Kasuwar inshorar lafiya

A Amurka, kasuwanni na Inshorar lafiya,  wanda kuma ake kira **musayar kiwon lafiya**, ƙungiyoyi ne a kowace jiha inda mutane za su iya siyan inshorar kiwon lafiya. Mutane na iya siyan inshorar kiwon lafiya wanda ya dace da Dokar Kare Marasa Lafiya da Kulawa mai araha (ACA, wanda aka fi sani da "Obamacare") a musayar kiwon lafiya ta ACA, inda za su iya zaɓar daga kewayon tsarin kula da kiwon lafiya da aka tsara da kuma daidaita da masu inshora da ke shiga musayar.

An ba da cikakken ƙwararrun musayar kiwon lafiya ta ACA kuma tana aiki ta Janairu 1, 2014, ƙarƙashin dokar tarayya.  An fara rajista a kasuwanni a ranar 1 ga Oktoba, 2013, kuma an ci gaba har tsawon watanni shida.  Tun daga 19 ga Afrilu 2014[sabunta] mutane miliyan 8.02 sun yi rajista ta kasuwannin inshorar lafiya.  Ƙarin ƙarin miliyan 4.8 sun shiga Medicaid.  Rijistar 2015 ta fara ne a ranar 15 ga Nuwamba, 2014, kuma ya ƙare a ranar 15 ga Disamba, 2014. Ya zuwa Afrilu 14, 2020, mutane miliyan 11.41 sun yi rajista ta kasuwannin inshorar lafiya.  

Hakanan musayar kiwon lafiya masu zaman kansu wadanda ba ACA ba suna cikin jihohi da yawa, suna da alhakin yin rajistar mutane miliyan 3. Wadannan musayar sun riga sun riga sun wuce Dokar Kulawa mai araha kuma suna sauƙaƙe shirye-shiryen inshora ga ma'aikatan ƙananan da matsakaitan kasuwanci.

## Tarihi
Musayar inshorar lafiya a Amurka tana faɗaɗa ɗaukar hoto yayin baiwa masu inshora damar yin gasa ta hanyoyi masu tsada da kuma taimaka musu su bi dokokin kariyar mabukaci.  Musanya ba su ne masu inshorar kansu ba, don haka ba sa yin haɗari da kansu, amma suna ƙayyade wane kamfanonin inshora ke shiga cikin musayar.  Kyakkyawan musanya yana haɓaka bayyana gaskiya da lissafin inshora, yana sauƙaƙe ƙara yawan rajista da isar da tallafi, kuma yana taimakawa yada haɗari don tabbatar da cewa an raba kuɗin da ke da alaƙa da tsadar jiyya a cikin manyan ƙungiyoyin mutane, maimakon yaɗuwa cikin ƴan masu cin gajiyar.  Musayar inshorar lafiya tana amfani da musayar bayanan lantarki (EDI) don watsa bayanan da ake buƙata tsakanin musayar da dillalai (abokan ciniki), musamman ma'amalar 834 don bayanan rajista da ma'amalar 820 don biyan kuɗi mai ƙima. 

Health exchanges first emerged in the private sector in the early 1980s, and they used computer networking to integrate claims management, eligibility verification, and inter-carrier payments. These became popular in some regions as a way for small and medium-sized businesses to pool their purchasing power into larger groups, reducing cost. An additional advantage was the ability of small businesses to offer a range of plans to employees, allowing them to compete with larger corporations. The largest such exchange prior to the ACA is CaliforniaChoice, established in 1996. By 2000, CaliforniaChoice's membership included 140,000 individuals from 9000 business groups.&#x5B;**'&#x5D;</sup>

Obamacare ya ci gaba da manufar musayar inshorar kiwon lafiya a matsayin babban bangare na kiwon lafiya. Shugaba Obama ya bayyana cewa ya kamata ya zama "kasuwa inda Amurkawa za su iya tsayawa daya don shirin kiwon lafiya, kwatanta fa'idodi da farashi, kuma su zaɓi shirin da ya fi dacewa a gare su, kamar yadda membobin Majalisa da iyalansu zasu iya. Babu ɗayan waɗannan tsare-tsaren ya kamata su musanta ɗaukar hoto bisa ga Yanayin da ya riga ya kasance, kuma duk waɗannan tsare-shiryen ya kamata su hada da kunshin fa'idar da za a iya hanawa, da kyau. Jihohi na iya zaɓar haɗuwa tare don gudanar da musayar jihohi da yawa, ko kuma suna iya zaɓar fita daga gudanar da musuqyar kansu, a wannan yanayin gwamnatin tarayya za ta shiga don ƙirƙirar musayar don amfani da 'yan ƙasa.

