Nyika dzakawanda dzakagadziriswa kana dziri kutevera 1332 Waivers
Chikamu 1332 cheChinakidzika Care Care Act chakabvumirwa pakusikwa kwe 1332 waivers. Kana zvichigamuchirwa nehurumende yehurumende, 1332 waivers inobvumira kuti nyika dzisimudze kana kuti dzichinje zvakasiyana-siyana zveAACA kuitira kushandisa shanduko, nzira yehupfumi yekuchinja hutano. Asi kuti vadzivirire vatengi, ACA inosanganisira mitemo yakaoma maererano nezvinodiwa neAACA, uye inoda nyika kuti ivone kuti vanhu vachave vakanyatsochengetedzwa pasi pekuregererwa sezvavanenge vaine ACA ivo pachavo.
Kunyange zvazvo ACA yakagadzwa muna 2010 uye zvakawanda zvezvikamu zvayo zvakaitwa mugore ra2014, yekutanga nguva inobvira yakaitika ye1332 waivers yaive munaJanuary 2017. Imwe nyika-Hawaii-yakanga ine 1332 waiver muna January 2017, asi mamwe akawanda nhepfenyuro dzave dzichienderera mberi muna 2017, uye zvinotarisirwa kuti zvizhinji zvichitevera zvakatevera mumakore anotevera.
Nokudaro nekutaura kwemashure makumi matatu namatanhatu nemakumi matatu nemakumi matatu nemakumi matatu nemakumi maviri nemakumi mashanu (100) yaivers akanga aine ruzivo mune zvemakore asati apfuura, zvinowanzoitika pakukurukura zvino. Ngatitarisei kuti 1332 vashandisi vanoshanda sei, chii chinogona kuita (uye hachikwanise) kuita navo, uye kuti vari kushandiswa sei ikozvino.
Mitemo Yekutanga ye 1332 Waivers
Apo ACA yakanyorwa, vatongi vemitemo vakabvuma kuti nyika dzine maitiro akasiyana-siyana akasiyana-siyana angave asingashumirwi zvakanaka ne-size-fit-all approach. Panguva imwecheteyo, vaiziva zvakare kuti dzimwe nyika dzingada nzira yekudzivirira hutano yehutano, izvo zvingadai zvichisiya vatengi zvishoma munzira yekudzivirira kuchengetedza kana nyika dzichibvumirwa kuregerera ACA zvinyorwa pasina mitemo yakasimba inodzora iyo nzira.
Nhoroondo, pamberi peAACA isati yamboita dare rehurumende maererano nehurongwa hwehutungamiri huripo, nyika dzaive pese pamepu maererano nekuraira kwoutachivhu woutano. Dzimwe nyika dzaive dzatova nemitemo panzvimbo yaipfuura mitemo yeAACA (New York, somuenzaniso, haibvumiri kuti premium ive yakasiyana nezera, iro rakanyanya kusimba kupfuura ACA; mutemo weNew York wave uri munzvimbo kubva kuma1999).
Kune rumwe rutivi rwemagetsi, dzimwe nyika dzakasarudza kutora mari yakawanda-inotengeswa, isina zvishoma munzira yekugadzirisa kutungamirirwa pamberi peAACA yakagadzirisa zvishoma mitemo inoshandiswa mune imwe nyika.
Saka sezvo Chikamu 1332 cheAACA chichibvumira nyika kuti dzigadzirise uye dzitore nzira dzavo dzekugadzirisa hutano hwakanaka, pane mitemo yekutanga inofanira kuteverwa. Chokutanga, pane zvimwe zvikamu zveAACA zvinogona kusunungurwa ne 1332 waiver. Zvikamu zvisingadikanwi zvinosanganisira:
- ACA Musoro I, Subtitle D, Zvikamu I uye II. Izvi zvikamu zvine chokuita nezvinokosha zvinodiwa mune zvehutano zvinodiwa , izvo zvinokosha zvekukosha kwezvinodiwa (kureva, kupiwa kweAACA inoda kuti zvirongwa zvose zvienderane neyendarira, sirivha, ndarama, platinum, kana zvikamu zvinotyisa), mitemo inotsanangura kuti vashandirwi vanoonekwa sediki mapoka, ruzivo rwehutachiwana hunotarisirwa, izvo zvinongodaro zvinoshandiswa pakudzivirira (kureva, mutemo unoda bhizinesi mumusika wega kana weboka duku kuti aise zvirongwa zvavo zvega uye / kana zviduku mune imwe dziva risina ngozi, pasinei nokuti ' inotengeswa kana kuti isiri-kushandiswa), uye zvinotarisirwa maererano nemabasa anoshandiswa nehupfumi hwehurumende anofanira kuita.
