Macheke Aulere a ACA Awopsezedwa ndi Chigamulo cha Khothi: Kuwombera

Mammogram, monga iyi yomwe idachitika ku Chicago mu 2012, ndi imodzi mwazinthu zopewera zaumoyo zomwe Affordable Care Act imafuna kuti mapulani azaumoyo azilipira kwaulere kwa odwala. Koma izi zitha kusintha, ngati chigamulo cha Seputembara 7 cha woweruza wa federal ku Texas chipitirizidwa pa apilo.

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Mammogram, monga iyi yomwe idachitika ku Chicago mu 2012, ndi imodzi mwazinthu zopewera zaumoyo zomwe Affordable Care Act imafuna kuti mapulani azaumoyo azilipira kwaulere kwa odwala. Koma izi zitha kusintha, ngati chigamulo cha Seputembara 7 cha woweruza wa federal ku Texas chipitirizidwa pa apilo.

Heather Charles/Chicago Tribune/News Tribune Service kudzera pa Getty Images

Tom ndi Mary Jo Yorke ndi banja losamala za thanzi, omwe mokhulupirika amayezetsa thupi pachaka komanso kuyezetsa khansa yapakhungu nthawi zonse. Mary Jo, amene amayi ake ndi azakhali ake awiri anali ndi khansa ya m’mawere, amapimidwanso mammogram.

York, yemwe amakhala ku New Berlin, ndipo amalembetsa nawo mapulani aumoyo ammudzi a Choir, omwe, monga mapulani ambiri azaumoyo mdziko muno, amafunikira pansi pa Affordable Care Act kuti alipire chithandizocho, ndi ena opitilira 100, popanda kuchotsera kapena kuchotsera. zopereka.

Tom York, wazaka 57, akuti amayamikira udindo wa lamuloli chifukwa, pofika chaka chino, ndalama zomwe anachotsedwa pa ndondomeko yake zinali $ 5,000, kutanthauza kuti popanda lamulo la ACA, iye ndi mkazi wake anayenera kulipira mtengo wonse wa mautumikiwa ndalama zomwe zaperekedwa zidachotsedwa. “Colonoscopy ikhoza kuwononga $ 4,000,” akutero. “Sindinganene kuti ndithana nazo, koma ndinayenera kuganizira mozama.”

Chigamulo chaposachedwa cha khothi chikhoza kuonjezera mtengo waumoyo wa ogula

Tsopano mapulani azaumoyo ndi olemba anzawo ntchito omwe ali ndi inshuwaransi – omwe amalipira okha ndalama zachipatala za ogwira ntchito ndi odalira – angaganize zolipiritsa mamembala awo ndi antchito awo kugawana ndalama za chithandizo chodzitetezera. Zili choncho chifukwa woweruza wa boma adagamula pa Seputembala 7 pamlandu waku Texas womwe udabweretsedwa ndi magulu achitetezo omwe amati lamulo la ACA loti mapulani azaumoyo azilipira ndalama zonse zodzitetezera ndi zosemphana ndi malamulo.

Woweruza Reed O’Connor adavomereza. Ilo linanena kuti mamembala a gulu limodzi mwa magulu atatu omwe akupereka malingaliro, US Preventive Services Task Force, sanasankhidwe mwalamulo pansi pa Constitution chifukwa sanasankhidwe ndi purezidenti ndikutsimikiziridwa ndi Senate.

Ngati udindo wopereka chithandizo chodziletsa uchotsedwa pang’ono, zotsatira zake zitha kukhala zododometsa za mapulani azaumoyo omwe amaperekedwa m’mafakitale osiyanasiyana komanso m’malo osiyanasiyana mdziko muno. Odwala omwe ali ndi vuto lalikulu lazachipatala kapena omwe ali pachiwopsezo chachikulu pamikhalidwe yotere akhoza kukhala ndi vuto lopeza dongosolo lomwe limakwaniritsa ntchito zopewera komanso zowunikira. M’malo mwake, adzayenera kulipira co-pay kapena kuchotseratu ndalama zambiri asanayambe ndondomeko yawo ya inshuwalansi kuti athandize kulipira mtengo wa cheke chamtengo wapatali kapena ntchito zodzitetezera. Mapulani azaumoyo omwe amakhudza ntchito zopewera popanda Kufuna kuti olandira akumane ndi ndalama zochotsera pachaka akuti ali ndi “ndalama yoyamba” ya chithandizo chaumoyo.

