Mayiko angapo agwiritsidwa ntchito kapena akutsata 1332 Waivers
Gawo 1332 la Zamtengo wapatali la Care Act linaloledwa kuti pakhale 1332 osungira katundu. Ngati boma likuvomerezedwa ndi boma, 1332 waivers amalola kuti mayiko asinthe kapena kusintha zinthu zosiyanasiyana za ACA kuti agwiritse ntchito njira zatsopano zogwirira ntchito zaumoyo. Koma pofuna kuteteza ogula, ACA imaphatikizapo malangizo okhwima pa zomwe ACA zikhoza kutetezedwa, ndipo zimafuna kuti awonetsetse kuti anthu adzatetezedwe pokhapokha ngati atakhala ndi ACA iwowo.
Ngakhale kuti ACA inakhazikitsidwa mu 2010 ndipo zambiri mwazigawozo zinagwira ntchito mu 2014, masiku oyambirira ogwira ntchito okhwimitsa ntchito 1332 ndi January 2017. Dziko limodzi lokha-Hawaii-linali ndi 1332 kuchoka mu January 2017, koma ena ambiri akuti chaka cha 2017 chimasokonekera, ndipo zikuyembekezeredwa kuti zambiri zidzawatsatira m'tsogolo.
Tsono ngakhale kukamba za 1332 kuopseza kunali makamaka maphunziro mmbuyomu, ndizotheka kukambirana tsopano. Tiyeni tiwone momwe 1332 kuchotsera ntchito, zomwe zingathe (ndi zosatheka) kuzichita nawo, ndi momwe zikugwiritsidwira ntchito panopa.
Malamulo Oyambirira a 1332 Waivers
Pamene ACA inalembedwa, olemba malamulo adavomereza kuti mayiko ali ndi zinthu zosiyana siyana zomwe sizingatheke kutumikiridwa ndi njira imodzi yofanana. Panthawi imodzimodziyo, amadziwanso kuti mayiko ena angasankhe njira yothetsera mavuto a zaumoyo, omwe amasiya odwala kuti asatetezedwe ngati mayikowa amaloledwa kusiya ACA popanda malamulo otsogolera ndondomekoyi.
Kale, ACA isanayambe kukhazikitsidwa pansi pazigawo zoyendetsera malamulo, zidalembedwa ponseponse pamapu momwe analamulira inshuwalansi ya umoyo. Ena amati kale anali ndi malamulo omwe anadutsa malamulo a ACA (New York, mwachitsanzo, salola kuti payimayi ikhale yosiyana ndi zaka, zomwe zimakhala zovuta kuposa ACA; malamulo a New York akhala akuchitika kuyambira m'ma 1990).
Kumalo ena kumapeto kwa masewerawa, mayiko ena adakonda kutenga njira zambiri zogulitsira malonda, osakhala ndi njira yowonongeka pamaso pa ACA asanayambe kukhazikitsa malamulo omwe angagwiritsidwe ntchito m'mayiko onse.
Tsono pamene Gawo 1332 la ACA likulola mayiko kuti amange ndikuyendetsa okha njira zowonetsera thanzi, pali malamulo ena omwe ayenera kutsatira. Choyamba, pali zikhazikitso zina za ACA zomwe zingachotsedwe ndi 1332 waiver. Zigawo zosasinthika ndizo:
- ACA Mutu Woyamba, Mutu D, Mbali I ndi II. Zigawozi zikukhudzana ndi zofunika zofunika zaumoyo , zomwe zimayenera kuti zikhale zofunika (mwachitsanzo, thandizo la ACA lomwe likufuna kuti zolinga zonse zizigwirizana ndi mkuwa, siliva, golide, platinamu, kapena magulu oopsa). magulu, zofunikira zokhudzana ndi maukonde, zomwe zimakhala zovuta zopezeka pamadzi (ie, lamulo lomwe limafuna inshuwalansi pamsika wa gulu kapena gulu laling'ono kuyika mapulani awo onse kapena / kapena ang'onoang'ono padziwe limodzi loopsya, mosasamala kanthu kuti ' kugulitsidwa kapena kusinthanitsa), ndi zofunikira pazinthu zomwe ntchito zogwirizana ndi boma ziyenera kuchita.
