Zomera za ACA kwa Amwenye Achimereka ndi Amwenye a Alaska
The Affordable Care Act - aka Obamacare - wapereka anthu ambiri omwe sali ovomerezeka a ku America ndi a Alaska omwe ali ndi mwayi wopeza inshuwalansi. Malinga ndi US Census data , pali Ambiri Achimereka Achimereka ndi Achimereka ku United States. Kuchokera mu 2009 mpaka 2011, pafupifupi 30 peresenti ya iwo sankathandizidwa - poyerekeza ndi 17 peresenti ya chiŵerengero chonse cha US.
Amwenye Achimereka ndi Amwenye a Alaska ali ndi mwayi wopeza chithandizo chamankhwala chaulere choperekedwa ndi zipatala za Indian Health Service (IHS), koma malo a IHS amakhala pafupi ndi malo osungirako malo, ndipo anthu oposa atatu pa anayi onse a ku America ndi a Alaska Native sakhala pamtunda. Ngakhalenso pamene malo a IHS ali m'deralo, Boma la Accountability Office lapeza kuti chithandizo chamankhwala sichifunika nthawi zonse.
Kwa zifukwa zosiyanasiyana, Achimereka Achimereka ndi Amwenye a Alaska ali ndi mavuto aakulu okhudzana ndi thanzi labwino kuposa anthu onse a ku United States. Pofuna kuthetsa kusiyana kwa zaumoyo, komanso pofuna kuchepetsa kuchuluka kwa anthu a ku America ndi a Alaska, ACA ili ndi zinthu zina zomwe zimapangitsa kuti anthu athe kupeza komanso kupeza chithandizo chamankhwala chothekera kwa Amwenye Achimereka ndi a ku Alaska:
Kugawidwa kwa ndalama zochepa
Kugawana mtengo ndi kuchuluka kwa ndalama zomwe odwala ayenera kulipira chifukwa cha thanzi lawo.
Pansi pa ACA, ndalama zonse zomwe zili kunja kwa ndalama sizingapitilire madola 6,850 kwa munthu mmodzi yekha mu 2016, ngakhale kuti mapulani azaumoyo angathe kukhala ndi malire ochepa, ndipo ali ndi kusintha kwakukulu pa momwe akugwiritsira ntchito ndalama zawo pogwiritsa ntchito mapepala, zoperewera, ndi coinsurance.
Kwa Achimereka Achimereka ndi Amwenye a Alaska, pali zofunikira zokhudzana ndi kugawa ndalama:
- Kwa Achimereka Achimereka ndi Amwenye a Alaska omwe ali ndi ndalama zokwana 300 peresenti ya umphawi (pafupifupi $ 60,000 kwa banja la atatu, kapena $ 75,000 kwa banja la atatu ku Alaska), kulibe kugawana mtengo pa mapulani a inshuwalansi a malonda omwe adagulidwa mwa kusinthana . Malipiro a mwezi uliwonse (mtengo wa inshuwalansi yokha) ayenera kulipidwa, ngakhale thandizo la premium likhoza kuthetsa gawo lalikulu la mtengo, malingana ndi phindu. Koma mukamalandila, palibe copays, deductibles, kapena coinsurance.
- Kwa anthu onse a ku America ndi a Alaska omwe amalembetsa mgwirizano wa zaumoyo pogwiritsa ntchito kusinthanitsa - kuphatikizapo olembetsa omwe ali ndi ndalama zapakhomo pamtundu wapamwamba kuposa 300% - palibe kugawana ndalama (copay, deductible, coinsurance) kwa chithandizo chilichonse chaumoyo chomwe chimapezeka pa IHS kapena malo amtundu, kapena kuchokera kwa wothandizira amene wagwirizana ndi IHS.
Kulembetsa kwa chaka chonse
ACA inalongosola lingaliro la kulembetsa kwa omasuka ku msika wa inshuwalansi payekha. Pakafika chaka cha 2014, inshuwalansi ya umoyo paokha ingathe kugulitsidwa nthawi iliyonse pachaka, koma ofunsira ntchito m'mayiko ambiri ayenera kukhala okhutira kuti athe kuvomerezedwa.
Pansi pa ACA, aliyense akhoza kutenga chithandizo, mosasamala za mbiri yachipatala.
Koma malondawa ndi akuti inshuwalansi ya umoyo imapezeka pokhapokha panthawi yolembetsa (polemba 2016, kufalitsa koyamba kunayamba pa November 1, 2015 ndipo ikupitirira mpaka pa 31, 2016). Pambuyo pa kulembedwa kwa omasuka kumathera, kufalitsa kungathe kugulidwa ndi anthu omwe ali ndi zochitika zoyenera zomwe zimayambitsa nthawi yolembera yapadera .
Koma Achimereka Achimereka ndi Okalamba a Alaska sikuti amangolembetsa pa nthawi yolembetsa, ndipo safunikanso zochitika zoyenerera. Iwo amatha kulemba nthawi iliyonse, chaka chonse (kupyolera mwa kusinthanitsa kokha; kulembetsa kwa chaka chonse sikugwiritsanso ntchito kusinthanitsa). M'mayiko ambiri, kufotokozera kudzakhala koyambirira pa mwezi woyamba pambuyo pa kulembetsa ngati akulembetsa pa 15 mweziwo, ndipo mwezi woyamba wotsatira wachiwiri kwa olembetsa omwe anamaliza pambuyo pa 15, mwezi uno (Massachusetts, Rhode Island, ndi Washington boma zonse zimaloleza kulembetsa - kwa aliyense wofunsira - kuti adzatsiridwe mochedwa monga mwezi wa 23 wa mweziwu kuti uchitike mwamsanga mwezi woyamba wa mwezi wotsatira).
