Ukuguqulwa kwezeMpilo kuye kwaba yizindaba ezingekho ukuma phakathi kuka-2017, ngakho-ke uma udidekile ngalokho okwenzekile nokuthi kuzokwenzekani ngo-2018, awukho wedwa. Ake sibuke ukuthi yini eyashintshayo, yini ehlala efanayo, nokuthi yini ongayilindela ngokwempilo yomshwalense wakho wezempilo ngo-2018.
Izinguquko ezinikezwayo azenzwanga
Naphezu kwemihlahlandlela eqhubekayo mayelana nokuguqulwa kwezempilo ngonyaka ka-2017, izinguquko eziningi ezihlongozwayo zinyanyekile emvinini.
I- American Health Care Act (AHCA) yadluliselwa yi-House Republican ngo-Meyi ngomzamo wokuqeda uMthetho Wokunakekelwa Onganakekelwayo, kodwa inguqulo yeSenate, uMthetho we- Better Care Reconciliation Act (BCRA), wehlulekile ngoJulayi. Eqinisweni, i-Senate Republican yazama ukudlulisa izinguqulo ezintathu ezihlukile zokuqedwa kwe-bill- "skinny", i-Obamacare Repeal Reconciliation Act, ne-BCRA-futhi akukho okutholakala ukwesekwa okwanele ukudlula.
NgoSeptemba, ukuchitshiyelwa kukaGraham-Cassidy-Heller-Johnson kwathathwa njengenguqulo ebuyekeziwe ye-ACA yomthetho we-ACA, kodwa impumelelo yayo ibonakala ingacabangi ngemuva kokuthi uSeninkulu uJohn McCain (R, Arizona) umemezele ukuphikiswa kwakhe.
USenator Rand Paul (R, Kentucky) usuvele echaze ukuphikisana, futhi uSenator Lisa Murkowski (R, Alaska) noSusan Collins (R, Maine) bancike ekuphikisweni. ISepthemba 30 yisikhathi esiphezulu seSenate sokusebenzisa inqubo yokubuyisana kwesabelomali ezobavumela ukuba basuse i-ACA ngamavoti angu-50 (kanye nokuvota kwe-tie-breaker eyenziwa yi-Vice-President) futhi ugweme umshini we-filibuster.
Futhi uma amaRenanethi amaRepublican amathathu noma ngaphezulu ephikisana nesilinganiso, angeke adlule.
Ngakho-ke nakuba sekube khona izingqikithi eziningi zomthetho ezethulwa ngo-2017-futhi iNdlu yadlulisa uMthetho weMpilo waseMelika-akukho okwenziwe kuwo.
Lokhu kusho ukuthi i-ACA isasebenza ngokugcwele, kufaka phakathi izinsizakalo ze-premium , ukunciphisa ukwabelana ngezindleko (aka, izinsizakalo zokwabelana ngezindleko), ukunwetshwa kwe-Medicaid , igunya elithile , igunya lomqashi , ukuvikelwa kwabantu abanezimo ezandulele , kubalulekile izinzuzo zezempilo , imithetho yokulahlekelwa kwezidakamizwa, njll.
Izinsizakalo zokwabelana ngezindleko zizoqhubeka zitholakala ngo-2018, kungakhathaliseki ukuthi uhulumeni wesifundazwe unikeza ngemali yezinkampani zomshuwalense ukuba zibophe (ukukhishwa kwezimali kuye kwaba imbangela yokungaqiniseki okukhulu kulo lonke u-2017). Ama-insurers emazweni amaningi afaka izindleko zokuhlinzeka ngemali eyabelwe izindleko kuma-premium azobe ekhokhisa ngo-2018, futhi lezo zimali eziphakeme eziphezulu zizocutshungulwa kwabaningi ababhalisile ngezimali ezikhokhelwayo ezinkulu. Ukuqeda izinsizakalo zokwabelana ngezindleko ngokuphelele (noma izinsizakalo ze-premium) kungenziwa kuphela ngomthetho.
Izinguquko Ngenxa Yomthetho Wokuqiniswa Kwemakethe
Ngo-Ephreli 2017, i-HHS yaqedela ukubaluleka kwemakethe ababeyiphakamisile ngoFebhuwari. Nakuba lo mbuso wawuhloswe ngokuqinile ekuqiniseni imakethe yomshuwalense wempilo yomuntu ngamunye, awuzange uhlangabezane nezici ezimbili eziye zadambisa kakhulu imakethe ngayinye: ukungabi nokuqiniswa okuqinile komsebenzi ngamunye (okwenziwe noma owaziwayo, njengoba umthelela namanje kuncane abantu abanobungozi ababhalisa ekukhunjweni kanye nedamu lokufaka ingozi elibhebhethekisa kakhulu impilo), kanye nokuxhasa okuqhubekayo kokunciphisa izindleko.
