Sangano rehutano hwehutano (AHPs) rave rakapoteredza kwemakumi emakore, richibva kuHarare Employee Retirement Income Security Act (ERISA) muna 1974, uye zvikurukuru inotungamirirwa nehurumende pasi pemitemo mitsva yakagadzwa kumavambo ekuma1980. The Affordable Care Act (ACA) yakagadza mitemo mitsva yakagadzirirwa kupa humwe huviriro kune nhengo dzeAHP.
Asi Mutungamiri weTrump anoda kusunungura mitemo yeAHPs, ndicho chikonzero ivo vave vachigadzira zvinyorwa zvitsva munguva pfupi.
Muna Gumiguru 2017, Mutungamiri Trump's "Healthcare Choice nekukwikwidzana" yakarongeka , pakati pezvimwe zvinhu, mitemo mitsva inotarisirwa "kuwedzera kuwanika" kune AHPs kumabhizimisi mashoma uye vanhu vanozvishandira iye zvino vari pasi peboka reAACA nemitemo yepamusi wega .
Uye kumavambo kwaJanuary 2018, Dhipatimendi reBabasa rakabudisa mitemo yakagadzirirwa inotora kubva kuMutungamiri weChishanu yekutonga, kuzarura mazuva emazuva makumi mashanu ekutaura (iwe unogona kutumira mashoko pano).
Muchidimbu: Maitiro AHPs Angakwanisa Sei Kuchinja Utano Wenyu Wehutano
Kana iwe uine chinyorwa kubva kune mukuru wavanoshandira, Medicaid, kana Medicare, mitemo mitsva yakarongwa haizokanganisa kugoverwa kwako. Kana iwe uine chinyorwa mumakambani ega kana kuti maduku maduku, zvisinei, mitemo yakarongwa inogona kuchinja kugoverwa kwako, zvichienderana neunogara.
Mitemo haisati yapedzwa, uye hazvina kunyatsojeka kuti nyika dzinorevei dzichagadzirisa mitemo mitsva kana uye iyo inopedziswa.
Asi kuwedzerwa kusvika kune AHPs kunogona kukonzera mari shoma yehutano yemishonga yehutano kumapoka maduku uye vanhu vanozvishanda vanobatana neshamwari dzinopa AHPs. Zvisinei, nemayero emadhora aya akaderera aigona kuuya achienderana nekuderedza muhutano hwehutano huripo. Izwi rokuti "iwe unowana izvo unobhadhara" zvakaoma kudzivisa.
Kune rumwe rutivi, vanhu uye mabhizimisi maduku vasingabatanidzi masangano uye kuwana rubatsiro pasi peAHPs vanogona kuona zvikwereti zvakakwirira mumakore anotevera, uye / kana mushambadziri wekushambadzira yemishurenzi, uye vashoma vatsigiri vanopa kugoverwa. Izvi zvingabva pamusana pekuti AHPs ingangodaro yakagadzirirwa kukwidza mabhizimisi ane hutano, vashandi vaduku, kusiya imwe yakwegura, yekutengesa mari yezvirongwa zveAACA-zvinogamuchirika.
Vaya vasingabatanidzi AHPs vangasanganisira mabhizimisi maduku uye vanhu vanozvishanda vanofarira kuramba vakachengetedza zvikuru ACA-inoenderana nekugadzirisa, uye vanhu vasiri ivo vanozvishanda-uye naizvozvo havakwanisi kubatana neAHP-kusanganisira vati vashandi vekare .
Kana iwe ikozvino uchishanda kune vashandi vaduku vasina kupa hutano hwehutano uye iwe unowana kugoverwa kwako mukutsinhanisa, iwe unokodzera kubhadharwa mari yepayimusi (premium tax credits) inobva pamusha wako wemari. Asi kana waunoshandira aifanira kubatanidzwa nesangano uye kupa AHP chinyorwa chinosangana nechinangwa cheAACA chisingakwanisi, iwe haungazokwanisi kubhadhara mari yepamberi.
