwa ukukhusela abathengi, i-ACA iquka izikhokelo eziqinileyo ngokwemigaqo ye-ACA enokuthi ikhutshwe, kwaye idinga amazwe ukuqinisekisa ukuba abantu baya kuba bancinci ngokukhuselweyo phantsi kokususwa njengoko beza kuba ne-ACA ngokwayo.
Nangona i-ACA yenziwe ngo-2010 kwaye ubuninzi beemigaqo zayo zaqalisa ukusebenza ngo-2014, umhla wokuqala owenziwe ngokukhawuleza wama-1332 waivers nguJanuwari 2017. Kuphela kwimeko-eHawaii-ine-1332 yaiver esebenza ngoJanuwari 2017, kodwa Amazwe aqhubekele ukuxoshwa ngo-2017, kwaye kulindeleke ukuba ezinye zilandele iminyaka ezayo.
Ngoko ngelixa ukuthetha ngama-1332 waivers kwakubaluleke kakhulu kwimfundo kwiminyaka eyadlulileyo, kunokwenzeka ukuba ufikelele kwingxoxo ngoku. Makhe sijonge ukuba i-1332 yaivers isebenza njani, yiyiphi into enokuyenza (kwaye ayinakuyenza) kunye nabo, nendlela abaye baqaliswa ngayo ngoku.
Imigaqo eSeko ye-1332 Waivers
Xa i-ACA yaqulunqwa, abagwebi bayavuma ukuba amazwe aneemeko ezahlukeneyo ezinokuthi zingakhonzwwanga kakuhle ngokulinganayo komlinganiselo. Ngelo xesha, babesazi ukuba ezinye iinqununu ziza kukhetha indlela yokubakhokelela ekunakekeleni ukunakekelwa kwempilo, eya kubashiya abathengi ngendlela encinci yokukhusela ukukhusela ukuba amazwe avunyelwe ukuba akhuphe imibandela ye-ACA ngaphandle kwezikhokelo eziqinileyo ezilawulayo kwinkqubo.
Ngokomlando, phambi kokuba i-ACA idale umgangatho wesigqeba ngokubhekiselele kwisakhelo solawulo oluyisiseko, onke amazwe aphezu kwemephu ngokubhekiselele kwindlela abalawula ngayo i-inshorensi yempilo. Amanye amaziko sele sele enemimiselo ebekwe kwindawo eyadlula imithetho ye-ACA (i-New York, umzekelo, ayivumeli iiprayimari zihluke ngobudala, obunzima kakhulu kune-ACA; umgaqo-nkqubo waseNew York usele ndawo ukususela ngo-1990).
Ngomnye umgca wembonakalo, ezinye iindawo zikhethwa ukuthabatha indlela eninzi yemarike, ngokungenanto encinane kwindlela yokulawula phambi kokuba i-ACA ifake imigangatho ephantsi esetyenziswa kuwo wonke urhulumente.
Nangona iCandelo 1332 ye-ACA ivumela amazwe ukuba avuselele kwaye athathe indlela yawo yokuguqulwa kwezempilo, kukho imigaqo ethile ebalulekileyo ekufuneka ilandelwe. Okokuqala, kukho izibonelelo ezithile ze-ACA ezingasuswa kunye ne-1332 waiver. Iziqendu ezikhunjulwe ziquka:
- I-ACA Isihloko I, i-Subtitle D, iIngxenye I no-II. Ezi ziqendu zibhekiselele kwimfuno ebalulekileyo yempilo, iimfuneko zexabiso le- actuarial (oko kukuthi, ukubonelelwa kwe-ACA efuna ukuba zonke izicwangciso zilungele kwi-bronze, isilivere, igolide, iplatinum, okanye iindidi ezinobungozi), imigaqo echaza ukuba ngabaphi abaqeshi babonwa njengabancinci amaqela, iimfuno zokuncedisa inethiwekhi, imfuno yecala elilodwa lomngcipheko (oko kukuthi, umthetho ofuna i-insurer kumakethi okanye ngamakethi amancinci amaqela ukuba afake zonke izicwangciso zeqela ngalinye kunye / okanye amancinci kwinqanaba elilodwa lomngcipheko, kungakhathaliseki ukuba kuthengiswa nge-off or exchange-off exchange), kunye neemfuno ngokwemisebenzi enokuthi i-exchange-based exchange exits.