Akukhona nje ukuthi lezo zinkinga azikhulunywanga embusweni wokuqiniswa kwemakethe, ziye zaqhubeka nokubangela ukungaqiniseki emakethe ezizayo ezinyangeni ezalandela, futhi ziye zadlala indima ebalulekile kwabanye abathwalense abakhetha ukushiya emakethe ekupheleni kuka-2017 noma bafake amaphrimiyamu amaningi kakhulu ngo-2018 kunokuba bekungaba khona ukukhokhisa.
Kodwa umthetho wokusimamisa imakethe ukhulume nezinye izinkinga, nakuba zicindezela kakhulu kunomsebenzi ngamunye kanye nokunciphisa ukwabelana ngezindleko. Izinguquko ngokuvamile zisebenza kubantu abathengisa ukuthengwa komakethe ngamunye, ukushintshanisa noma okungahambisani naye :
- Ezingxenyeni eziningi, ukubhaliswa okuvulekile kuye kwafinyelelwa emavikini ayisithupha nje futhi kuzosebenza kusukela ngoNovemba 1 kuya kuDisemba 15, nazo zonke izinhlelo ziphumelela ngoJanuwari 1, 2018. Kodwa kunezingxenyana eziyisishiyagalolunye zokuhwebelana eziye zadlulisela isikhathi sokugcina ukubhalisa , ngakho qiniseka ukuthi uyazi ukuthi isebenza kanjani esimweni sakho.
- Uma ngabe inqubomgomo yakho ikhanseliwe ngokungakhokhwa kwama-premium ngo-2017 futhi ubhalise kabusha nomshuwalense ofanayo (noma omunye umshuwalense onenkampanini efanayo yomzali) ngesikhathi sokubhalisa okuvulekile, umshwalense uzokwazi ukukukhokha ukuthi ukhokhe wakho- amaphrimiyamu akhokhelwayo ngaphambi kokwenza ukukhishwa okusha kwakho. Ngokuvamile, kufanele kube inyanga eyodwa kuphela yezinkokhelo ezikhokhwa ngaphambilini, ngoba amaprimiyamu awakhokhiswa ngemuva kokuthi uhlelo luphele.
- Inani elivumelekile le- actuarial ububanzi lensiza ngayinye yensimbi yokufakwa kwezimakethe emakethe yeqembu ngalinye nelincane lamandisiwe. Izinhlelo ze-bronze zizoba nobubanzi be -4 / + 5, ngenkathi isiliva, igolide, ne-platinum izinhlelo zizoba ne--4 / + 2 ibanga. Ama-bronze amapulani ane-actuarial value ngamaphesenti angama-60, isiliva cishe ngamaphesenti angu-70, igolide cishe ngamaphesenti angu-80, ne-platinum cishe amaphesenti angu-90. Kodwa zingashintsha ngokuvumelana nezigaba ezivumelekile ze-minimus, eziye zavulwa ngo-2018. Lokhu kusho ukuthi kungase kube khona ukuhlukahluka okuningi kusuka kwelinye icebo kuya kwelinye ngaphakathi kwezinga lensimbi elinikeziwe, ngakho abantu namabhizinisi amancane bazofuna ukuqhathanisa ngokucophelela izinketho ezehlukene ezitholakalayo ngo-2018.
Izinzuzo kanye nokuguqulwa kokungena emakethe yeqembu ngalinye namancane kuzokwenzeka njengoba nje benakho eminyakeni edlule, ngokulungiswa kwemingcele yokudonswa kwemali kanye ne-out-of-pocket, kanye namanethiwekhi omhlinzeki kanye nezinhlu zezidakamizwa ezihlanganisiwe. Ungacabangi ukuthi uhlelo owawuthathe ngonyaka odlule luzobe luyindlela engcono kunazo zonke ngawe ngo-2018-kuhlale kuwukuhlakanipha ukuqhathanisa izinketho ozitholayo ngesikhathi sokubhalisa okuvulekile, futhi wenze izinguquko uma kudingeka.
Ukusizwa Okuncane Nokungeniswa Kwezokubhalisa
Uma uhlala esimweni esingenayo umshwalense wezempilo futhi sithembele ku-HealthCare.gov, ungase ubone ukuthi ukumaketha, ukufinyeleleka, nokubhalisa kunomkhawulo ngesikhathi sokubhalisa okuvulekile kokubanjelwa kuka-2018 kunalokho bekukade kudlule.
