Mutungamiri Wenyu kune Mamiriro Ekufanovapo-neMitemo Inokudzivirira
Vazhinji veAmerica vane zvinetso zvehutano izvo makambani einishuwarenzi anogona kurondedzera semamiriro akambovapo . Chimwe chiitiko chisati chavapo chiri chirwere chehutano chiripo musati maisa mapurogiramu ehutano yehutano kana kunyora mune chirongwa chitsva chehutano.
Pakupera kwezuva racho, makambani einishuwarenzi ega uye zvirongwa zvehutano mabhizimisi anotarisa pamatambudziko avo.
Izvo zviri mukuda kwavo, saka, kusarudza vanhu vane mamiriro ezvinhu akagarapo, vamanikidze nguva yekumirira vasati vatanga kugovera kana kutengesa zvikwereti zvepamusoro uye kunze kwemari yezvokubhadhara kuti vafukidze vanhu vane mamiriro ezvinhu akambovapo, sezvo vanhu avo vangangodaro inodhura iyo inshurensi mune zvezvinodhurira mari. Asi zvigadziro izvi hazvidiwi, uye zvinowedzera zvakaoma kuti vanhu vawane hutano hwehutano, ndicho chikonzero mitemo yakasiyana-siyana nehurumende mitemo yakagadzirisa nyaya iyi mumisika zhinji yveshuwarenzi.
Chimwe chiitiko chekare chiripo chinogona kuva chinhu chakajairika sehuwandu hwehutano hweropa kana kushaya mitezo, kana seyakakomba sekenza, rudzi rwechipiri chirwere cheshuga , kana zvirwere zvehutano zvechirwere zvinokanganisa chikamu chikuru chevanhu.
Kusati gore ra2014, munyika dzakawanda , imwe marongerwo ehutano hwehutano (rudzi rwaunotenga iwe, kunze kwekuwana kubva kune waunoshandira) rinogona kuramba kuparidzirwa chero chipi zvacho chakabatana nemamiriro ako akagara akambovapo, anokubhadhara miriyamisi yakakwirira zvichienderana nehutano hwako , kana kunyange kuramba chikumbiro chako zvachose.
Uye kana iwe uri kunyora muurongwa hwemushandirwi, iwe wakatarisana nenguva yekumirira maitiro ekugadzirisa mararamiro akadai kana iwe usina kunge wakaramba uchivhara mberi usati wanyoresa muurongwa hutsva.
The Affordable Care Act uye Zvirongwa Zvisati Zvavapo
Chimwe chezviratidzo zveMurwere Kudzivirirwa uye Affordable Care Act rakasimbiswa kuva mutemo muna March 2010, kwaiva kubviswa kwezvakaitika kare izvo zvinotarisirwa nezvirongwa zvehutano.
Kubudirira kubva munaSeptember 2010, vana vasati vava nemakore 19 vane mamiriro ekutanga asati asvika havakwanisi kurambidzwa kuwana chirongwa chehutano hwevabereki vavo , uye makambani einishuwarenzi vakanga vasingachabvumirwi kusabvisa mamiriro ezvinhu akambovapo kubva pakubatanidzwa kwehutano hwemwana.
Uye kutanga munaJanuary 2014, zvose zvirongwa zvehutano zvitsva (zvose uye zvekare -zvinoshandiswa ) zvinotarisirwa kuti zvive nechokwadi chekuita, izvo zvinoreva kuti mamiriro ezvinhu akagara asati agone haakwanise kutariswa paanofunga apo anenge akanyorwa anyoresa. Zvikomborero zvinogona kungosiyana zvichienderana nezera, zip code, kushandiswa kwefodya, uye ukuru hwemhuri. Saka munhu ari pakati pekurapwa kwemukenza achabhadhara premium yakafanana neyezera ravo-muvakidzani uyo ane utano hwakakwana, uye kurapwa kwekenza kuchafukidzwa neurongwa hwehutano hutsva.
