Mtsogoleli Wanu Wotsata Zomwe Zilipo Kale ndi Malamulo Amene Amakutetezani
Ambiri Achimereka ali ndi mavuto okhudzana ndi thanzi omwe makampani a inshuwalansi amatha kufotokozera kuti alipo kale . Chikhalidwe chisanayambe ndi vuto la thanzi lomwe liripo musanayambe kugwiritsa ntchito inshuwalansi ya umoyo kapena kulembetsa dongosolo latsopano la thanzi.
Kumapeto kwa tsikulo, makampani a inshuwalansi okhaokha ndi ndondomeko zaumoyo ndi malonda omwe akuyang'ana pazochitika zawo zachuma.
Choncho, ndizofunikira kwambiri kuti asatuluke anthu omwe alipo kale, kuti aziyembekezera nthawi yodikirira asanayambitse kapepala kapenanso kukweza ndalama zowonjezera komanso ndalama zowonongeka kuti athetse anthu omwe alipo kale, popeza anthuwa mtengo wa inshuwalansi kwambiri muzogulitsa ndalama. Koma zoterezi ndizosavomerezeka, ndipo zimapangitsa kuti anthu azivutika kwambiri kupeza chithandizo cha thanzi, chifukwa chake malamulo osiyanasiyana a boma ndi a boma akhala akuyang'anira nkhaniyi m'misika yambiri ya inshuwaransi.
Chikhalidwe choyambirira chikhoza kukhala chinthu chofala monga kuthamanga kwa magazi kapena kudwala, kapena ngati khansa, mtundu wa shuga , kapena matenda a mphumu omwe amakhudza chiwerengero chachikulu cha anthu.
Pambuyo pa 2014, m'mayiko ambiri , ndondomeko ya thanzi ya malonda (mtundu womwe mumadzigulira nokha, mosiyana ndi kupeza kwa abwana) ingakane kulumikizidwa kwa chirichonse chokhudzana ndi chikhalidwe chanu chomwe chinayamba kale, kukupatsani malipiro apamwamba pogwiritsa ntchito mbiri yanu yachipatala , kapena ngakhale kukana pempho lanu palimodzi.
Ndipo ngati mutalembera ndondomeko ya abwana, munakhala ndi nthawi yodikira kuti mukhale ndi nthawi yoyenera kufotokozera ngati simunapitirize kufotokozera nthawi zonse musanalowe mu dongosolo latsopano.
The Affordable Care Act ndi Zinthu Zomwe Zisanafikepo
Chimodzi mwa zizindikiro za Chitetezo cha Patient ndi Affordable Care Act chomwe chinasindikizidwa kukhala lamulo mu March 2010, chinali kuthetseratu zikhalidwe zomwe zinalipo kale zomwe zimayikidwa ndi ndondomeko zaumoyo.
Kuyambira mu September 2010, ana omwe ali ndi zaka zoposa 19 omwe analipo kale sankatha kulandira thandizo la thanzi la makolo awo , ndipo makampani a inshuwalansi sanaloledwe kuchotsa mikhalidwe yomwe inalipo kale kuchokera kuchipatala cha mwana.
Ndipo kuyambira mu Januwale 2014, njira zatsopano zaumoyo (zotsatila ndi zotsutsana ) zinafunikanso kuti zitsimikizidwe, zomwe zikutanthauza kuti zinthu zomwe zakhalapo kale silingaganizidwe ngati wolembapo akulembetsa. Zoyamba zimangokhala zosiyana malinga ndi zaka, zip code, kugwiritsa ntchito fodya, ndi kukula kwa banja. Choncho munthu pakati pa chithandizo cha khansa amapereka malipiro omwewo monga wokondedwa wawo wa msinkhu womwe ali ndi thanzi labwino, ndipo mankhwala opatsirana khansa adzakonzedwa ndi dongosolo latsopano la thanzi.