- ACA Chikamu 1402. Chikamu chine chokuita nekuderedza kugovana mari (CSR), iyo inoderedza mari-ye-inodhura mari yevanyoresa mari shoma nemaronga esirivha.
- Chikamu 36B cheChipatimendi CheMutero. Ichi chikamu chine chokuita neAACA's premium tax tax (premium subsidy) . Inosimbisa mitemo maererano neyo anokodzera kubhadhara mutero wechikwereti, iyo mari yakawanda sei inokodzera kubhadhara mutero wechikwereti ichave, uye kuti mari yechikwereti inoparadzirwa sei.
- Chikamu 4980H cheMukati Revenue Re Code. Ichi chikamu chinotaura nezvemahofisi eAACA, anoshandisa vashandi vane makumi mashanu kana makumi maviri evashandi vese venguva yakazara kuti vape zvikwereti, huwandu hwehutano hwehutano hwehutano kana kutarisana nemutengo wekutengesa mutero.
- Chikamu 5000A cheMukati Revenue Code. Ichi chikamu chine chokuita nebasa reAACA, iro rinoda vazhinji vekuAmerica kuchengetedza utano hwehutano inshuwarheni kana kutarisana nemhosva yemutero.
Kubvumira kuti zvinoreva kusunungura zvigadziro izvo zvinovapa humwe ruzivo rwakakosha maererano nekuchinja kwavanogona kuita. Asi zvizhinji zvekudzivirirwa kwevatengi kweAACA hazvisi mune zvikamu zvisingadikanwi. Nhengo yeAACA inorambidza vatsigiri vekuchengetedza vatsva vane mamiriro ekutanga (kana kuvabhadhara mari mikuru yakakwirira) haigoni kuregererwa ne 1332 waiver, uyewo ACA inorambidzwa panguva yehupenyu nemiganhu yegore yezvinodiwa zvehutano hunokosha (kunyange zvataurwa pamusoro apa, zvinokosha hutano hunobatsira hunozvipa ivo pachavo hunogona kuchinjwa).
Nyika haigoni kugadzirisa murairo weAACA unoda vatsigiri vekuchengetedza vana vechidiki kuti varambe vari muurongwa hwehutano hwevabereki kusvikira makore 26 (iyi inoratidzirwa urongwa hunoti inenge isingadi kuregerera), uye havagoni kurega mitemo yakawanda inorambidza kusarura kunobva munhoroondo yezvokurapa, urema, rudzi, zera, kana zvepabonde.
Kunyange zvazvo kune humwe hunokosha huri maererano nezvinogona kuregererwa, ACA inosanganisira mitemo mitatu inokosha inoda kuti nyika dzive nechokwadi chokuti vagari vayo havazove vakaipa kupfuura pasi pe 1332 waiver kupfuura ivo vaizove neAACA isina kugadziriswa panzvimbo. Kuti Chikamu 1332 waiver chibvumirwe, hurumende inofanira kuratidzira mumagumisiro ayo ekuregererwa kuti kana kuregererwa kushandiswa:
- Bhuku richave rinenge rakazara sezvarinenge pasina kunze kwekuregererwa.
- Bhuku richave risingakwanisi kutengesa sezvo ringadai risina kubviswa.
- Nhamba yevanhu vanozove nekugoverwa kana waiver iri panzvimbo iyo inofanira kuva yakawanda seyange iine chinyorwa kunze kwekuregererwa.
Uye mutemo wechina unovimbisa kuti hurumende yehurumende haichazove yakanyanya kuipa pasi pemashoko ekuregererwa:
- Kuregererwa kunofanirwa kuve kusava neutongerwe kwehurumende yehurumende.