Gare gare munyaya ino, tichatarisa pane zvingashandurwa pasi peTrute Administration. Asi kutanga, ngatitarisei kuti mamiriro ezvinhu akavapo sei akamboshandiswa kusati kwaitwa maAACA kuchinja:
Iyo Pre-ACA Pre-ACIFI Mamiriro Ako Kusagadzikana
Pre-ACA, mamiriro ezvinhu akambovapo anogona kuchinja hutano hwehutano hwehutano . Kana iwe uri kubvunza yunishuwarenzi mumusika wega wega, mamwe makambani ehutano yehutano achakubvuma iwe nemamiriro ezvinhu nekupa nguva yakagara iripo nguva yekuregererwa, kana kubviswa zvakakwana pamamiriro ezvinhu aimbovapo.
Kunyange zvazvo urongwa hwehutano hwakakagamuchira iwe uye iwe waive uchibhadhara miriyamisi yako yemwedzi, iwe haungave wakave nehupfumi chero hupi nehanya kana hutano hwakabatana nemamiriro ako akagara akambovapo. Zvichienderana nemitemo uye yehurumende yehurumende yemainishuwarenzi, nguva iyi yekudzivisa inogona kubva pamwedzi mitanhatu kusvika pakusunungurwa zvachose.
Zvimwe zvirongwa zvemisika
Semuenzaniso, Lori aiva nemunyori wemakore makumi mana nemashanu (40-year-old) munyori wekuzvipira, kuwana hutano hwehutano mu-pre-ACA pamusika mumwe nomumwe. Ane ropa rakanyanya rakamanikidzwa rakanyatsochengetedzwa pamishonga miviri. Akasarudza kutenga yake yehutano inshuwarisi iyo yaisanganisira kushandisa mishonga.
Iyo chete yehutano yehutano yehutano yaaiwana yaive nemwedzi wegumi nemasere kubva pakusuruvara kweropa rake. Kwemwedzi gumi nembiri yekutanga, maitiro ake ose (kusanganisira chiremba anoshanyira uye mishonga) yakabatana nehuwandu hwemhepo yakanatswa. Zvisinei, mukati megore rokutanga rokuvhara, akawanawo chirwere uye urinary tract infection, zvose zviri zviviri zvakavharwa zvachose nokuti dzakanga dzisati dzavapo.
Kunyange zvazvo nguva dzenguva isati dzavepo dzakasara dzisati dzashandiswa, dzaive dzakajairikawo kuona chigarire chisati chavapo chiripo chisingawanikwi muhutano hwehutano inshuwarheni. Pasi pezvakagadziriswa, mamiriro ezvinhu aimbovapo aisazombovharwa neurongwa. Munhu akavhuna ruoko muchiitiko chechando chechikepe mumakore ake evechiri kuyaruka uye akapedzisira ane tsvimbo yekotani mumaoko ake angave akapiwa urongwa mumusika mumwe oga gare gare, asi nekuregererwa zvachose pane chero chipi zvacho chine chokuita ne "kugadzirisa mukati" (kureva., tsvimbo uye chero ipi zvayo yakagadzirwa) muruoko rwake.
Nenguva iyo ACA yakagadziriswa, mamiriro ezvinhu aimbovapo asati asvika, uye kunyorwa kwekunyora kwekuwedzera kwakatora nzvimbo yavo kakawanda. Saka mune muenzaniso waLori, pamusoro apa, kambani yveshuwarhu yehutano ingadaro yakabvumirana kuvhara Lori zvakakwana (kusanganisira iyo yerupemheta), asi nekambani yaive ye 25 muzana kana 50 muzana yakakwirira kudarika chiyero cheumwe munhu ane makore.
Iye zvino sezvo ACA yakashandiswa, mamiriro ezvinhu akambovapo haasisiri chinhu mukutengesa kana kukodzera, uye inishuwarenzi hazvibvunzizve nezvezvenhoroondo yezvehutano apo vanhu vanyoresa.