Mitemo Yemazuva Ano: Mitemo Inotarisa Zvichienderana nekukura kweboka
Musoro wezvinyorwa zvinorongwa, "Tsanangudzo ye'Ushandi 'Pasi Pechikamu 3 (5) cheE ERISA-Association Health Plans," inobatanidza chikonzero chebvunzo: Chaizvoizvo, ndiani anobvumirwa kubatana pamwechete kuti aumbe boka guru, mushandirwi -sponsored plan?
Izvi zvakakosha nokuti ACA inotungamirira mapoka makuru uye maduku zvakasiyana. "Boka duku" rinoreva kusvika kune vashandi makumi mashanu munyika dzakawanda, asi kusvika kuvashandi zana muCalifornia, Colorado, New York, uye Vermont. Uye boka diki rinotonga pasi peAACA (nokuda kwezvirongwa zvinobudirira munaJanuary 2014 kana kuti gare gare) zvinowanzofanana nemitemo yekutengeserana kwemusika mumwechete: Zvirongwa zvinofanira kugadziriswa-nharo, nezvikwereti zvinopesana chete zvichienderana nenzvimbo, vashandi vezera remakore ( mukati mechiyero chepamusoro che 3: 1 chekare kune vashandi vaduku), pasinei nokuti mushandi anovimba neurongwa, uye kushandiswa kwefodya.
Zvinhu zvakadai sehutano, rudzi rwemabhizimisi, uye hutano huzhinji hweboka hahugoni kushandiswa kugadzirisa mapeamisi.
Uye mapoka maduku maduku anoitwa kubva muna 2014 anofanira kuvhara mazano eAAC anokosha , uye anowanikwa mune imwe yenhengo dzeAACA (bronze, sirivha, ndarama, kana platinum), iyo inowanikwa yezvinokosha .
Mimwe mitemo yeAACA inoshandisa zvirongwa zveboka guru uye zvirongwa zvekuzvipira (izvo zvinonyanya kuzivikanwa nevashandirwi vakawanda), asi mitemo haisi yakasimba. Zvikomborero zveboka rakakura uye zvirongwa zvehupfumi huri pasi pehutano humwechete hunoshandiswa kumagadziro evanhu nemapoka maduku, zvinogona kusiyana zvichienderana nezvenhoroondo yezvokurapa kwezvechiremba, uye haufaniri kufanana ne3: 1 age band chiyero chinoshandiswa pamusika wemapoka evanhu (kureva kuti, miripo yevashandi vakwegura inogona kuva kanopfuura katatu mashandiro ekubhadhara vashandi vaduku). Uye boka guru uye zvirongwa zvehupfumi hazvifanirwi kuvhara kubatsira kweAACA hutano hunokosha.
Mukuwedzera, nepo zvizhinji zveAACA zvido zvisingashandisi kune boka guru uye zvirongwa zvekuzvidzivirira, zvigadziro zvehupfumi hazvisi pasi pemitemo yehurumende. Pane kudaro, inotungamirirwa nehurumende yehurumende, pasi pe ERISA mirayiridzo. Saka iwe unogona kufunga nezvehutungamiri hwekutonga sekuve hwakanyanya zvakanyanya kune zvirongwa zveboka rimwe nerimwe uye zviduku, zvisinganyanyobatsiri kune zvirongwa zvehutano, uye pane imwe nzvimbo pakati pemapoka makuru anotenga kugoverwa kubva kune inshuwarisi yekambani pane kuzvidzivirira, sezvo kambani dzemishuwarisi dzinotengesa zvirongwa izvi zvinotungamirirwa nehurumende mutemo, kunyange zvazvo mitemo yakasununguka pasi peAACA kana ichienzaniswa nemagadzirirwo evanhu neavo mashoma (kazhinji, sangano guru nderokuti, vangangodaro vanozvidzivirira).
