Kodi Obamacare m'malo mwake adzateteza othandizira a Medicare?
The Affordable Care Act, aka Obamacare , sadangotenga inshuwalansi kwa mamiliyoni ambiri a ku America kudzera mu Health Insurance Marketplace koma adawonjezera Medicaid m'mayiko angapo. Anthu omwe sankatha kupeza inshuwalansi ya umoyo anali ndi mwayi watsopano. Anthu ambiri amaiwala, komabe pulogalamuyi inakhudza kwambiri Medicare .
Lamuloli linawonongedwa mu 2017 ndi Republican Congress. Komabe, kubwezeretsa sikudachitike, osachepera.
Cholinga chothandizira Obamacare choyamba chiyenera kulingalira momwe Chithandizo Chosawonongeka Chothandizira chinakhudzira Medicare. Ndiye ziyenera kulingalira momwe ziti zidzathetsere (kapena ngati zidzakwaniritsa) zosowazo ndi malamulo atsopano.
CMS Innovation Center
Ngati sitisintha, sitimakula. Centers for Medicare ndi Medicaid (CMS) Innovation Center inakhalapo pansi pa Chithandizo Chachikulu cha Care Act ndipo ikuyang'ana njira zowonetsera njira zatsopano zopezera ndalama komanso njira zothandizira zaumoyo kuti zisamangowonjezera ubwino wake komanso kuchepetsa ndalama za Medicare, Medicaid , ndi Ana a Inshuwalansi Program (CHIP) .
Siyani kulakwitsa. CMS imayambitsa malo onse ogulitsa inshuwalansi. Ngati CMS ikupeza chinachake chimene chimagwira ntchito, asungichuma apadera amatsimikiza kuti alowe nawo.
Kuyambira pachiyambi, zitsanzo zopitirira 30 zowonetsera zakonzedwa ndikufufuza.
CMS Innovation Center yayang'anitsitsa mabungwe osamalira owerengetsa komanso kulipira malipiro monga njira zosiyana zothetsera chisamaliro. Kusintha kwa pay-to-service (dokotala ndalama zothandizira aliyense) kulipira-zapamwamba (dokotala amalipidwa pogwiritsa ntchito zotsatira za chisamaliro chapamwamba) zikuyenda bwino.
Pafupifupi magawo 30 peresenti ya malipiro a Medicare tsopano akutsatiridwa motere.
Mapulogalamu a zaumoyo apindulitsanso khalidwe kwa mamiliyoni ambiri a ku America. Initiative Primary Primary Initiative inalola kuti kuwonjezeka kwa chisamaliro chapadera muzinthu zina kuti apindule osowa. Matenda Odzidzimutsa Otsiriza Otsiriza (ESRD) Care Initiative amachititsa kuti anthu omwe ali pa dialysis athe kupeza chithandizo. Kuyamba Kwambiri kwa Amayi ndi Ana Amanda kunachepetsa kubadwa msinkhu msinkhu komanso mavuto a nthawi yaitali kwa mabanja atsopano. Chiwopsezo cha matenda a shuga chakhala chikuyenda bwino kwambiri chidzawonjezeka mu dziko lonse mu 2018.
Kodi Obamacare abwezeretsetsa mapulogalamuwa? Chombo cha Obamacare chiyenera kuganizira mmene chidzakhudzire kukula kwa mankhwala, zomwe zimakhala zabwino komanso zogulira.
Kunyenga, Kutaya, ndi Kuzunza
Kunyenga, kuwonongeka, ndi nkhanza zowonjezereka mu chisamaliro, zimabweza okhoma msonkho ndalama pamapeto pake. Bungwe Lopereka Chithandizo Chopanda Phindu linatenga njira zothetsera kugwiritsira ntchito molakwa ndikugwiritsanso ntchito ndalamazo pulogalamu ya Medicare. Icho chinatero polimbikitsa Medicare Fraud Strike Force.
The Medicare Fraud Strike Force inakhazikitsidwa mu 2007 ndipo ikugwira ntchito mogwirizana ndi Dipatimenti Yachilungamo, Federal Bureau of Investigation, Office of the Inspector General, ndi malamulo apadziko.
Akugwira ntchito kuchokera ku mizinda 9 ku Baton Rouge, Louisiana; Brooklyn, New York; Chicago, Illinois; Dallas, Texas; Detroit, Michigan; Houston, Texas; Miami, Florida; Los Angeles, California; ndi Tampa, Florida - Medicare Fraud Strike Force yasunga pulogalamuyi mobwerezabwereza monga momwe inachitira Chigamulo cha Care Care chisanakhazikitsidwe mu 2010.