Pambuyo pake m'nkhani ino, tiyang'ana kusintha komwe kungakhale pansi pa Ulamuliro wa Trump. Koma choyamba, tiyeni tiwone momwe zinthu zakhala zikuyendetsedwera kale asanayambe kusintha kwa ACA:
Mkhalidwe wa Pre-ACA Pre-Existing Ulipo Kupatula
Pre-ACA, chikhalidwe chisanayambe chikhoza kuthandizira inshuwalansi ya umoyo wanu. Ngati mutapempha inshuwalansi pamsika wina, makampani ena a inshuwalansi amakuvomerezani inu mwachikhalidwe powapatsa nthawi yopezekapo, kapena kuchotsedwa kwathunthu pa chikhalidwe chomwe chilipo kale.
Ngakhale kuti ndondomeko yaumoyo yakulandirani inu ndipo mukulipira malipiro anu a mwezi, simukanakhala ndi chithandizo kwa chisamaliro chilichonse kapena ntchito zokhudzana ndi chikhalidwe chanu chomwe munalipo kale. Malinga ndi ndondomeko ndi malamulo a inshuwalansi a boma lanu, nthawi yosungira nthawiyi ingakhale yochokera pa miyezi isanu ndi umodzi ndikukhalapo kosatha.
Zolinga za malonda payekha
Mwachitsanzo, Lori anali mlembi wazaka 48 yemwe anali wodziimira payekha, kupeza chithandizo cha umoyo pa msika wa pre-ACA. Ali ndi kuthamanga kwa magazi komwe kunayendetsedwa bwino pa mankhwala awiri. Iye adagula kugula inshuwalansi yake ya umoyo yomwe idaphatikizapo mankhwala.
Ndondomeko yokha ya mtengo wapatali yomwe angapeze inali ndi miyezi 12 yokhala ndi nthawi yopuma. Kwa miyezi 12 yoyamba ya ndondomeko yake, zonena zake zonse (kuphatikizapo madokotala ndi maulendo) zokhudzana ndi kuthamanga kwake kwa magazi zinatsutsidwa. Komabe, mkati mwa chaka choyamba cha kufalitsa, nayenso anali ndi matenda a chimfine ndi matenda a mkodzo, onse omwe anali otsekedwa kwathunthu chifukwa sanali kale.
Ngakhale kuti nthawi yayitali yokhalapo nthawi yowonongeka idagwiritsidwa ntchito, zimakhalanso zachizoloŵezi kuona chikhalidwe chokhazikika chisanakhalepo pamsika wa inshuwalansi. Pansi pazifukwazo, chikhalidwe chisanayambe sichidzakwaniritsidwe ndi ndondomekoyi. Munthu amene adathyola mkono wake pangozi yachinyumba ali wamng'ono ndipo amatha kukhala ndi ndodo ya titaniyamu m'dzanja lake akhoza kupatsidwa ndondomeko pamsika womwewo patapita nthawi, koma ndi kuchotsedwa kosatha pa chirichonse chokhudzana ndi "kukonza mkati" (mwachitsanzo, ndodo ndi zipangizo zilizonse) m'manja mwake.
Panthawi yomwe ACA inakhazikitsidwa, chikhalidwe chomwe chinalipo kale sichinali chochepa, ndipo kuwonjezeka kwa chiwerengero kunkachitika nthawi zambiri. Kotero mu chitsanzo cha Lori, pamwambapa, kampani ya inshuwalansi ya umoyo mwina inavomereza kuphimba Lori mwathunthu (kuphatikizapo kuthamanga kwake kwa magazi), koma ndi premium yomwe inali 25 peresenti kapena 50 peresenti kuposa kuposa mlingo wa wina wa msinkhu wake.
Tsopano kuti ACA yakhazikitsidwa, zikhalidwe zomwe zakhalapo kale sizinapangitse mtengo kapena zoyenera, ndipo mapulogalamu a inshuwalansi salinso akufunsa za mbiri yachipatala pamene anthu akulembetsa.