Zvakarongwa AHP Zvinyorwa Zvingaita Kuti Unyore Mitemo
Pasi pemitemo yemazuva ano, AHPs inobvumirwa kupa boka guru kana zvirongwa zvekuchengetedzwa kwehutano kune nhengo dzavo, asi mitemo yakanyatsokwana: Vashandi vanofanira kubatana pamwe chete kune chimwe chinangwa pane kungoita AHP (izvi zvinonzi " yekare, "iyo inowanzoreva kuti inofanirwa kuva mune imwe yebhizimisi imwechete), inofanirwa kuva nekutonga pamusoro peAHP, uye nhengo yevashandi vanofanira kuva nevashandi vanopfuura (kureva, havagoni kuva vadzidzisi chete vasina vashandi).
Izvo zvinorongerwa mitemo zvingasununguka mitemo iyoyo. Kana kugadziriswa sekusarudzwa, mitemo mitsva inobvumira vashandi kubatana pamwe chete kuti vagadzire AHP zvichienderana nemashandiro akagoverwa OR inogoverwa nzvimbo, iyo inogona kuva nyika kana nzvimbo inowanikwa munzvimbo dzakadai, sedunhu kana guta (kuchengeta mupfungwa kuti dzimwe nzvimbo dzemaguta dzinowedzera kudarika imwe yenyika). Saka zvikwata zvishoma zvitsva zvekugadzirisa motokari munzvimbo dzakasiyana-siyana zvinogona kubatana pamwechete kuti zvigadzire AHP, kana mabhizimisi maduku akawanda asingabatanidzi ose ari muguta rimwechete kana kuti nyika inogona kubatana pamwechete kuti iite AHP.
Kunyange zvazvo boka rezvigadziri zvingakwanise kufananidzira tsanangudzo yemazuva ano yekushamwaridzana iyo inogona kubatana pamwe chete nezvinodiwawo, mitemo mitsva inobvumira vashandi kuumba sangano kunyange kana nzvimbo iyo ndiyo inowanzova inofarira.
Zvisinei, mitemo yakarongeka icharamba ichida shamwari kuti dzive "masangano echokwadi ane sangano rehurongwa rinodiwa kuti riite 'muchidimbu' chevatori vechikamu." Kushamwaridzana kwaizofanira kuva nemitemo nemitemo uye kutarisirwa nemabhizimisi anosanganisira nhengo yaro. Saka nepo boka revashandirwi richigona kubatana pamwe nechinangwa chikuru chekuwana boka guru kana inshuwarisi yehutano yehutano (uye nokudaro kudzivisa mitemo yeAACA neyochechi yeboka duku), ivo vaifanira kuumba sangano regafide kuitira kuti vaite saizvozvo.
Pasi pemitemo yemazuva ano, vanhu vanozvishanda vasina vashandi havagoni kubatana neAHPs kuti vawane ERISA-kutungamirirwa kwehutano hwehutano (kusiyana neAACA-inoenderana nemusika wekutengeserana kwemakethe). Asi mitemo inosarudzwa inogona kurega kutonga, zvichibvumira "vashandi" kuti vabatane neAHPs chero bedzi vasina kukodzera kubhadhara inshuwalhu yehutano kubva kune imwe sarudzo yakarongerwa, vanoshanda maawa makumi maviri nemaviri pamwedzi, uye vanowana zvakakwana kubva pane zvavo pachavo -basa rekuvhara mari yekugoverwa kunopiwa neAHP.
Rudzi Rudzii Rwokunge AHPs Ripe?
Kana hutungamiri huri kurongwa hwakagadziriswa, itsva AHPs inogona kutanga kuonekwa zvakanaka munguva pfupi, uye inogona kunge yakakura zvakasiyana maererano nehuwandu hwehuwandu hwavanopa. Asi kazhinji, chinangwa chose chekuwedzera AHPs ndechekuderedza mari yehutano hwehutano. Uye sezvo mitemo yakasarudzwa isingaiti chinhu chokuderedza mari yehutano (iyo ndiyo inoita mari yehutano inshuwarheni), nzira chete yekuti ivo vave nezvikwereti zviduku ndeyekucheka makona maererano nemitengo inopiwa, kana kuti kubata nhengo yehutano huri hutano kupfuura huwandu.
