Mapulani a zaumoyo a bungwe la AHPs akhala akuzungulira kwa zaka makumi ambiri, kuchokera ku Employee Retirement Income Security Act (ERISA) ya 1974, ndipo makamaka akutsatira malamulo a boma pansi pa malamulo atsopano omwe adakhazikitsidwa kumayambiriro kwa zaka za m'ma 1980. The Affordable Care Act (ACA) inakhazikitsa malamulo atsopano othandizira kupereka ma chitetezo kwa mamembala a AHP.
Koma Boma la Trump likufuna kumasula malamulo a AHPs, chifukwa chake apanga nyuzipepala zatsopano posachedwapa.
Mu October 2017, bungwe la Pulezidenti Trump la "Healthcare Choice ndi Mpikisano" linayitanitsa, mwa zina, malamulo atsopano okhudzana ndi "kuwonjezera mwayi" wopita ku AHP kwa mabungwe ang'onoang'ono ndi ogwira ntchito omwe panopa akutsatira malamulo a ACA ndi magulu awo a msika .
Ndipo kumayambiriro kwa mwezi wa 2018, Dipatimenti Yacchito inalembera malamulo omwe anapatsidwa kuchokera ku Pulezidenti wa October, kutsegula ndemanga ya masiku makumi asanu ndi awiri (potsatsa ndemanga pano).
Mwachidule: Kodi AHPs Angasinthe Bwanji Inshuwalansi Yanu ya Umoyo?
Ngati muli ndi chithandizo kuchokera kwa abwana ambiri, Medicaid, kapena Medicare, malamulo atsopano omwe sakufunira sadzakhudza zomwe mukuwerenga. Ngati muli ndi chithunzi m'misika yamagulu kapena magulu ang'onoang'ono, komabe malamulo omwe angakonzedwe angakhudze momwe mukuchitira, malinga ndi kumene mukukhala.
Malamulowa sanakwaniritsidwebe, ndipo sizikudziwika bwino kuti mayiko a leeway adzayenera kuletsa malamulo atsopano ngati atatsirizidwa.
Koma kupititsa patsogolo mwayi wopita ku AHPs kungabweretse ndalama zochepa zothandizira inshuwalansi kwa magulu ang'onoang'ono ndi anthu ogwira ntchito omwe amagwirizana nawo omwe amapereka AHPs. Komabe, ndi malipiro ochepa omwe angabweretse ndalama zomwe zingathandize kuchepetsa ubwino wa inshuwalansi. Malingaliro akuti "mumapeza zomwe mumalipira" ndi zovuta kupewa.
Kumbali inayi, anthu ndi mabungwe ang'onoang'ono omwe sagwirizana nawo mabungwe ndikupeza chithandizo pansi pa AHPs amatha kuona mapepala apamwamba m'zaka za mtsogolo, ndi / kapena malonda a inshuwalansi osakhazikika, osakhala ndi inshuwalansi ochepa omwe amapereka chithandizo. Izi zikhoza chifukwa chakuti AHPs angakonzedwe kuti apemphe makampani okhala ndi thanzi labwino, antchito achinyamata, kusiya msika wachikulire, odwala ku mapulani ovomerezeka a ACA.
Anthu omwe sagwirizane ndi AHPs angaphatikizepo malonda ang'onoang'ono ndi anthu ogwira ntchito omwe amafuna kusunga chithandizo chawo cholimba cha ACA, ndi anthu omwe sali odzigwira okha-choncho osayenera kulumikizana ndi AHP-kuphatikizapo otha msinkhu .
Ngati panopa mukugwira ntchito kwa abwana ang'onoang'ono omwe sapereka chithandizo chaumoyo ndipo mumapeza ndalama zowonjezereka, mutha kulandira ndalama zowonjezera (ndalama zanu zowonjezera msonkho) zimachokera pakhomo lanu. Koma ngati abwana anu akulowa nawo gulu ndikupereka chithandizo cha AHP chomwe chikugwirizana ndi zomwe ACA imanena kuti zingakwanitse, simungathe kulandira thandizo la premium.