Vashandi-vakagadzirirwa zvirongwa
Kana iwe uri kuwana inshuwarisi mubasa rako , zvichienderana neushandi wako uye zvirongwa zvehutano zvaunopiwa, iwe unogona kunge wakave nenguva yekuregererwa kwekare. Zvisinei, nguva yekuregererwa yaive yakareba kumwedzi gumi nemaviri (mwedzi gumi nemana kana iwe wakanyoresa muchirongwa chehutano) uye wakashandisa chete kuhutano hwawakatsvaka kurapwa mumwedzi mitanhatu usati wanyoresa muurongwa hwehutano (izvi zvinodzivirirwa zviri pasi pashandi -kuronga zvirongwa zvehutano zvaive zvichibva kuHIPAA, yakurukurwa pasi apa).
Semuenzaniso, Mike ane makore 34 akawana basa idzva mushure mekusashanda uye asingabatsiri kwenguva inenge gore. Kambani yake itsva yakabvumira vashandi kuti vabatane muurongwa hwehutano hwavo pakuguma kwekubhadhara kwekutanga. Mike akanga ane urombo hwakanaka uye akaramba achikuvadza mabvi achitamba basketball paaiva nemakore makumi maviri. Asi mumwedzi mitanhatu isati yasvika panguva yaakanyorera urongwa hwehutano hwemushandi, akanga asina chiremba anoshanyira uye haana kutora chero mishonga. Akange asina kuisa pasi, saka, kune imwe nguva yekuregererwa nokuda kwemamiriro ake ezvinhu aimbovapo. Nguva pfupi mushure mekunge atanga kushanda, chirwere chake chakasuruvara, asi akafukidzwa zvakakwana nokuda kwehutano hwake hwehutano hwakasangana nokuti hwakanga husingafungi kuti hwakagara huripo sezvo akanga asina kupiwa mushonga uyu mumwedzi mitanhatu isati yanyoresa muchirongwa chaanoshandira.
Iye zvino sezvo ACA yakashandiswa, haisisiri basa kana Mike akanga aine chinyorwa asati asangana neurongwa hwake hwevashandi, kana kuti aitsvaga kurapwa chero mishonga chero ipi zvayo mumwedzi asati asangana neurongwa-mamiriro ake akagara aripo akafukidzwa nzira.
HIPAA uye Chikwereti Chakanaka
Muna 1996, Congress yakapa Health Insurance Portability uye Accountability Act (HIPAA), mutemo unopa kukudzivirira kwakanyanya kwauri nevemumhuri yako, kunyanya paunenge uchinyora mugadziro inopiwa nemushandi. Izvi zvinodzivirira zvinosanganisira:
- Mienzaniso pamusoro pekushandiswa kwemamiriro ezvinhu akagara asati awanikwa kunze kwezvirongwa zvehutano zvakashandiswa nevanoshandira.
- Kunodzivirira vashandirwo-vakatsigirwa zvirongwa zvehutano kubva pakusarura iwe nekukuramba iwe kuvhara kana kukuridzira zvakawanda pamusoro pekuparidzirwa zvichienderana nezvinetso zvehutano hwemhuri yako kana yemhuri.
- Kazhinji vanovimbisa kuti kana iwe ukatenga utano hwehutano inshuwarheni, unogona kuwedzerazve kugovera kwako pasinei nemamiriro ezvinhu ehutano mumhuri yako.
Kunyange zvazvo HIPAA isingashandisi mumamiriro ezvinhu ose, mutemo wakaita kuti zvive nyore kuti vanhu vachinje kubva pane imwe chirongwa chehutano chakashandiswa nevanoshandira kune mumwe, pasinei nezvakaitika kare.
Uye kunyange zvazvo HIPAA kudzivirirwa kwaisazoendesa kune mumwe munhu pachake pamusika, dzimwe nyika dzainge dzatora mitemo yaibvumira HIPAA-vakakodzera kuti vatenge kutenga yakavhiringidzika nyaya inotengeswa mumusika mumwe nomumwe (HIPAA-inokodzera inoreva kuti munhu wacho aive nemwedzi gumi nemasere ekubhadhara chikwereti pasina chinyorwa chemazuva anopfuura makumi matanhatu nemasere, uye kuparidzirwa kwemazuva ano kwakange kuri pasi peurongwa hunobhadharwa nevashandirwi, chirongwa chehurumende, kana chirongwa chechechi; zvakare, munhu wacho anofanira kunge akapedza COBRA kana iripo, uye haikwanisi kukodzera kana Medicare kana Medicaid).
