Amalungiselelo e-ACA kwabamaMelika baseMelika nabakwa-Alaska
Umthetho Wokunakekelwa Okunakekelwayo - aka Obamacare - unikeze abaningi baseMelika baseMelika nabase-Alaska ababengaqinisekisiwe ngethuba lokuthola umshuwalense wezempilo. Ngokusho kwe- US Census data , kunezigidi ezingu-5.2 zamaMelika aseMelika nama-Alaska Natives e-United States. Kusukela ngo-2009 kuya ku-2011, cishe amaphesenti angama-30 kubo ayengaqinisekisiwe - uma kuqhathaniswa no-17% we-US inani labantu.
AbakwaMelika baseMelika nabakwa-Alaska bafinyelela ekunakekelweni kwezempilo kwamahhala okuhlinzekwa yizikhungo ze-Indian Health Service (IHS), kodwa izindawo zeHS zivame ukuba ziseduze nokubhuka, futhi ngaphezu kwezintathu zamaMelika aseMelika naseAlaska Abemi abahlali ezindaweni zokubhuka noma ezizweni. Ngisho nalapho izikhungo ze-IHS zendawo, i-Office Accountability Office ithola ukuthi ukunakekelwa kwezempilo okudingekile akutholakali ngaso sonke isikhathi ngesikhathi esifanele.
Ngezizathu ezihlukahlukene, amaMelika aseMelika nama-Alaska Abomdabu banemiphumela embi kakhulu yezempilo kunomphakathi wase-US wonke. Ukuze kulungiswe ukungalingani kwezempilo, futhi ngomzamo wokunciphisa izinga elingavunyelwanga phakathi kwamaMelika aseMelika kanye nama-Alaska Natives, i-ACA ihlanganisa ezinye izinto ezenza ukufinyeleleka kufinyelelwe kalula futhi ukunakekelwa kwezempilo kufikeleleke kakhulu kubantu baseMelika nabama-Alaska Amanani:
Ukwabelana ngezindleko ezincane
Ukwabelana ngezindleko kungumthamo wemali iziguli okufanele zikhokhelwe ukunakekelwa kwezempilo.
Ngaphansi kwe-ACA, izindleko eziphelele ezingaphandle kwe-pocket azikhawuli ngaphezu kwamaRandi 6,850 kumuntu oyedwa ngo-2016, nakuba izinhlelo zezempilo zingaba nemingcele ephansi, futhi zibe nezimo eziguquguqukayo ngokwenza indlela yokwakha ukwabelana ngezindleko ngokusebenzisa amakhophi, ama-deductibles, kanye ne-coinsurance.
Kubantu baseMelika baseMelika nabaseAlaska, kunezinhlinzeko ezikhethekile mayelana nokwabiwa kwemali:
- Kubantu baseMelika baseMelika nabakwa-Alaska abanezindlu ezingenayo ezingeni lika-300% lobukhulu bobuphofu (cishe amaRandi angama-60,000 emndenini wezintathu, noma i-$ 75,000 emndenini wezintathu e-Alaska), akukho ukwabelana ngemali emiphakathini yomshuwalense wezempilo ethengwe ngoshintsho . Izinkokhelo zenyanga zonke (izindleko zomshuwalense uqobo) kumele zikhokhwe, nakuba izinsizakalo ze-premium zingakwazi ukukhipha ingxenye enkulu yezindleko, kuye ngenzuzo. Kodwa uma kunakekelwa, akukho ama-copays, ama-deductibles, noma i-coinsurance.
- Kubo bonke abantu baseMelika baseMelika nabakwa-Alaska ababhalisa ohlelweni lwezempilo ngokusebenzisa ukushintshaniswa-kubandakanya ababhalisile ngemali engenayo emakhaya ngaphezu kuka-300% wezinga lobuphofu - akukho ukwabelana ngezindleko (ikhophi, ukuchithwa, ukukhokhelwa kwemali) kwanoma yikuphi ukunakekelwa kwempilo etholakala kwi-IHS noma isikhungo sezinhlanga, noma kumhlinzeki owenziwe nge-IHS.