Malamulo Amakono: Malamulo Osavuta Malinga ndi Kukula kwa Gulu
Mutu wa malamulo omwe akufuna, "Tanthauzo la 'Employer' Pansi pa Gawo 3 (5) la ERISA-Association Health Plans," akufotokozera mwachidule nkhaniyi: Mwachidziwikire, ndani amaloledwa kuti agwirizane kuti apange gulu lalikulu, wogwira ntchito -dongosolo lotsogolera?
Izi ndizofunika chifukwa ACA imayang'anira magulu akuluakulu ndi ang'ono mosiyana. "Gulu laling'ono" limatanthauza antchito 50 m'mayiko ambiri, koma ogwira ntchito 100 ku California, Colorado, New York, ndi Vermont. Ndipo malamulo amtundu waung'ono pansi pa ACA (chifukwa chokonzekera bwino mu Januwale 2014 kapena panthawi ina) ndi ofanana ndi malamulo a malonda payekha malonda: Zolinga ziyenera kutsimikiziridwa, ndi malipiro omwe amasiyana okha malinga ndi malo, zaka za antchito ( mkati mwa chiŵerengero chapamwamba cha 3: 1 kwa okalamba kapena ogwira ntchito antchito), kaya wogwira ntchitoyo amadalira dongosolo, ndi fodya.
Zomwe zili monga chikhalidwe, mtundu wa malonda, komanso thanzi la gululi silingagwiritsidwe ntchito kuti lizindikire mapepala.
Ndipo ndondomeko zing'onozing'ono za magulu kuyambira chaka cha 2014 ziyenera kupindula ndi zofunikira za thanzi la ACA, ndipo zimagwira ntchito imodzi mwazitsulo za ACA (bronze, siliva, golide, kapena platinamu), zomwe ndizoyeso.
Malamulo ena a ACA amagwiritsidwa ntchito pazinthu zazikulu za magulu ndi mapulani omwe amadzipangira okha (omwe ali otchuka kwambiri ndi olemba ntchito kwambiri), koma malamulo sali okhwima. Ndondomeko ya gulu lalikulu komanso ndondomeko zodzipangira zothandizira ndalama sizinagwirizane ndi ndondomeko yofanana yomwe ikugwiritsidwa ntchito pazinthu za gulu limodzi ndi zing'onozing'ono, zingasinthe malinga ndi mbiri yokhudza zachipatala, ndipo sichiyenera kugwirizana ndi zaka 3: 1 zaka Chiŵerengero chomwe chikugwiritsidwa ntchito ku msika wa magulu ang'onoang'ono (mwachitsanzo, malipiro a antchito akale angakhale oposa katatu ndalama zomwe zimaperekedwa kwa antchito achinyamata). Ndipo magulu akuluakulu komanso malingaliro omwe ali ndi ubwino wawo sayenera kubisa zofunikira za thanzi la ACA.
Kuonjezera apo, ngakhale zambiri zomwe ACA akufunikira sizikugwiritsidwa ntchito ku gulu lalikulu ndi malingaliro aumwini, inshuwalansi zokhazokha sizikuphatikizidwa ndi malamulo a boma. Mmalo mwake, iwo amalamulidwa ndi boma la federal, pansi pa ERISA malangizo. Kotero mukhoza kulingalira za ndondomeko zoyendetsera ntchito monga zovuta kwambiri pazinthu za gulu limodzi ndi zing'onozing'ono, zopanda malire pazinthu zodzipangira okhaokha, ndi kwinakwake pakati pa magulu akuluakulu omwe amagula zofalitsa kuchokera ku kampani ya inshuwalansi m'malo modzikonda okha, chifukwa Makampani ogulitsa inshuwalansi omwe amagulitsa malonda awo amatha kukhala ndi malamulo a boma, ngakhale ndi malamulo ochezeka pansi pa ACA poyerekeza ndi ndondomeko ya gulu limodzi ndi yazing'ono (makamaka, bungwe lalikulu ndilo, makamaka kuti likhale lokhazikika).
