Izizwe eziningana ziye zafezwa noma ziphikelela ama-1332 Waivers
Isigaba 1332 soMthetho Wokunakekelwa Onganakekelwayo uvumelekile ekudalweni kwama-1332 waivers. Uma kuvunywe uhulumeni wesifundazwe, ama-1332 waivers avumela amazwe ukuba aguquke noma ashintshe izinhlinzeko ezihlukahlukene ze-ACA ukuze asebenzise indlela entsha yokuziphendulela kwezempilo. Kodwa ukuvikela abathengi, i-ACA ihlanganisa imihlahlandlela eqinile ngokwemigomo yemigomo ye-ACA engasuswa, futhi idinga amazwe ukuqinisekisa ukuthi abantu bayobe bavikeleke kahle ngaphansi kokushiya njengoba bezobe beba ne-ACA ngokwayo.
Nakuba i-ACA inqunywe ngo-2010 futhi inqwaba yezinhlinzeko zayo yaqala ukusebenza ngonyaka ka-2014, izinsuku zokuqala eziphumelelayo ezinamathuba angu-1332 aivers kwaba ngoJanuwari 2017. Isimo esisodwa kuphela-eHawaii-sasine-1332 waiver kusukela ngoJanuwari 2017, kodwa izifundazwe ziqhubekele phambili ngonyaka ka-2017, futhi kulindeleke ukuthi okuningi kulandele iminyaka ezayo.
Ngakho-ke lapho inkulumo ka-1332 waivers yayiyinhloko yezemfundo eminyakeni eyandulela, kungenzeka ukuthi ivele ingxoxo manje. Ake sibuke ukuthi kanjani ama-1332 waivers asebenza kanjani, ukuthi yini engakwazi (futhi engenakuyenza) nayo, nokuthi isebenza kanjani kuze kube manje.
Imithetho eyisisekelo ye-1332 Waivers
Lapho i-ACA ibhalwa, abameli bamukela ukuthi izimo zinezimo ezihlukahlukene ezingahle zingasetshenziswe kahle ngendlela eyodwa-evumelana nayo yonke. Ngesikhathi esifanayo, babesazi nokuthi abanye bathi bangakhetha indlela yokuzikhandla kwezempilo, okuzoshiya abathengi ngendlela encane yokuvikela uma izifunda zivunyelwe ukuba zenze izinhlinzeko ze-ACA ngaphandle kwemihlahlandlela eqinile elawulayo inqubo.
Ngokwemlando, ngaphambi kokuthi i-ACA idale isiteleka sombuso ngokulandela uhlaka oluyisisekelo lokulawula, kusho ukuthi yonke indawo imephu ngokulawulwa komshwalense wezempilo. Ezinye izifunda sezivele zineziqondiso endaweni ezadlula imithetho ye-ACA (eNew York, isibonelo, ayivumeli ama-premium ahluke ngobudala, okuyinto eqinile kakhulu kune-ACA; umthethonqubo waseNew York ubelokhu ukhona kusukela ngawo-1990).
Ngakolunye uhlangothi lomkhakha, amanye amazwe atholakala ukuthatha indlela engaphezulu yemakethe, engenayo indlela yokulawula ngaphambi kokuba i-ACA isungule izindinganiso ezincane ezisebenza kuwo wonke amazwe.
Ngakho-ke ngenkathi iSigaba 1332 se-ACA sivumela izifunda ukuba zithuthukise futhi zithathe indlela yazo yokulungisa izinguquko zezempilo, kuneziqondiso ezithile eziyisisekelo okumelwe zilandelwe. Okokuqala, kunezinhlinzeko ezithile ze-ACA ezingasuswa nge-1332 waiver. Izigaba ezingavumelekile zihlanganisa:
- I-ACA Isihloko I, Ingqikithi D, Izingxenye I no-II. Lezi zigaba ziphathelene nezidingo ezidingekayo zezempilo , izidingo zamanani ezifanele (ie, ukuhlinzekwa kwe-ACA okudinga ukuthi wonke amapulani afaneleke kunoma iyiphi ibhedu, isiliva, igolide, iplatinum, noma izigaba eziyingozi), imithetho echaza ukuthi yibaphi abaqashi ababhekwa njengabancane amaqembu, izidingo zokwanele kwenethiwekhi, isidingo esisodwa sezimiso zokungena engozini (okusho ukuthi, umthetho obudinga umshwalense kumakethe noma emakethe amancane ukubeka wonke amapulani akhe noma / noma amancane emgodini owodwa wobungozi, kungakhathaliseki ukuthi ' sithengiswa noma sisebenzelana ngokushintshaniswa), kanye nezidingo ngokwemisebenzi ukuthi ukuhwebelana okusekelwe emazweni kufanele kwenziwe.