I-HHS yamemezela ngasekupheleni kuka-Agasti ukuthi izokwehlisa isabelomali sokumaketha ye-HealthCare.gov kuze kube yizigidi ezingu-10 kulo nyaka, kusukela ku-$ 100 million ngonyaka odlule. Baphinde baqaphele ukuthi bazokwehlisa isabelomali ohlelweni lwe-Navigator, olunikeza usizo lwabantu ababhalisiwe kubantu abashintana nabo. Ukushintshaniswa kukahulumeni kuxhaphaza izinhlelo zabo ze-Navigator, futhi izimali zabo zezimali azithinteki isabelomali esinqunyiwe.
Izinhlelo zezempilo emakethe ngayinye nazo ziye zanciphisa amakhomishana omthengisi wokuthengiswa kwamakethe eminyakeni embalwa edlule, ekuqedeni ngokuphelele kwezinye izimo. Lokhu kubangelwa ikakhulukazi ekungeneni inzuzo yemakethe ngayinye yabaningi bomshuwalense, njengoba manje i-ACA ishintshe imithetho; abanye bomshuwalense banqume ukuthi abafuni ukukhokha abathengi ukuze balethe ibhizinisi ekugcineni liyi-money loser ye-insurer. Amakhomishoni ngokuvamile yindlela kuphela yabathengi abazokhokhwa ngayo, ngakho abanye abathengi baye bakhetha ukungasebenzi nomsebenzi ngamunye wemakethe ngoba abakwazi ukukhokhela ukusebenza mahhala.
Konke lokhu kusho ukuthi imakethe ngayinye ebhaliswe kwezinye izingxenye zezwe ingathola ukuthi akukho usizo lokubhalisa oluningi olutholakalayo njengalokhu lwalukhona. Kuzobe kusekhona usizo olutholakalayo, kodwa ababhalisile bazodinga ukuhlela phambili futhi balinde kuze kugcinwe ukugcina ngomzuzu wokugcina ukuthi umzuzu wokugcina uzofika ngokushesha kakhulu kuningi kakhulu kulo nyaka kunalokho okwenze eminyakeni edlule.
Kuphinde kubonakale ukuthi i-HealthCare.gov, i-portal yokubhalisa ingosi esetshenziswe abantu basezifundazweni ezingu-39, izoba phansi ukulungiswa okuhleliwe ngeSonto elikhulu ngesikhathi sokubhalisa okuvulekile kulokhu, ngisho nangosuku lokuqala lokubhalisa okuvulekile, ngoNovemba 1. Lokhu kuhambisane kakhulu, futhi kungaphetha ukuguqula ngaphambi kokubhalisa okuvulekile. Kodwa okwamanje, abantu abanokuthengwa kwemakethe ngamunye kungaba ukuhlakanipha ukuhlela ukubhalisa noma ukuhlela izinguquko ukuthatha isikhathi eside kunokujwayelekile kulo nyaka.
Amapulatifomu Wokubhalisa Nokuhlela Ukutholakala
Uma unayo imakethe emakethe ngayinye, noma ukushintshaniswa, ungase udingeke ukhethe uhlelo oluhlukile ngo-2018 ngenxa yomshuwalense wakho ophuma emakethe, noma ungathola ukuthi ufinyelela izinhlelo ezintsha ngenxa yomshuwalense ongena emakethe endaweni yakho (nansi uhlu lwemikhumbi emikhulu neminyango).
Nakuba kube khona ukukhuluma okuqhubekayo kwamanani "angenalutho" ngo-2017, zonke izifundazwe kuleli lizwe okungenani unomshuwalense oyedwa ohlangene ukuze anikeze ukuhlinzeka ngo-2018 ekushintsheni phakathi nango-Septhemba. Lokhu kungase kushintshe, kodwa kuyaphawuleka ukuthi kuwo wonke amazwe lapho kwakukhona khona izifunda ezingenasibambisomali ezihlongozwe ukunikeza ukuhlinzeka ngo-2018, ababheki bomshuwalense sebeye bafika ukugcwalisa izindawo ezingenalutho (lokhu kwenzeka e-Ohio, eWisconsin, e-Nevada, eVirginia, e-Indiana , Kansas, Missouri, naseWashington).