- ACA Gawo 1402. Gawoli likukhudzana ndi kuchepetsa kugawa malipiro (CSR), zomwe zimachepetsa ndalama zowonongeka kwa olemba malipiro ochepa omwe amapanga ndalama.
- Gawo 36B la Internal Revenue Code. Gawoli likunena za ACA's premium tax credit (premium subsidy) . Amakhazikitsa malamulo omwe akuyenera kulandira msonkho wa msonkho wapadera, ndalama zonse zomwe amalembetsa misonkho, komanso momwe msonkho waperekera.
- Gawo 4980H la Internal Revenue Code. Gawoli likunena za udindo wa abwana a ACA, zomwe zimafuna kuti olemba ntchito azikhala ndi antchito okwana 50 kapena ochuluka omwe amagwira nawo ntchito yowonjezereka kuti athe kupereka ndalama zowonjezera, inshuwalansi ya thanzi kapena kuchepetsa msonkho.
- Gawo 5000A la Internal Revenue Code. Gawoli likukhudzana ndi udindo wa ACA, womwe umafuna kuti ambiri a ku America azikhala ndi inshuwalansi ya zaumoyo kapena kuti adzalandire chilango cha msonkho.
Kuloleza kuti zisonyeze zomwezo zikuwathandiza kukhala ndi chidziwitso chofunika kwambiri pa kusintha komwe angapange. Koma zambiri zazitetezo zofunikira za ACA sizili m'zigawo zosatsutsika. Cholinga cha ACA chomwe chimaletsa insurers kukana anthu omwe ali ndi zikhalidwe zomwe zakhalapo kale (kapena kuwapatsa malipiro apamwamba) sizingathetsedwe ndi 1332 kulandidwa, ngakhalenso ACA imaletsa moyo wawo wonse ndi malire pachaka kuti athandize thanzi labwino (ngakhale monga taonera pamwamba, phindu la thanzi likhoza kusintha).
Mayiko sangathe kusintha malamulo a ACA omwe amafuna inshuwalansi kuti alole achinyamata kuti akhalebe pa dongosolo la thanzi la makolo mpaka zaka 26 (izi ndizo zotchuka zomwe zimati mwina sizikanafuna kutero), ndipo sangalepheretse malamulo omwe amaletsa chisankho chochokera ku mbiri yachipatala, kulemala, mtundu, zaka, kapena chikhalidwe.
Ngakhale kuti pali kusiyana kwakukulu pa zomwe zingachoke, ACA imaphatikizapo malamulo atatu omwe amafunikira kuti awonetsetse kuti anthu omwe amakhalamo sadzakhala ochepa poyerekeza ndi 1332 kusiyana ndi momwe angakhalire ndi ACA yosasinthika. Kuti chigawo cha 1332 chivomerezedwe kuti chivomerezedwe, boma liyenera kuwonetsa pazifukwa zomwe zimachokera kuti ngati ntchitoyo ikutsatiridwa:
- Kuphatikizidwa kudzakhala kosakwanira ngati kungakhale kopanda kuchotsedwa.
- Kuphatikizira kudzakhala kosachepera mtengo ngati kungakhale kopanda kuchotsedwa.
- Chiwerengero cha anthu omwe adzakhale ndi chithandizo pakangoyamba kuchokapo ayenera kukhala ochuluka omwe angakhale nawo chithunzi popanda kuchotsedwa.
Ndipo lamulo lachinai limatsimikizira kuti boma la federal silidzakhala loipa kwambiri potsata lamuloli:
- Chiwongolerocho chiyenera kukhala chopanda mbali kulowerera boma la federal.
