Vatengi Vagamuchira Bhiriyoni Yemadhora MuMLR Inoshandiswa
The Affordable Care Act, yakagadzwa muna 2010, yakaita shanduko dzakawanda kumitemo inoshandiswa kune utano hwehutano inshuwarheni. Chimwe chezvinhu izvozvo chaiva mutemo unotungamirira purogiramu yemayero emari ayo makambani einishuwarenzi aifanira kupedza painyorese 'mari yezvechiremba, zvisinei nekutarisira mari.
Pamberi peAACA, makambani einishuwarenzi aigona kuisa mazano avo.
State inshuwarisi vemapurisa yaizoongorora premium justification iyo inshuwarisi yakarongeka, kunyange zvazvo kubvunzurudza kwacho kwakanga kusiri nguva yakasimba. Uye kana inshuwarisi yaive yakanyanyisa mari yekushandisa mari, kwakanga kusina zvakawanda munzira yekushandisa vatongi kana vatengi.
Asi ACA yakagadza chirwere chekurasikirwa chikwata (MLR) chinodiwa, chinotsanangura huwandu huwandu huripo hwemaimariyamu ayo inshuwarisi anogona kudhura pamari yekutarisira. Mumakaka makuru eboka, vatengesi vanofanira kupedza makore makumi mapfumbamwe nemakumi mashanu emadhora ekurapa mari uye utano hwehutano hunovandudzwa . Mune misika yemukati uye yeboka duku, chikumbaridzo chinenge 80 muzana. Saka vatsigiri vanogona kushandisa mari yepamusoro 15 kana 20 muzana yemari yezvikwereti pamari yekutarisira (zvichienderana nokuti chirongwa chacho chinotengeswa mumusika mukuru weboka, kana mumushamba weboka rimwechete uye mushoma), uye mamwe ose ehurumende yepayimari iyo iyo inshuwarisi inounganidza inofanira kushandiswa pamashoko ekurapa uye zvinhu zvinowedzera hutano hwehutano hwevarwere.
"Boka Guru" rinowanzoreva mainishuwarenzi anotengeswa kune vashandi vane vanopfuura 50 vashandi. Asi muCalifornia, Colorado, New York, uye Vermont, zvirongwa zveboka guru zvinotengeswa kune vashandi vane vashandi vanopfuura 100, sezvo mushamba muduku weboka mumatunhu iwayo unosanganisira vashandi vane vanosvika zana.
Chii chaive Mupepeti MLRs Isati ya ACA?
Mitemo yeAACA yeMLR yakatanga kushanda muna 2011. Isati yaitika, inenge zvikamu zviviri kubva kune zvitatu zvevashandi vezvekuchengetedza mabhadharo vakanga vatova kutoshandisa huwandu hwenhengo dzavo dzemakambani pamitauro yezvokurapa, asi pakanga pasina nzira yekugadzirisa iyo yakanga isina ' t.
Uye yakasiyana zvikuru kubva pamusika mumwe kune imwe. Maererano neHurumende Accountability Office kuongororwa, 77 muzana yemakwikwi makuru emakambani uye makumi manomwe kubva muzana yevatsigiri vekidiki vechechi vakanga vatotanga kusangana nemitemo itsva yeMLR muna 2010 (vasati vashanda), asi 43% chete yevashandi vezvemisika vaitengesa 80 muzana yemari yepamusoro pamari yezvokurapa gore iroro. Uye maererano neCMS data, 45 kubva muzana yevanhu vane mararamiro emakisi yeruzhinji muna 2010 vakafukidzwa nezvigadziro zvaive zvichishandisa zvikamu makumi maviri ne25 kubva muzana yemari yemari pamari yekushandisa mari.
Zvakakosha kucherechedza pano kuti vanenge 7 kubva muzana veAmerica vane ruzivo mumusika mumwe nomumwe, asi 49 muzana vane huwandu mumisika yavanoshandira, kusanganisira vashandi vakuru nevaduku.
Mari dzomutungamiri dzakagara dzakaderera apo bhizinesi inogona kuvhara hupenyu hwehupenyu nehumwe hurongwa hwekutenga.
Ndicho chikonzero mitemo yeMLR yakanyanyisa kune vatsigiri vemazana makuru kune boka duku uye vatsigiri vemisika.
Iko MLR Inoteerera Sei Kumanikidzirwa?
Mitemo yeAACA yeMLR inoshandiswa kune zvirongwa zvakakwana zvakachengetedzwa mumunhu mumwe chete, boka duku, uye mabhizimusi makuru emapoka, kusanganisira zvikwata zvekurukure uye zvakakura. Asi hazvirevi kune zvirongwa zvehupfumi huripo (hukuru hwevashandirwi, ivo vanowanzove ivo vanozvitsigira, panzvimbo yekutenga kuvharwa kwevashandi vavo; 61 muzana yevashandi vose vane basa rakashandiswa nevanoshandira vanovharwa pasi pega-inshuwarisi zvirongwa).