Ukushintshaniswa komshuwalense ngokwawo akushintshi ngo-2018. Zonke lezi zizwe ezisebenzisana ngazo ngo-2017 zizoqhubeka zenza njalo ngo-2018, futhi zonke izifunda ezisebenzisa i-HealthCare.gov ngo-2017 zizoqhubeka nokukwenza kanjalo. Izifunda ezingu-12 kuphela ezinamapulatifomu abo okubhalisa; okunye-kufaka phakathi izivumelwano zokubambisana, ukuhwebelana kwezempi, kanye nokushintshaniswa kombuso ngokusebenzisa isiteji sikahulumeni-konke ukusebenzisa i-HealthCare.gov.
Kodwa-ke, abathengi emazweni amaningi bangathola ukuthi kulula ukubhalisa "ngokushintshanisa" ngesayithi lomdayisi lomuntu wesithathu, njengoba uhulumeni wesifundazwe evumela " ummeleli oqondile wokubhalisa indlela " eqala ukuwa okuzoqeda isidingo sabafaki sicelo hamba emuva nangaphandle kusuka kusayithi lomthengisi webhubhu kuya kwi-HealthCare.gov. Abathengi bazobe besadingeka ukudala i-akhawunti ku-HealthCare.gov, kodwa bazokwazi ukuqedela yonke inqubo kusayithi lomthengisi webhu.
Futhi uma uthengisa ukufakwa kweqembu elincane ekushintsheni, ungabona umehluko, njengoba i-HealthCare.gov ishintshile ekusebenziseni inqubo yokubhalisa ngokuqondile yamabhizinisi amancane. Ukushintshaniswa kwe-inshuwalense yezempilo yebhizinisi encane akukaze kuvezwe ikakhulukazi, noma kunjalo; Amabhizinisi amaningi abhalisile-ngokuqondile-ngokusebenzisa ama-insurers-kusukela ekuqaleni.
Izinguquko Ngenxa Yomyalelo Omkhulu We-Trump ku-ACA
Ngosuku lwakhe lokuqala ehhovisi, u-Presiden Trump wasayina i-oda elihle elihloswe ngokuthi "ukunciphisa umthwalo wezomnotho woMvikeli WezoMpilo kanye noMthetho Wokunakekelwa Okungenakusiza okulindelekile." Ngaleso sikhathi, ukulindela phakathi kwezokuPhatha kweTrump kwakuyi-bill ye-ACA yokuchithwa eyodluliselwa maduzane, okwakungeke kwenzeke.
Kodwa i-oda elilawulayo liqondisa ama-federal ejensi ukuba abe mnene ngangokunokwenzeka- ngaphandle kokuhambisana nomthetho-lapho kuqiniswa izinhlinzeko ze-ACA.
Isigunyazo ngabanye, esidinga abantu abaningi baseMelika ukuthi balondoloze umshwalense wezempilo oqhubekayo noma abhekane nesigwebo sentela, bekulokhu kucatshangwa njalo kusukela ku-oda oluphezulu. Ukucaca, isinqumo ngasinye sisekhona ngo-2017 , futhi kubonakala sengathi kuzoba njalo ngo-2018. Iningi lamaphrojekthi e-ACA okuchithwa abakwaRiphablikhi aseCongress asewethule ngo-2017 (kuhlanganise noGraham-Cassidy-Heller-Johnson umthethosivivinywa) ngabe usanciphisa isigwebo somuntu ngamunye ku-$ 0, sivuselele ekuqaleni kuka-2016. Kodwa akekho kulezi zindleko ezenziwe.
EzokweMpilo, uTim Jost wabika ngo-Agasti ukuthi lo myalelo ngamunye okwamanje uqiniswe yi-IRS, naphezu kwamahemuhemu okuphambene nalokho, futhi iwebhusayithi ye-IRS ithi nakuba ngabe i-oda elihle , " izinhlinzeko zomthetho ze-ACA zisasebenza kuze kube yilapho kushintshwe yiCongress, futhi abakhokhi bentela bahlala bephoqelekile ukuba balandele umthetho futhi bakhokhe lokho abangakhokhwa. Abathengi kufanele baqhubeke nokufaka intela yabo yentela njengoba bevame ukukwenza . "
Kodwa-ke, i-IRS yavumela abantu ukuba bafake izintela zentela ka-2016 entwasahlobo ka-2017 engaphenduli umbuzo mayelana nokuthi ngabe ufaki unemshuwalense wezempilo ngo-2016 . Baye bakuvumela ukuthi kube ngo-2014 no-2015, kodwa behlose ukwenqaba ukubuya okunjalo ngo-2016, futhi badinga zonke izihlungi ukuphendula lo mbuzo. Bashintsha inkambo ngalolu shintsho ngemuva kokuhleleka kukaMengameli uTrump, futhi baqhubeka nokwamukela ukubuyisa "okuthulile" okwakungasho ukuthi ngabe umfaki wentela unemali yomshwalense wezempilo noma cha.