- I-ACA Icandelo 1402. Eli candelo libhekiselele ekunciphisanisweni kweendleko (CSR), okunciphisa iindleko ezingaphandle kwe-pocket kubhalisi abangaphantsi-mali abanezicwangciso zesilivere.
- Icandelo lama-36B ye-Internal Revenue Code. Eli candelo libhekiselele kwingxowa-mali ye-premium yerhafu (premium subsidy) . Iseka imithetho ngokwemiqathango yokufumana iitaliti yentlawulo ye-premium, ukuba ingaba yintoni enye inkokhelo yentlawulo yokubhalisa irhafu eya kubhaliswa, kunye nendlela ukuhlawulwa kwentlawulo yeerhafu ngayo.
- Icandelo 4980H ye-Internal Revenue Code. Eli candelo libhekiselele kumgunyazo we-ACA yomqeshi, ofuna abaqeshi nabasebenzi abalinganayo bexesha elipheleleyo abangama-50 ukuba banikeze ngexabiso elincinci, ubuncinci bomshuwalense wezempilo okanye babhekane nesohlwayo serhafu.
- Icandelo 5000A ye-Internal Revenue Code. Eli candelo libhekiselele kumgunyazo ngamnye we-ACA, obangela ukuba abaninzi baseMelika bahlale banjengo-inshorensi yempilo okanye bajongane nesohlwayo serhafu.
Ukuvumela ukuba amazwe avumele ukuba loo migaqo ibonelele ngokuqinisekileyo i-latitude ebalulekileyo ngokutshintshwa kwabo. Kodwa ezininzi ze-ACA ezibalulekileyo zokukhusela abathengi azikho kwizo zicatshulwa. Umbandela we-ACA owenqabela abatshorensi ukuba bangabanqweneli abafakizicelo abaneemeko eziphambili (okanye ukubethelela iiprayimari eziphezulu) akunakunqunyulwa ngo-1332 waiver, kwaye i-ACA ingavunyelwe ukuvavanywa kwimida yokuphila kunye neminyaka yeenzuzo zezempilo ezibalulekileyo (nangona njengoko kuchazwe ngasentla, kubalulekile inzuzo yezempilo ngokwabo iyakutshintshwa).
Amazwe akakwazi ukulungisa umgaqo we-ACA ofuna abaqinisekisi ukuba bavumele abantu abadala ukuba bahlale kwisicwangciso sezempilo somzali de kube yiminyaka eyi-26 (eli libonelelo elithandwayo elisenokuthi lingafuneki ukuliyeka nantoni na), kwaye abayikwazi ukuyiyeka imigaqo-jikelele evimbela ucalulo olusekelwe kwimbali yonyango, ukukhubazeka, ubuhlanga, ubudala, okanye isini.
Nangona kukho ububanzi obubalulekileyo ngokubhekiselele kwinto enokuthi ikhutshwe, i-ACA iqulethe imithetho emithathu engundoqo efuna iindawo ukuqinisekisa ukuba abahlali babo abayi kuba nzima kakhulu phantsi kwe-1332 waiver kunokuba babeya kuba ne-ACA engagqibekanga. Ukuze icandelo le-1332 waiver livunywe, urhulumente kufuneka akhombise iziphakamiso zayo zokumisa ukuba xa kuphunyezwa i-waiver:
- Ubungakanani buya kuba buncinane njengoko buza kuba ngaphandle kokushiya.
- Ubungakanani buya kuba ubuncinane njengoko buya kuba ngaphandle kokushiya.
- Inani labantu abaya kuba negalelo emva kokuba i-waiver isendaweni kufuneka ibe ubuncinci banokubhengezwa ngaphandle kokushiya.
Kwaye umthetho wesine uqinisekisa ukuba urhulumente wesigqeba akayi kuba ngaphantsi komqathango we-waiver:
- Ukuxoshwa kufuneka kube yintlupheko yokungathathi hlangothi kurhulumente wephondo.
Nangona amazwe angathabatha imali abayifumana ngayo inkxaso ye-premium kunye nokunciphisa iindleko kwaye bayisebenzise enye injongo, umzekelo, urhulumente wesigqeba akanakuphelisa ukuchitha imali ngaphezulu kwimeko engaphantsi kweso sikhundla kunokuba babeza kuchitha ngaphandle ukukhutshwa.
