Ukuqonda Imali Yenzuzo Yababheki Bempilo Yobumfihlo
Esinye sezigxeko ezivame ukwenziwa ezinkampanini zomshuwalense wezempilo eziyimfihlo ukuthi zizuzisa ngenani labantu abagulayo. Kodwa ake sihlolisise idatha bese sibona ukuthi isithathaphi. Ingabe izinkampani zomshuwalense ezizimele zenza izinzuzo ezingenangqondo?
Yekaphi Umshuwalense Wezempilo Ozimele?
Ngaphambi kokuphendula umbuzo mayelana nenzuzo, kubalulekile ukubuka ukuthi ukuvame ukuba nomshuwalense wezempilo wangasese ku-United States.
Ngamanye amazwi, bangaki abantu abangathinteka kulo mbuzo.
Ngokusho kwedatha kaKaiser Family Foundation, cishe ingxenye yesithathu yamaMelika yayine-inshuwalense yempilo yomphakathi ngo-2016 (ikakhulukazi i-Medicare ne-Medicaid). Amanye amaphesenti ayisishiyagalolunye ayengaqinisekisiwe, kodwa abanye banomshwalense wezempilo wangasese ukuthi bazithengela bona emakethe ngayinye (amaphesenti angu-7) noma ukuhlinzekwa okunikezwa umqashi (amaphesenti angu-49). Cishe isigamu samaMelika sinokuhlinzekwa okunikezwe ngumqashi, nakuba amaphesenti angu-63 alabo abathinteka ngokweqile noma ngokugcwele ngokwezimali ngumqashi (okusho ukuthi umqashi unesikhwama sakhe sokufaka izindleko zezokwelapha, kunokuba athenge ukukhokhelwa emshuwalense wezempilo othwala).
Kodwa abahlomulayo abaningi be-Medicare nabakwaMedicaid banemininingwane ehlinzekwa ngekhampani yomshuwalense wezempilo yangasese, naphezu kokuba babhalise izinhlelo zokunakekelwa kwemali ezixhaswe esidlangalaleni.
Amaphesenti angu-33 abahlomuli be-Medicare abhalisiwe ku-Medicare Advantage amapulani aqhutshwa ngabathwali bomshwalense bodwa, kanti izifunda ezingu-39 zinezinkontileka zokunakekelwa kweMedicaid nezithwali zangasese zokuhlanganisa ezinye noma zonke izibalo zabo zokubhalisa iMedicaid. Ngisho phakathi kwabahlomuli be-Original Medicare, ingxenye yesine inezinhlelo zeMedigap ezithengwa kubathwali bomshuwalense wangasese kanti le namba iyanda (yanda ngamaphesenti ayisithupha kusukela ngo-2013 kuya ku-2015 yedwa).
Uma sibeka konke lokhu ndawonye, kuyacaca ukuthi inani elikhulu lamaMelika linokuhlinzekwa kwezempilo okuhlinzekwa noma ephethwe yinkampani yangasese yomshuwalense wezempilo. Futhi izinkampani zomshuwalense wezempilo zangasese zivame ukuthola i-rap embi uma kuziwa ezindabeni zokunakekelwa kwezempilo.
Ingabe Inzuzo Yomshuwalense Ayinangqondo?
Izihloko eziningi zilotshwe ngabantu abazama ukuthola ukutholakala ngesikhathi sokubhalisa okuvulekile. Amanye alawa avela ukuhlanganisa imali ngenzuzo eholela ekudidekeni. Yiqiniso, abathwali bomshuwalense wezempilo abanemali banenzuzo ebalulekile, ngenxa yokuthi baqoqa ama-premium ama-insurance amaningi.
Kodwa kungakhathaliseki ukuthi izimali ezingenayo imali ziqoqa kuma-premium, zidingeke ukuthi zichithe iningi lazo ezimangalo zezokwelapha kanye nokuthuthukiswa kwekhwalithi yezempilo. Futhi nakuba ukugxekwa okuvamile ukuthi izinkampani zomshuwalense wezempilo zikhokha ama-CEO awo kakhulu, lokho kubonakala ngokwengeziwe ukuthi ukukhula kwamaholo e-CEO, ngokujwayelekile, kuye kwadlula kakhulu ukukhula kwamaholo eminyaka embalwa edlule. Azikho abathwali bomshuwalense wezempilo abamele emafenini angu-100 anama-CEO aphezulu akhokhelwayo, nakuba kunezinkampani eziningana zokwelapha.
Ngakho-ke uma umholo we-CEO wesikhombisa noma ayisishiyagalombili ubonakala unengqondo kumsebenzi ojwayelekile, ngokuqinisekile kuhambelana nesimiso sebhizinisi.
Futhi i-CEO yenkampani yomshuwalense wezempilo ayikho phakathi kwama-CEO aphezulu kakhulu akhokhelwa izinkampani ezinkulu. Iqiniso lihlala ukuthi amaholo ayingxenye yezindleko zokuphatha ukuthi izinkampani zomshuwalense wezempilo zidinga ukukhawulela ngaphansi kwemithethonqubo ye-Care Affordable Career's loss (MLR). Futhi kanjalo kukhona inzuzo.
Bangakanani Ababheki Bempilo Abahlomulayo?
Uma sibheka imigqa ejwayelekile yenzalo yizimboni, izinkampani zomshuwalense wezempilo ziseduze kakhulu nephansi, ngenani eliphelele lentengo engamaphesenti angu-3.3 kuphela. Ngokombono, izimboni zebhange nezengcebo zinezikhwama zokuzuza ezilinganiselwa ezingamaphesenti angama-20, kanti abakhiqizi bezidakamizwa ezinkulu benza isilinganiso samaphesenti angu-22.
I-ACA isebenzisa iziqondiso ze-MLR ezidinga izinkampani zomshuwalense wezempilo ukuba zichithe ingxenye enkulu yalezi ziqoqo ezikhokhelwayo ezikweletini zezokwelapha. Lokhu kubeka ngokuzenzakalelayo izindleko zabo zokuphatha - kubandakanya isinxephezelo esikhulu kanye nezinzuzo - ezingekho ezingamaphesenti angama-20 emali engenayo ye-premium. Kodwa ayikho imfuneko efanayo yezibhedlela, abakhiqizi bedivaysi, noma abakhiqizi bezidakamizwa.
Ngaphansi Kwezinzuzo Zezinkampani Zomshuwalense Ezizimele: Zingqondo Noma Zingenangqondo?
Izindleko zokunakekelwa kwempilo yimbangela yokushayela imishanguzo yomshuwalense wezempilo. Kuyiqiniso ukuthi izinkampani zomshuwalense wangasese zikhokhela amaholo abo okuncintisana ama-CEO futhi kumele zihlale zinenzuzo ukuze zihlale ebhizinisini. Kodwa izinzuzo zabo zizithoba kakhulu uma kuqhathaniswa nezinye izimboni.
Uma unemibuzo eminye emva kokufunda mayelana nenzuzo, funda ngezinsiza ezingcono zokuthola ulwazi mayelana nomshuwalense wezempilo kanye nenqubomgomo yezempilo.
> Umthombo:
> Kaiser Family Foundation. Umshwalense Wokubambisana Kwabantu Bonke. Isikhathi 2016. https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22% I-7D