Pachigamulo chomwechi sabata yatha, O’Connor adanena kuti kufuna kuti oimba mlandu alipirire mankhwala a kachilombo ka HIV mophwanya lamulo la Religious Freedom Restoration Act la 1993. Akuganizanso kuthetseratu lamulo la ndalama zogulira njira zolerera, zomwe odandaulawo adatsutsanso Primary. lamulo. O’Connor anachedwetsa chigamulo pa izi ndi malamulo amilandu mpaka atalandira zidule zoonjezera kuchokera kumagulu omwe adazengera mlandu pa Seputembala 16. Kaya woweruzayo achite zotani, n’kutheka kuti boma lichita apilo ndipo likhoza kukafika ku Khoti Lalikulu Kwambiri. khoti.

Kuyeza kuyezetsa khansa, shuga, kukhumudwa ndi matenda opatsirana pogonana kumakhala pachiwopsezo ngati chisankhocho chipitilira

Ngati O’Connor akanalamula kuti kuthetsedwe mwamsanga kwa ntchito yopereka chithandizo popanda malipiro a ntchito zomwe zavomerezedwa ndi Preventive Services Task Force, pafupifupi theka la ntchito zodzitetezera zomwe zikulimbikitsidwa pansi pa ACA zingakhale pangozi. Mayesowa ndi monga kuyezetsa khansa, shuga, kuvutika maganizo ndi matenda opatsirana pogonana.

Ndizotheka kuti mapulani ambiri azaumoyo ndi owalemba ntchito omwe ali ndi inshuwaransi adzalumikizana ndikulipiritsa ndalama zochotsedwa ndi ndalama zolipirira zina kapena zonse zomwe ogwira ntchito amalimbikitsa.

“Olemba ntchito akuluakulu aziwunika zomwe amapeza ndi dola yoyamba ndi zomwe sachita,” atero a Michael Thompson, CEO wa National Alliance of Healthcare Buyers Alliances, gulu lopanda phindu la olemba ntchito komanso mapulani azaumoyo omwe amagwira ntchito limodzi kuti achepetse mitengo. . . Amakhulupirira kuti ma inshuwaransi azaumoyo ndi olemba anzawo ntchito omwe ali ndi chiwongola dzanja chambiri ndi omwe angawonjezere kugawana ndalama pazolinga zawo zaumoyo.

“Ikulowetsanso chisokonezo chomwe ACA idapangidwira kukonza”

Izi zitha kusokoneza misika ya inshuwaransi yazaumoyo, atero a Kathryn Hempstead, mlangizi wamkulu wa mfundo ku Robert Wood Johnson Foundation.

Ma inshuwaransi adzapanga mapindu awo odzitetezera kuti akope anthu athanzi kuti athe kuchepetsa malipiro, monga momwe mungayembekezere, zomwe zimayambitsa matenda ambiri komanso achikulire omwe ali ndi chithandizo chochepa komanso ndalama zambiri zotuluka m’thumba. “Ikubweretsanso chisokonezo chomwe ACA idapangidwira kukonza,” akutero. “Imakhala mpikisano wopita pansi.”

Ntchito zomwe zikuyembekezeka kwambiri pakugawana ndalama ndi kupewa HIV ndi kulera, akutero Dr. Jeff Levine Shears, wamkulu wa zaumoyo wa anthu ku WTW (omwe kale anali Willis Towers Watson), yemwe amalangiza olemba anzawo ntchito za mapulani azaumoyo.