Ndondomeko zoperekedwa ndi ogwira ntchito
Ngati mutalandira inshuwalansi kuntchito yanu , malingana ndi abwana anu komanso ndondomeko zaumoyo zomwe mumapereka, mwinamwake munakhalapo nthawi yodzipatula. Komabe, nthawi yotsalirayo inali yochepa kwa miyezi 12 (miyezi 18 ngati inu mwalemba kale pulogalamu yaumoyo) ndipo mumangogwiritsira ntchito pazomwe munkafuna chithandizo mu miyezi isanu ndi umodzi musanalowe mudongosolo laumoyo -ndondomeko zathanzi zothandizira zinali zochokera ku HIPAA, zomwe zafotokozedwa pansipa).
Mwachitsanzo, Mike wazaka 34 adapeza ntchito yatsopano atakhala wopanda ntchito komanso wosatonthozedwa kwa chaka chimodzi. Kampani yake yatsopano inalola antchito kuti agwire nawo ndondomeko yake yaumoyo kumapeto kwa nthawi yoyamba. Mike anali ndi mphumu yochepetsetsa ndipo ankangowonjezera bondo akusewera basketball ali ndi zaka za m'ma 20s. Koma m'miyezi isanu ndi chimodzi asanalowe m'ndondomeko ya thanzi la abwana ake, iye sanapite kukaonana ndi dokotala ndipo sanatenge mankhwala alionse. Iye sankagonjetsedwa, choncho, nthawi iliyonse yotsalira chifukwa cha zinthu zomwe analipo kale. Atangoyamba kumene kugwira ntchito, mphumu yake inakula kwambiri, koma anaphimbidwa chifukwa cha vuto lake lonse la chisamaliro chifukwa chakuti sanaganizidwe kuti analipo kale chifukwa sankachiritsidwa miyezi isanu ndi umodzi asanayambe kulemba mu dongosolo la abwana ake.
Tsopano kuti ACA yakhazikitsidwa, sizingatheke ngati Mike anali ndi chithandizo asanayambe kulowetsa ndondomeko ya abwana ake, kapena akufunafuna chithandizo chamankhwala pa miyezi ingapo asanalowe nawo ndondomeko - zikhalidwe zake zisanafikepo zimayikidwa njira.
HIPAA ndi Phindu Lofunika
Mu 1996, Congress inapereka Health Insurance Portability Act (HIPAA), lamulo lomwe limapereka chitetezo chofunika kwa inu ndi mamembala anu, makamaka pamene mukulembera mu dongosolo loperekedwa ndi abwana. Zitetezo izi zikuphatikizapo:
- Zolingalira pa kugwiritsiridwa ntchito kwa chikhalidwe chisanayambe chosagwiritsidwe ntchito muzinthu zothandizira zaumoyo.
- Zimaletsa zolinga zaumoyo zogwiritsidwa ntchito ndi abwana kuti zisakuchitireni cholakwika ndikukukanikirani kapena kukupatsani ndalama zambiri chifukwa cha zochitika zaumoyo wanu.
- Kawirikawiri amatsimikizira kuti ngati mutagula inshuwalansi ya thanzi, mukhoza kuyambiranso kufotokozera mosasamala kanthu za thanzi lanu m'banjamo.
Ngakhale kuti HIPAA siimagwiritsidwa ntchito pazochitika zonse, lamulo linapangitsa kuti anthu asinthe kuchoka ku dongosolo lina lachipatala lomwe limathandizidwa ndi ogwira ntchito, kupatulabe zomwe zilipo kale.
Ndipo ngakhale kuti kuteteza kwa HIPAA sikunayende pamsika payekha, mayiko ena adalandira malamulo omwe amalola kuti anthu oyenera a HIPAA azigula malonda oyenera pamsika wawo (HIPAA-adatanthawuza kuti munthuyo anali ndi miyezi 18 yokhala ndi ngongole popanda kusiyana kwa masiku osapitirira 63, ndipo kufotokoza kwaposachedwa kumeneku kunali pansi pa ndondomeko yovomerezedwa ndi abwana, ndondomeko ya boma, kapena ndondomeko ya tchalitchi; komanso, munthuyo ayenera kuti anatopetsa COBRA ngati ilipo, ndipo sangakwanitse kwa Medicare kapena Medicaid).
