Ukunakekelwa kokuvikeleka kwamahhala - enye yezinzuzo zezempilo ezidingekayo ze-ACA - iphakathi kwezinhlinzeko ezithandwa kakhulu zoMthetho Wokunakekelwa Okunenzuzo. Ama-Insureds kuwo wonke ama-ACA-amalungiselelo afanelekayo akudingeki akhokhe noma yini ohlwini olude lwezinsizakalo zokuvimbela ezisebenza kubesifazane, izingane, nakubo bonke abantu abadala.
Ukunakekelwa kokuvikeleka kwamahhala kuyasebenza ezinhlelweni eziningi zezempilo e-US manje, futhi kwasungulwa ngaphambi kwenqwaba yezinhlinzeko ze-ACA ngo-2014.
Ukuhlinzekwa kusebenza kumacebo ngabanye kanye nezinhlelo zeqembu elikhulu nezincane. Izinhlelo zezempilo ezikhululekile zikhululekile emithethweni yokubheka ukunakekelwa kokuvikela ngaphandle kokwabelana ngezindleko (izinhlelo eziningi ezisekelwe kakhulu yizo ezazisesimweni sokuqala kusukela ngo-Mashi 23, 2010, i-ACA isayinwe emthethweni). Ngonyaka we-2014, cishe ingxenye yesine yabasebenzi abanezinhlelo ezixhaswe ngumqashi babenomsebenzi omkhulu wokubambisana. Kodwa ukusabalalisa kwezinhlelo ezinkulu kuhla kancane kusukela ngo-2010.
Izinkinga zokubeletha - yini ehlanganisiwe mahhala?
I-HHS yenze uhlu lwezinsizakalo zokuzivikela eziqondene nabesifazane ezaqala ukusebenza kuzo zonke izinhlelo ezintsha nezintsha zokuvuselela okungezona ngo-Agasti 2012. Kuhlanganisa ukufakwa kokukhulelwa ngaphandle kokukwabelana ngezindleko. Kodwa lokho akusho ukuthi zonke izinketho ezikhona zokulawula ukuzalwa zizohlinzekwa ngumphathi womshuwalense wezempilo ngaphandle kwezindleko.
I-HHS yacacisa ukuthi izinhlelo zezempilo kufanele zihlanganise okungenani indlela eyodwa yezo zonke izindlela ezigunyaziwe ze-FDA zokuvimbela ukukhulelwa kwabesifazane, ngaphandle kwezidakamizwa ezikhishwa ngamabomu (izinhlelo zezempilo azidingeki ukuthi zimboze ukuvimbela imithi yamadoda, kuhlanganise nama-vasectomies).
Uma izinguqulo ezijwayelekile zohlobo oluthile lokuvimbela inzalo ziyatholakala, uhlelo lwezempilo lunganikeza uhlobo olujwayelekile ngaphandle kokwabelana ngezindleko kodwa lunikeza i-copay uma umshwalense ekhetha uhlobo lwegama lomkhiqizo (kunesidingo sokuthi i-copay ikhishwe uma udokotela ophephile unquma ukuthi okunye okuhlinzekwa mahhala ngecebo lempilo kungabe kungalungile isiguli).
Kukhona izinhlobo ezingu-18 ezihlukene zokubeletha kwezinsikazi ezithandwa yi-FDA:
• Ukuhlinza inzalo
Ukufakelwa kokufaka inzalo yokuhlinza
• Induku ehlongozwayo
• Idivayisi ye-Copper intrauterine (IUD)
• IUD nge progestin
• Shot / injection (Depo-Provera)
• Ukukhulelwa komlomo (iphilisi), ne-estrogen ne-progestin
• Ukukhulelwa komzimba nge progesin kuphela ("i-mini-pilill")
• Ukukhulelwa komzimba ngokweqile ukusetshenziswa okulinda isikhathi sokuya esikhathini (owaziwa nangokuthi unomuthi wokucindezela esikhathini)
• I-patch
• Indandatho yokuvimbela ukubeletha
• I-Diaphragm
• isiponji
• Ikhanda lomlomo wesibeletho
• Ikondomu yabesifazane
• I-Spermicide
• Ukwelashwa okuphuthumayo (Uhlelo B / emva kwepilisi)
• Ukwelapha okuphuthumayo (Ella / Ulipristal acetate)
Umphathi womshuwalense wezempilo kufanele akunike okungenani okukodwa okukodwa kulezi zigaba ezingu-18, ngaphandle kwezindleko ezingaphandle kwe-pocket. Kwezinye izinhlobo zokuvimbela ukukhulelwa, kunezinketho eziningi ezitholakalayo, futhi umshuwalense wakho wempilo yomshuwalense angenza i-copay iningi lazo, uma nje okungenani kunikezwa eyodwa ngaphandle kwakho.