- I-ACA Isigaba 1402. Lesi sigaba sibhekisela ekunciphiseni ukwabelana ngezindleko (CSR), okunciphisa izindleko ezingaphandle kwe-pocket kubhalisile abasebenzisa imali encane ngenhloso yesiliva.
- Isigaba 36B se-Internal Revenue Code. Lesi sigaba sikhokhelwe ngesikweletu se- ACA sika-premium tax (premium subsidy) . Ibeka imithetho ngokuqondene nokuthi ubani ofanelekile kwekhredithi yentela ye-premium, ukuthi yikuphi inani lesikweletu sokukhokhela intela elizofanele, futhi ukuthi kusakazwa kanjani isikweletu.
- Isigaba 4980H se-Internal Revenue Code. Lesi sigaba sibhekisela ekugunyazweni komqashi ka-ACA, okudinga abaqashi abasebenzi abangu-50 noma ngaphezulu abalingana nesikhathi esigcwele ukuba banikeze umshwalense wempilo engabizi, noma ubhekane nenkokhelo yentela.
- Isigaba 5000A se-Internal Revenue Code. Lesi sigaba sikhuluma ngokugunyazwa ngabanye be-ACA, okudinga abantu baseMelika abaningi ukuba bagcine umshuwalense wezempilo noma babhekane nesigwebo sentela.
Ukuvuma ukuthi ukuyeka lezo zinhlinzeko kubanikeza ithuba elibalulekile ngokushintsha izinguquko abangayenza. Kodwa eziningi ze-ACA ezibalulekile zokuvikela izimboni azikho kulezo zigaba ezingavumelekile. Ukuhlinzekwa kwe-ACA okuvimbela abanikezeli bomshuwalense ukuba benqabe abafakizicelo abanezimo ezikhona ngaphambili (noma ukuwashayela amaphrimiamu aphakeme) ngeke bakwazi ukukhishwa nge-1332 waiver, futhi ukuvimbela i-ACA esikhathini sokuphila kanye nomnyaka wezinzuzo zezempilo ezibalulekile (nakuba kuboniswe ngenhla, kubalulekile imithetho yokuhlomula ezempilo ngokwayo ingalungiswa).
Amazwe awakwazi ukulungisa umthetho we-ACA odinga inshuwalense ukuvumela abantu abasha ukuba bahlale ohlelweni lwezempilo lomzali kuze kube yiminyaka engu-26 (lokhu kuhlinzekwa okuthandwayo okusho ukuthi ngeke kufune ukuyeka noma kunjalo), futhi abakwazi ukuyeka imithetho evamile evimbelayo ukubandlulula okusekelwe emlandweni wezokwelapha, ukukhubazeka, ubuhlanga, ubudala, noma ubulili.
Nakuba kunezici ezithile ezibalulekile mayelana nokuthi yini engasuswa, i-ACA ihlanganisa nemithetho emithathu eyisisekelo edingayo izifundazwe ukuqinisekisa ukuthi izakhamuzi zabo ngeke zibi kakhulu ngaphansi kwe-1332 waiver kunokuba zibe ne-ACA engalungile endaweni. Ukuze isigaba se-1332 waiver sivunyelwe, umbuso kumele ubonise ngeziphakamiso zawo zokuyeka ukuthi uma ukukhishwa kwemisebenzi kusetshenziswe:
- Ukubheka kuzoba okungenani okunzulu njengokungathi kungabikho ukuyeka.
- Ukubheka kuzoba okungenani okungabizi kakhulu njengoba bekungekho ngaphandle kokukhishwa.
- Inombolo yabantu abazokwazi ukufaka isikhangiso uma ukukhishwa kwesikhashana kusemthethweni kufanele kube okungenani kuningi okungaba nokuthunyelwa ngaphandle kokushiya.
Futhi umthetho wesine uqinisekisa ukuthi uhulumeni wesifundazwe ngeke abe mkhulu kakhulu ngaphansi kwemigomo yokulinda:
- Ukuxoshwa kufanele kube ukungabi nalutho kuhulumeni kahulumeni.
