Kusintha kwaumoyo wakhala mu nkhani pafupifupi yosayima mu 2017, kotero ngati mutasokonezeka pa zomwe zachitika ndi zomwe zidzachitike mu 2018, simuli nokha. Tiyeni tiwone zomwe zikusintha, zomwe zikukhala zomwezo, ndi zomwe mungathe kuyembekezera inshuwalansi yaumoyo mu 2018.
Zosinthidwa Zomwe Sizinachitike
Ngakhale kuti nkhani zokhudzana ndi chithandizo cha zaumoyo zakhala zikuchitika mu 2017, kusintha kwakukulu komwekukufota kwafota pa mpesa.
Bungwe la American Health Care Act (AHCA) linaperekedwa ndi House Republicans mu May pofuna kuyesa kubwezeretsa ntchito yosamalira ndalama, koma bungwe la Senate, Better Care Reconciliation Act (BCRA), linalephera mu July. Ndipotu, a Senate Republican anayesera kupatulira malemba atatu osiyana-siyana - kubwezeretsedwa "kosalala", lamulo la Obamacare Repeal Reconciliation Act, ndi BCRA-ndipo palibe amene adalandira chithandizo chokwanira kuti apite.
Mu September, kusintha kwa Graham-Cassidy-Heller-Johnson kunayambika monga ndondomeko ya Senate yotsutsa malamulo a Senate, koma kupambana kwake kunkawoneka mosakayikitsa Pambuyo Pulezidenti John McCain (R, Arizona) adalengeza kutsutsa kwake.
Pulezidenti Rand Paul (R, Kentucky) adanena kale kutsutsa, ndipo a Senators Lisa Murkowski (R, Alaska) ndi Susan Collins (R, Maine) adatsamira kutsutsa. September 30 ndi nthawi ya Senate yogwiritsira ntchito ndondomeko ya mgwirizano wa bajeti yomwe ingalole kuti iwo abweretse ACA ndi mavoti 50 (kuphatikizapo voti yopumitsa voti yomwe wapatsidwa ndi Pulezidenti Wachiwiri) ndi kupewa filibuster.
Ndipo ngati atatu kapena ambiri a Republican Senators akutsutsana ndi muyeso, iwo sudzadutsa.
Kotero ngakhale kuti pakhala pali malamulo ambiri omwe adayambitsidwa mu 2017-ndipo nyumbayo inadutsa American Health Care Act-palibe mwa iwo adakhazikitsidwa.
Izi zikutanthauza kuti ACA ikadali yogwira ntchito, kuphatikizapo kupereka ndalama zothandizira ndalama , kuchepetsa kugwirizanitsa ndalama (aka, thandizo logawana ndalama), kuwonjezereka kwa Medicaid , udindo waumwini, udindo wa abwana , kuteteza anthu omwe alipo kale , zofunika phindu la thanzi , malamulo othandizira odwala ndalama, ndi zina zotero.
Kugawidwa kwa ndalama za ndalama kudzapitirizabe kupezeka mu 2018, mosasamala kanthu kuti boma limapereka ndalama zothandizira olemba inshuwalansi kuti aziwaphimba (vuto la ndalama lidayambitsa chifukwa chosadalirika mu 2017). Ogwirizanitsa m'mayiko ambiri akuphatikizapo mtengo wopereka ndalama zothandizira ndalama zomwe amapereka ndalamazo pamalipiro awo omwe adzakonzekera 2018, ndipo malipiro apamwambawa adzakhululukidwa kwa olembetsa ambiri ndi ndalama zowonjezereka. Kuchotsa ndalama zopatsana ndalama zonse (kapena thandizo la premium) zingatheke kupyolera mwa malamulo.
Zosintha Chifukwa cha Msika Wolimbitsa Ulamuliro
Mu April 2017, HHS inakhazikitsa lamulo lokhazikitsa malonda omwe adalonjeza mu February. Ngakhale kuti lamuloli linkafuna kukhazikitsa mgwirizano wa inshuwalansi ya umoyo, sizinagwirizane ndi zifukwa ziwiri zomwe zakhala zowononga kwambiri msika wawo: kusowa kwa mphamvu zogwiritsira ntchito udindo wawo (zenizeni kapena zodziwika, monga momwe zimakhudzira komabe anthu ochepa akulembetsa ku chiwopsezo ndi dziwe loopsya lomwe likuwononga thanzi lawo lonse), komanso ndalama zopitilira zogawanika.