Asi mune dzimwe nyika, pamberi pegore ra2014, kana HIPAA-vanhu vakakodzera vaida kutenga yavo yehutano inshuwarheni uye vaiva nemamiriro ezvinhu asati avapo, ivo chete chete-yakasarudzwa-chisarudzo chaiva nzvimbo yepamusoro-pangozi yehurumende .
Kunyange zvazvo Trump Administration neRepublicans muCongress vakaedza kubvisa uye kuchinja ACA muna 2017, uye vangaramba varipo iyo kana vachichengetedza hukuru hweRubansan muCollection mushure mekusarudzwa kwe 2018, kubviswa kweAACA hakuzovi neHIPAA, iyo yakatotanga ACA kwemakore anoda kusvika makumi maviri .
Chikwereti Chine Chikwereti
Chimwe chinhu chinokosha cheHIPAA chinozivikanwa sechikwata chekubhadhara . Kuvharidzirwa kunokweretesa ndeyehutano hwehutano hwehutano hwakanga uine iwe usati wasvika pakanyoresa urongwa hwako hwehutano hutsva, chero bedzi usina kukanganiswa nenguva ye 63 kana kupfuura mazuva. Nguva yakawanda yawakanga uine "chikwereti" yehutano yveshuwarenzi yekugadzirisa inogona kushandiswa kukanganisa kusati kwavapo kune nguva yekuregererwa kwenguva muurongwa hwako hutsva hwehutano hwakabhadharwa, pamberi peAACA yakabvisa nguva yakagara isipo yekusadzingwa nguva.
Nheyo yepamusoro: Kana waive nemwedzi gumi nemana yehutano hwehutano hwehutano pamabasa ako apfuura uye iwe wakanyoresa hurongwa hwako hutsva hwehutano husingashandisi pasina mazuva makumi matanhatu kana kupfuura, chirongwa chako chitsva chehutano hachikwanisi kukuisa pasi pepakutanga. iripo mamiriro ekuregererwa. Uyu mutengi kudzivirirwa akanga atovapo pamberi pe ACA, uye kuedza kubvisa uye kusimbisa ACA hakuzogadzirisa urongwa uhwu, sezvo ichi chikamu cheHIPAA pane ACA.
Semuenzaniso, Greg akasarudza kuchinja mabasa kuti ave nemikana yakanaka yekusimudzira. Akashanda nemumwe muchengeti uye akawana basa idzva, iro raakatanga mavhiki maviri mushure mekusiya kubva panzvimbo yake yekare. Basa rake idzva rakapa inshuwarisi yehutano yakafanana, inowanikwa mushure memwedzi wokutanga webasa, uye akanyora muurongwa hwemhuri. Kunyange zvazvo Greg aine hutano hwakanaka, mudzimai wake aiva nerudzi rwechipiri rwechirwere cheshuga uye mumwe wevana vake aive nechirwere cheputi.
Greg akanga akashandira kambani yake yekare kwemakore maviri, panguva iyo mhuri yake yakafukidzwa pasi peurongwa hwemushandi uyu. Akanga asina kuparidzirwa mukati memavhiki maviri ainge ari pakati pemabasa, uye pamwedzi wokutanga webasa rake idzva, asi nguva yake isingasimbiswi yaiva pasi pemasikati makumi matanhatu. Saka pasinei nehutano hwehutano hwakagara huri mumhuri yake, urongwa hweGrath hwehutano hwakanga husingakwanisi kuisa mamiriro ekutanga asati asvika.
Iye zvino sezvo ACA yakashandiswa, muchengeti waGreg haakwanisi kuisa mamiriro ekugadzirira kwenguva yakatarwa kune chero vanyori vatsva, zvisinei nehuwandu hwezvehutano kana hutano hwehutano hwehutano.
Mamiriro Ekutanga akavapo uye Trump Administration
Mutungamiri Trump akatsigira chivimbiso chokubvisa uye kutsiva ACA. Akatora hurumende nehuwandu hweRepublican muHarare neSeneate, uye vatongi veRepublican vakanga vamanikidza kubviswa kwe ACA kuburikidza nehupfumi hwaB Obama Administration.