Akucaci ukuthi i-IRS izoshintsha isimo sayo kule nkinga eya enkathini yokufaka intela ekuqaleni kuka-2018, kodwa akunakwenzeka ukuthi bayokwenza, banikezwe i-Trump's executive order.
Iqembu Elikhulu, Imithi, neMedicaid: Izinguquko Zonyaka Ezivamile Zifake isicelo
Iningi lempikiswano yokuguqulwa kwezempilo ngonyaka wezi-2017 liye lagxila emakethe ngayinye, emakethe yeqembu elincane, naseMedicaid. Kodwa njengoba kuphawuliwe ngenhla, iningi lalezo mpikiswano alizange liholele kunoma yiziphi izinguquko ezibonakalayo. Kubantu abathola umshwalense wabo kubaqashi abakhulu, i-Medicare, noma i-Medicaid (abanjwe ndawonye, okungabantu abaningi kakhulu), izinguquko zango-2018 zizoba uhlobo olufanayo lwezinguquko ezenzeka ngonyaka.
Vula ukubhaliswa kwe-Medicare Advantage ne-Medicare Part D egijima kusukela ngo-Okthoba 15 kuya kuDisemba 7, nazo zonke izinguquko ziphumelela ngoJanuwari 1, 2018. Amalungiselelo amanje azoshintsha cishe ngo-2018-njengoba enza njalo ngonyaka-ngakho kubalulekile ukuba ababhalise ukuthi bathathe isikhathi ngenkathi bevulekile ukubhalisa ukuqhathanisa izinketho ezihlukahlukene ezikhona futhi ukhethe lowo ozokwazi ukuhlangabezana nezidingo zabo ngonyaka ozayo.
Kunjalo nakwezinhlelo ezixhaswe ngumqashi. Abaqashi abaningi banokubhaliswa okuvulekile ekwindla, kanti inzuzo iguqulwa ngoJanuwari 1. Uma uhlelo lwakho luhlangabezana nezinguquko ngonyaka ozayo, noma uma kukhona izinketho ezintsha ezitholakalayo kuwe, ukubhaliswa okuvulekile kuyoba ithuba lakho lokushintsha izinzuzo zakho uma ukhetha ukwenza kanjalo.
Azikho iziphakamiso zokulungiswa kwezempilo ezihlobene neMedicaid ezenziwe ngo-2017, okusho ukuthi ukufaneleka kuzoqhubeka ngo-2018 ngokuyinhloko kungashintshi kusukela ngo-2017, kuhlanganise nokukhuliswa kwe-ACA's Medicaid. Azikho amazwe amasha akhulise ukufaneleka kwe-Medicaid ngo-2017, ngakho amazinga okuthola imali ngokufaneleka kokunakekelwa kwe-Medicaid ahlala efana nokuqala kwawo konyaka. Uma uthola isicelo esivela ku-agency yakho ye-Medicaid ejensi ukuze ubuyekeze ukufaneleka kwakho kwe-Medicaid, uzofuna ukunikeza amadokhumenti adingekayo ngokushesha ngangokunokwenzeka ukuze ugweme ukuphelelwa yisikhathi ekukhunjweni.
> Imithombo:
> Cassidy.Senate.gov. Umbhalo Wokuchitshiyelwa 543 ku-HR1628 (ukuguqulwa kwe- Graham-Cassidy-Heller-Johnson ku-American Health Care Act ). Kuthulwe ngo-Septhemba 13, 2017.
> Amasevisi e-Medicare naseMedicaid Services. Ikusasa le-SHOP. I-CMS ihlose ukuvumela amabhizinisi amancane kuma-SHOPs esebenzisa i-HealthCare.gov Ukuthobeka okukhulu uma ubhalisa ku-Healthcare Coverage . Ngo-May 15, 2017.
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. Ukuvikelwa kwesineke nomthetho wokunakekelwa okunganakekelwayo: Ukuqiniswa kwemakethe . April 2017.
> Insizakalo yangaphakathi yeNgeniso, Ukuhlinzekwa Kwamalungelo Omuntu Ngamunye.
> WhiteHouse.gov, ihhovisi likaNobhala Wezezindaba. I-Order Yokunciphisa Ukunciphisa Umthwalo Wezomnotho Wokuvikelwa Kwabaguli kanye Nokunakekelwa Okunakekelwa Ngokwethenjelwa Okulindelekile Ukuphinda. NgoJanuwari 20, 2017.