Koma m'mayiko ambiri, isanafike chaka cha 2014, ngati anthu oyenerera a HIPAA afunika kugula inshuwalansi yawo ya umoyo komanso anali ndi zinthu zisanayambe kupezeka, njira yawo yokhayo inali yotetezedwa ndi boma .
Ngakhale kuti Boma la Trump ndi Republican mu Congress linayesa kubwezeretsa ndi kubwezeretsa ACA mu 2017, ndipo akhoza kupitirizabe njirayi ngati amasunga mabungwe a Republican mumsonkhanowu pambuyo pa chisankho cha 2018, kubwezeretsedwa kwa ACA sikungakhudzire HIPAA, yomwe idatha zaka makumi awiri .
Zolemba Zokongola
Mbali yofunikira ya HIPAA imadziwika ngati kufalitsa ngongole . Kupeza ngongole kwambiri ndi inshuwalansi yaumoyo yomwe mudali nayo musanalowe m'ndondomeko yanu yatsopano, malinga ngati simunasokonezedwe ndi masiku 63 kapena kuposa. Ndalama yomwe munali nayo "inshuwalansi" inshuwalansi yowonjezera ingagwiritsidwe ntchito kuthetseratu nthawi yopezeka nthawi yowonongeka mu ndondomeko yanu yathanzi, pamaso pa ACA isanachotse nthawi yowonongeka.
Mfundo yaikulu: Ngati mwakhala ndi miyezi 18 yowonjezera zaumoyo pantchito yanu yam'mbuyomu ndipo munalembetsa ndondomeko yathanzi lanu yothandizira abambo popanda kupuma kwa masiku 63 kapena kuposerapo, kupezeka kwachikhalidwe. Kutetezedwa kwa ogulitsa kumeneku kunali koyambirira pamaso pa ACA, ndipo kuyesa kubwezeretsa ndi kubwezeretsa ACA sikungakhudzire izi, chifukwa ndi gawo la HIPAA m'malo mwa ACA.
Mwachitsanzo, Greg adasintha ntchito kuti apite patsogolo. Anagwira ntchito ndi wolemba ntchito ndipo adapeza ntchito yatsopano, yomwe adayambitsa masabata awiri atasiya ntchito yake. Ntchito yake yatsopano imapereka inshuwalansi yaumoyo yemweyo, yomwe imapezeka mwezi woyamba, ndipo analembetsa ndondomeko ya banja. Ngakhale Greg anali ndi thanzi labwino, mkazi wake anali ndi shuga ya mtundu wa 2 ndipo mmodzi mwa ana ake anali ndi mphumu.
Greg adagwira ntchito kwa kampani yake yapitayo kwa zaka ziwiri, panthawi yomwe banja lake linakumbidwa ndi dongosolo la abwana ake. Analibe chidziwitso pakati pa masabata awiri omwe anali pakati pa ntchito, komanso mwezi woyamba wa ntchito yake yatsopano, koma nthawi yake yosatsimikiziridwa inali yosakwana masiku 63. Kotero ngakhale kuti analipo kale ndi thanzi labwino m'banjamo, dongosolo la thanzi la Greg silinathe kuyika nthawi yowonongeka.
Tsopano kuti ACA yakhazikitsidwa, wogwira ntchito a Greg sangapangitse kuti pakhale nthawi yowonjezerapo yodikirapo pazolembera, ngakhale atakhala mbiri yakale kapena mbiri ya inshuwalansi.
Zinthu Zomwe Zidalipo Kale ndi Utumiki wa Trump
Pulezidenti Trump adalonjeza pa lonjezo lochotsa ndi kubwezeretsa ACA. Anagwira ntchito ndi a Republican ambiri mu Nyumba ndi Senate, ndi a Republican lawmakers adakankhira kubwezeretsa ACA mu Obama Administration udindo.