Sizinangokhalako zokhazokha pokhazikitsa malamulo okhwima pamsika, apitirizabe kuchititsa kuti pakhale msika wosadalirika wa msika m'miyezi yotsatira, ndipo athandiza kwambiri mabungwe ena a inshuwalansi akusiya kuchoka kumsika kumapeto kwa 2017 kapena kutulutsa ndalama zapamwamba kwambiri kwa 2018 kuposa momwe iwo akanachitira mwina.
Koma lamulo la kukhazikika kwa msika linayankha zinthu zina zingapo, ngakhale kupondereza kwakukulu kusiyana ndi kudzipereka kwa munthu payekha komanso kuchepetsa kugawa malipiro. Zosinthazi zimagwiritsidwa ntchito kwa anthu omwe amagula malonda awo pamsika, kapena kusinthanitsa :
- M'mayiko ambiri, kulembetsa kwasindikizidwa kwafupikitsidwa kwa milungu isanu ndi umodzi ndipo idzatha kuyambira November 1 mpaka December 15, ndi mapulani onse ogwira ntchito pa January 1, 2018. Koma pali magawo asanu ndi anayi omwe akutsutsana ndi boma omwe awonjezera nthawi yolembetsa , kotero onetsetsani kuti mukudziwa momwe zimagwirira ntchito m'dera lanu.
- Ngati ndondomeko yanu inakhululukidwa kuti musapereke malipiro mu 2017 ndipo mutayitananso ndi inshuwalansi yemweyo (kapena inshuwalansi yomwe ili ndi kampani yofanana ya makolo) panthawi yolembetsa, wothandizira inshuwalansi adzakufunsani kuti mulipire ndalama zanu zapitazo- malipiro oyenera musanayambe kufalitsa kwanu kwatsopano. Kawirikawiri, iyenera kukhala mwezi umodzi wokha-chifukwa cha malipiro oyenerera, popeza malipiro saperekedwa pambuyo poti mapulaniwa achotsedwa.
- Mtengo wovomerezeka wamtengo wapatali umakhala wosiyanasiyana pa mndandanda uliwonse wa zitsulo m'misika ya gulu limodzi ndi yaing'ono yowonjezera. Zolinga zamkuwa zidzakhala ndi -4 / + 5 zosiyana, pamene siliva, golide, ndi platinum zolinga zidzakhala ndi -4 / + 2 kusiyana. Ndondomeko zamkuwa zimakhala pafupifupi 60 peresenti, siliva pafupifupi 70 peresenti, golide pafupifupi 80 peresenti, ndi platinum pafupifupi 90 peresenti. Koma amasiyana malinga ndi maulendo a minimus adaloledwa, omwe awonjezeredwa mu 2018. Izi zimangotanthauza kuti pangakhale kusiyana kwakukulu kuchokera ku dongosolo limodzi kupita ku gawo lachitsulo, kotero anthu ndi mabungwe ang'onoang'ono adzafuna kufananitsa bwino Zosankha zosiyanasiyana zomwe zilipo mu 2018.
Kupindula ndi kufotokozera kusintha kwa msika wamagulu ndi gulu laling'ono kudzachitika monga momwe iwo alili m'zaka zapitazi, ndi kusintha kwa malire okhuta ndi osatulutsa, pamodzi ndi magulu opereka mankhwala ndi mndandanda wa mankhwala. Musaganize kuti ndondomeko yomwe munasankha chaka chatha idzakhala yabwino kwambiri kwa inu mu 2018-nthawizonse ndibwino kulinganitsa zomwe mungapeze panthawi yolembetsa, ndikusintha ngati kuli kofunikira.
Thandizo lochepa la Kugulitsa ndi Kulembetsa
Ngati mumakhala m'dera lomwe mulibe inshuwalansi yathanzi ndipo mumadalira HealthCare.gov, mungaone kuti malonda, kufalitsa, ndi kulembetsa thandizo ndizochepa pa nthawi yolembera kwa 2018 kusiyana kale.