Asi kana chokwadi chekutsvaga chakanga chiripo, vatungamiriri veRubbublican muCongress havana kukwanisa kutora rubatsiro rwakakwana kuti vapfuure chero ipi zvayo yeAACA kubvisa zvikwereti izvo zvaionekwa muna 2017. Imba yakapfuudza America Health Care Act kubvisa zvikamu zve ACA, asi mimwe mitauro yemutemo yakakundikana kupfuura muSénate kuitira kuti chiyero chisati chagadziridzwa.
IAACA haina kubviswa
Pakutanga kwa2018, chirongwa chega chaAACA chakanga chakabviswa chaiva chirango cheumwe munhu, uye icho chinodzokorora hachina kutora kusvikira muna 2019. Vanhu vasina kubvumidzwa muna 2018 vachiri pasi pekutongwa, asi avo vari uninsured muna 2019 uye nechekunze haazogoni kutarisana nechirango, kunze kwekuti nyika yavo ikashandise imwe (Massachusetts yakatova nemvumo yega yega pamberi pe ACA; DC iri pedyo nekuita chimwe chete, uye dzimwe dzakawanda dzinogona kutevera sutu).
Mamwe emitero yeAACA (mutero wemichina yezvokurapa, mutero weCadillac, uye yehutano yemishuwarisi yemutero) yakanonoka kumavambo 2018 pasi pekugadzirisa kusarudzwa kwemari, asi hazvina kubviswa.
Uye zvose zvekuchengetedza vatengi vaAACA, kusanganisira zvigaro zvine chokuita nemamiriro ezvinhu akambovapo, hazvina kusimba kubva muna 2018. Kutaura zvazviri, kwaiva kuunganidzirira kuchema pamusoro pekuvapo kwehutano hwematambudziko akaparadza kuparadza kwe ACA muna 2017, nemamiriyoni evanhu kutaurirana nevatongi uye kuratidza kunetseka kuderedza kana kubvisa ACA kwaizotidzorera kumazuva ehutano huripo huripo huripo uye mibvunzo yezvechirwere yepirusi inobvunza nezvehutano hwehutano.
Zvirongwa zvisingabatanidzi mamiriro ezvinhu akambovapo zvinogona kuva zvakanyanya muna 2018 uye mberi
Nokuti nguva iripo, ACA haina kunyatsogadzirisa uye hurumende huru yekuedza kubvisa uye kuidzosera iyo yakanyanya kuiswa. Izvozvo zvinogona kuramba zviripo kusvikira mushure megore ra2018, uye remangwana rezvinyorwa zvakadaro zvinotarisana zvikuru pamusangano wezvematongerwe enyika weCongress mushure memavirira.
Asi Mutungamiri weTrump ari kushanda kuti ashandise mitemo mitsva inozoita kuti kusava neAACA-yakakwana kugoverwa kwehutano kuwanikwe. Izvi zvinosanganisira kuronga zvirongwa zvehutano zvemabhizimisi maduku uye vega proprietors, uye zvirongwa zvehutano zvenguva pfupi zvevanhu.
Nekuwedzerwa kushandiswa kwehurongwa hwehutano hwehutano hwakasarudzirwa , hwakasarudzwa neHurumende Inotonga kutanga kwegore ra2018 , mapoka maduku uye vanhu vanozvishanda vanogona kuwana kugoverwa pasi pemitemo mizhinji yeboka, iyo inonyanya kusununguka kupfuura boka duku nemitemo yemakethe pamusana pokuteerera ACA. Maererano nemamiriro ezvinhu akambovapo, mapoka makuru emapoka haafaniri kusanganisira kugoverwa kwezvinhu zvose zveAACA zvinokosha zvehutano , uye mabhizimisi makuru eboka anogona kugadzirisa purogiramu mumatongerwo emapoka eboka, izvo zvisingabvumirwi mumakambani ega kana kuti maduku maduku .
