ACA Zvinyorwa zveVanhu veAmerica uye Alaska Natives
Iyo Inogadziriswa Care Care Act - Aka Obamacare - yakapa vazhinji vekare vasina uninsured VaAmerica uye veAlaska vagari nemukana wekuwana inshuwarhu yehutano. Maererano neUnited States Census data , kune mamiriyoni 5.2 eAmerican uye Alaska Natives muUnited States. Kubvira muna 2009 kusvika muna 2011, vanenge makumi matatu kubva muzana vavo vakanga vasina uninsured - vachienzaniswa ne17% yevanhu vose veUnited States.
Vanhu vekuAmerica neAlaska Natives vane rusununguko rwehutano hwehutano hwakapiwa nehutano hweIndia Health Service (IHS), asi zvivako zveHS zvinowanzove zviri pedyo nekuchengetedzwa, uye zvinopfuura zvitatu zvevamwe veNative America neAlaska Natives havararami mumasangano kana kumarudzi. Kunyangwe apo zvivako zveHS zviri mahara, Hurumende yeHurumende yeGwaro reHurumende yakaona kuti kutarisirwa kwehutano kunokosha hakusi nguva dzose inowanika panguva yakakodzera.
Nokuda kwezvikonzero zvakasiyana-siyana, vanhu vekuAmerica neAlaska vagari vane hurombo hwehutano hwehutano kupfuura huwandu hweUnited States yose. Kutarisana nekusawirirana kwehutano, uye mukuedza kuderedza kusinganzwisisiki kwehutano pakati pevanhu vekuAmerica neAlaska Natives, ACA yakaisanganisira zvimwe zvigadzirwa zvinoita kuti kuwedzerwa kuve nyore kuwana uye hutano hunodiwa zvikuru kune vekuAmerica neAlaska Natives:
Kugovana-kugovana-mari
Kugovana-mari-mari ndiyo mari iyo varwere vanofanira kubhadhara nokuda kwehutano hwavo.
Pasi peAACA, mari yakawanda yekutengesa mari inosvika kudarika madhora 6,850 kune munhu mumwechete muna 2016, kunyange zvazvo zvirongwa zvehutano zvingava nemiganhu yakaderera, uye ine huwandu hunochinja mumamiriro ekugadzirisa kwavanoita mari kuburikidza nekushandisa mapepa, kudzikinura, uye coinsurance.
Kune vekuAmerica neAlaska Natives, pane zvikamu zvakakosha pamusoro pekugovana mari:
- Kune vekuAmerica neAlaska Natives nemari yemhuri kusvika ku300% yehurombo huwandu (anenge madhora makumi matanhatu emakumi matanhatu emhuri yemhuri yevatatu, kana $ 75,000 kumhuri yevatatu muAlaska), hapana kugovana-kugovana kune hurongwa hwehutano hwehutano hwakatengwa kuburikidza nekutsinhanisa . Purogiramu yemwedzi nemwedzi (iyo mari yehushuwarisi pachayo) inofanira kubhadharwa, kunyange zvazvo rubatsiro rwemari yepamende inogona kukanganisa chikamu chikuru chemari, zvichienderana nemari inowanikwa. Asi kana kutaridzirwa kugamuchirwa, hapana chekubhadhara, kubhadhara, kana kubhadhara mari.
- Kune vose vekuAmerica neAlaska Natives vanopinda muurongwa hwehutano kuburikidza nekutsinhanisa - kusanganisira vanoverengera pamwe nemari inowanikwa mumhuri inopfuura 300% yehurombo huwandu - hapana kugovana-mari (copay, deductible, coinsurance) kune chero hupi hwehutano hunowanikwa paHSS kana sangano remadzinza, kana kubva kumubatsiri ane kambani neHS.
Kunyorwa kwegore rose
IAACA yakataurira pfungwa yekunyora kusununguka kumunhu mumwe wehutano inshuwarheni. Kusati gore ra2014, inshuwarisi yehutano yega yega inogona kutengwa chero nguva mukati megore, asi vashandi vematunhu akawanda vaifanira kunge vane utano kuitira kuti vabvumirwe kugoverwa.
Pasi peAACA, munhu wese anogona kuwana kugoverwa, pasinei nenyaya yezvokurapa.
Asi kushandiswa-inyanzvi ndeyekuti inshuwarano yehutano inowanika pahuwandu hwehuwandu hwekunyora (nokuda kwekugoverwa muna 2016, kutumirwa kusununguka kwakatanga munaNovember 1, 2015 uye inopfuurira kusvika paJanuary 31, 2016). Mushure mekunyora kusununguka kunopera, kugoverwa kunogona kutengwa chete nevanhu vanoona zviitiko zvinokonzera zvinotanga nguva dzekunyora dzinokosha .