Ziziphi iiMerika eziye zafumana ukuvunyelwa kweSivumelwano sazo kwi-1332 Waivers?
Iintetho ezine-eHawaii, Alaska, eMinnesota, nase-Oregon-zifumene imvume yokunikezelwa kwemibutho yee-1332 zokukhishwa kwee-1332 ngoNovemba 2017.
I-Hawaii yaqalisa ukusebenza ngo-2017 kwaye yavumela urhulumente ukuba alahle utshintshi lwaloo shishini lwezempilo. I-Hawaii inomthetho ukususela ngowe-1970 ofuna ukuba bonke abaqeshi (kungakhathaliseki ukuba lukhulu kangakanani ishishini) ukubonelela ngokukhawuleza kunoma yimuphi umqeshwa osebenza okungenani iiyure ezingama-20 ngeveki, kwaye ukufihla umsebenzi akuyi kuhlawula umqeshwa ngaphezu 1.5 ipesenti yomvuzo wabo. Lo mgaqo ogqithiseleyo-kokubili ngokubhekiselele ekufikeleleni kunye nabasebenzi ukuba banikwe inkxaso-ngaphandle kwe-ACA, kwaye urhulumente wesigqeba wavuma ukuba iHawaii ingasebenzisa i-1332 waiver ukuqeda imfuno ye-ACA egcina ubuncinane boshishino lwe-inshurensi yezempilo .
E-Alaska, eMinnesota, nase-Oregon, ukukhishwa kwe-1332 evunyiweyo kusebenza ngoJanuwari 2018. Kwiimeko zonke ezintathu, ukuxhaswa kusetshenziselwa ukuvumela inkxaso-mali yenkqubo ye-reinsurance. Ukuqinisekiswa yinkqubo apho umntu ohlukeneyo (urhulumente, kula maxesha) uyavuma ukuthatha iindleko zamabango ezidlula inani elithile leedola, kwaye zibafikele kude zifike kwenye ixabiso lemali. Isiphumo siyi-premium eziphantsi, kuba aba-inshurensi abengekho kwinqanaba leendleko ezipheleleyo zeemali-dolophu eziphezulu (i-ACA ifake iprogram yokuvuselela ihlabathi lonke, kodwa yayisesikhashana kwaye yaphela ngo-2016).
Xa ama-premium ehla, ezinye izinto ezimbini zenzeka:
- Phakathi kwabantu abangafumani inkxaso-mali ye-premium, abantu abaninzi bathenga i-inshorensi kuba iya kuba nexabiso eliphezulu.
- Kwaye phakathi kwabantu abafumana inkxaso-mali ye-premium, imali efunyenwe nguRhulumente karhulumente kwiinkxaso-mali iyancipha (oku kuba inkxaso-mali ye-premium yenzelwe ukugcina igalelo kumanqanaba acatshangelwayo athengekayo; xa iiprayimari zangaphambili zenkxaso-mali ziphantsi, inkxaso akudingeki ukuba ube mkhulu ukuze ufumane imali engaphantsi kwenkxaso-mali emva kwinqanaba elifanayo elifikelelekayo).
Ngako-ke abantu abaninzi baphela ngokugqitywa ngenkqubo yokuvuselela, kwaye urhulumente usindisa imali kwi-premium inkxaso. E-Alaska, eMinnesota, nase-Oregon, amazwe aya kuvunyelwa ukuba asebenzise imali leyo urhulumente weburhulumenteni uya kuchitha imali kwi-premium yenkxaso-mali, kwaye endaweni yoko uyisebenzise ukuxhaswa kwinkqubo yokubuyisela inkxaso (oku kwaziwa ngokuba "ukugqithiswa kwemali"). Kuzo zonke iindawo ezintathu, iiprayimari ze-2018 ziphantsi kakhulu kunokuba zingenakho inkqubo yoqinisekiso, kwaye kulindeleke ukuba kubangele abantu abaninzi abanomshuwalense wezempilo.