An sanya hannu kan ACA a matsayin doka a ranar 23 ga Maris, 2010. Dokar ta buƙaci musayar inshorar lafiya ta fara aiki a kowace jiha a ranar 1 ga Oktoba, 2013 .  A cikin shekara ta farko ta aiki, bude rajista a kan musayar ya gudana daga Oktoba 1, 2013, zuwa Maris 31, 2014, kuma shirye-shiryen inshora da aka saya a ranar 15 ga Disamba, 2013, ya fara ɗaukar hoto a ranar 1 ga Janairu, 2014 .    Don 2015 bude rajista ya fara a ranar 15 ga Nuwamba, 2014, kuma ya ƙare a ranar 15 de Fabrairu, 2015.

=== Farko na farko ===
On the date the Patient Protection and Affordable Care Act of 2010 was enacted,  only a few health insurance exchanges across the country were up and running. Among them were the Massachusetts Health Connector, the New York [[HealthPass]] - a non-profit exchange, and the [[Utah Health Exchange]]. Advocates claim  these exchanges make these "markets" more efficient, providing oversight and structure, arguing that previous health insurance markets in the United States are poorly-organized and deal with wide variations in coverages and requirements among different companies, employers, and policies.

Ba a san yawan mutane da suka samu nasarar shiga cikin makon farko ba. An shirya shafin yanar gizon kasuwar tarayya don kulawa a karshen mako.

CGI Group came under media scrutiny as a developer behind several marketplace websites, after numerous issues surfaced with the federal health insurance marketplace, HealthCare.gov.

A ranar 1 ga Oktoba, 2013, kasuwanni na jihar sun buɗe ga jama'a, kuma wasu daga cikinsu sun ba da rahoton kididdigar farko. A cikin mako na farko na rajista:

* Mutane 28,699 da suka yi rajista a Kasuwar shirin kiwon lafiya ta California 
* Mutane 17,300 da suka yi rajista a Kasuwar shirin kiwon lafiya na Kentucky 
* Fiye da mutane 40,000 da suka yi rajista a kasuwar Lafiya ta Jihar NY 
* A ranar 8 ga Oktoba, 2013, ''The Seattle Times'' ta ruwaito cewa fiye da mutane 9,400 sun shiga Kasuwar shirin kiwon lafiya ta Washington. Koyaya, wani rahoto daga baya ya bayyana cewa da yawa da aka haɗa a cikin wannan ƙididdigar sun kasance masu shiga Medicaid. Ya zuwa 21 ga Oktoba, 2013, mazauna Washington 4,500 ne kawai suka shiga cikin inshora masu zaman kansu ta hanyar kasuwar jihar.

=== Yarda hukuncin haraji ===
On October 23, 2013, ''The Washington Post'' reported that Americans with no health insurance would have an additional six weeks before they would be penalized. That deadline was extended to March 31, and those who do not enroll by then may still avoid incurring penalties and getting locked out of the healthcare enrollment system this year. Exemptions and extensions apply to:

* Wadanda ke zaune a jihohin da ke amfani da musayar tarayya, waɗanda zasu iya amfani da kansu daga "lokaci na musamman" wanda ke bawa mutane damar kauce wa azabtarwa da yin rajista a cikin shirin kiwon lafiya ta hanyar bincika akwati mai launin shudi a tsakiyar watan Afrilu na shekara ta 2014, suna mai cewa sun yi ƙoƙarin yin rajista kafin lokacin da aka ƙayyade (yin haka yana ba da lokaci ba a tantance shi ba don yin rajista bayan haka). Jaridar ''New York Post'' ta ba da rahoton cewa: "Wannan hanyar za ta dogara da tsarin girmamawa; gwamnati ba za ta yi ƙoƙari ta tantance ko mutumin yana faɗin gaskiya ba". Kasuwancin da ke gudanar da jihohi suna da nasu dokoki; da yawa za su ba da irin wannan kari.
* Membobin Shirin Inshora na Pre-Existing Condition, waɗanda aka ba su tsawaita wata ɗaya har zuwa ƙarshen Afrilu 2014 . 
* Wadanda suka samu nasarar neman izinin zama bisa ga ka'idojin da HealthCare.gov ta buga, wadanda ba a buƙatar su biya harajin haraji idan ba su shiga cikin shirin inshorar lafiya ba.