Choncho ngakhale kuti mayiko angatenge ndalama zomwe akanalandira kuti apereke ndalama zothandizira ndalama komanso kugwiritsira ntchito ndalama zogawa ndalamazo, ndikuzigwiritsa ntchito pazinthu zina, mwachitsanzo, boma la federal silingathe kuthera zambiri mu boma pansi pa kuchotsedwa kumene iwo akanatha popanda kuchotsedwa.
Ndi Maiko ati Amene Amalandira Uvomerezo wa Federal kwa awo 1332 Waivers?
Madera anayi a Hawaii, Alaska, Minnesota, ndi Oregon-alandira chivomerezo cha boma pamaboma awo 1332 kuyambira November 2017.
Hawaii inayamba mu 2017 ndipo inalola boma ligwetse inshuwalansi ya thanzi la inshuwalansi. Hawaii wakhala ndi lamulo kuyambira m'ma 1970 omwe amafuna olemba onse (ngakhale kuti bizinesi yayikulu bwanji) kupereka chithandizo kwa wogwira ntchito aliyense amene amagwira ntchito maola makumi awiri ndi awiri pa sabata, ndipo kulumikizidwa kwa wogwira ntchito sikungathe kulipira antchito kuposa 1.5 peresenti ya malipiro awo. Ili ndi lamulo lovuta kwambiri-ponena za kukwanitsa komanso omwe antchito akuyenera kupatsidwa chithandizo-kusiyana ndi ACA, ndipo boma likuvomereza kuti Hawaii ingagwiritse ntchito 1332 kuchotsa kuthetsa kufunika kwa ACA komwe kumasunga kusinthanitsa kwa inshuwalansi ya thanzi laling'ono .
Ku Alaska, Minnesota, ndi Oregon, mavoti ovomerezeka okwana 1332 amayamba mu January 2018. Pazochitika zitatuzi, ntchitoyi ikugwiritsidwa ntchito polola ndalama za federal kuti zikhale ndi ndondomeko zowonjezera boma. Kulimbikitsanso ndi njira yomwe zimakhala zosiyana (boma, m'mabungwe awa) likuvomereza kutenga ndalama za madandaulo omwe amaposa ndalama zina, ndikuphimba mpaka atapeza ndalama zina. Zotsatira zake ndizoperekera ndalama zochepa, popeza a inshuwalansi sakulipira ndalama zokwanira za ndalama zambiri (ACA ikuphatikizapo pulogalamu ya reinsurance yapadziko lonse, koma inali ya kanthawi ndipo inangotha kupyolera mu 2016).
Pamene malipiro amachepetsa, zinthu zina ziwiri zimachitika:
- Pakati pa anthu omwe sapatsidwa ndalama zothandizira, anthu ambiri amagula inshuwalansi chifukwa imakhala yotsika mtengo.
- Ndipo pakati pa anthu omwe amalandira ndalama zothandizira ndalama, ndalama zomwe boma limagwiritsa ntchito pothandizira zimachepetsa (izi ndizo chifukwa ndalama zothandizira ndalama zapadera zimapangidwira kuti zikhale zowonjezera; musasowe kuti mukhale wamkulu kuti mutenge ndalama zothandizira pambuyo pa mtengo womwewo wotsika mtengo).
Choncho anthu ambiri amatha kukhala ndi ndondomeko yowonjezera, ndipo boma limasunga ndalama pa ndalama zowonjezera. Ku Alaska, Minnesota, ndi Oregon, boma liloledwa kugwiritsira ntchito ndalama zomwe boma la federal likanagwiritsa ntchito popereka ndalama zothandizira ndalama, ndipo m'malo mwake zimagwiritsira ntchito ndalamazo pothandizira pulogalamu ya reinsurance (izi zimatchedwa "kupititsa ndalama"). Muzinthu zonse zitatu, malipiro a 2018 ndi ofooka kwambiri kuposa omwe sakanakhala nawo pulogalamu ya reinsurance, ndipo izo zikuyembekezeka kuti zithetse anthu ambiri okhala ndi inshuwalansi ya umoyo.