Saka kunyange zvazvo nyika inogona kutora mari yavangadai yakagamuchira nokuda kwekubhadharwa mari yepamusoro uye kubhadhara mari uye kuishandisa kune chimwe chinangwa, somuenzaniso, hurumende yehurumende haigoni kupedza kushandisa zvakawanda muhurumende pasi pekuregererwa kwavanenge vasati vashandisa pasina the waver.
Ndeapi Mahedheni Akagamuchira Kubvumirwa kweGesheni Kwevane 1332 Waivers?
Zvikamu zvina-Hawaii, Alaska, Minnesota, uye Oregon-zvakagamuchirwa nehurumende pamusana pemakore avo 1332 kubva munaNovember 2017.
Hawaii yakatanga kuitika muna 2017 uye yakabvumira hurumende kubvisa bhizinesi yehutano yehutano inshuwarheni. Hawaii yakange iine mutemo chaiwo kubvira kuma1970 inoda kuti vashandi vose (zvisinei kuti ibhizimisi racho rakakura sei) kupa ruzivo kumunhu chero upi zvake anoshanda maawa makumi maviri pavhiki, uye kubhadharwa kwebasa hakukwanisi kubhadhara mushandi kupfuura 1.5 muzana yemisha yavo. Uyu ndiwo mutemo wakaoma zvikuru-zvose maererano nekutarisira uye izvo vashandi vanofanira kupiwa kugoverwa-kupfuura ACA, uye hurumende yehurumende yakabvuma kuti Hawaii ingashandisa 1332 waiver kubvisa kudai kweAACA iyo inotarisira kuchengetedza bhizinesi rehutano hwehutano hwehutano .
MuAlaska, Minnesota, uye Oregon, zvibvumirano zvinogamuchirwa 1332 zvinotanga kushanda munaJanuary 2018. Muzviitiko zvitatu izvi, kuregererwa kuri kushandiswa kubvumira mari yehurumende yehurongwa hwehupfumi hwehurumende. Reinsurance ndiyo imwe nzira iyo yakasiyana-siyana (iyo nyika, mumatambudziko aya) inobvumirana kutora mari yezvikwereti zvinopfuura kudarika imwe dollar yemari, uye kuvafukidza kusvika vasvika kune imwe dhora mari. Mhedzisiro iyi inobhadhara mirimbamende shoma, sezvo vatsigiri vasiri vashandi havakwanisi kubhadhara mari yakazara yemadhora akawanda (iyo ACA yaisanganisira purogiramu yenyika yose yekupa reinsurance, asi yaiva yenguva uye yakapedzisa kusvika muna 2016).
Kana mapeamisi paanoderera, zvimwe zvinhu zviviri zvinoitika:
- Pakati pevanhu vasina kuwana rubatsiro rwemari yepamusoro, vanhu vakawanda vanotenga inshuwarisi sezvo inowedzera kutengesa.
- Uye pakati pevanhu vanowana rubatsiro rwemari yepamusoro, mari iyo hurumende inoshandiswa kupedza mari iyo inopera (izvi ndezvokuti premium rubatsiro yakagadzirirwa kuchengetedza kugoverwa pamatanho anotaridzika kutenga; apo ma-premium premiums premiums are lower, the subsidies haufaniri kunge yakakura kuti uwane mari inotevera-rubatsiro kusvika kune imwechete yepamusoro yepamusoro).
Saka vanhu vakawanda vanopedzisira vakaputirwa nehurongwa hwekuvandudza huri munzvimbo, uye hurumende inochengetedza mari pamusoro pekubatsira mari. MuAlaska, Minnesota, uye Oregon, hurumende dzichabvumirwa kushandisa mari iyo hurumende yehurumende ingadai yakashandisa pamari yekubhadharisa mari, uye panzvimbo iyo inoshandisa iyo kubhadhara purogiramu reinsurance (iyi inozivikanwa se "kupfuura-kuburikidza kuchengetedza"). Muzvikamu zvitatu zvese, mapeamendi e 2018 akadzika zvakanyanya kudarika zvaangadai asina purogiramu yezvekudzorera, uye izvo zvinotarisirwa kuunza vanhu vakawanda vane utano hwehutano.