Ukubhaliswa konyaka
I-ACA iveza umqondo wokubhalisa okuvulekile kumakethe yomshuwalense wezempilo ngamunye. Ngaphambi kuka-2014, umshuwalense wezempilo ngamunye ungathengwa nganoma yisiphi isikhathi phakathi nonyaka, kodwa abafakizicelo emazweni amaningi kufanele babe nokuphila okunempilo ukuze bavunyelwe ukukhokhelwa.
Ngaphansi kwe-ACA, wonke umuntu angazuza, kungakhathaliseki ukuthi umlando wezokwelapha.
Kodwa ukuhweba ukuthi lowo mshwalense wezempilo utholakala kabanzi ngesikhathi sokubhalisa okuvulekile (ukubhalwa ngo-2016, ukubhaliswa okuvulekile kwaqala ngoNovemba 1, 2015 futhi kuyaqhubeka kuze kube nguJanuwari 31, 2016). Emva kokubhalisa okuvulekile sekuphela, ukuthengwa kungathengwa kuphela ngabantu abahlangabezana nezenzakalo ezifanelekayo ezibangela izinkathi zokubhalisa ezikhethekile .
Kodwa amaMelika aseMelika nalabo baseAlaska abavunyelwe ukubhalisa ngesikhathi sokubhalisa okuvulekile, futhi abadingi izenzakalo ezifanelekayo. Bangakwazi ukubhalisa nganoma isiphi isikhathi, unyaka wonke (ngokusebenzisa ukushintshaniswa kuphela; ukubhaliswa kwonyaka wonke akusebenzi ukusebenza). Ezingxenyeni eziningi, ukuhanjiswa kuzoba ngempumelelo ngenyanga yokuqala emva kokubhalisa uma bebhalisa nge-15 yenyanga, kanti ngenyanga yokuqala yesibili elandelayo ukubhaliswa kugcwaliswe emva kwenyanga yeshumi nanhlanu (iMassachusetts, Rhode Island, futhi Izwe laseWashington lonke livumela ukubhaliswa - kunoma yimuphi umfakisicelo - ukuba kugcwaliswe sekupheleni njengoba inyanga yesi-23 yokukhishwa kusebenza kahle ngenyanga yokuqala elandelayo).
Asikho isijeziso sokungaqinisekisiwe
Ngaphansi kwe-ACA, kunesijeziso sokungaqinisekisiwe . Kubalwa kumbuyiselo yentela, futhi kusebenza kunoma ubani ofuna ukufaka i-return emuva engakaqinisekisiwe ngonyaka odlule futhi angafanelanga ukukhululwa ehlathini.
Kodwa abantu baseMelika baseMelika nalabo baseAlaska abangamalungu esizwe esihlonishwayo (noma ngubani okufanelekele ukunakekelwa nge-IHS) akhululwe ekujezisweni. Bangathola ukukhululwa kwabo ekushintsheni noma kusuka ku-IRS uma befaka intela yabo yentela (lena ifomu elisetshenziselwa ukucela ukukhululwa, emazweni angu-38 asebenzisa i-Healthcare.gov).
Kuye kwaba nokucindezela okuphawulekayo ukuze abantu baseMelika baseMelika nabakwa-Alaska babhalise izinhlelo zezempilo ngokusebenzisa ama-ACA exchange. Kodwa izinselele zihlala ngokwemigomo yezempahla, imfundo yabathengi, futhi kwezinye izimo, ukungathembeki kohulumeni kahulumeni. Nakuba ubuholi bezinhlanga buye basebenza ekusakazeni igama lokuthi ukubhalisa ekuhlinzekeni kwezempilo ngokusebenzisa ukuthengiselana kwe-ACA kuyasiza kumaMelika aseMelika nase-Alaska Abomdabu, akukho sinxephezelo samalungu esizwe abakhetha ukuhlala engaqinisekisiwe esikhundleni salokho.
