Gulu la madotolo mdziko muno sabata ino lapempha kuti athetseretu dongosolo lachinsinsi la Medicare lomwe a Biden White House adalandira kuchokera kwa oyang'anira a Trump ndipo kenako adasinthanso - pomwe kukhala bwino zigawo zake zoopsa kwambiri.
Tsopano imadziwika kuti Accountable Care Organisation Realizing Equity, Access, and Community Health (ACO REACH) Model, kuyesaku kumayika chiwongola dzanja pakati pa omwe adzapindule ndi Medicare ndi othandizira azaumoyo. Boma la federal limalipira apakati a ACO REACH kuti atetezere chisamaliro cha odwala pomwe amawalola kutenga ndalama zambiri ngati phindu.
Pulogalamu yoyendetsa yosinthidwa, yomwe idakhazikitsidwa popanda kuvomerezedwa ndi Congress ndipo ikuyenera kuchitika mpaka 2026, zinayamba mwalamulo mwezi uno, ndipo olimbikitsa zaumoyo omwe akupita patsogolo akuwopa kuti kuyesaku kuloledwa kusokoneza Medicare.
Lachiwiri kalata Mlembi wa Zaumoyo ndi Zaumoyo Xavier Becerra ndi Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure, Physicians for a National Health Program (PNHP) adanena kuti ACO REACH "ikuwopseza kukhulupirika kwa Medicare yachikhalidwe, komanso mwayi kwa mabungwe. kutenga ndalama kwa okhometsa msonkho pamene akukana chisamaliro kwa opindula. "
Gululi, lomwe limalimbikitsa chithandizo chamankhwala omwe amalipira m'modzi, adadandaula chifukwa cha ganizo la a Biden kuti alole makampani ndi zolemba zachinyengo ndi nkhanza zina kutenga nawo mbali mu ACO REACH woyendetsa, amene amangopatsa odwala achikhalidwe cha Medicare ku mabungwe achinsinsi popanda chilolezo chawo.
CMS idatero mu a cholengeza munkhani Lachiwiri kuti "ACO REACH Model ili ndi ma ACO 132 okhala ndi othandizira azaumoyo 131,772 ndi mabungwe omwe amapereka chithandizo kwa opindula pafupifupi 2.1 miliyoni" mu 2023.
"Monga tanenera, PNHP imakhulupirira kuti pulogalamu ya REACH imawopseza kukhulupirika kwa Medicare yachikhalidwe ndipo iyenera kuthetsedwa kwamuyaya," Dr. Philip Verhoef, pulezidenti wa gulu la madokotala, analemba m'kalata yatsopanoyi. "Kaya wina akugwirizana ndi mawuwa, tonsefe tiyenera kuvomereza kuti makampani omwe apezeka kuti aphwanya malamulo alibe malo oyang'anira chisamaliro cha omwe apindula ndi Medicare."
Zina mwa zitsanzo za PNHP zomwe zatchulidwa zinali Clover Health, yomwe yakhala ikugwira ntchito zomwe zimatchedwa Direct Contracting Entities (DCEs) - dzina la anthu omwe ali ndi anthu payekha pansi pa nthawi ya Trump yoyendetsa ndege ya Medicare - m'mayiko oposa khumi ndi awiri, kuphatikizapo Arizona, Florida. , Georgia, ndi New York.
PNHP idanenanso kuti mu 2016, CMS idalipira Clover-chachikulu Medicare Ubwino wothandizira—chifukwa “chogwiritsa ntchito ‘zamalonda ndi zotsatsa zomwe zinali ndi mawu olakwika’ okhudza kufalitsa kwa opereka chithandizo kunja kwa intaneti, pambuyo pa madandaulo ochuluka ochokera kwa odwala omwe anakanidwa kufalitsa ndi dongosolo lake la MA. Clover adalephera kukonza zinthuzo atapempha mobwerezabwereza ndi CMS. "
Humana, inshuwaransi ina yayikulu yokhala ndi mano mu woyendetsa privatization wa Medicare, "adatolera molakwika pafupifupi $200 miliyoni kuchokera ku Medicare pochulukitsa matenda a odwala," PNHP idatero, potchulapo zaposachedwa. Federal audit.
"Zikuwoneka kuti pakusankha kwake [kwa ACO REACH], CMS sinalepheretse kuphatikizidwa kwamakampani omwe ali ndi mbiri yamakhalidwe otere," Verhoef adalemba. "Potengera zomwe zapezazi, tili ndi nkhawa kuti CMS ikuloleza mosayenera ma DCEwa kuti apitilizebe ku ACO REACH mu 2023."
Pomwe woyendetsa ndege wa Medicare adapeza chidwi chochepa kuchokera kwa opanga malamulo pomwe olamulira a Trump adakhazikitsa koyamba m'miyezi yake yomaliza kulamulira, mamembala omwe akupita patsogolo a Congress angowonjezera kuwunika kwa pulogalamuyi.
Mwezi watha, Sen. Elizabeth Warren (D-Mass.) ndi Rep. Pramila Jayapal (D-Wash.) adatsogolera gulu la opanga malamulo ku chenjezo kuti ACO REACH "imapereka mwayi kwa ma inshuwaransi azaumoyo omwe ali ndi mbiri yobera ndi kuzunza Medicare ndikubera okhometsa msonkho kuti awononge dongosolo la Medicare."
"Takhala tikukhudzidwa kwa nthawi yayitali ndikuwonetsetsa kuti chitsanzochi sichikupatsanso opeza phindu m'mabizinesi mwayi winanso woti achotsere Medicare yachikhalidwe," opanga malamulowo adalemba, akubwereza nkhawa za PNHP. "Kupitirizabe kutenga nawo mbali kwa makampani omwe ali ndi mbiri yachinyengo ndi nkhanza zikuwopseza kukhulupirika kwa pulogalamuyi."
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