Ingabe i-Obamacare esikhundleni sayo izovikela abahlomuli be-Medicare?
Umthetho Wokunakekelwa Okuncintisayo, u- Obamacare , awugcini nje ukuletha inshuwalense kubantu abayizigidi baseMelika ngokusebenzisa indawo yomshuwalense wezempilo kodwa futhi wandisa iMedicaid emazweni amaningana. Abantu abangakwazi ukukhokhela umshuwalense wezempilo babe nokufinyelela okusha. Yikuphi abantu abaningi abakhohlwayo, kodwa ukuthi lolu hlelo lubuye lwaba nomthelela ojulile ku-Medicare .
Umthetho ubhekene nokuqedwa ngo-2017 yiRepublican Congress. Noma kunjalo, ukuphinda akuzange kwenzeke, okungenani kungakafiki.
Uhlelo oluthatha isikhundla se-Obamacare kumele luqale luhlole indlela uMnyango Wokunakekelwa Ongathintekayo ongathinteka ngayo uMuthi. Khona-ke kufanele icabange ukuthi izobhekana kanjani (noma ngabe izobhekana nabo) lezo zidingo ngomthetho omusha.
I-CMS Innovation Center
Uma singashintshi, asikhulumi. Izikhungo ze-Medicare ne-Medicaid (CMS) Innovation Center zafika ngaphansi kweNcwadi Yokwelashwa Engathengi futhi zibukeka ngezindlela zokubonisa izindlela ezintsha zokukhokha kanye nezokunakekelwa kwezempilo ukuze kungabi ngcono kuphela izinga lokunakekelwa kodwa nokunciphisa izindleko ze-Medicare, Medicaid , kanye ne- Child Health Insurance Program (CHIP) .
Makube khona iphutha. I-CMS ibeka isiteji sayo yonke imboni yomshuwalense. Uma i-CMS ithola okuthile okusebenzayo, abaqinisekisi bangebunikazi bayaqiniseka ukuthi bajoyine imbangela.
Kusukela ekuqalisweni kwayo, amamodeli angaphezu kuka-30 okukhokha ahlongozwa futhi ahlolwe.
Isikhungo se-CMS Innovation sibheke izinhlangano zokunakekelwa ngokuziphendulela kanye nezinkokhelo ezikhokhwayo njengezindlela ezahlukene zokukhokha ukunakekelwa kwempilo. Ukushintshwa kokukhokhela insizakalo (udokotela okhokhelwa insizakalo ngayinye) ukukhokha-ngekhwalithi (udokotela ubuyiselwa ngokusekelwe emiphumeleni yokunakekelwa kwekhwalithi) iyaqhubeka.
Imali engamaphesenti angama-30 eNkokhelo ye-Medicare manje isetshenziswe ngale ndlela.
Izinhlelo zokunakekelwa kwezempilo ziye zathuthukisa ikhwalithi kubantu abayizigidi baseMelika. I-Comprehensive Primary Care Initiative ivumele ukukhuliswa kokunakekelwa okuyinhloko kwezinye kuthiwa ukuzuzisa labo abaswele. I-Comprehensive End-Stage Disease Disease (ESRD) Yokuqala Yokunakekela ithuthukise ukutholakala kokunakekelwa kwabantu abakwi-dialysis . Isiqalo Sokuqina Kwabanina NamaNtsana sancipha ukubeletha ngaphambi kokuzalwa kanye nezinkinga zesikhathi eside emindenini emisha. Uhlelo Lokuvikela Isifo Sikashukela luye lwaphumelela kangaka luzokhuliswa lonke jikelele ngo-2018.
Ingabe ukuchithwa kwe-Obamacare kuzoqeda lezi zinhlelo? Ukufakwa esikhundleni se-Obamacare kufanele kucatshangelwe ukuthi kuzoba nomthelela kanjani ekukhuleni okuzayo kwemithi, kokubili ngekhwalithi nangezindleko.