Nenguva yaJuly 31 gore roga rega, vambisi vezvemishumo vanoparidza kuCMS nemashandiro avo emari uye mari yegore rinopfuura.
Vatsigiri vanoonekwa sevakasangana neMLR zvinodiwa kana vakashandisa zvinenge 85 kubva muzana zvemazana emakambani makuru emakambani ekurapa uye kuvandudzwa kwehutano, uye 80 muzana yeboka duku uye mapeamisi emakisi ega ega nezvekurapa uye kuvandudzwa kwehutano.
Vatsigiri vasiri kusangana nezvinangwa izvi vanofanira kutumira maranho kune vatsigiri vemitemo, zvichida kuvabhadhara ivo kune zviyero zvemaripo yakange yakakwirira kwazvo. Zvakatarisirwa neMLR zvakatanga muna 2011, uye chekutanga chekubhadharwa kwekutora zvakatumirwa muna 2012. Kubvira muna 2014, zvikwereti zvekubhadhara zvakagadziriswa kubva kune insurer yemakore matatu emusorosoro weMLR, panzvimbo yeMLR yegore rokutanga.
HHS inogona kuisa mvumo yemari kune vatsigiri vehurumende vasingatauri MLR data, kana kuti isingateereri zvido zvekuburitswa.
Ndivanaani Vanowedzera Kudzora?
Muna 2017, vanhu vanosvika mamiriyoni 3.9 vakagamuchira mhinduro dzeMLR, zvichibva pamakambani avo einishuwarenzi, kana kuti vakapfuura kuburikidza nevashandi vavo. Izvo chete inenge 1.2 muzana yevanhu veUnited States, saka vanhu vazhinji vari kuwana MLR inoputsika. Zvechokwadi, iyo ACA yaMLR inotonga inoshanda chete kune zvikwereti zvakakwana zvakashandiswa nevashandirwi uye zvirongwa zvemakethe. Havana kushanda kumagadzirirwo evanhu vakazvipira, kana kuMedareidhi uye Medicaid, iyo inotakura chunk yakakura yevanhu (asi kune maMeri mitemo yakasiyana yeMedare Advantage uye Chikamu D D, uye nezvezvirongwa zvekuchengetedzwa kweMedicaid ).
Asi kunyange pakati pezvirongwa zvehutano izvo zviri pasi pemitemo yeAACA yeMLR, vazhinji varikuteerera uye haafaniri kutumira chekiti chekutsvaga. Uye kutevedza kwave kuri nani nekufamba kwenguva. 95 kubva muzana yevanhu vane mararamiro ehutano hwemakethe aive akafukidzwa nezvirongwa zvakasangana neMLR zvinodiwa muna 2016 (kunze kwe 62 peresenti ye nhengo muna 2011). Mumakethe makuru eboka, 96 muzana yevanyorese vari mune zvirongwa izvo zvakasangana nemitemo yeMLR muna 2016, uye mumusika wemapoka maduku, 90 muzana yevanyori vakanyatsogadziriswa nezvirongwa zveMLR-zvakakwana muna 2016.
MLR rebate yakabva kune bhizinesi rese bhizinesi mubato rega rega rega (boka guru, uye munhu / boka duku). Saka hazvibatsiri kuti zviyero zvepurayamisi yako zvakashandiswa pamari yako yezvechiremba, kana kuti zviyero zvezana remari yako yevashandi zvakashandiswa pamari yeboka rose rekurapa. Zvinonyanya kukosha ndeye kana zvikwereti zvose zve inshuwarisi zvayo zvakabatanidzwa, uye zvichienzaniswa nehuwandu hwehuwandu hunopedzerwa nemubhizimisi pamari yekurapa uye kuvandudzwa kwehutano.
Zviri pachena kuti zvingasazoshanda kutarisa MLR pane imwe nzvimbo, sezvo munhu anogara ane utano gore rose angangova nemadhora mashomanana emadhora muzvikwereti, zvichienderana nemadhora mashomanana emadhora, apo munhu anorwara zvikuru anogona kunge ane mamiriyoni emadhora muzvikwereti, achienzanisa nemamwe mashoma madhora madhora muzvikwereti. Izvo zvose zvinotsigira inshuwarheni ndeyokuvhara dambudziko revanhu vose kuburikidza nehuwandu hwevanhu vanoita bhizinesi, saka ndiyo nzira iyo MLR inotonga inoshanda, zvakare.