Ngakho-ke lapho izifunda zingathatha imali abazoyitholela imali yokukhokhela ama-premium kanye nokunciphisa izindleko futhi bayisebenzise ngenhloso ethile, isibonelo, uhulumeni wesifundazwe angeke aqede ukuchitha okuningi esesimweni esingaphansi kokushiya ngaphandle kokube besichitha ngaphandle ukuxoshwa.
Iziphi Izizwe Eziye Zamukela Ukwamukelwa Kwemigomo Yabo Abangu-1332 Waivers?
Ama-Four-eHawaii, Alaska, Minnesota, nase-Oregon-athole imvume yokugunyazwa kwama-1332 waivers kusukela ngoNovemba 2017.
I-Hawaii yaqala ukusebenza ngo-2017 futhi yavumela umbuso ukuba wehlele ukushintshwa komshuwalense wezempilo webhizinisi elincane. I-Hawaii iye yaba nomthetho osebenzayo kusukela ngawo-1970 owadinga bonke abaqashi (kungakhathaliseki ukuthi ibhizinisi likhulu kangakanani) ukunikeza ukukhokhelwa kunoma yimuphi umsebenzi osebenza okungenani ngamahora angama-20 ngesonto, futhi ukukhokhelwa komsebenzi akukwazi ukukhokhela umsebenzi ngaphezu Amaphesenti angu-1.5 enkokhelo yabo. Lokhu kuyimithetho eqinile kakhulu-kokubili ngokusho kokukwazi ukukhokhela futhi abasebenzi okufanele banikezwe ukuhlinzekwa-kune-ACA, futhi uhulumeni wesifundazwe wavuma ukuthi iHawaii ingasebenzisa i-1332 waiver ukuqeda imfuneko ye-ACA egcina ukuhwebelana kwemishwalense yezempilo emincane .
E-Alaska, e-Minnesota nase-Oregon, ama-1332 waivers avunyelwe ukusebenza ngoJanuwari 2018. Kuzo zonke izimo ezintathu, ukuxoshwa kusetshenziselwa ukuvumela ukuxhasa ngemali izinhlelo zikahulumeni zokuvuselela izinsizakalo. Ukuqiniswa kabusha kuyisimiso lapho inhlangano ehlukile (isimo, kulezi zimo) sivuma ukuthatha izindleko zezimangalo ezidlula inani elithile lama dollar, futhi zimboze aze afinyelele esinye isamba sama dollar. Umphumela uba amaphrimiyamu aphansi, ngoba ababheki besikhwama sezimali abangekho kwi-hook yezindleko ezigcwele zezimangalo eziphezulu kakhulu (i-ACA ifaka uhlelo lokuvuselela umhlaba wonke, kodwa okwesikhashana futhi lwaphela ngo-2016).
Lapho ama-premium ehla, ezinye izinto ezimbili zenzeka:
- Phakathi kwabantu abangatholi izinsizakalo ze-premium, abantu abaningi bathengisa umshuwalense ngoba kuba okungabizi kakhulu.
- Futhi phakathi kwabantu abathola izinsizakalo ze-premium, inani likahulumeni wesifundazwe okufanele lisebenzise ekusizeni liyehla (lokhu kungenxa yokuthi izinsizakalo ze-premium zenzelwe ukugcina imibiko kumazinga okubhekwa njengengakhokhwa; lapho amaphrimiamu akhokhelwa ngaphambili, imali akudingeki ukuba ube mkhulu ukuze uthole imali elandelayo emva kokusizwa kuze kube sezingeni elifanayo elikhokhelekayo).
Ngakho-ke abantu abaningi baqeda uhlelo oluqinisekisiwe lokuvuselelwa kabusha, futhi uhulumeni ubeka imali ngemali ekhokhelwa yi-premium. E-Alaska, e-Minnesota nase-Oregon, lezi zizwe zizovunyelwa ukusebenzisa imali uhulumeni ohulumeni abazobe esebenzile ekusizeni imali eyinzuzo, futhi esikhundleni salokho bayisebenzise ukuze baxhaswe uhlelo lokuvuselelwa kabusha (lokhu kuyaziwa ngokuthi "ukudlula kokungena"). Kuzo zonke izigaba ezintathu, amaphrimiyamu ka-2018 aphansi kakhulu kunokuba ayengenakho uhlelo lokuvuselelwa kabusha, futhi kulindeleke ukuthi kubangele abantu abaningi abanomshwalense wezempilo.