EMassachusetts idibene no-1332 waiver ngoSeptemba 2017, ifuna ukuseka isikhwama se- premium stabilization kwiindawo zokunciphisa iindleko zokunciphisa indleko ngo-2018. Kodwa amaziko e-Medicare kunye neeNkonzo zeMedicaid zenze ukuba isiluleko sokuxhaswa sithunyelwe ngokukhawuleza, kwaye akukho ixesha lokuba livunywe ngexesha lokuqalisa ukubhaliswa okuvulekileyo ngomhla kaNovemba 1, 2017 (ekugqibeleni, inkxaso-mali yokunciphisa iindleko yachithwa nguRhulumente waseburhulumenteni ngo-Oktobha 2017 ).
Amazwe Aye Ahlutha Imisebenzi Yabo Ye-1332 ye-Waiver Proposals
Iine-California, iVermont, i-Oklahoma kunye ne-Iowa-zingenise iifayile ezili-1332 kodwa zanquma ukungahambi phambili nazo.
I-California iphakamise isiphakamiso se-1332 waiver esiya kubavumela abafuduki abangabonakaliyo ukuba bathenge intengo epheleleyo (ie, ngaphandle kwemali-mali ye-premium). Kodwa urhulumente wasusa isiphakamiso sokuxoshwa ekuqaleni kuka-2017, kuba babexhalabele ukuba ulawulo lweTrump lingasebenzisa idatha esuka kutshintshiselwano lombuso ukulandelela phantsi nokuxosha abafuduki abangabhalwanga phantsi.
I-Vermont ithumele isiluleko se- 1332 saiver ekuqaleni kwawo-2016, icela imvume yokungabi ne-portal exchange (portfolio). Ukukhishwa kwabo kwakubonwa kungaphelelanga, kwaye abazange baqhube phambili ngokugqiba. Kodwa i-Vermont isetyenzisiwe ngqo kwi-SHOP yobhaliso lwabiwo-mali ukususela ngo-2014. I-Vermont yaqwalasela nokusebenzisa i-wavering ye-1332 ukuseka inkqubo yokuhlawula enye into ebeyicwangcise ukuyisebenzisa ngo-2017, kodwa ekugqibeleni yatsho iiplagi kulo msebenzi ngaphambi kokungeniswa kwesiluleko sokuxoshwa, njengoko bazimisele ukuba inkqubo yokuhlawula omnye yombuso iya kuba yindleko.
I-Iowa ne-Oklahoma zombini zithumele iziphakamiso ze-1332 zokukhishwa kwezimali ngo-2017 ukuba zizimisele ukuphumeza ngexesha le-2018, nethemba lokunciphisa ama-premium kumashishini abo ase-inshurensi. Ukuxoshwa kwe-Iowa kwakuya kutshintshela kakhulu imarike yombuso, ngelixa i-Oklahoma yayiza kuseka inkqubo yokuvuselela kwakhona kunye neli lizwe elilindelekileyo emva koko kulandelelwano lwexesha elizayo le-1332 ukwenzela ukuba kwenziwe utshintsho oluthe xaxa. Kodwa iziphakamiso zombini zokuxoshwa zihoxiswa nguRhulumente xa kubonakala ukuba abaza kuvunywa ngexesha lokuba benze umehluko kuma-premium ama-2018.
Iinkcukacha kuzo zonke iifayile ezi-1332 ezithunyelwe ngokusemthethweni kwi-CMS, kubandakanywa nalawo ahoxisiwe kwaye avunyelwe, ziyafumaneka kule khasi lewebhu le-CMS.
Kwaye nezinye iindidi zibhekiselele kwii-1332, kwaye zenze umthetho ukuba uqalise inkqubo, okanye ziqulunqe esidlangalaleni iziphakamiso ze-1332 zaiver. Lindela ukufumana oku ngakumbi kulo lonke u-2018.
> Imithombo:
> Amasebe e-Medicare kunye neeNkonzo zeMedicaid, iZiko loLwazi loThengi kunye noLawulo lweNtshuwalense. Icandelo 1332: i-State Innovation Waivers.
> I-Cornell Law School, i-Legal Information Institute. 42 Ikhodi yase-US ยง 18052 - Ukulungiswa kwezinto ezintsha zoMbuso
> HealthCare.gov. Funda uMthetho woNonophelo ongenakunceda.
> Howard, uHeather. Robert Wood Johnson Foundation. Ezinye iiSates Ukujonga kwiCandelo 1332 iWaivers. Novemba 6, 2017.