Funso lachiwiri la kafukufuku wambiri likhoza kukonza malipiro a inshuwalansi ya mano

Anthu okhala ku Massachusetts amatha kuvota kuti athetse zinyalala zoyang’anira pamalipiro a inshuwaransi ya mano ndi kafukufuku wa Novembala, koma kusanthula kwatsopano kumachenjeza ogula kuti mwina sangawone kukhudzidwa kwakukulu – ngakhale funsolo litapambana pazisankho.

Funso lachiwiri pa voti ya anthu limafunsa ngati ovota akugwirizana ndi zomwe inshuwaransi ya mano imanena kuti 83% ya ndalamazo zimagwiritsidwa ntchito posamalira odwala, osati pa ndalama zoyendetsera ntchito, misonkho kapena phindu. Ngati onyamulira amawononga ndalama zosakwana masenti 83 pa dola iliyonse yamalipiro apamwezi olembetsa – malire omwe amadziwika kuti chiŵerengero cha kutaya – ayenera kutumiza kuchotsera kwa anthu omwe ali ndi inshuwaransi ndi magulu.

Koma ndizovuta kudziwa ngati chiwopsezocho chikugwirizana ndi kuchuluka koyenera, komanso momwe zingakhudzire madokotala ndi odwala, malinga ndi lipoti lotulutsidwa Lachinayi ndi Center for State Policy Analysis ku Tufts University Jonathan M. Tisch. . College of Civic Life.

“Funso lovoterali limapangidwa ndi zidziwitso zochepa,” lipotilo ndi MassLive lidatero. “Sizidziwikiratu ngati inshuwaransi ya mano pano ili pafupi – kapena kutali – ndi zofunikira za 83 peresenti. Ndipotu, palibe chifukwa chomveka cha chiwerengero cha 83 peresenti, ndipo kuyika izo kungatipangitse ife dziko lokhalo lotayika lokhazikika. chiŵerengero cha inshuwalansi ya mano. “

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Mwa kuyankhula kwina, pakhoza kukhala zotsatira “zang’ono” kapena “zowonjezereka” ndi zotsatira zochititsa chidwi kuchokera mu kafukufukuyu, kutengera kulondola kwa kafukufuku wochepa mpaka pano.

Inshuwaransi yosinthidwa ya mano iyamba kugwira ntchito mu Januware 2024.

Lipotilo, lomwe silimayimilira kapena kutsutsana ndi funso la kafukufukuyu, likunena kuti kuchuluka kwa kutayika kwa dzino kukuwonetsa muyezo wamba wa inshuwaransi yachipatala. Ku Massachusetts, makampani a inshuwaransi yazachipatala ayenera kukumana ndi 85% kapena 88%, koma amapatsidwanso kusinthasintha kuposa momwe ma inshuwaransi amano ayenera kutsatira malamulo aboma.

Malipiro apamwamba a inshuwalansi ya zachipatala amadaliranso mawerengedwe omwe ali ndi chiopsezo chachikulu, mosiyana ndi malipiro a inshuwalansi a mano otsika mtengo omwe amaganizira kuopsa kocheperako komanso “malire ogwiritsira ntchito”.

“Popanga ziwerengero zotayika za inshuwaransi yachipatala, opanga malamulo ndi owongolera amatsogozedwa ndi chidziwitso chochuluka chokhudza kayendetsedwe ka msika komanso thanzi lazachuma lamakampani a inshuwaransi,” lipotilo likutero. “Palibe chidziwitso chofananira chokhudza ndalama zomwe zilipo panopa kumakampani a inshuwaransi ya mano ku Massachusetts. Kafukufuku wokhawo wofunikira kuti afotokozedwe momveka bwino amagwiritsa ntchito njira zomveka koma adalamulidwa ndi gulu lazamalonda lamakampani a inshuwaransi yamano.”