Uye kana mitemo inorongedzwa yezvirongwa zvehutano zvenguva pfupi inogadziriswa, vashandi vanogona kutanga kupa "zvirongwa zvenguva pfupi" (kutengeswa kutanga muna July 2018) nekuvhara kwenguva yakareba kwemazuva 364. Iyi tsanangudzo-kusvika-364-yekare yakanga yasati yashandiswa muhurumende yehurumende pamberi pe 2017, asi Obama Administration yakashandura tsanangudzo kuitira kuti zvirongwa zvenguva pfupi hazvigone kuva nemakore anopfuura matatu (iyo Obama Admin kutonga kwapera muna 2016, asi haina kutora kusvika muna 2017).
Izvi zvinokosha nekuti zvirongwa zvenguva pfupi zvakagara zvisiri kunze kubva kumitemo yaAACA. Vanogona uye vanoita zvigadziro zvekugadzirisa munhoroondo yezvechiremba, uye vanowanzova nechokufukidzira chisimbiso chero chipi zvacho chakabatana nemamiriro ezvinhu akambovapo. Kubvumira vanhu kuti vachengetedze zvirongwa izvi zvekuda gore rose zvinoreva kuti vamwe vanhu vachava nehupfumi pasi pezvirongwa zvisingabatanidzi mamiriro akambovapo. Izvo zvirongwa zvicharatidza kuti zvinokanganisa vanhu vane hutano, vachisiya vanhu vanorwara muAACA-inotenderwa dzimba ye inshuwarisi. Izvo, izvozvi, zvichaendesa mberi ma-premium mu ACA-inoenderana nemusika. Asi zvirongwa zveAACA-zvinopfuurira zvicharamba zvichifukidza mamiriro ezvinhu akambovapo.
Kunyange zvisati zvaitika neBrazil Administration zvigadziriswa zvenguva pfupi kwemwedzi mitatu, dzimwe nyika hadzina kuvabvumira zvachose, uye dzimwe nyika dzakapedza ivo kumwedzi mitanhatu murefu. Asi pasinei nekuwanikidzwa, vanhu vanotenga inshuwalense yenguva pfupi havakwanisi kufungidzirwa inshumo mumaziso eAACA. Nguva shomanana yehutano inshuwarhu haisi yepamusoro inokosha kukosha , kuitira kuti vanhu vanoshandisa zvirongwa zvenguva pfupi vanozviisa pasi pemutemo weAACA wega chirango . Asi chirango ichocho hachizoshandi zvakare kubva muna 2019, sezvo chave chichiendeswa mberi sechikamu cheGOP mutero. Saka kunyange zvazvo vamwe vanhu vangave vakashandura kubva purogiramu dzenguva pfupi gore ra2017 risati rasvika nokuti vaida kudzivisa mutemo weAACA wega, chirwere ichocho hachizoshandisi kubva muna 2019.
Kuti zvive zvakajeka, vanhu vachiri kukwanisa kuwana humwe humwe hutengeserwo hwemakiti hunosanganisira ACA's pre-existing protections condition. Asi iye zvino iyo mitemo yekuedza kubvisa ACA yakaiswa pamusana wemoto, Hurongwa hweTrump huri kushanda kuti udzikinure mitemo kuburikidza nekuita kwekutonga.
Sources:
> Dhipatimendi Rezvoutano uye Human Services, HIPAA. uye HealthCare.gov, HIPAA-Yakakodzera Munhu mumwe nomumwe.
> Dhipatimendi reMabasa. Tsanangudzo ye "Washandi" Pasi Pechikamu 3 (5) cheE ERISA-Association Health Plans . Yakarongwa munaJanuary 2018.
> Dhipatimendi reHurumende, Basa, uye Utano & Human Services. Nguva Yenguva Pfupi, Yakawandisa Nguva Inoshuwarenzi . Yakapiwa February 2018.
> HealthCare.gov, Verengai Mutengo Wakanaka Wechirongwa.
> Kaiser Family Foundation, Health Insurance Market Reforms: Guaranteed Issue . June 2012.
> Kaiser Family Foundation, Non-Group Coverage for HIPAA-Eligible Individuals, June 2012.