Ukukhwabanisa, ukuTshiswa nokuhlukunyezwa
Ukukhwabanisa, ukudoba nokuhlukunyezwa kuqhubekile ekunakekelweni kwezempilo, ukukhokhela abakhokhi bakho intela ngokuhamba kwesikhathi. I-Care Affordable Act yathatha izinyathelo zokunciphisa lokhu kusetshenziselwa kabi futhi iqondise kabusha imali ukuthi ibuyele emuva ohlelweni lweMediare. Yenza kanjalo ngokuqinisa i-Medicare Fraud Strike Force.
I-Medicare Fraud Strike Force yasungulwa ngo-2007 futhi isebenza ngokubambisana noMnyango Wezobulungiswa, i-Federal Bureau of Investigation, iHhovisi loMhloli Wezobukhulu, kanye nokusetshenziswa komthetho wendawo.
Ukusebenza kwamadolobha ayisishiyagalolunye ezweni lonke - iBat Rou Rouge, eLouisana; EBrooklyn, eNew York; I-Chicago, i-Illinois; I-Dallas, eTexas; I-Detroit, eMichigan; I-Houston, eTexas; IMiami, eFlorida; I-Los Angeles, eCalifornia; futhi eTampa, eFlorida - i-Medicare Fraud Strike Force igcine lolu hlelo ngokuphindwe kabili njengalokhu lwenze ngaphambi kokuba uMthetho Wokunakekelwa Ongenakusiza unqunywe ngo-2010.
Kusukela ngo-June 2016, imizamo ye-Medicare Fraud Strike Force yabangela izinsolo ezingu-2 522. Isibalo esikhulu kunazo zonke emlandweni weMisebenzi yabasebenzi senzeke ngoJuni 2016 lapho abantu abangu-301, abangu-61 babo bebaqeqeshi bezokwelapha abanelayisensi, bakhokhiswa ngenhloso yokwenza inkohlakalo yokunakekelwa kwempilo, ukukhishwa kwemali kanye nokwebiwa kwezazisi .
Umsebenzi wabo wobugebengu wabiza cishe amaRandi ayizigidi eziyizigidi ezingu-900 ekukhokhiseni amanga.
Izinguquko zokunakekelwa kwezempilo ezithuthuka phambili kumele ziqhubeke nokuthatha inhloso kulabo abazama ukusebenzisa kabi uhlelo. Kuyoba yindlela kuphela yokugcina izindleko phansi kulabo abakudinga kakhulu.
Amanani okuFunda esibhedlela
Wonke umuntu uyavuma ukuthi ukunakekelwa esibhedlela kufanele kube yizinga eliphezulu kakhulu. Ukuphila kwabantu kanye nenhlalakahle kuxhomeke kulo. I-Care Affordable Act yathatha izinyathelo zokugqugquzela izibhedlela ukuba zithuthukise izinga labo lokunakekelwa. Benza kanjalo ngokuhlola ukuthi bangaki abantu abafakwe esibhedlela zingakapheli izinsuku ezingama-30. Njengoba bevunyelwe esibhedlela, babecabanga ukuthi kungaba isibonakaliso sokuthi lesi sibhedlela asizange senze ukunakekelwa komuntu ngaphambi kokuba akhululwe.
Uhlelo lokunciphisa ama-Readmissions, oludalwa ngaphansi koMthetho Wokunakekelwa Okungenakusiza, lubuke ngokukhethekile ukuvuma kwe- heart , ukuhluleka kwenhliziyo , ukukhuphuka kwe-pneumonia , ukuguqulwa kwesigqila / ukuguqa, kanye nesifo se-chronic obstructive pulmonary (COPD) . Izibhedlela ezazinamazinga aphezulu okufunda kule ndawo zihlawuliswa ngamaphesenti wehla emithwalweni yabo ye-Medicare.