Malangizo Othandizira AHP Angamasule Malamulo
Pansi pa malamulo amasiku ano, AHPs amaloledwa kupatsa gulu lalikulu kapena malingaliro omwe ali ndi malingaliro awo kwa mamembala awo, koma malamulowo ndi okhwima kwambiri: Olemba ntchito ayenera kuyanjana pokhapokha kupanga kokha AHP (izi zimatchedwa "commonality" ofunika, "omwe amatanthauza kuti ayenera kukhala mu malonda omwewo), ayenera kukhala ndi ulamuliro pa AHP, ndipo olemba ntchito ayenera kukhala ndi antchito angapo (mwachitsanzo, sangathe kukhala eni eni okha opanda antchito).
Zomwe akufunazo zidzasintha malamulowa. Ngati zidzakwaniritsidwe, malamulo atsopanowa angalole ogwira ntchito kuti agwirizane kuti apange AHP pogwiritsa ntchito malonda ogawana OR OR, malo omwe angakhale dziko kapena dera lomwe likupezeka, monga dera kapena mzinda (kukumbukira) kuti madera ena akumidzi akudutsa kudera loposa umodzi). Choncho masitolo ang'onoang'ono ang'onoang'ono okonza magalimoto m'madera osiyanasiyana angagwirizane kuti apange AHP, kapena malonda ang'onoang'ono osagwirizana omwe ali mumzinda womwewo kapena boma angagwirizane kuti apange AHP.
Ngakhale gulu la makina likanatha kutsata ndondomeko yeniyeni ya bungwe lomwe lingagwirizanitse ndi chidziwitso chofanana, malamulo atsopano amalola ogwira ntchito kupanga bungwe ngakhale kuti malo awo ndi omwe amapezeka mwachidwi.
Komabe, malamulo omwe akufunsidwa akadali osowa kukhala mabungwe kuti akhale "mabungwe enieni omwe ali ndi dongosolo la bungwe lofunikira kuti achite 'mwa chidwi' cha olemba ntchito." Chiyanjano chiyenera kukhala ndi malamulo apamwamba ndi maulamuliro ndikuyang'aniridwa ndi malonda omwe ali ndi umembala wawo. Kotero ngakhale gulu la olemba ntchito lingagwirizane ndi cholinga chachikulu chopeza gulu lalikulu kapena inshuwalansi ya umoyo wothandizira (motero kupeŵa malamulo a ACA ndi magulu ang'onoang'ono), iwo amayenera kupanga bungwe loona kuti achite zimenezo.
Pansi pa malamulo amasiku ano, anthu ogwira ntchito omwe alibe antchito sangathe kulumikizana ndi AHPs kuti apeze chithandizo cha ERISA-chokhazikika (osati chogwirizana ndi ACA). Koma malamulo omwe angakonzedwe akhoza kumasula malamulowa, kulola "ogwira ntchito" kuti alowe nawo AHPs malinga ngati sakuyenera kulandila inshuwalansi yothandizidwa ndi ndondomeko inayake yomwe amagwiritsidwa ntchito ndi abwana, ntchito maola oposa 120 pamwezi, ndi kupeza ndalama zokwanira paokha -kugwira ntchito kutseka mtengo wa chithandizo choperekedwa ndi AHP.
Kodi Mtundu Wotani Wopereka AHP ungapereke?
Ngati lamuloli likukwaniritsidwa, AHPs yatsopano ingayambe kuonekera mwachilungamo posachedwa, ndipo pangakhale kusiyana kwakukulu pokhudzana ndi ubwino umene akupereka. Koma mozama, mfundo yonse yowonjezera AHPs ndi kuchepetsa mtengo wa kulandila zaumoyo. Ndipo popeza kuti malamulo omwe sakufunawa amachititsa kanthu kuti achepetse mtengo wa chithandizo chamankhwala (chomwe chimapangitsa kuti inshuwalansi yaumphawi iwonongeke), njira yokhayo yomwe iwowo angakhalire ndi ndalama zochepetsera ndalama ndi kudula ngodya malinga ndi mapindu omwe amaperekedwa, kapena kuwongolera umembala wathanzi kuposa wamba.
