A photo shows a medical professional giving a woman a mammogram screening.

Chigamulo cha khothi chikhoza kulimbikitsa malingaliro opikisana azaumoyo kuti achitenso ntchito zopewera

Tom ndi Mary Jo York ndi banja losamala za thanzi, omwe amapita kukayezetsa zachipatala pafupipafupi ndikupimidwa pafupipafupi ngati ali ndi khansa yapakhungu. Mary Jo, amene amayi ake ndi azakhali ake awiri anali ndi khansa ya m’mawere, amapimidwanso mammogram.

York, yemwe amakhala ku New Berlin, Wisconsin, adalembetsa nawo mapulani azaumoyo ammudzi, omwe, monga mapulani ambiri azaumoyo mdziko muno, amafunikira pansi pa Affordable Care Act kuti alipire chithandizocho, ndi ena opitilira 100, osatolera. kuchotsera kapena zopereka.

Tom York, 57, adati amayamikira ntchitoyo chifukwa mpaka chaka chino kuchotsera pa ndondomeko yake kunali $ 5,000, kutanthauza kuti popanda makonzedwe a ACA, iye ndi mkazi wake anayenera kulipira mtengo wonse wa mautumikiwa mpaka kuchotserako kukwaniritsidwa. “Colonoscopy ikhoza kuwononga $ 4,000,” adatero. “Sindinganene kuti ndithana nazo, koma ndinayenera kuganizira mozama.”

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 anagamula pa September 7 pamlandu wa ku Texas womwe unaperekedwa ndi magulu odziletsa omwe amati udindo wa ACA woti mapulani a zaumoyo azilipira ndalama zonse zothandizira zothandizira, zomwe nthawi zambiri zimatchedwa kufalitsa kwa dola yoyamba, ndizosagwirizana ndi malamulo.

Woweruza Reed O’Connor adavomereza. Anagamula kuti mamembala a gulu limodzi mwa magulu atatu omwe amapereka malingaliro pazofalitsa, US Preventive Services Task Force, sanasankhidwe mwalamulo pansi pa Constitution chifukwa sanasankhidwe ndi pulezidenti 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.

O’Connor adanenanso kuti kufuna kuti oimba mlandu alipirire mankhwala oletsa kachilombo ka HIV kuphwanya lamulo la Religious Freedom Restoration Act la 1993. Akuganizanso kuchotseratu chilolezo cha ndalama zoyamba za kulera za kulera, zomwe odandaulawo adatsutsanso pansi pa lamuloli. O’Connor anachedwetsa chigamulo pa izi ndi malamulo othetsera vutoli mpaka atalandira zidule zowonjezera kuchokera kumagulu omwe adatsutsidwa pa September 16. Kaya woweruzayo achite zotani, n’kutheka kuti boma lichita apilo ndipo likhoza kukafika ku Khoti Lalikulu Kwambiri. khoti.

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 olemba anzawo ntchito omwe ali ndi chiwongola dzanja chambiri komanso makampani a inshuwaransi yazaumoyo ndi omwe amawonjezera kugawana ndalama.

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

Ananeneratu kuti ma inshuwaransi apanga phindu lawo lachitetezo kuti akope anthu athanzi kuti athe kuchepetsa ndalama zomwe amalipira, zomwe zimapangitsa kuti pakhale matenda ambiri komanso okalamba omwe ali ndi ndalama zochepa komanso ndalama zotuluka m’thumba. “Ikubweretsanso chisokonezo chomwe ACA idapangidwira kukonza,” adatero. “Imakhala mpikisano wopita pansi.”

Ntchito zomwe zingatheke kuti zigwirizane ndi kugawana ndalama ndizo kupewa HIV ndi kulera, adatero Dr. Jeff Levine Shears, mkulu wa zaumoyo wa anthu ku WTW (omwe kale anali Willis Towers Watson), omwe amalangiza olemba ntchito pa mapulani a zaumoyo.

Kafukufuku wasonyeza kuti kuthetsa kugawana ndalama kumawonjezera kugwiritsa ntchito njira zodzitetezera ndikupulumutsa miyoyo. ACA itapempha Medicare kuti iwonetsere zowunika za khansa ya colorectal popanda kugawana mtengo, matenda a khansa ya colorectal adakali aang’ono amakula ndi 8% pachaka, kupititsa patsogolo moyo wa anthu masauzande ambiri, malinga ndi kafukufuku wa 2017 wofalitsidwa mu nyuzipepala ya Health Affairs.

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 wavomereza ulamuliro wamalamulo a mabungwe ena awiri aboma omwe amalimbikitsa njira zodzitetezera kwa amayi ndi ana komanso katemera, kotero zikuwoneka kuti 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, adanena kuti amakhulupirira kwambiri ubwino wa ntchito zodzitetezera ndipo amakonda kuwapangitsa kuti azitha kupezeka kwa olembetsa mwa kuchotsera ndalama zomwe amapeza komanso kulipira.

Koma ngati ntchitoyo yathetsedwa pang’ono, akuyembekeza kuti omwe akupikisana nawo akhazikitse kuchotsera ndikugula zinthu zodzitetezera kuti zithandizire kuchepetsa malipiro awo ndi pafupifupi 2%. Pambuyo pake, adati, adzachitanso zomwezo kuti mapulani ake azikhala opikisana pamsika wa ACA ku Wisconsin. “Ndimadana nazo kuvomereza kuti tiyenera kuganiza mozama kuti tigwiritse ntchito njirayi,” adatero Rakowski, 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 okhometsa msonkho angachite ngati makhothi athetsa ntchito zoteteza.

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, anthu ovutika akuda ndi a bulauni omwe apindula chifukwa chochotsa kugawidwa kwa ndalama zidzakhudzidwa mopanda malire” adatero Dr. A. Mark Fendrick, University Director of Michigan Center for Value-Based Insurance Design, 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, ndi maulendo a dokotala omwe angawononge 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 jakisoni ndi 74%, adanena kuti boma silinawonetse chidwi chokakamiza boma kuti lipereke chithandizo chopanda mtengo cha PrEP.

“Tikuyesera kuti tisavutike kupeza PrEP, ndipo pali zopinga zambiri kale,” adatero Carl Schmid, mkulu wa bungwe la HIV+ Hepatitis Policy Institute. “Ngati ndalama zogulira ndalama zoyambirira zitatha, anthu sakanatenga mankhwalawo. Zingakhale zowononga kwambiri kuyesetsa kwathu kuthetsa HIV ndi matenda a chiwindi.”

Robert York, wothandizira LGBT yemwe amakhala ku Arlington, Virginia, yemwe sakugwirizana ndi Tom York, watenga Discovy, mankhwala otchedwa PrEP, kwa zaka zisanu ndi chimodzi. Ananenanso kuti kugawana mtengo wa mankhwalawa ndi kuyezetsa kogwirizana ndi miyezi itatu iliyonse malinga ndi dongosolo lazaumoyo la abwana ake kungakakamize 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,” adatero iye. “N’chifukwa chiyani wina angayese izi?”

KHN (Kaiser Health News) ndi chipinda chankhani cha dziko chomwe chimatulutsa utolankhani wozama pazaumoyo. Pamodzi ndi kusanthula mfundo ndi kafukufuku, KHN ndi m’modzi mwa atatu oyendetsa KFF (Kaiser Family Foundation). KFF ndi bungwe lopanda phindu lomwe limapereka chidziwitso pazaumoyo kudziko lonse.

Gwiritsani ntchito zomwe tili nazo

Nkhaniyi itha kupangidwanso kwaulere (zambiri).

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