Kafukufuku wasonyeza kuti kuthetsa kugawana ndalama kumawonjezera kugwiritsa ntchito njira zodzitetezera ndikupulumutsa miyoyo. ACA itafuna kuti Medicare iwonetsere zowunika za khansa yapakhungu popanda kugawana ndalama, matenda a khansa ya colorectal oyambilira amakula 8% pachaka, kupititsa patsogolo moyo wa anthu masauzande ambiri, malinga ndi kafukufuku wa 2017 wofalitsidwa m’magazini. Zaumoyo.

Kuonjezera kugawana mtengo kungatanthauze mazana kapena masauzande a madola mu ndalama zomwe zimagwiritsidwa ntchito kunja kwa thumba kwa odwala chifukwa ambiri a ku America amalembedwa m’mapulani otsika kwambiri. Mu 2020, pafupifupi pachaka pamsika wa inshuwaransi pawokha anali $4,364 pazachitetezo chapayekha ndi $8,439 pakubweza mabanja, malinga ndi eHealth, broker wa inshuwaransi pa intaneti. Pamapulani a olemba anzawo ntchito, inali $1,945 kwa munthu payekha komanso $3,722 ya mabanja, malinga ndi KFF.

O’Connor adavomereza ulamuliro wa mabungwe ena awiri a federal kuti apereke chithandizo chodzitetezera kwa amayi ndi ana komanso katemera, kotero kuperekedwa kwa dola yoyamba pazithandizozi sikuli pachiwopsezo.

Ngati mabwalo amilandu asintha zomwe bungwe la Preventive Services Task Force likufuna, oyang’anira mapulani azaumoyo adzakumana ndi chigamulo chovuta. Mark Rakowski, pulezidenti wa bungwe lopanda phindu la Chorus Community Health Plans, akuti amakhulupirira kwambiri ubwino wa ntchito zodzitetezera ndipo amakonda kuwapangitsa kuti azitha kupezeka kwa olembetsa mwa kuchotsera ndalama zomwe zimachotsedwa ndi kulipira limodzi.

Koma ngati ntchitoyo yathetsedwa pang’ono, akuyembekeza kuti omwe akupikisana nawo azitha kuchotsera ndikugula zinthu zodzitetezera kuti zithandizire kuchepetsa malipiro awo ndi pafupifupi 2%. Kenako, akuti, akuyenera kuchita zomwezo kuti mapulani ake azikhala opikisana pamsika wa ACA ku Wisconsin. “Ndimadana nazo kuvomereza kuti tiyenera kuganiza mozama kuti tigwiritse ntchito njirayi,” akutero Rakovsky, ndikuwonjezera kuti atha kupereka mapulani ena opanda chitetezo chopanda mtengo komanso malipiro apamwamba.

Lamulo lachitetezo cha ACA Protective Services limagwira ntchito pazolinga zapadera m’misika yapayekha komanso yamagulu, yomwe imakhudza anthu aku America opitilira 150 miliyoni. Ndi lamulo wamba, lokondedwa ndi 62% ya aku America, malinga ndi kafukufuku wa 2019 KFF.

Ndalama zoyendetsera ntchito zodzitetezera zomwe ACA imalamula ndizochepa koma sizochepa. Zimayimira 2% mpaka 3.5% ya ndalama zonse zapachaka zoperekedwa ndi olemba anzawo ntchito pazaumoyo, kapena pafupifupi $100 mpaka $200 pa munthu aliyense, malinga ndi Institute for Healthcare Costs, gulu lofufuza lopanda phindu.

Ma inshuwaransi akuluakulu angapo azamalonda ndi magulu a inshuwaransi yazaumoyo sanayankhe pempho loti apereke ndemanga kapena anakana kuyankhapo pazomwe olipira inshuwaransi angachite ngati makhothi athetsa ntchito yoteteza.

Kusiyana kwa thanzi kungachuluke

Akatswiri akuwopa kuti kugawana ndalama pazithandizo zodzitetezera kungawononge kuyesetsa kwakukulu kuti muchepetse kusiyana kwaumoyo.