Palibe chilango chosavomerezedwa
Pansi pa ACA, pali chilango chosavomerezedwa . Zomwe zimawerengedwa pamabwerero a msonkho, ndipo zimagwiritsidwa ntchito kwa aliyense amene akuyenera kubwezeretsa wobwezeretsedwa yemwe sanavomerezedwe chaka chapitazo ndipo sanalandire chilango.
Koma Achimereka Achimereka ndi Amwenye a Alaska amene ali mamembala a fuko lodziwika bwino (kapena omwe ali oyenerera kusamaliridwa kudzera mu IHS) samasulidwa ku chilango. Amatha kupeza malipiro awo kuchokera ku kusinthanitsa kapena ku IRS pamene apereka msonkho wawo wa msonkho (uwu ndi mawonekedwe omwe akugwiritsidwa ntchito kupempha kuti achoke, mu mayiko 38 omwe amagwiritsa ntchito Healthcare.gov).
Pakhala phokoso lalikulu kuti Achimereka Achimereka ndi a Alaska alowe muzinthu zathanzi kudzera mu mgwirizano wa ACA. Koma zotsalira zimakhalabe mwazinthu zogwirira ntchito, maphunziro a ogula, ndipo nthawi zina, kudalira boma la federal. Ngakhale utsogoleri wa mafuko wakhala akugwira ntchito kufalitsa mawu kuti kulembetsa chithandizo cha umoyo kudzera ku mgwirizano wa ACA ndi opindulitsa kwa Achimereka Achimereka ndi Amwenye a Alaska, palibe chilango cha mamembala amitundu amene amasankha kukhala osatonthozedwa m'malo mwake.
Mchitidwe Wowonjezera Umoyo wa Indian
Bungwe la Indian Health Care Improvement Act, lomwe linapereka ndalama za IHS, linaperekedwa ndi Congress mu 1976 ndipo linatsimikizidwanso m'chaka cha 2000. Koma ACA yatsindikitsanso bungwe la Indian Health Care Improvement Act, ndipo linapindulapo phindu lina , kuphatikizapo mapulogalamu a chithandizo chamaganizo ndi khalidwe labwino, ndi mautumiki a nthawi yaitali.
Kusintha kwa Medicaid
Mu 2014, chiwerengero cha umphawi pakati pa anthu amtundu wa Amwenye Achimerika ndi a Alaska anali 28.3%, poyerekeza ndi 15.5% kwa anthu onse a ku United States. Akuluakulu a ku America ndi A Alaska (omwe ali apamwamba kuposa gulu lina lililonse) amachititsa kuti ACA's Medicaid ikule kwambiri.
ACA imafuna kuwonjezereka kwa Medicaid kuti igwirizane ndi anthu onse akuluakulu omwe ali ndi ndalama zaumphawi mpaka 138 peresenti ya umphaŵi (ana anali ataphimbidwa kale ndi ndalama zapamwamba zothandizira ndalama pothandizana ndi Dipatimenti ya Inshuwalansi ya Medicaid ndi Ana), ndipo boma lidzalipira nthawi zonse zosachepera 90% za mtengo wa kuwonjezeka kwa Medicaid.
Koma Khoti Lalikulu la Chigamulo linagamula mu 2012 kuti likhoza kuchoka ku Medicaid, ndipo pakadali pano, mayiko 19 sanayambe kufotokozera nkhani ya Medicaid.
M'mayiko asanu ndi awiri (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, ndi South Dakota), Achimereka Achimereka ndi Alaska Native amapanga pafupifupi 3 peresenti ya anthu onse. Mwa maikowa, onse koma Oklahoma ndi South Dakota afalitsa Medicaid.
Koma oposa theka la Achimereka Achimwenye ndi a Alaska amakhala m'mayiko asanu ndi awiri okha (Alaska, North Carolina, Texas, New Mexico, Oklahoma, California, ndi Arizona). Mwa iwo akuti, North Carolina, Texas, ndi Oklahoma sizinawonjezere Medicaid. Pakati pa maiko atatuwa, pali anthu 1,1 miliyoni pa kusiyana kwa chiwerengero, chiwerengero chomwe chimaphatikizapo Amwenye Achimereka.
Anthu omwe ali ndi kusiyana kotere sakuyenerera ku Medicaid chifukwa boma silinayambe kulandira chithandizo, ndipo sayeneranso kupereka ndalama zothandizira pazinthu zothandizira chifukwa zopereka zothandizira sizingapezeke kwa anthu omwe ali ndi ndalama mu umphaŵi (popeza ankayenera kupeza mwayi wa Medicaid m'malo mwake).
Kotero pamene kukula kwa Medicaid kwakhudza kwambiri polimbikitsa anthu a ku America omwe ali ndi ndalama zochepa komanso anthu a ku Alaska, izi zimagwiritsidwa ntchito m'madera omwe Medicaid yowonjezera.