Koma pamene zowonongeka zinali zowonjezereka, atsogoleri a Repubublican ku Congress sanalephere kupeza chithandizo chokwanira kuti apitirize kulipira ngongole za ACA zomwe zinaganiziridwa mu 2017. Nyumbayi inadutsa American Health Care Act kuti iwononge mbali zina za ACA, koma Mabaibulo angapo amalephera kupita ku Senate kotero kuti muyeso sunayambe wakhazikitsidwa.
ACA sanachotsedwe
Kumayambiriro kwa chaka cha 2018, bungwe lokhalo la ACA lomwe linachotsedwa ndilo chilango cha munthu aliyense, ndipo kubwezeretsa sikugwira ntchito mpaka 2019. Anthu omwe sali ovomerezeka mu 2018 akadakali chilango, koma omwe ali osalimbikitsidwa mu 2019 ndi kupitirira sichidzapatsidwa chilango, pokhapokha ngati dziko lawo likugwiritsira ntchito chimodzi (Massachusetts kale anali ndi udindo wovomerezeka pamaso pa ACA; DC yayandikira kukwaniritsa chimodzi, ndipo mayiko ena angatsatire).
Zina za msonkho wa ACA (msonkho wa chipatala, msonkho wa Cadillac, ndi msonkho wa inshuwalansi) inachedwa kumayambiriro kwa chaka cha 2018 potsatira ndondomeko ya bajeti, koma sanachotsedwe.
Ndipo zonse zomwe ACA amadzitetezera ogula, kuphatikizapo zomwe zakhudzana ndi zinthu zomwe zakhalapo kale, zimakhala zofanana ndi za 2018. Ndipotu, kudandaula zakumayambiriro komwe kunakhalapo mavuto omwe adawonongedwa ndi ACA kubwezeretsa mu 2017, ndi mamiliyoni a anthu kulankhulana ndi olemba malamulo ndi kufotokoza nkhawa zomwe zimafooketsa kapena kubwereza ACA zidzatibwezeretsanso masiku a chikhalidwe choyambirira chisanakhalepo ndi mafunso okhudza mbiri yachipatala omwe amachititsa inshuwalansi zaumoyo.
Mapulani omwe amaletsa mikhalidwe yomwe inalipo kale ingakhale yofala kwambiri mu 2018 ndi kupitirira
Kwa nthawiyi, ACA ndi yovuta ndipo ntchito yaikulu yowonongeka ndi kubwezeretsa ntchitoyi yakhala ikugwiritsidwa ntchito. Izi zikhoza kukhalabe choncho mpaka pambuyo pa miyezi ya 2018, ndipo tsogolo la malamulo otere limadalira makamaka pa ndale za Congress pambuyo pa miyezi.
Koma Boma la Trump likugwira ntchito kuti ligwiritse ntchito malamulo atsopano omwe angapangitse chithandizo chachipatala chosagwirizana ndi ACA chovomerezeka. Izi zimaphatikizapo kupanga mgwirizano wathanzi kwa makampani ang'onoang'ono komanso malonda okha, komanso mapulani a zaumoyo a anthu a nthawi yayitali .
Pokhala ndi mwayi wochulukitsa mgwirizano wa zaumoyo, osonyezedwa ndi Boma la Trump kumayambiriro kwa 2018 , magulu ang'onoang'ono ndi ogwira ntchito angathe kupeza chithandizo pansi pa malamulo akuluakulu a gulu, omwe amamasuka kwambiri kusiyana ndi kagulu kakang'ono ndi malamulo a msika pamsika pochita mogwirizana ndi ACA. Malingana ndi momwe zinthu zilili kale, magulu akuluakulu a gulu sagwiranso ntchito kufotokozera zofunikira zaumoyo zonse za ACA, ndipo mabungwe akuluakulu ogulitsa mabungwe angakhazikitse ndalama zowonjezera pa mbiri yachipatala, zomwe siziloledwa m'misika kapena gulu laling'ono .