Mune misika yemunhu mumwe nomumwe, vatsigiri vasiri kusangana neMLR zvinoda kutumira rubatsiro rwekubhadhara zvakananga kune umwe neumwe wezvikwata. Asi mumakambani anoshandiswa nevashandirwi (boka guru neboka duku), inshuwarisi inotumira ruregerero chekutsvaga kumushandi. Kubva ipapo, mushandirwi anogona kugovera mari yekunyora, kana kushandisa shanduro yekuderedza mitambo yemunguva yemberi kana kuvandudza mazano kune vashandi.
Mhinduro dzeMLR hazvirevi kuteresa, asi kune dzimwe mamiriro ezvinhu mavari (kusanganisira mamiriro ezvinhu umo vanozvinyora vanozvidzivirira vanobvisa purogiramu yavo pamutero wavo wemutero). IRS inotsanangura mutero wekuregererwa kweMLR kuno, pamwe nemuenzaniso mimwe mienzaniso.
Zvikamu Zvipi Zvakaputika?
Zvose zvikwereti zvaive zvakakwirira zvikuru kune 2011 kupfuura zvave zvichive mumakore akatevera, apo vambisi vezvemishonga vakashandisa mitemo mitsva. Gore rega roga, CMS inoparadzira mashoko anoratidza huwandu hwekubhadharisa mari uye zviyero zvekubhadhara kwemhuri muhurumende imwe neimwe yakagamuchira zvikwereti. Mumakore matanhatu ekutanga, MLR yakaputsika yakadzoka ne $ 3.24 mabhiriyoni kune vatengi:
- $ 1.1 biliyoni gore ra2011 (zvikwereti zvakatumirwa muna 2012)
- $ 504 mamiriyoni muna 2012 (zvikwereti zvakatumirwa muna 2013)
- $ 333 Mamiriyoni muna 2013 (mabhadharo akatumirwa muna 2014)
- $ 469 Mamiriyoni muna 2014 (mabhesi akatumirwa muna 2015)
- $ 397 Mamiriyoni muna 2015 (zvikwereti zvakatumirwa muna 2016)
- $ 447 Mamiriyoni muna 2016 (kubhadhara kwakatumirwa muna 2017)
Muna 2017, munhu wega wega akawana rubatsiro rweMLR akawana $ 113, asi yakasiyana zvikuru kubva kune imwe nyika kuenda kune imwe. Vanhu vomuCalifornia avo vakawana zvikwereti vakagamuchira chikamu che $ 599, nepo vanhu vane gumi nevatanhatu vasina hupfumi zvachose, nokuti vese ve-inshuwarisi munyika idzodzo vakasangana neMLR.
Vashandi vanopedza mwedzi yakawanda gore roga roga vachiona kuti zviyamu zvadzo zvinokonzerwa nei gore rinouya, uye iyo inorongedzwa mitero inowanikwa kaviri nehurumende nehurumende. Asi zvido zvehutano zvinogona kuchinja zvakanyanya kubva kune rimwe gore kusvika kune rinotevera, uye zvirevo izvo vashandi vanoshandisa hazviwanzopedzi kuva yakarurama. Saka kuregererwa kweMLR kunoshandiswa secheperi, kana vatsigiri vekugadzirisa vanopedzisira vasingadi kupedza 80 muzana (kana 85 muzana mumusika mukuru wemapoka) emishandirapamu pane mari yezvehutano uye kuvandudzwa kwehutano.
Semuenzaniso, muna 2017, apo bhizimisi vaiisa mitero yemumwe mutengesi wegore ra2018, kwaive nekusava nechokwadi kwakanyanya maererano nehutungamiri hweTrump yaizoenderera mberi kupa hurumende mari yekudhura kugovana mari (CSR). Pakupedzisira, Mutungamiri akagumisa mari iyo, asi chisarudzo ichocho chakauya masvondo mashomanana vasati vanyora vanyora, uye mitero muhurumende dzakawanda yakanga yatotangwa. Vatsigiri vanoongorora muzviitiko zvakawanda kuti vachinje mararamiro avo mumazuva anoita kuti vanyori vabudise, asi vazhinji vezvematongerwo enyika vakanga vatotaurira vatsigiri vekuchengetedza kuti vatsigire matanho avo pamusana pekufungidzira kuti CSR mari ichagadziriswa, nemitengo yepamusoro yekuchengetedza iyo yaizoshandiswa kana iyo haina 's kuguma kuva mhaka.
Asi muLouisana, vatongi vanoona munaSeptember 2017 (mwedzi isati yasvika CSR mari yakabviswa nehurumende yehurumende) iyo vatsigiri vehurumende munyika vakapa mazinga zvichienderana nekufungidzira kuti CSR mari ichapera, uye pakanga pasina purogiramu yekuchengetedza panzvimbo yekugadzirisa iyo iyo mitero kana hurumende yehurumende yakasarudza kuramba ichipa CSR mari kune vatsigiri. Pane kudaro, hurumende yakatsanangura kuti mitemo yeMLR ingashandiswa kuigadzirisa gare gare, pamwe nevanyori vanogamuchira zvikwereti kubva muna 2019, kana vakaguma vane mari mbiri yeCRR (kuburikidza nemari yepamusoro yepamusoro uye pamwe chete nehurumende yemari).