I-Massachusetts iphinde ithumele u-1332 waiver ngoSepthemba 2017, efuna ukusungula isikhwama sokuzinza imali esiyinkokhelo esikhundleni sezinkokhelo zokunciphisa izindleko zakwa-federal ngo-2018. Kodwa amaCenter for Medicare neMediicaid Services anqume ukuthi isiphakamiso sokuxoshwa sithunyelwe kakhulu kakhulu, futhi Isikhathi sokukuthola sivunyiwe ngesikhathi sokuqala ukubhaliswa okuvulekile ngomhla kaNovemba 1, 2017 (ekugcineni, imali yokunciphisa imali yokwabiwa kwemali yaqedwa nguhulumeni wesifundazwe ngo-Okthoba 2017 ).
Izizwe Eziye zaKhipha Iziphakamiso Zabo Ezi-1332
I-California, i-Vermont, i-Oklahoma, ne-Iowa-ithumele ama-1332 waivers kodwa yabe isinqumo sokungahambi phambili nabo.
I-California yayiphakamise isiphakamiso se-1332 saiver esizovumela abafuduki abangabhalisiwe ukuba bathenge intengo ephelele (okungukuthi, ngaphandle kwemali ekhokhelwa yi-premium) umshuwalense wezempilo esimeni sikahulumeni. Kodwa umbuso wasusa isiphakamiso sokuxoshwa ekuqaleni kuka-2017, ngoba babekhathazekile ngokuthi i-Trump Administration ingasebenzisa idatha kusuka ekushintshaneni kombuso ukulandelela phansi futhi ixoshe abafuduki abangabhalisiwe.
I-Vermont ithumele isiphakamiso sika-1332 sokuxoshwa ekuqaleni kuka-2016, icela imvume yokungabi nebhizinisi elincane lokuhwebelana (SHOP). Ukushiya kwabo kwakubhekwa kungaphelele, futhi abaqhubekanga ngokuqedela. Kodwa i-Vermont isetshenzisile indlela yokuqondisa ukushintshwa kwe-SHOP kusukela ngonyaka ka-2014. I-Vermont nayo ihlose ukusebenzisa uhlelo lwe-1332 waiver ukuze kuqaliswe uhlelo olulodwa olukhokha ukuthi lube lusebenze kusukela ngo-2017, kodwa ekugcineni ludonsa ipulaki kulolu hlelo ngaphambi kokuhambisa isiphakamiso sokuxoshwa, njengoba baqaphela ukuthi uhlelo olusekelwe ohulumeni olulodwa oluzosekelwa luzobiza kakhulu.
I-Iowa ne-Oklahoma zombili zanikeze iziphakamiso ezingu-1332 zaiver ngo-2017 ukuthi zihlose ukuzisebenzisa ngesikhathi sika-2018, nethemba lokunciphisa amaphrimiyamu kumakethe yomshuwalense wabo ngabanye. Ukuxoshwa kuka-Iowa kwakuyoshintsha kakhulu imakethe yombuso ngamunye, ngenkathi i-Oklahoma izobe isungule uhlelo lokuvuselela kabusha futhi uhulumeni walindeleke ukuthi kulandelwe izinkampani ezilandelayo ezingu-1332 ukuze zenze izinguquko ezengeziwe. Kodwa iziphakamiso zombili zokuxoshwa zaxoshwa nguhulumeni lapho kubonakala ukuthi ngeke zivunyelwe ngesikhathi sokwenza umehluko kuma-premium angu-2018.
Imininingwane yazo zonke izintambo ezingu-1332 ezithunyelwe ngokusemthethweni ku-CMS, kufaka phakathi lezo ezikhishwe futhi zivunyiwe, ziyatholakala kuleli khasi lewebhu le-CMS.
Futhi ezinye izilimi eziningana zicubungula ama-1332 waivers, futhi ziye zafaka umthetho ukuqala inqubo, noma zenze esidlangalaleni iziphakamiso ezingu-1332 zaiver. Lindela ukubona okuningi kwalokhu kulo lonke u-2018.
> Imithombo:
> Amasevisi e-Medicare naseMedicaid Services, Isikhungo Sokwaziswa Komthengi kanye Nokuqapha Umshwalense. Isigaba 1332: I-State Innovation Waivers.
> Cornell Law School, Legal Information Institute. 42 US Code ยง 18052 - Ukunikezelwa kwemibuso emisha
> HealthCare.gov. Funda uMthetho Wokunakekelwa Onganakekelwayo.
> Howard, uHeather. Robert Wood Johnson Foundation. Ama-Sates amaningi abheka Isigaba 1332 ama-Waivers. Novemba 6, 2017.