HHS inalengeza kumapeto kwa mwezi wa August kuti idzakonza bajeti ya HealthCare.gov kufika pa $ 10 miliyoni chaka chino, kuyambira $ 100 miliyoni chaka chatha. Iwo adanenanso kuti iwo adzakonza bajeti ya pulogalamu ya Navigator, yomwe imapereka thandizo lolembetsa mwa anthu kwa anthu omwe sanena kuti iwo sagwirizana. Kusinthana kwa boma kumapereka mapulogalamu awo a Navigator, ndipo ndalama zawo sizimakhudzidwa ndi bungwe la federal.
Mapulani a zaumoyo pamsika pawokha akhala akuchepetsanso ma komiti a malonda omwe akugulitsidwa pamsika pazaka zingapo zapitazo, kuthetsa izo panthawi zonse. Izi ziyenera kuchitika kwakukulu kwa zopanda phindu za msika wa ogulitsa ambiri, tsopano kuti ACA yasintha malamulo; ena a inshuwalansi adasankha kuti sakufuna kulipira abwereranso kuti abweretse bizinesi yomwe pamapeto pake imakhala wopereka ndalama kwa inshuwalansi. Kawirikawiri makompyuta ndiwo njira yokhayo yomwe amalonda amalandirira, kotero ena amalonda asankha kugwira ntchito ndi malonda awo pamsika chifukwa sangakwanitse kugwira ntchito kwaulere.
Zonsezi zikutanthauza kuti olembetsa malonda m'madera ena a dziko angapeze kuti palibenso thandizo lolembetsa ngati momwe kale linalili. Padzakhalabe thandizo likupezeka, koma olembetsa adzafunika kukonzekera patsogolo osati kuyembekezera mpaka mphindi yomaliza-kukumbukira kuti nthawi yomaliza idzafika mofulumira kwambiri mu chaka chino kusiyana ndi momwe anachitira m'zaka zapitazo.
Zikuwonekeranso kuti HealthCare.gov, khomo lolembetsa kusinthana komwe anthu amagwiritsa ntchito mu mayiko 39, lidzakhala pansi pokonzekera kukonzekera kwa chunk lalikulu la Lamlungu lambili panthawi yotsegulidwa kugwa uku, ndipo ngakhale usiku tsiku loyamba lolembetsa, November 1. Ichi ndi kusuntha kwakukulu, ndipo chimatha kusintha musanayambe kulembetsa. Koma pakalipano, anthu omwe ali ndi malonda paokha angakhale anzeru kukonzekera kulembetsa kapena kukonza kusintha kumatenga nthawi yayitali kuposa chaka chino.
Mapulogalamu olembetsa ndi Mapulani Opezeka
Ngati muli ndi chithunzi pamsika, pamasewero kapena pamsika, mutha kusankha zosankha zosiyana za 2018 chifukwa cha inshuwalansi yakuchoka pamsika, kapena mungapeze kuti muli ndi mwayi wotsatsa malonda atsopano chifukwa cha inshuwalansi kulowa msika m'deralo (apa pali mndandanda wa zikuluzikulu ndi zolowera).
Ngakhale kuti pakhala pali zigawo zokhazikika za zigawo za "2017" mu 2017, dera lonse la dziko lili ndi inshuwalansi imodzi yokha yopereka 2018 kufotokozera pofika pakati pa mwezi wa September. Izi zikhoza kusintha, koma n'zochititsa chidwi kuti m'mayiko onse omwe anali ndi zigawo zoyambirira popanda olemba inshuwalansi akukonzekera kupereka chithandizo cha 2018, mabungwe a inshuwalansi adakwera kudzaza malo omwe alibe (izi zinachitika ku Ohio, Wisconsin, Nevada, Virginia, Indiana , Kansas, Missouri, ndi Washington).