Ndipo ngati malamulo omwe akufuna kukonzekera kwa nthawi yayitali amatha kukwanilitsidwa, inshuwalansi angayambe kupereka mapulani a "nthawi yochepa" (kugulitsa mofulumira mwezi wa July 2018) ndi nthawi yopitirira mpaka masiku 364. Tsatanetsatane wa masiku makumi atatu ndi 364 idagwiritsidwa ntchito kale ku federal kumayambiriro a 2017, koma Obama Administration anasintha malingaliro kotero kuti mapulani a nthawi yayitali sakanatha kukhala ndi miyezi yoposa itatu (ulamuliro wa Obama unatsirizidwa mu 2016, koma sizinayambe mpaka 2017).
Izi ndi zofunika chifukwa mapulani a nthawi yayitali akhala akuphatikizapo malamulo a ACA. Angathe komanso kuchita zofunikira pambiri ya mbiri yachipatala, ndipo amakhala ndi chosowa chokwanira chilichonse chokhudzana ndi chikhalidwe chomwe chilipo kale. Kulola anthu kusunga ndondomekoyi kwa chaka chathunthu kudzatanthawuza kuti anthu ambiri adzakhala ndi chithandizo pansi pa ndondomeko zomwe sizikuphimba mikhalidwe yomwe ilipo kale. Zolinga zimenezo zidzakondweretsa anthu abwino, kusiya anthu odwala mu phukusi la inshuwalansi lovomerezeka la ACA. Izi, zidzatenganso ndalama zowonjezera ku mgwirizano wa ACA. Koma mapulani ovomerezeka a ACA adzapitirizabe kubisalapo.
Ngakhalenso Obama asanayambe kukonzekera kwa miyezi itatu, mayiko ena sanawalole konse, ndipo maiko ena amalephera kwa miyezi isanu ndi umodzi. Koma mosasamala kanthu za kupezeka, anthu amene amagula inshuwalansi yaifupi yaying'ono saganiziridwa kuti ali ndi inshuwalansi pamaso pa ACA. Inshuwalansi ya nthawi yayitali sichifunika kwenikweni , kotero anthu omwe amagwiritsa ntchito mapulani afupikitsa amatsatira chilango cha ACA payekha . Koma chilango chimenecho sichidzagwiranso ntchito mpaka chaka cha 2019, chifukwa chafufuzidwa mwachindunji monga gawo la msonkho wa msonkho wa GOP. Tsono ngakhale kuti anthu ena angakhale atasiya njira zochepa zisanafike chaka cha 2017 chifukwa adafuna kupewa chilango cha ACA payekha, chilimbikitsochi sichidzagwiranso ntchito kuyambira 2019.
Kuti zikhale zomveka, anthu adzalandire kufotokozera malonda omwe akuphatikizapo chitetezo cha chikhalidwe cha ACA. Koma tsopano malamulo omwe amayesa kubwezeretsa ACA adayikidwa pamoto wam'mbuyo, Boma la Trump likugwira ntchito kuti athetsere malamulo pamagwiridwe otsogolera.
Zotsatira:
> Dipatimenti ya zaumoyo ndi zithandizo zaumunthu, HIPAA. ndi HealthCare.gov, HIPAA-Oyenerera Aliyense.
> Dipatimenti ya Ntchito. Tanthauzo la "Employer" Pansi pa Gawo 3 (5) la ERISA-Association Health Plans . Yaperekedwa mu January 2018.
> Maofesi a Ndalama, Ntchito, Zaumoyo & Zopereka zaumunthu. Nthawi yayitali, yayitali Nthawi inshuwalansi . Ndemanga ya February 2018.
> HealthCare.gov, Read the Affableable Act Act.
> Kaiser Family Foundation, Kusintha kwa Msika wa Inshuwalansi ya Zaumoyo: Nkhani Yotsimikizika . June 2012.
> Kaiser Family Foundation, Wopanda Gulu la Anthu Ovomerezeka a HIPAA, June 2012.