Malamulo omwe angakonzedwe amaletsa AHPs kuti asasankhidwe mwachindunji malinga ndi umoyo wawo, kotero sangathe kukana bizinesi kapena wogwira ntchito kuchokera kwa amembala mu bungwe (ndipo motero AHP chithandizo) malinga ndi mbiri yachipatala. Komabe, AHPs ikhoza kukhala ndi chidziwitso champhamvu chokonzekera kufotokozera kwawo mwa njira zomwe sizikukondweretsa anthu omwe ali ndi zikhalidwe zomwe zakhalapo kale. Ogwirizanitsa anali atachita kale zimenezi mpaka ACA-mwachitsanzo, kupereka mapulani azaumoyo omwe ankangogwiritsa ntchito mankhwala osokoneza bongo, kapena omwe sanapereke chithandizo chamaganizo ngakhale pang'ono.
ACA imaimitsa zizoloŵezizo, ndipo ndondomeko za inshuwalansi za umoyo wa munthu aliyense ndi zazing'ono zomwe zikugwira ntchito kuyambira January 2014 zinayenera kukwaniritsa miyezo yochepa yowunikira. Koma malamulo ambiri a ACA sagwiritsidwa ntchito ku magulu akuluakulu ndi mapulani omwe amapanga, chifukwa chake lingaliro lokulitsa mwayi wopeza mwayi wa AHPs ndi lothandiza kwa makampani ang'onoang'ono omwe ali ndi antchito abwino.
The American Academy of Actuaries ndi National Association of Inshuwalansi Commissioner adafotokoza zodetsa nkhaŵa mu 2017 (pamene kuwonjezeka kwa AHP kunali kuganiziridwa ndi olemba malamulo) za zotsatira za AHPs kuwonjezera pa malonda a gulu limodzi ndi aang'ono. Mabungwe awiriwa adanena kuti AHPs yatsopano ndi yowonjezereka ingapangitse kusankha kosasokonezeka m'misika yamtundu wa anthu ndi aang'ono, monga AHPs angapange zolinga zawo kuti azipempha mabungwe ang'onoang'ono (ndi anthu ogwira ntchito) omwe ali ndi thanzi labwino , antchito achinyamata, kusiya anthu okalamba, odwala m'mayiko omwe ali ovomerezeka, ACA-ovomerezeka ndi magulu ang'onoang'ono.
AAA ndi NAIC amadziwanso kuti AHPs a zaka makumi angapo zapitazo nthawi zambiri amakumana ndi insolvency, vuto lomwe lingabwererenso. Ndipo popeza kuti mapulaniwa sakulamulidwa ndi inshuwalansi ya boma, mamembala sangakhale nawo pokhapokha ngati AHP yawo itatha, satha kulipira.
> Zotsatira:
> American Academy of Actuaries. Kalata kwa olemba malamulo okhudza kukula kwa mgwirizano wa thanzi . March 8, 2017.
> Magulu a Medicare ndi Medicaid Services, Center for Information Consumer Information ndi Inshuwalansi. Kusintha kwa Masitolo Kusintha; Zolemba Zenizeni Zomwe Mayiko Amasiyana.
> Dipatimenti ya Ntchito, Ogwira Ntchito Phindu la Ukhondo. Tanthauzo la "Employer" Pansi pa Gawo 3 (5) la ERISA-Association Health Plans. Lofalitsidwa ku Federal Register January 4, 2018.
> Keith, Katie. Health Affairs. Mgwirizano wa Zaumoyo wa Zaumoyo Wovomerezeka Wolamulira: Zimene Zimanena ndi Zimene Zingachite. January 5, 2018.
> Association of National Insurance Commissioners. Kalata kwa olemba malamulo okhudza kukula kwa mgwirizano wa thanzi . February 28, 2017.