Kuyambira mwezi wa June 2016, ntchito za Medicare Fraud Strike Force zinayambitsa zifukwa zokwana 2,522. Mbalame yaikulu kwambiri mu mbiri ya Task Force inachitika mu June 2016 pamene anthu 301, 61 mwa iwo omwe ali ndi chilolezo cha zamankhwala, anaimbidwa mlandu wopanga chithandizo chachipatala, kuphwanya ndalama, komanso kubala kwadzidzidzi .
Ntchito yawo yachinyengo inali ndalama zokwana madola 900 miliyoni polipira ngongole.
Kusintha kwa chithandizo cha zaumoyo kupitabe patsogolo kuyenera kupitiliza kuchitapo kanthu kwa iwo omwe amayesa kugwiritsa ntchito molakwa dongosolo. Idzakhala njira yokhayo yosungira ndalama kwa iwo omwe amafunikira kwambiri.
Chiwerengero cha Kuwerengera Chipatala
Aliyense amavomereza kuti chisamaliro cha chipatala chiyenera kukhala chapamwamba kwambiri. Miyoyo ya anthu ndi moyo umadalira pa izo. The Affordable Care Act inachita zowonetsera kuti zipatala zikhazikitse bwino kuti zisamalire bwino. Iwo anachita zimenezi poyesa momwe anthu ambiri analembedwera kuchipatala mkati mwa masiku 30. Kuloledwa ku chipatala, iwo amaganiza, zikanakhala chizindikiro kuti chipatalacho sichinasamalire munthu aliyense asanamasulidwe.
Ndondomeko yochepetsedwa ya Readmissions, yomwe imapangidwa pansi pa Affordable Care Act, imayang'anitsitsa zovomerezeka chifukwa cha matenda a mtima , kulephera kwa mtima , chibayo , kuthana ndi mawondo, komanso matenda osokoneza bongo (COPD) . Mzipatala zomwe zinkawerengedwa kwambiri m'dera lino zidalangidwa ndi kuchepa kwa chiwerengero cha ndalama za Medicare.
Kuchokera mu 2012, chiwerengero cha kuwelera kuchipatala chakhala chikuchepa. Chiwerengero cha kuvutika kwa mtima kwadutsa ndi 2,8 peresenti, kuperewera kwa mtima kwa 2,8 peresenti, ndi chibayo cha chibayo ndi 1.5 peresenti kuyambira 2007 mpaka 2014. Funsoli ndiloti kapena ayi izi zikuwonetsa kusintha kwa chisamaliro chabwino. Pali nkhawa kuti zipatala zitha kupeŵa chilango poika anthu "pansi poyang'ana" kusiyana ndi kuwawerengera ngati odwala.
Ndi Chisamaliro Chamtengo Wapatali Chotsani, Pulogalamu Yowonongeka ya Readmissions ikhoza kuchoka. Tikuyembekeza, padzakhala kupitilizidwa, kapena kuyesayesa kwatsopano kuthana ndi chisamaliro cha anthu omwe amasamalidwa kuchipatala.
Gawo D Dulani ya Donut
Medicare Part D inakhalapo Pulezidenti George W. Bush pamene Medicare Modernization Act inachitikira mu 2003. Othandizira adatha kugwiritsa ntchito phindu la gawo la mankhwala D kuyambira mu January 2006 ndi pulogalamu imodzi. Lamuloli linaphatikizapo "malo obisala" omwe amafunika kuti apeze thandizo la mankhwala a Medicare amapereka 100 peresenti ya mankhwala awo pokhapokha pamene gawo lawo D linagwiritsira ntchito ndalama zina m'chaka choperekedwa.
Obamacare anathandiza kuchepetsa ndalama zomwe zinali kunja .
Choyamba, izo zinagwirizana ndi opangira mtengo omwe angakulipireni mankhwala anu. Okonza maina, makamaka, amapereka mankhwala awo pafupipafupi 50 peresenti panthawi imene mudali mu dzenje lakupangira.
Chachiwiri, Obamacare adachepetsa kuchuluka kwa momwe mungaperekere mndandanda mwa kufunsa kuti D gawo D likukonzekera kulipira gawo laling'ono la mankhwala omwe mumagwiritsa ntchito pothandizira. Mutha kulipirira zambiri kuti mutuluke kunja kwa chingwe, koma ndalamazo zinali zofunika. White House inanena kuti ndalama zathandiza anthu oposa 8 miliyoni, kuwapulumutsa $ 11.5 biliyoni kuyambira 2010.
Chachitatu, kuchuluka kwa mapulani omwe mumapereka kwa mankhwala anu pang'onopang'ono kudzawonjezeka mpaka mpata wotsekedwa utatsekedwa ponseponse ndi 2020. Mwachidule, mutha kulipira malipiro anu omwe mumakhala nawo nthawi zonse, kupereka ndalama zowonjezera ndalama, ndi zina zambiri.