Kusukela ngo-2012, izinga lokubhaliswa kwezibhedlela liye lahla kancane. Izinga lokubukwa kwenhliziyo liyehla ngamaphesenti angu-2,8, izinga lokuhluleka kwenhliziyo ngamaphesenti angu-2,8, kanye namanani e-pneumonia ngamaphesenti angu-1.5 kusukela ngo-2007 kuya ku-2014. Umbuzo, yiqiniso, ukuthi ngabe lokhu ngempela kubonisa ukuthuthukiswa kokunakekelwa kwekhwalithi. Kunokukhathazeka ukuthi izibhedlela zingase zigweme izijeziso ngokubeka abantu "ngaphansi kokubheka" ngokungafani nokuzifunda njengeziguli.
Ngomthetho wokunakekelwa okunganakekelwayo ususe, uhlelo lokunciphisa ama-Readmissions lungase luhambe. Ngethemba ukuthi kuzoqhubeka nokuqhubeka, noma imizamo emisha yokubhekana nekhwalithi yokunakekela abantu abasithola ezibhedlela.
Ingxenye D Donut Hole
I-Medicare Part D yaba khona ngaphansi kukaMengameli uGeorge W. Bush lapho uMthetho weMedricare Modernization ufezeka ngo-2003. Abahlomuli bakwazi ukusebenzisa ngokunenzuzo izinzuzo zeNgxenye D izidakamizwa eziqala ngoJanuwari 2006 nge-caveat eyodwa. Umthetho wawuhlanganisa i-"hole hole" engavamile, igalelo lokubiza elidinga ukuthi abahlomuli be-Medicare bakhokhele amaphesenti angu-100 ngaphandle kwe-pocket imishanguzo yabo kanye kanye nohlelo lwabo lwe-Part D basebenzisa imali ethile ngonyaka onikeziwe.
U-Obamacare wasiza ukwehlisa lezo izindleko ezingaphandle kwe-pocket .
Okokuqala, ixoxisane nabakhiqizi bezindleko bangakukhokhisa ngemithi yakho. Abakhiqizi begama lomkhiqizo, ikakhulukazi, banganikeza izidakamizwa zabo isaphulelo samaphesenti angu-50 phakathi nesikhathi owawukhona emgodini we-donut.
Okwesibili, u-Obamacare wehlile ukuthi ungayikhokha imali engakanani uma ufuna i-Part D izinhlelo ukuthi ukhokhe ingxenye encane yezindleko zakho ezidakamizwa phakathi nomgodi we-donut. Uzokhokha okungaphezulu ukuthi uzophuma ngaphandle komgodi we-donut, kodwa ukugcina kwakubalulekile. I-White House ibika ukuthi ukulondoloza kuye kwazuza abantu abangaphezu kwezigidi ezingu-8, kubalondoloza imali engaphezu kuka-11.5 billion kusukela ngo-2010.
Okwesithathu, inani lemali lakho elikhokhelwa imithi yakho lizokhula kancane kancane kuze kube yilapho igebe lokuvala livaliwe ngokuphelele ngo-2020. Ngamane nje, uzokhokha ama-premiums akho, ama-deductibles, ama-copayments, nokunye okunye.
Umgodi we-donut wawuzobuya ngokuqedwa kwe-Obamacare. Njengoba izidakamizwa zemithi zibiza kakhulu kunanini ngaphambili, umthelela kubadala baseMelika uzoba yinkimbinkimbi. Ukufakwa esikhundleni se-Obamacare kuyodinga ukucabangela lokhu ukuqinisekisa ukuthi abantu bangafinyelela imithi abayidingayo.
Amasevisi Wokuhlola Okuvimbelayo
I-Obamacare iphinde ithuthukise ukuhlinzeka ngezinsiza zokuhlola zokuvikela. Uma nje udokotela wakho esamukela isabelo , okusho ukuthi wavuma kuMnyango WezeMithi Wezokwelapha, lezo zinsizakalo zokuvimbela ngeke zisadinga ukukhokha imali noma ukukhokhelwa kwemali. Banikezwa kuwe mahhala.