Kusinthanitsa kwa inshuwalansi sikukusintha mu 2018. Zonse zomwe zimayendetsa zokambirana zawo mu 2017 zidzapitirizabe kutero mu 2018, ndipo maiko onse omwe amagwiritsa ntchito HealthCare.gov mu 2017 adzapitirizabe kuchita zimenezo. Zigawo 12 zokha zili ndi masitepe awo olembetsa; zonsezi kuphatikizapo mayiko ndi mgwirizano wa mgwirizano, kugwirizana kwa mgwirizanowo, ndi kusinthasintha kwa boma pogwiritsa ntchito nsanja ya federal-zonse ntchito HealthCare.gov.
Komabe, ogula m'mayiko ambiri angapeze kuti kuli kosavuta kulembetsa "kusinthanitsa" kudzera pa webusaiti ya munthu wina yemwe ali pa webusaitiyi, monga boma la boma likuloleza " njira yowunikira olembetsa " kuyambira chigwachi chomwe chidzathetsa kufunikira kwa opempha pitani kumbuyo ndi kutsogolo pa webusaiti ya webusaitiyi kupita ku HealthCare.gov. Ogulitsa adzafunikanso kulenga akaunti pa HealthCare.gov, koma adzatha kumaliza ntchito yonse pa webusaiti ya webusaitiyi.
Ndipo ngati mukugula zochepa pazokhazikitsana , mukhoza kuona zosiyana, monga HealthCare.gov yasintha kugwiritsa ntchito njira yowunikira mwachindunji makampani ang'onoang'ono. Bungwe laling'ono la inshuwalansi la zamalonda silinakhale lodziwika kwambiri, komabe; malonda ambiri alembetsa nawo-mwachindunji kupyolera mwa inshuwalansi-kuyambira pachiyambi.
Kusintha Chifukwa cha Dongosolo la Trump la Executive pa ACA
Pa tsiku lake loyamba ku ofesi, Presiden Trump inasaina lamulo loyang'anira "kuchepetsa kulemera kwachuma kwa Wodwala ndi Chitetezo chosayembekezeka." Panthawi imeneyo, chiyembekezo mu Dipatimenti ya Trump chinali chakuti chigamulo cha ACA choletsedwa chidzaperekedwa mwamsanga, zomwe sizinachitike.
Koma bungwe lolamulira limalimbikitsa mabungwe a federal kukhala omvera monga momwe angathere- kuphatikizapo lamulo-pamene akukakamiza zochitika za ACA.
Udindo waumwini, womwe umafuna kuti ambiri a ku America akhalebe chithandizo cha inshuwalansi chokhalitsa kapena akuyang'aniridwa ndi chilango cha msonkho, wakhala akuganiziridwa nthawi zonse kuyambira pamene lamulolo lidayinidwa. Kuti zikhale zomveka, ntchitoyi ilipobe mu 2017 , ndipo zikuwoneka kuti izi zidzakhalanso choncho mu 2018. Ambiri mwa ndalama zowonongeka za ACA zomwe a Republican adalengeza mu 2017 (kuphatikizapo Graham-Cassidy-Heller-Johnson Bill) zidzathetsa chilango cha munthu aliyense pa $ 0, kubwezeretsedwa kumayambiriro kwa 2016. Koma palibe mpheteyi yomwe yakhazikitsidwa.
Pa zaumoyo, Tim Jost adalengeza mu August kuti ntchitoyi idakalipobe ndi IRS, ngakhale zabodza zotsutsa, ndipo webusaiti ya IRS inati ngakhale kuti malamulowa akutsatira, " malamulo a ACA akugwirabe ntchito mpaka kusinthidwa ndi Congress, ndipo okhometsa msonkho amakhalabe omvera kutsatira lamulo ndikulipira zomwe angayang'ane. Okhoma msonkho ayenera kupitiliza kupereka mafomu awo a msonkho monga momwe amachitira . "
Komabe, IRS inalola kuti anthu apereke misonkho ya 2016 kumayambiriro kwa 2017 omwe sanayankhe funso la ngati foniyo inali ndi inshuwalansi ya umoyo mu 2016 . Iwo adalola kuti chaka cha 2014 ndi 2015, koma adafuna kukana zobwezeretsa zoterezi mu 2016, ndipo amafuna kuti onse osungira mayankho ayankhe funsolo. Iwo adasintha njirayi potsata ndondomeko ya Pulezidenti Trump, ndipo adapitiriza kuvomereza kubwerera "chete" komwe sikunanene ngati kapena msonkho wa msonkho uli ndi inshuwalansi.