Kafukufukuyu, wopangidwa ndi National Association of Dental Plans, adapeza kuti mapulani ambiri a inshuwaransi ali kale pantchito yoponya voti, ndipo chiwopsezo chotayika chikuzungulira 80%. Kuti muwonjezere mfundo za 3 peresenti, a inshuwalansi adzafunika kuchepetsa malipiro a mwezi uliwonse kapena kuwongolera ntchito zawo kuti achepetse ndalama zoyendetsera ntchito kapena phindu, malinga ndi lipoti la Tufts.

Mwa njira ina, makampani a inshuwaransi amatha kulipira zambiri pamadandaulo a mano, monga kupatsa mano kuti alipire ndalama zambiri pamachitidwe awo. Izi, kwenikweni, zitha kupatsa madokotala mwayi wokambirana chifukwa makampani a inshuwaransi nthawi imodzi amafuna kukwaniritsa zofunikira za chiwongola dzanja chatsopano.

Koma zikhoza kupangitsa odwala kulipira ndalama zambiri zothandizira mano.

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“Chifukwa chimodzi n’chakuti inshuwaransi yambiri ya mano imaphatikizapo mitengo ya inshuwaransi yokwera kwambiri, ndipo wodwala amalipira peresenti ya ndalama zonse,” linatero lipotilo. “Chinthu china ndi chakuti pamene mitengo ikukwera, odwala ambiri adzafika pa kapu yapachaka – ndipo amafunika kulipira chithandizo china chilichonse ndi ndalama zawo.”

Lipotilo limathandizira izi, komabe, poyembekezera kuwonjezeka kwamitengo komwe “kuyenera kukhala kochepa”. Lipotilo linanenanso kuti referendum pa voti “sangabweretse kutsika kwakukulu kwa malipiro omwe angapangitse inshuwalansi kukhala yotsika mtengo.”

Kalozera wodziwitsa anthu ovota kuchokera kuofesi ya Secretary of State Bill Galvin ali ndi chenjezo lamphamvu pafunso lovota. Malingaliro otsutsana ndi a Luis Rizzoli, a Komiti Yoteteza Kufikira Kwa Anthu ku Quality Dental Care, akuti masauzande a Bay-states adzataya inshuwaransi yawo yamano.

“Pamene mitengo ya ogula ikukwera, sitifunikira lamulo latsopano lomwe lingawonjezere ndalama ndikuchepetsa kusankha,” Rizzoli adalemba.

Komabe, funso lovota likhoza kulimbikitsa msika wa inshuwaransi wowonekera bwino, ndikutsegulira njira “zosintha mwadala zamtsogolo,” lipotilo likutero. Mapulani a mapindu a mano ayenera kutsata zofunikira zochitira lipoti nthawi zonse, monga kuwululira kuchuluka kwa kutayika ndi ndalama zoyendetsera ntchito kwa Commissioner wa Massachusetts Department of Inshuwalansi.

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Dental Insurance Quality Commission, yomwe imathandizira funso la kafukufukuyu, idati Delta Dental idalipira $ 382 miliyoni m’mabonasi akuluakulu, ma komisheni ndi zolipira mu 2019 ku Massachusetts, pomwe idawononga $ 177 miliyoni pakusamalira odwala, malinga ndi kalozera wazovota waboma.

Ngati funso la voti likadutsa, nyumba yamalamulo ku Massachusetts ikhoza kusintha kuchuluka kwa kutayika ndikuwongolera kukhazikitsidwa kwake, mwina kuyika njira yodutsamo kuti ifike 83%.

“Ngati ovota akana funso ili, momwe zinthu ziliri zipitilira, kutanthauza kuti ma inshuwaransi a mano azisunga ndalama zomwe amalipira komanso mitengo,” lipotilo likutero. “Panthawi yomweyo, sipadzakhala malipoti osintha kapena kusintha kwakukulu kwa chidziwitso chathu chandalama zoyambira makampani a inshuwaransi ya mano ku Massachusetts.”

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