Izinsizakalo zokuvikela zamahhala ezihlanganiswe yi-Medicare zihlanganisa:
- Ukuvakasha Kwaminyaka Yonke
- Ukuqapha kwengcindezi yegazi
- Ukuhlolwa komdlavuza wesibeletho (ama- mammograms )
- Ukuhlolwa komdlavuza wesibeletho (ukuhlolwa kwe-Pap smears nokuhlolwa kwe-papillomavirus (HPV)
- Ukuhlolwa komdlavuza weColon (ukuhlolwa kwegazi okwemvelo, i-colonoscopy, sigmoidoscopy)
- Ukuhlola ukucindezeleka
- Ukuhlolwa kwe-Lipid
- Ukuhlolwa komdlavuza we-prostate (i-prostate-specific antigen)
- Amagciwane (umkhuhlane, i-pneumococcal)
Ezinye izinhlelo zokusebenza-ukuhlolwa kwesisu ngesisu, ukuhlolwa kwesifo sikashukela , ukuhlolwa kwe- hepatitis C, ukuhlolwa kwe-HIV, ukuhlolwa komdlavuza wamaphaphu, ukuhlolwa kwe- osteoporosis nokuhlolwa kwezifo ezithathelwana ngocansi-kuzophinde kube mahhala kodwa kutholakala kuphela kubantu ababhekwa njengengozi enkulu. Ukuhlolwa komdlavuza weColon ngesitifiketi se-DNA kuyobekwa kuphela uma lowo muntu engozini enkulu.
Ukunciphisa izinzuzo zokuqashwa kwabasebekhulile abangabagcina bephilile noma abangavumela ukwelashwa kokuqala kwezifo eziyinkimbinkimbi kuqondene. Ngingasho ngisho nokuphakamisa izinkinga zokuziphatha. Masingakhohlwa ukuthi isifo esithuthukisiwe kakhulu uma sitholwa, kuyodingeka ukwelaphe ngokweqile. Ukufakwa esikhundleni se-Obamacare kufanele kubhekane nemiphumela yezempilo kanye nezindleko zesikhathi eside kulabo abahlanganisa.
Izwi kusuka
Ihhovisi le-Congressional Budget Office elingabambisanga lihlolisise imiphumela ye-Obamacare yokuchithwa futhi ihlongozwe ukuthi ukusetshenziswa kweMedricare kuzokwenyuka ngamaRandi ayizigidi ezingama-802 ngaphezu kweminyaka eyishumi. Uhlelo olusha lokunakekelwa kwempilo luzodinga ukufaka lokhu ku-equation.
Inkinga yokuguqulwa kwempilo ayiyona nje kuphela kwezombangazwe kodwa ezomzwelo. Kungakhathaliseki ukuthi ungakholelwa yini ekufanelekeni kwe-Care Affordable Act, udinga ukuqonda ukuthi iziphi izinhlinzeko zemithi ezizoguqulwa ngokuguqulwa komthetho. Izokwazisa ukuthi yini okufanele uyibuke lapho ukushintshwa kwe-Obamacare okungenakugwema kufezeka.
> Imithombo:
> UBoccuti C, uCasillas G. Efuna ukuguqulwa kwezibhedlela ezimbalwa: Uhlelo lokunciphisa isibhedlela saseMedare. http://kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program/. Ishicilelwe ngo-September 30, 2016.
> Imiphumela Yomnotho kanye Nemiphumela Yomnotho Yokuphinda Ukuphinda Umthetho Wokunakekelwa Onganakekelwa. Iwebhusayithi ye-Congressional Budget Office. https://www.cbo.gov/publication/50252. Ishicilelwe ngo-Juni 19, 2015.
> Izici eziyinhloko zoMthetho Wokunakekelwa Onganakekelwa Ngonyaka. Iwebhusayithi yoMnyango WezeMpilo NezeMisebenzi Ye-US. https://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca-by-year/index.html. Kubuyekezwe ngo-Agasti 13, 2015.
> Medicare Strike Force Force. Ihhovisi le-Inspector General - Iwebhusayithi yoMnyango WezeMpilo NezeMelika. https://oig.hhs.gov/fraud/strike-force/.
> Izinsizakalo Zokuvimbela Nokuhlola. Medicare.gov. https://www.medicare.gov/coverage/preventive-and-screening-services.html.