“Ngati zisiyidwa kwa mapulani aumwini ndi olemba ntchito kuti apange zisankho izi zokhudzana ndi kugawana ndalama, midzi yakuda ndi ya bulauni yosasungidwa yomwe yapindula chifukwa chochotsa kugawana ndalama idzakhudzidwa mopanda malire,” akutero Dr. A. Mark Fendrick, University Director. wa Michigan Center for Existing Insurance Design. on Value, yemwe adathandizira kupanga ACA’s Preventive Services Coverage Division.

Ntchito imodzi yomwe ikudetsa nkhawa kwambiri ndi pre-exposure prophylaxis for HIV, kapena PrEP, mankhwala othandiza kwambiri omwe amalepheretsa anthu omwe ali pachiwopsezo chotenga kachilombo ka HIV. Otsutsa pamlandu waku Texas adati kulipira PrEP kumawakakamiza kuthandizira “khalidwe logonana amuna kapena akazi okhaokha” lomwe amatsutsa zachipembedzo.

Kuyambira 2020, mapulani azaumoyo akhala akufunika kuti apereke mankhwala a PrEP, mayeso okhudzana ndi labu, komanso kuyendera madokotala komwe kungawononge ndalama zambiri pachaka. Mwa anthu 1.1 miliyoni omwe angapindule ndi PrEP, 44% ndi akuda ndipo 25% ndi Puerto Rico, malinga ndi Centers for Disease Control and Prevention. Komanso, ambiri a iwo ali ndi ndalama zochepa. Lamulo lopereka chithandizo cha PrEP lisanayambe kugwira ntchito, pafupifupi 10% yokha ya anthu oyenerera akuda ndi a Latino anayamba kulandira chithandizo cha PrEP chifukwa cha kukwera mtengo kwake.

O’Connor, ngakhale adatchula umboni wosonyeza kuti mankhwala a PrEP amachepetsa kufala kwa kachilombo ka HIV kudzera mu kugonana ndi 99% komanso pogwiritsa ntchito jekeseni ndi 74%, adanena kuti boma silinawonetse chidwi chokakamiza boma kuti lipereke chithandizo chopanda mtengo cha PrEP.

“Tikuyesera kuti zikhale zosavuta kupeza PrEP, ndipo pali zopinga zambiri kale,” akutero Carl Schmid, mkulu wa bungwe la HIV+ Hepatitis Policy Institute. “Ngati ndalama zogulira ndalama zoyambazo zitatha, anthu sakanamwa mankhwalawa. Zingakhale zowononga kwambiri kuyesayesa kwathu kuthetsa HIV ndi matenda a chiwindi.”

Robert York, wochita zachiwerewere yemwe amakhala ku Arlington, ku Virginia, watenga PrEP, mankhwala opangira kupewa HIV, kwa zaka zisanu ndi chimodzi.

John Jack Gallagher


Bisani mawu ofotokozera

Kusintha kwa mawu

John Jack Gallagher

Robert York, wochita zachiwerewere yemwe amakhala ku Arlington, Virginia, sagwirizana ndi Tom York ndipo watenga Discovery, mankhwala otchedwa PrEP, kwa zaka zisanu ndi chimodzi. Akuti kulipira kogawenga kotala kotala kwa mankhwalawa ndi kuyezetsa kogwirizana ndi dongosolo laumoyo wa abwana ake kungapangitse kusintha kwa ndalama zake. Mtengo wogulitsa mankhwala okha ndi pafupifupi $2,000 pamwezi.

Koma York, wazaka 54, adatsindika kuti kukhazikitsidwanso kwa kugawana ndalama kwa PrEP kungakhudze kwambiri anthu omwe ali m’magulu opeza ndalama zochepa komanso oponderezedwa.

“Tagwira ntchito molimbika ndi anthu ammudzi kuti tiyike PrEP m’manja mwa anthu amene akuifuna,” akutero. “N’chifukwa chiyani wina angalingalire izi?”

KHN (Kaiser Health News) ndi pulogalamu yodziyimira payokha KFF (Caesar Family Foundation).

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