Asi VaMamerica veAmerica neAlaska Natives havangoregi kunyora panguva yekunyorwa kwakasununguka, uye havadi zviitiko zvakakodzera. Vanogona kunyoresa chero nguva, gore rose (kuburikidza nekutsinhanisa chete, kunyorwa kwegore rose hakuiti kushandiswa-kushandiswa). Munyika dzakawanda, kugoverwa kuchave kunobudirira kutanga kwemwedzi zvichienderana nekunyora kana vakanyoresa nemwedzi we15 wemwedzi, uye wekutanga wepiri wechipiri unozotevera kunyora kunopedzerwa mushure megumi nemwedzi wemwedzi (Massachusetts, Rhode Island, uye Washington vese vanobvumira zvinyorwa - kune ani zvake anokumbira - kuti apedze sekupera kwekuti 23rd of the month for coverage effective the first of the month following).
Hapana chibharo chekusava nekusimbiswa
Pasi peAACA, pane chirango chekusabvumirwa . Inotarirwa pamitero inoshandiswa, uye inoshandiswa kune chero ani zvake aifanira kutumira kudzoka uyo asina kubvumirwa munguva yegore rapfuura uye haana kukodzera kubhadhara kubva kune chirango.
Asi vemuAmerica neAlaska vagari vemumhuri avo vari nhengo dzedzinza rinozivikanwa nehurumende (kana kuti avo vanokodzera kutarisirwa kuburikidza neHS) havaregereri kurangwa. Vanogona kuwana chikwereti chavo kubva kuchitsinhanho kana kubva kuRR apo pavanopa mitero yavo yekudzosa (iyi ndiyo fomu inoshandiswa kukumbira kuregererwa, mumatunhu 38 anoshandisa Healthcare.gov).
Pakave nechishuwo chakakosha chekuti vanhu vekuAmerica neAlaska vagari vepanzvimbo vakanyorese zvirongwa zvehutano kuburikidza neAACA kushandiswa. Asi zvinetso zvinoramba zvichiri maererano nekugadzirisa zvinhu, kutenga vatengi, uye mune dzimwe nguva, kusavimba nehurumende yehurumende. Kunyange zvazvo hutungamiri hwemadzinza akashanda kuparadzira shoko rekunyora muhutano hwehutano kuburikidza neAACA kugoverana kunobatsira kuVaAmerica neAlaska Natives, hapana chirango chemhuri dzinosarudza kuramba dzisina uninsured pane.
Indian Health Care Improvement Act
IInternational Health Care Improvement Act, iyo inobhadhara IHS, yakaendeswa neCongress muna 1976 uye yakapedzisirwa zvakare kubvumidzwa muna 2000. Asi ACA yakagadzirisa zvachose Indian Health Care Improvement Act, uye yakawedzera mamwe mazano , kusanganisira mapurogiramu ekurapa kwepfungwa nehutsika, uye kushanda kwenguva refu kwenguva refu.
Medicaid kuwedzera
Muna 2014, uwandu hwehurombo pakati pevamwe veMadzinza eAmerica neAlaska MaNative aiva 28.3%, zvichienzaniswa ne15.5% yevanhu vose veUnited States. Iyo yakakwirira-kupfuura yehuwandu hwehurombo huwandu pakati pevanhu vekuAmerica neAlaska Natives (yakakwirira kudarika mamwe mapoka emarudzi) inoita kuti ACA's Medicaid kuwedzere kunyanya kukosha.
IAACA yaida kuti kuwedzerwa kweMedicaid kuvhare vanhu vose vakuru nemari yemhuri kusvika 138% yehurombo hwehutano (vana vakanga vatotanga kuvharwa nepamusoro pemari yemari pasi pekubatanidzwa kweMedicaid neIndaneti Health Insurance Program), uye hurumende yehurumende ichagara ichibhadhara zvinenge 90 muzana yemari yekuwedzera Medicaid.
Asi Dare Repamusorosoro rakatonga muna 2012 kuti nyika inogona kusarudza kubva muMedicaid kuwedzera, uye kusvikira ikozvino, nyika dzisati dzave dzisina kuwedzera Medicaid.
Mune dzimwe nyika zvinomwe (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, uye South Dakota), Vanhu vekuAmerica neAlaska Natives vanosanganisira zvikamu zvinenge zvitatu zvehuwandu hwevanhu. Pakati idzodzo, dzose asi Oklahoma neSouth Dakota dzakawedzera Medicaid.
Asi inopfuura hafu yevose vemuAmerican uye veAlaska vagari vanogara mumatunhu manomwe chete (Alaska, North Carolina, Texas, New Mexico, Oklahoma, California, uye Arizona). Pakati idzodzo, North Carolina, Texas, uye Oklahoma havasati vakura Medicaid. Pakati pezvinhu izvi zvitatu chete, pane vanhu vane mamiriyoni 1,1 mupakati pekuvhara, nhamba iyo inosanganisira vamwe vekuAmerica.
Vanhu vari munharaunda yekuvharidzira havafananidzi kuMedicaid nokuti nyika haina kuwedzera kukodzera, uyewo haikodzeri kuwana rubatsiro rwepayimusi muhutano nokuti rubatsiro hahuwanikwe kune vanhu vane mari iri pasi peurombo (sezvo vaifanirwa kuva nekutambira kuMedicaid pane).
Saka kunyange kuwedzerwa kweMedicaid kwakagadzirisa zvakanyanya mukusimbisa vana vanobva muNative America uye vaAlaska Natives, izvi zvinoshanda chete mumamiriro ekuti Medicaid yakawedzerwa.