=== Tasirin ===
Aiwatar da musayar mutum ya canza aikin inshora ga mutane. Yaduwar wannan kasuwar babbar mayar da hankali ga ACA. Fiye da mutane miliyan 1.3 sun zaɓi tsare-tsaren rufe kasuwar 2015 a cikin makonni uku na farko na lokacin bude rajista na shekara, gami da mutanen da suka sabunta ɗaukar su da sabbin abokan ciniki.

Ya zuwa Janairu 3, 2014, mutane miliyan 2 sun zaɓi shirin kiwon lafiya ta hanyar kasuwanni na inshorar kiwon lafiya. Ya zuwa Afrilu 19, 2014, mutane miliyan 8.0 sun sanya hannu ta hanyar kasuwar inshorar kiwon lafiya kuma ƙarin miliyan 4.8 sun shiga Medicaid. Ya zuwa watan Fabrairun, 2015, kimanin mutane miliyan 11.4 sun sanya hannu ko kuma an sabunta su ta atomatik don ɗaukar kasuwa na 2015. A yau, an gudanar da abubuwan da suka faru a cikin gida sama da 1,400 a jihohin kasuwa na tarayya a duk faɗin ƙasar.

=== Dokokin Kare Marasa Lafiya da Kulawa Mai Rashin Farashi ===

* An haramta masu inshora daga nuna bambanci ko cajin mafi girma ga kowane mutum bisa ga yanayin kiwon lafiya ko jinsi.
* An haramta masu inshora daga kafa kudaden kashe kudi na shekara-shekara na adadin dala akan fa'idodin kiwon lafiya masu mahimmanci.
* Dukkanin tsare-tsaren inshorar kiwon lafiya masu zaman kansu da aka bayar a Kasuwar dole ne su ba da waɗannan fa'idodi masu mahimmanci na kiwon lafiya: kulawa ta ambulatory, sabis na gaggawa,[[Asibiti|A asibiti]] (kamar tiyata), kula da haihuwa da jarirai, sabis na rashin lafiya da miyagun ƙwayoyi, magunguna, sabis na farfadowa da habilitative (hidimomi don taimakawa mutanen da ke da rauni, nakasassu, ko yanayin da ba da za su warke ba), sabis na dakin gwaje, sabis na rigakafi da lafiyar yara.
* A karkashin tanadin umarni na mutum (wani lokacin ana kiransa "abin da ake buƙata na alhakin raba" ko "mafi ƙarancin abin da ake buƙatu"),  mutanen da ba a rufe su da manufofin inshorar kiwon lafiya masu karɓa za a caje su harajin haraji na shekara-shekara na $ 95, ko har zuwa 1% na samun kudin shiga a kan mafi ƙarancin shigarwa,  wanda ya fi girma; wannan zai tashi zuwa mafi ƙaranci $ 695 ($ 2,085 ga iyalai),  ko 2.5% na samun kudin haya a kan mafi karancin shigarwa. Ana ba da hukuncin, ma'ana cewa idan mutum ko iyali yana da ɗaukar hoto na wani ɓangare na shekara ba za su kasance da alhakin ba idan ba su da ɗaukar hoto ƙasa da watanni uku a cikin shekara. Ana ba da izinin cirewa saboda dalilai na addini, ga membobin ma'aikatun kiwon lafiya, ko kuma ga waɗanda manufofin da ba su da tsada za su wuce 8% na kuɗin shiga. Har ila yau an cire su ne 'yan ƙasar Amurka waɗanda suka cancanci zama mazauna wata ƙasa ta waje a ƙarƙashin dokar cire kuɗin shiga ta IRS. A cikin shekara ta 2010, Kwamishinan ya yi hasashen cewa masu ba da inshora za su samar da fom ɗin da ke tabbatar da muhimmiyar ɗaukar hoto ga mutane da IRS; mutane za su haɗa wannan fom ɗin zuwa dawowar harajin Tarayya. Wadanda ba a rufe su ba za a tantance su a kan harajin harajin Tarayya. A cikin kalmomin dokar, mai biyan haraji wanda ya kasa biyan hukuncin "ba zai kasance ƙarƙashin kowane hukunci ko hukunci ba" kuma ba zai iya sanya takaddama ko haraji a kan dukiyarsu ba, amma IRS za ta iya hana dawo da haraji na gaba daga gare su.