Phokoso lachitsulo likanabwerera ndi kubwezeretsedwa kwa Obamacare. Ndi mankhwala osokoneza bongo amakula kuposa kale lonse, zomwe zimakhudza akuluakulu a ku America zingakhale zowawa. Cholinga cha Obamacare chiyenera kuchitapo kanthu pofuna kutsimikizira kuti anthu angathe kupeza mankhwala omwe akufunikira.
Ntchito Zowonetsera Zowonongeka
Obamacare imathandizanso kuti ntchito zowonongeka zisawonongeke. Malinga ngati dokotala wanu akulandira gawo , kutanthauza kuti anavomera ku Ndondomeko ya Medicare Physician Fee, ntchito zotetezazo sizikanasowetsanso ndalama kapena ndalama. Adzaperekedwa kwa inu kwaulere.
Ntchito zothandizira zaulere zomwe zimapezeka ndi Medicare zikuphatikizapo:
- Maulendo a pachaka a bwino
- Kuwonetsetsa kwa magazi
- Kuyezetsa khansa ya m'mimba ( mammogram )
- Kuyeza khansa ya m'mimba (mapuloteni a pap ndi mankhwala a papillomavirus (HPV))
- Kuyezetsa khansa ya Colon (kuyesa magazi kumatsenga, colonoscopy, sigmoidoscopy)
- Kuwonetsetsa maganizo
- Lipid akuwonetsera
- Kuyeza khansa ya prostate (prostate-specific antigen)
- Katemera (chimfine, pneumococcal)
Zowonjezera machitidwe-kutsegula m'mimba pamimba, kuyang'ana matenda a shuga, kuyang'ana kwa hepatitis C, kuwonetsa kachirombo ka HIV, kuyezetsa khansa ya m'mapapo, kuyang'ana matenda a matenda opatsirana pogonana, ndi kuunika kwa matenda opatsirana pogonana-zidzakhalanso zaufulu koma zimapezeka kwa anthu omwe amaonedwa kuti ali pangozi. Kuyezetsa khansa ya Colon ndi chitsimikizo cha DNA chikanakhala chophimba ngati munthuyo ali pa ngozi yaikulu.
Kuchepetsa chithandizo kwa okalamba omwe angawathandize kukhala ndi thanzi labwino kapena omwe angalole kuti mankhwala oyambitsidwa msanga aziwathandiza. Ndikhoza kunena ngakhale kukweza nkhani. Tisaiŵale kuti matenda opitirira kwambiri ndi omwe amapezeka, ndizofunika kwambiri kuti muwachiritse. Cholinga cha Obamacare chiyenera kuganizira za zotsatira za umoyo komanso mavuto omwe amakhalapo kwa nthawi yaitali.
Mawu ochokera
Bungwe la Congressional Budget Office lomwe silinagwirizane ndi bungwe lina linayang'ana zomwe zinachitika ku Obamacare ndikugwiritsanso ntchito kuti ndalama za Medicare zidzakwera madola 802 biliyoni pa zaka 10. Ndondomeko yatsopano ya zaumoyo iyenera kuyambitsa izi mu equation.
Nkhani yothetsa chisamaliro cha zaumoyo sikuti imangokhudza zandale komanso zokakamiza. Kaya mukukhulupirira kapena kukhulupiliranso zofunikira za Care Act, muyenera kudziwa zomwe Medicare zidzasintha ndi kuchotsedwa kwa lamulo. Idzakuthandizani kudziwa zomwe mungayang'anire pamene malo osakanikizika a Obamacare akukwaniritsidwa.
> Zotsatira:
> Boccuti C, Casillas G. Akufuna Kupititsa Patsogolo Pa Chipatala Chochepa: Dipatimenti ya Kuchepetsa Kuvomereza Kuwerengera kwa Medicare Hospital. http://kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program/. Lofalitsidwa pa September 30, 2016.
> Ndalama zachuma ndi zachuma za kubwezeretsa ntchito yosamalidwa bwino. Webusaiti ya Congressional Budget website. https://www.cbo.gov/publication/50252. Idasindikizidwa pa June 19, 2015.
> Zopindulitsa Zofunikira za Care Affordable Act Chaka. Webusaiti ya US Department of Health and Human Services webusaitiyi. https://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca-by-year/index.html. Idasinthidwa pa August 13, 2015.
> Mankhwala Opondereza Okhwima. Ofesi ya Inspector General - webusaiti ya US Department of Health and Services webusaitiyi. https://oig.hhs.gov/fraud/strike-force/.
> Ntchito Zowonongeka ndi Zowonetsera. Medicare.gov. https://www.medicare.gov/kofunika/kukonzekera-ndi-screening-services.html.