I-LARC - engabizi ngaphansi kwe-ACA
Imfuneko yokuthi uhlobo ngalunye lwezokwelapha lube khona ngaphandle kokwabelana ngezindleko kubalulekile ikakhulukazi ekuvimbeleni ukuvimbela ukubeletha okuqhubekayo isikhathi eside (IUDs kanye nezinduku ezingasetshenziswa).
Lezi zikhetho zazivame ukubiza ngokweqile ngokwezindleko zangaphambili ngaphambi kwegunya le-ACA lokukhulelwa (naphezu kokuphila komkhiqizo, bavame ukubiza kakhulu kunezokwelapha zomlomo). Kodwa ziphumelela kakhulu futhi izifundo zifumene ukuthi abesifazane bayayithanda kwezinye izindlela zokuvimbela lapho izindleko zingasabi isivinini. Ukusetshenziselwa ukuvimbela ukuvimbela ukukhulelwa isikhathi eside kwakusanda kukhuphuka ngo-2012, futhi iphrojekthi yezochwepheshe ukuthi ukusetshenziswa kwabo kuzokwandisa ngenxa ye-ACA.
izinselelo zokugunyazwa kokukhulelwa
I-ACA ayikhiphi amasonto nezinzuzo ezingokwenkolo ezivela ekugunyazweni kokukhulelwa, kodwa ezinye izinhlangano ziye zahlambalaza igunya futhi ezinye ziye zanqoba enkantolo.
Ngo-2014, i-Hobby Lobby yafakazela ilungelo lokukhipha izinhlobo ezine zokwelapha kokubeletha (kokubili ama-IUD, kanye ne-Plan B no-Ella) kusukela ohlelweni lwezempilo lwabasebenzi. INkantolo Ephakeme ihlangene ne-Hobby Lobby, inquma ukuthi uhulumeni kufanele athole indlela yokuqinisekisa ukuthi izinkampani "ezinokubambisana" (njengeHobby Lobby) ezinezikhalazo kwezinye izindlela noma zonke izindlela zokulawulwa kokuzalwa zizokwazi ukugwema ukuzikhokhela njengengxenye yecebo labo lempilo.
NgoJulayi 2015, ngokuphendula isinqumo se-Burwell v. Ukubambisana kwe-Lobby, i-HHS yaqedela isinqumo esivumela indawo yokuhlala "inhlangano ebambe iqhaza kakhulu enenzuzo eyenza inzuzo yenkolo yokuhlinzekela ezinye izinto noma zonke izinsizakalo zokukhulelwa," okwamanje ukuqinisekisa ukuthi abesifazane banokufinyelela ohlangothini olugcwele lwezinkinga zokubeletha ezivunyelwe i-FDA. Ngaphansi kwendawo yokuhlala, umshuwalense wezempilo (noma umphathi wesithathu uma kukhona izinhlelo ezizimele) uthatha izindleko zokumboza ezinye noma zonke izinhlobo zokukhulelwa, ngaphandle kwezindleko kumfazi noma kumqashi. Indawo yokuhlala yezinhlangano ezenzelwe inzuzo ifana nendawo yokuhlala iHHS eyayihlinzekele ngaphambilini engenayo inzuzo engokwenkolo.