Massachusetts yakaendesawo 1332 waiver munaSeptember 2017, ichida kuisa premium stabilization fund panzvimbo yenyika yekubhadhara mari yekugoverana kwekubhadhara kwe 2018. Asi Centers for Medicare neMedicaid Services yakasarudza kuti kuregererwa kwekutsvaga kwakatumirwa zvakare, uye kwakanga kusina 'nguva yekuitora yakagamuchirwa panguva yekutanga kwekunyora kuzarura musi waNovember 1, 2017 (pakupedzisira, mari yekugoverana kuderedzwa mari yakabviswa nehurumende yehurumende munaOctober 2017 ).
Miti Iyo Yakabvisa Zvavo 1332 Zvido Zvokuda
Zvikamu zvina-California, Vermont, Oklahoma, neAo Iowa-vakaisa 1332 waivers asi vakabva vasarudza kusafambidzana navo.
California yakanga yakaronga kuti 1332 waiver yambiro iyo ingadai yakabvumira vasina kutumirwa kune dzimwe nyika kuti vatenge mutengo wakakwana (kureva, pasina ruzivo rwemari yepamutemo) hutano hwehutano muhutano hwehurumende. Asi hurumende yakasiya chirevo chekuregererwa mukutanga kwegore ra2017, nokuti vakange vaine hanya kuti Hurumende yeTrump ingashandisa dhamusi kubva kune shanduko yehurumende kuongorora pasi nekudzinga vanhu vasina kutumirwa kune dzimwe nyika.
Vermont yakapa sarudzo ye 1332 yaiver kutanga kwegore ra2016, ichikumbira mvumo yekusava nebhizimisi duku (SHOP) shanduro yemari. Kusunungura kwavo kwaionekwa sekusina kukwana, uye havana kuenderera mberi nekuipedzisa. Asi Vermont yakashandisa zvakananga-ku-insurer kuenda kune SHOP yokunyora kugoverana kubva muna 2014. Vermont yakafungawo kushandisa 1332 waiver kuti iite imwechete-mubhadharo yavakanga varonga kuitisa kunze kwegore ra2017, asi pakupedzisira vakapinza paki pane izvozvi vasati vaisa mvumo yekuregererwa, sezvo vakagadza kuti nyika-based single-payer system ingadai yakadhura.
Iowa neK Oklahoma zvose zvakaendesa 1332 waiver zvigadziro muna 2017 zvavaida kuronga munguva ye 2018, nechitarisiko chekudzivirira mari yepumisi mumisika dzavo dze inshuwarisi. Kubhadhara kwaIowa kwaizove kwakashandura hurumende yega yega, asi Oklahoma yaizogadzira purogiramu yekudzorera uye nyika inotarisirwa ichitevera izvozvo nehuwandu hwemangwana 1332 maiver kushandura zvakanyanya. Asi zvose zvakasununguka zvigadziriswa zvakabviswa nehurumende apo zvakazoonekwa kuti vakanga vasingazobvumirwi munguva yekuita mutsauko pamarimariyamu 2018.
Mashoko ezvese gumi nemakumi mapfumbamwe nemakumi matatu nemakumi matatu nemakumi maviri nemakumi matatu nemakumi maviri nemakumi maviri nemakumi mashanu nemakumi mashanu nemakumi mashanu nemakumi mashanu nemakumi mashanu nemakumi mashanu nemakumi mashanu nemakumi matanhatu nemakumi matanhatu nemashanu.
Uye kune dzimwe nyika dzakawanda dziri kutarisa 1332 waiver, uye dzakagadza mutemo kuti utange matanho, kana kuti yakagadzira pachena 1332 waiver zvirongwa. Tarisira kuti uone zvakawanda zveizvi muna 2018.
> Sources:
> Centers for Medicare neMedicaid Services, Center for Consumer Information and Insurance Oversight. Chikamu 1332: State Innovation Waivers.
> Cornell Law School, Legal Information Institute. 42 US Code ยง 18052 - Waiver for State innovation
> HealthCare.gov. Verengai Mutengo Wakanaka Wenyu.
> Howard, Heather. Robert Wood Johnson Foundation. Dzimwe Sates Kutarisa kune Chikamu 1332 Waivers. November 6, 2017.