Umthetho Wokuthuthukiswa Kwezempilo Kwe-Indian
UMthetho Wokuthuthukisa Ukunakekelwa Kwezempilo Kwe-Indian, okhokhela i-IHS, wadluliselwa yiCongress ngo-1976 futhi wagcina ukugunyazwa ngonyaka ka-2000. Kodwa i-ACA yaqinisekisa ngokugcwele uMthetho Wokuthuthukiswa Kwezempilo we-Indian, futhi yenezela izinzuzo ezengeziwe , kuhlanganise nezinhlelo zokwelashwa kwezempilo kwengqondo nokuziphatha, nezinsizakalo zokunakekela isikhathi eside.
Ukwandiswa kwe-Medicaid
Ngo-2014, izinga lobuphofu phakathi kwamaNdiya aseMelika aseMelika kanye nama-Alaska aseMelika ayeyi-28.3%, uma kuqhathaniswa no-15.5% kuwo wonke umuntu wase-US. Izinga eliphakeme kakhulu kunezinga lobuphofu phakathi kwamaMelika aseMelika kanye nama-Alaska Natives (aphakeme kunanoma yiliphi elinye iqembu lobuhlanga) kwenza ukwandiswa kwe-ACA's Medicaid kubaluleke kakhulu.
I-ACA idinga ukwandiswa kweMedicaid ukumboza bonke abantu abadala abanomholo wekhaya kuze kube ngu-138% wezinga lobuphofu (izingane zase zivele zihlanganiswe emazingeni aphezulu engenayo ngaphansi kwenhlanganisela yohlelo lwe-Medicaid ne-Children's Health Insurance Program), futhi uhulumeni wesifundazwe uyohlale ekhokha okungenani 90% wezindleko zokunwetshwa kweMedicaid.
Kodwa iNkantolo Ephakeme inqume ngo-2012 ukuthi izifundazwe zingakhetha ukukhuliswa kwe-Medicaid, futhi kuze kube manje, izifunda ezingu-19 namanje azikazanga ukunwetshwa kwe-Medicaid.
Ezindaweni eziyisikhombisa (i-Alaska, i-Arizona, i-Montana, i-New Mexico, i-North Dakota, i-Oklahoma, ne-South Dakota), amaMelika aseMelika kanye nama-Alaska aseMelika enza okungenani u-3% wabantu bonke. Kulawo mazwe, bonke kodwa i-Oklahoma neNingizimu Dakota baye bandisa iMedicaid.
Kodwa ngaphezu kwengxenye yabo bonke abantu baseMelika baseMelika nabama-Alaska bahlala emazweni ayisikhombisa (Alaska, North Carolina, Texas, New Mexico, Oklahoma, California nase-Arizona). Kulawo mazwe, iNorth Carolina, iTexas, ne-Oklahoma azange zandise iMedicaid. Ngaphandle kwalawo mazwe amathathu, kunabantu abayizigidi ezingu-1.1 ekungeneni kwekhasi, inombolo efaka phakathi amanye amaMelika aseMelika.
Abantu abasemkhawulweni wokungafihli abafanelekile ukubhekana ne-Medicaid ngoba umbuso awukwandanga ukufaneleka, futhi abafanelekeli ukukhokhelwa kwe-premium ekushintsheni ngoba izinsizakalo azitholakali kubantu abanenzuzo ngaphansi kwezinga lobuphofu (kusukela kwakufanele babe nokufinyelela eMedicaid esikhundleni).
Ngakho-ke ngenkathi ukwandiswa kweMedicaid kuye kwafaka umthelela omkhulu ekuqinisekiseni abantu baseMelika baseNingizimu Afrika abahola kancane nabase-Alaska Abomdabu, lokhu kusebenza kuphela ezindaweni lapho uMedicaid ukwandiswa khona.