Pakupedzisira, izvo hazvina kuitika, sezvo CSR mari yakabviswa zvechokwadi. Asi nzira yeLouisana kumamiriro acho muenzaniso wekuti mitemo yeMLR inogona kushandiswa sei kuvimbisa kuti vatengi vanozopedzisira vakachengetedzwa mumamiriro ezvinhu apo hazvina chokwadi kuti zvirevo zvichaguma sei zvichifananidza ne premium revenue.
Ko Dhemocrats 'Health Care Reform Proposals Ichachinja MLR Mitemo?
MunaMarch 2018, Sénatrice Elizabeth Warren (D, Massachusetts) akaunza Mutengi weEvenus Health Insurance Protection Act , chinangwa chekusimudzira uye kuchengetedza hutano hwehutano hwevatano. Chikamu chokutanga chemutemo chinoti kuwedzere kudiwa kweMLR pamakethe emunhu mumwe nomumwe uye maduku kusvika kumazana 85, zvichiita kuti zvienderane nezvinodiwa neboka guru riripo.
Uyu mutemo unobatanidzwa pamwe chete nevakawanda vakakurumbira veSenate Democrats, kusanganisira Maggie Hassan (New Hampshire), Bernie Sanders (Vermont), Kamala Harris (California), Tammy Baldwin (Wisconsin), naKirsten Gillibrand (New York). Asi hazvishamisi kuwana ruzivo muCongress kusvikira kana uye apo Democrats ine vazhinji.
Nokudaro kwenguva iyo iri, mitemo yeMLR yemazuva ano inogona kuramba iri panzvimbo. Asi Muteresi Health Insurance Protection Act inoshanda semugwagwa wekuti maDemocrates angada kuenda kana vakadzoka zvakare, saka zvinoita kuti tikwanise kuona zvipingamupinyi zvakanyanya kune vatsigiri vehupfumi mumakore anotevera. Kuti zvive zvakajeka, vazhinji vevareji, kunyanya mumusika mumwe nomumwe, vakave neMLRs zvakanaka kupfuura makumi mapfumbamwe nezana mumakore mashoma apfuura. Zvimwe zvave zvichinyanyisa 100 kubva muzana, izvo zviri pachena kuti hazvigoneki uye chikamu chechikonzero chekubhadharwa kwepayimusi kwawedzera zvakanyanya mumunhu mumwe chete-vatengesi vangave vasingakwanise kushandisa mari kune zvido kupfuura zvavanowana muzvikwereti.
Asi kune vamwe vatsigiri vese, kushandurirwa kune imwe yepamusoro yeMLR inowanikwa mumakethe ega uye eboka maduku kungavamanikidza kuti vanyatsobudirira. Kune rumwe rutivi rwemari, zvisinei, vanhu vanopikisa kuti mitemo yeMLR haiiti kuti vatsigiri vekuchengetedza vamanikidze kuisa dambudziko kuvarapi vezvokurapa (zvipatara, vanachiremba, vanogadzira zvinodhaka, nezvimwewo) kuderedza mari yakawanda sezvo zvikwereti zvingangokurudzirwa kuchengetedza zvichikwira nekuwedzera kweutano hwekutarisira mari. Vatsigiri vanofanirwa kushandisa mari yakawanda yevhizimisi idzodzo pamari yezvokurapa, asi kune vashandi, mari yepurayamendi inogona kuramba ichikwira pamatambudziko asingakwanisi kubhadharwa pasina kubhadhara mari.
> Sources:
> Centers for Medicare neMedicaid Services. Nzvimbo yeVatengi Ruzivo uye Inishuwarenzi Kutarisa. Kurasikirwa Kwechiremba.
> Centers for Medicare neMedicaid Services. Chidimbu che 2016 Chirwere Chekurasikirwa Chikafu Chibereko . Yakapikiswa uye Yakabudiswa muna 2017.
> United States Government Accountability Office. Tsamba yeKomiti Komiti yeZvondo neVashandi. Private Health Insurance: Zviratidzo Zvokutanga Zvinoratidza Kuti Vadiresi Vakawanda Vangadai Vakagadzirisa kana Kupfuura Nhepfenyuro Mutsva Yokurapa . Gumiguru 31, 2011.
> Warren, Elizabeth. Senate.gov. Consumer Health Insurance Protection Act . Yakagadzirwa March 2018.