Sindikudziwa ngati IRS idzasintha malingaliro awo pa nkhaniyi ndikulowa mu msonkho wa msonkho kumayambiriro kwa chaka cha 2018, koma nkukayikitsa kuti iwo adzapatsidwa dongosolo lolamulira la Trump.
Gulu Lalikulu, Mankhwala, ndi Medicaid: Zosintha Zachaka Zomwe Zimagwiritsidwa Ntchito
Zokambirana zambiri zothandizira zaumoyo mu 2017 zakhala zikuzungulira msika wina aliyense, msika wa kagulu kaang'ono, ndi Medicaid. Koma monga taonera pamwambapa, ambiri a zokambiranawo sanabweretse kusintha kwina kulikonse. Kwa anthu omwe amalandira inshuwaransi yawo kuchokera kwa abwana akulu, Medicare, kapena Medicaid (atengedwa pamodzi, ndiwo ambiri mwa anthu), kusintha kwa 2018 kudzakhala kusintha komweku komwe kumachitika chaka chilichonse.
Kutsegula kwa Medicare Advantage ndi Medicare Part D ikuyenda kuyambira October 15 mpaka December 7, ndi kusintha konse pa January 1, 2018. Zolinga zamakono zidzasintha kwa 2018-monga momwe zimachitira chaka chilichonse-kotero ndikofunikira kuti alembe kuti atenge nthawi panthawi yotseguka kulembetsa kuti mufanizire njira zosiyanasiyana zomwe mungapeze ndikusankha zomwe zingakwaniritse zosowa zawo m'chaka chomwe chikubwera.
N'chimodzimodzinso ndi ndondomeko zoperekedwa ndi abwana. Olemba ntchito ambiri ali ndi mwayi wolembetsa patsiku, ndipo phindu lidzasinthadi pa January 1. Ngati ndondomeko yanu ikukumana ndi kusintha kwa chaka chomwe chikubwera, kapena ngati pali zatsopano zomwe mungapeze, kulembetsa kwanu kudzakhala mwayi wanu kusintha mapindu anu mukasankha kuti muchite zimenezo.
Palibe ndondomeko zothandizira zokhudzana ndi chisamaliro zokhudzana ndi zachipatala zokhudzana ndi Medicaid zomwe zinakhazikitsidwa mu 2017, zomwe zikutanthauza kuti kuyenerera kudzapitirira mu 2018 kwakukulukulu kosasintha kuchokera mu 2017, kuphatikizapo kuwonjezeka kwa ACA's Medicaid. Palibe mayiko atsopano omwe adakwaniritsa kulandirira kwa Medicaid mu 2017, kotero kuti ndalama zowonjezerapo za kuwonjezeka kwa Medicaid zimakhala zofanana ndi zomwe zinaliri kumayambiriro kwa chaka. Ngati mutenga pempho kuchokera ku bungwe lanu la Medicaid kuti mutsimikizirenso kulondola kwa Medicaid, mufuna kupereka zofunikira mwamsanga kuti mutha kupezeka.
> Zotsatira:
> Cassidy.Senate.gov. Malemba a Chigamulo 543 ku HR1628 ( Graham-Cassidy-Heller-Johnson kusintha kwa American Health Care Act ). Anatulutsidwa pa September 13, 2017.
> Magulu a Medicare ndi Medicaid Services. Tsogolo la a SHOP. CMS ikufuna kulola malonda ang'onoang'ono mu SHOPs pogwiritsa ntchito HealthCare.gov Zowonjezereka kwambiri polembetsa ku Healthcare Coverage . May 15, 2017.
> Dipatimenti ya zaumoyo ndi zithandizo zaumunthu. Chitetezo cha odwala komanso chithandizo chamtengo wapatali . April 2017.
> Mapulogalamu apakati a Misonkho, Kupatsidwa Kwachindunji Kugawana.
> WhiteHouse.gov, Ofesi ya Mlembi. Order Order Kuchepetsa Kulemetsa kwachuma kwa Wodwala Chitetezo ndi Ntchito Yodalirika Yopanda Ntchito Akudikira Kubwereza. January 20, 2017.