Msika wa Massachusetts unaperekanso mndandanda wa 1332 mu September 2017, pofuna kukhazikitsa ndalama zowonjezera ndalama zowonjezereka m'malo mwa malipiro a kuchepetsa kugawa maliro kwa fuko la 2018. Koma Centers for Medicare ndi Medicaid Services adatsimikiza kuti pempho loperekedwa lidatumizidwa mochedwa, ndipo panalibe Nthawi yovomerezeka pa nthawi yoyamba yolembetsa pa November 1, 2017 (pomalizira pake, ndalama zochepetsera kugawanitsa ndalama zinachotsedwa ndi boma mu October 2017 ).
Malamulo Amene Achotsa Zosowa Zawo 1332
Zina zinayi ku California, Vermont, Oklahoma, ndi Iowa-zatulutsa zoperekera 1332 koma kenako zinafuna kuti zisapite patsogolo.
California idapanga chisankho cha 1332 chotsatira chomwe chikanaloleza anthu osamukira kudziko lina kuti akagule mtengo wamtengo wapatali (mwachitsanzo, popanda ndalama zothandizirapo) inshuwalansi ya umoyo mu kusintha kwa boma. Koma boma linachotsa chisankhocho kumayambiriro kwa 2017, chifukwa anali ndi nkhawa kuti Dipatimenti ya Trump ingagwiritse ntchito deta kuchoka ku boma kuti iwonetse pansi ndi kuthamangitsa anthu osamukira kwawo.
Vermont inapereka chisankho cha 1332 kumayambiriro kwa 2016, kupempha chilolezo kuti asakhale ndi khomo laling'ono la malonda (SHOP). Chiwongosoledwe chawo chinkayesa chosakwanira, ndipo sadapite patsogolo ndi kuchikwaniritsa. Koma Vermont wagwiritsira ntchito njira yowunikira anzawo ku SHOP kuyambira 2014. Vermont adagwiritsanso ntchito 1332 kuiii kukhazikitsa dongosolo lomwe iwo analingalira kuti azigwiritsira ntchito pofika mu 2017, koma potsiriza adatenga pulagi pochita zimenezi musanapereke chilolezocho, chifukwa iwo adatsimikiza kuti kachitidwe ka boma kamodzi kokha kakadula kwambiri.
Iowa ndi Oklahoma onse adalonjeza 1332 zoyenera mu 2017 zomwe akufuna kuti azitsatira mu 2018, ndi chiyembekezo chochepetsa malipiro m'misika yawo ya inshuwalansi. Kuchokera kwa Iowa kudzasintha kwambiri msika wa boma, pamene Oklahoma ikanayambitsa ndondomeko ya reinsurance ndipo boma likuyembekezerapo kuti padzakhalanso zochitika 1332 zomwe zidzachitike kuti zisinthe kwambiri. Koma mabungwe onse a boma adasiya kuchoka pamsonkhanowu pamene zinawonekera kuti sangavomerezedwe panthawi yopanga malipiro a ndalama zokwana 2018.
Zambiri zazitsamba 1332 zomwe zaperekedwa mwachindunji ku CMS, kuphatikizapo zomwe zatulutsidwa ndi kuvomerezedwa, zimapezeka pa tsamba loyamba la CMS.
Ndipo maiko ena ambiri akukambirana za 1332, ndipo adayambitsa malamulo kuti ayambe ntchito, kapena adalemba poyera mapulani 1332 okhudzidwa. Yembekezani kuti muwone zambiri mu 2018.
> Zotsatira:
> Magulu a Medicare ndi Medicaid Services, Center for Information Consumer Information ndi Inshuwalansi. Gawo 1332: Zowonongeka ndi boma.
> School of Law Cornell, Institute Information Information. 42 US Code § 18052 - Wopereka kuti boma likhale luso
> HealthCare.gov. Werengani Yopanda Thandizo Labwino.
> Howard, Heather. Robert Wood Johnson Foundation. Sates Wambiri Akuyang'ana Gawo 1332 Waivers. November 6, 2017.