Mitemo yakarongwa inogona kudzivirira AHPs kubva pakusarura zvakananga zvichienderana nehutano hwehutano, saka havazokwanisi kuramba bhizimisi kana mushandi kubva kuhutungamiri musangano (uye nenzira iyo AHP chinyorwa) zvichibva munhoroondo yezvokurapa. Zvisinei, AHPs inenge iine ruzivo rwakakosha rwokugadzira kugoverwa kwavo nenzira isingafadzi kune vanhu vane mamiriro ezvinhu akakwirira aimbovapo. Vatsigiri vanga vachitoita izvi kune imwe nzvimbo pamberi peAACA-somuenzaniso, kupa zvirongwa zvehutano zvinongobata zvinodhaka zvinowanzoitika, kana izvo hazvina kupa hutano hwehutano hwakakwana zvachose.
IAACA inomisa mitemo iyo, uye mapoka ehutano ehutano hwehutano hwevanhu nehudiki huripo kubva munaJanuary 2014 aifanira kutarisana nehuwandu hwekuvhara maitiro. Asi mazhinji emitemo yeAACA haishandisi kune boka guru uye zvirongwa zvehupfumi, ndicho chikonzero pfungwa yekuwedzera kusvika kune AHPs inofadza kumabhizimisi mashoma ane vashandi vane utano.
Sangano reAmerican Academy of Actuaries uye National Association of Inishuwarenzi Commissioners vakaratidza kuzvidya mwoyo muna 2017 (apo kuwedzera kweAHP kwaifungidzirwa nevatongi vemitemo) pamusoro pemigumisiro yekuwedzera AHPs pamisika yeboka rimwe nerimwe uye duku. Masangano maviri aya akataura kuti itsva uye yakawedzerwa AHPs inogona kukonzera kusarudzwa kusina kunaka mumatongerwe enyika (kureva kusina-AHP) nemakambani mashoma, sezvo AHPs inogona kuronga hurongwa hwavo hwokukwirira kumabhizimisi maduku (uye vanhu vanozvishanda) vane utano hwakanaka , vaduku vashandi, vachisiya vanhu vakwegura, vanorwara mumatongerwo enyika, ACA-vanoenderana nemakethe emapoka eboka.
IAAA neNaic zvakarewo maonero maviri ekuti AHPs emakore makumi emakore akambosangana neusolvency, nyaya inogona kubuda zvakare. Uye sezvo zvirongwa izvi zvisiri kutongerwa nehurumende inshuwarisi commissioners, nhengo dzingadai dzisina zvishoma munzira yekugadzirisa kana AHP yavo yakaguma isingakwanisi kubhadhara zvido zvavo.
> Sources:
> American Academy of Actuaries. Tsamba kune vateereri vemutemo maererano nekuwedzera kwesangano zvirongwa zvehutano . March 8, 2017.
> Centers for Medicare neMedicaid Services, Center for Consumer Information and Insurance Oversight. Market Rating Reforms; State Specific Rating Kusiyana.
> Dhipatimendi reVashandi, Vashandi Vezvikomborero Zvekuchengetedzwa Kwekuchengetedza. Tsanangudzo ye "Washandi" Pasi Pechikamu 3 (5) cheE ERISA-Association Health Plans. Yakabudiswa mu Federal Register January 4, 2018.
> Keith, Katie. Health Health. Sangano Rehutano Hwehutano Hwakagadzirirwa Mutemo: Zvinorevei uye Zvazvaizoita. January 5, 2018.
> National Association of Insurance Commissioner. Tsamba kune vateereri vemutemo maererano nekuwedzera kwesangano zvirongwa zvehutano . February 28, 2017.