* A cikin jihohi masu shiga, cancantar Medicaid an faɗaɗa;  duk mutanen da ke da kudin shiga har zuwa 133% na layin talauci sun cancanci ɗaukar hoto, gami da manya ba tare da yara masu dogaro ba.[1][2]  Har ila yau, dokar ta tanadi kashi 5% na "rashin kula da kudaden shiga", wanda ke yin iyakacin cancantar samun kudin shiga mai inganci 138% na layin talauci.[3]  Jihohi na iya zaɓar ƙara iyakar cancantar samun kuɗin shiga fiye da wannan ƙaramin abin da ake bukata.[3]  Kamar yadda aka rubuta, ACA ta hana duk tallafin Medicaid daga jihohin da ke kin shiga cikin faɗaɗawa.  Duk da haka, Kotun Koli ta yanke hukunci a cikin Ƙungiyar Ƙwararrun Ƙwararrun Kasuwanci ta Ƙasa v. Sebelius (2012) cewa wannan janyewar kudade ya kasance mai tilastawa ba bisa ka'ida ba kuma cewa jihohi ɗaya suna da 'yancin ficewa daga fadada Medicaid ba tare da rasa kudaden Medicaid da aka rigaya ba daga gwamnatin tarayya.  Ga jihohin da suka fadada Medicaid, doka ta tanadi cewa gwamnatin tarayya za ta biya 100% na fadada na shekaru uku na farko, sannan a hankali rage tallafin da take bayarwa zuwa kashi 90 cikin 2020.[4][5]  Tun daga ranar 25 ga Afrilu 2013[sabunta] jihohi goma sha biyar—Alaska, Alabama, Jojiya, Idaho, Indiana, Iowa, Louisiana, Mississippi, Nebraska, [[North Carolina]], Oklahoma, [[South Carolina]], Texas, [[Wisconsin]], da Virginia—ba sa shiga cikin faɗaɗa Medicaid, tare da ƙarin goma—Kansas, Maine,, Montana, Missouri, Ohio, Pennsylvania, South Dakota zuwa Michigan  shiga.[6][yana buƙatar sabuntawa]

==== Taimako ====
Ana ba da tallafin kuɗi na inshora ga mutanen da suka sayi shirin daga musayar kuma suna da kuɗin shiga na gida tsakanin 133% da 400% na layin talauci. Sashe na 1401 (36B) na PPACA ya bayyana cewa za a samar da kowane tallafi a matsayin mai ci gaba, bashi na haraji  kuma yana ba da tsari don lissafinsa: 

Kudin haraji mai dawowa hanya ce ta samar da fa'idodin gwamnati ga mutanen da ba su da nauyin haraji  (kamar Kudin harajin da aka samu). An canza tsarin a cikin gyare-gyaren (HR 4872) da aka zartar a ranar 23 ga Maris, 2010, a sashi na 1001. Don samun cancanta ga tallafin, masu cin gajiyar ba za su iya cancanci samun wasu karɓa ba. Ma'aikatar Lafiya da Ayyukan Dan Adam ta Amurka (HHS) da kuma Hukumar Haraji ta Cikin Gida (IRS) a ranar 23 ga Mayu, 2012, sun ba da dokoki na hadin gwiwa game da aiwatar da sabbin musayar inshora na kiwon lafiya don rufe yadda musayar za ta ƙayyade cancanta ga mutanen da ba su da inshora da ma'aikatan ƙananan kamfanoni da ke neman sayen inshora a kan musayar, da kuma yadda musayar zasu kula da ƙudurin cancanta ga mutane masu karamin karfi da ke neman sabbin fa'idodin Medicaid da ke neman fadada An jinkirta ƙididdigar ƙididdiga na shekara guda a kan tsare-tsaren rukuni, don ba ma'aikata lokaci don shirya sabbin tsarin lissafi, amma har yanzu ana shirin ƙididdigan don yin aiki a kan jadawalin don tsare-tsare na inshora a kan musayar;    HHS da Ma'aikatar Bincike sun lissafa abin da ƙididdigaren ƙididdigin ƙididdigal ɗin ƙididdigatattun kuɗin shiga don  don iyali na huɗu zai kasance a cikin 2014:



A cikin kasuwar mutum, wani lokacin ana tunanin shi a matsayin "kasuwar raguwa" na inshora, masu inshora gabaɗaya sun yi amfani da tsari da ake kira underwriting don tabbatar da cewa kowane mutum ya biya darajarsa ko ƙin ɗaukar hoto gaba ɗaya. Kwamitin Majalisar kan Makamashi da Kasuwanci ya gano cewa, tsakanin 2007 da 2009, manyan kamfanonin inshora guda huɗu sun ki inshora ga mutane 651,000 don yanayin kiwon lafiya na baya, adadi wanda ya karu sosai a kowace shekara,  tare da karuwar 49% a wannan lokacin.  Wannan yarjejeniyar ta ce an ki biyan da'awar 212,800 saboda yanayin da ya riga ya kasance kuma kamfanonin inshora suna da shirye-shiryen kasuwanci don iyakance kuɗin da aka biya bisa ga waɗannan yanayin da suka riga sun kasance. Wadannan mutanen da bazai sami inshora ba a karkashin ayyukan masana'antu na baya an tabbatar da inshora a karkashin ACA. Saboda haka, musayar inshora za ta sauya haɗarin kuɗi mafi girma ga masu inshora, amma za su taimaka wajen raba farashin wannan haɗarin tsakanin manyan mutane masu inshora. haramcin ACA na musanta ɗaukar hoto ga yanayin da ya riga ya kasance ya fara ne a ranar 1 ga Janairu, 2014. A baya, shirye-shiryen jihohi da na tarayya da yawa, gami da kwanan nan ACA, sun ba da kuɗi don tafkunan da ke da haɗari ga waɗanda ke da yanayin da ke akwai a baya.   Jihohi da yawa sun ci gaba da wuraren da suke da haɗari har ma bayan lokacin shiga kasuwa na farko. 

=== Ƙayyadadden bambancin farashi ===

: Abubuwan Farashi da aka ba da izini a cikin musayar a ƙarƙashin ACA:  Shekaru: 3:1 Matsayin shan sigari: 1.5:1
::* Shekaru: 3:1
::* Matsayin shan sigari: 1.5:1

Za a ba da izinin bambancin farashi ta yanki (a cikin jihar) da kuma abun da ke cikin iyali ("tier").

=== Matsayi masu kama da juna na tsare-tsare ===
A cikin musayar, ana ba da shirye-shiryen inshora a cikin matakai huɗu da aka tsara daga mafi ƙarancin kuɗi zuwa mafi girma: tagulla, azurfa, zinariya, da platinum. Shirye-shiryen sun kasance daga 60% zuwa 90% na takardun kudi a cikin karuwar 10% ga kowane shirin. Ga wadanda ba su kai shekara 30 ba (da wadanda ke da wahalar ba da izini), ana samun matakin "babban bala'i" na biyar, tare da manyan abubuwan da za a iya cirewa.

Kamfanonin inshora suna zaɓar likitoci da asibitoci waɗanda ke cikin hanyar sadarwa. [bayyanawa da ake buƙata] 

Masu goyon bayan sake fasalin kiwon lafiya sun yi imanin cewa ba da damar daidaitaccen shirye-shirye don yin gasa don kasuwancin mabukaci a wuri ɗaya mai dacewa zai sa farashin ya sauka. Samun wuri na tsakiya yana ƙara ilimin mabukaci game da kasuwa kuma yana ba da damar daidaitawa mafi girma don kammala gasa. Kowane ɗayan waɗannan tsare-tsaren za su kuma rufe alhakin masu amfani da kudaden da ke cikin aljihu a $ 6,350 ga mutane da $ 12,700 ga iyalai.

Wani binciken da Avalere Health ya yi ya ce farashin inshorar kiwon lafiya na shahararrun tsare-tsaren da ake samu a karkashin Obamacare na 2015 ya karu da kashi 3-4%. 

A cewar Ma'aikatar Lafiya da Ayyukan Dan Adam ta Amurka, yayin da rajista don Kasuwar Inshora ta Lafiya ta fara a ranar 15 ga Nuwamba, kimanin mutane miliyan 11.4 sun bincika zaɓin su, sun koyi game da taimakon kudi da ke akwai, kuma sun sanya hannu ko sabunta shirin kiwon lafiya wanda ya cika bukatun su kuma ya dace da kasafin kuɗin su. Ya zuwa Fabrairu, 2015, $ 268 shine matsakaicin kuɗin haraji na kowane wata ga mutanen da suka cancanci taimakon kuɗi a jihohi 37 ta amfani da HealthcCare.gov har zuwa Janairu 30.

== Tattalin arzikin musayar inshorar lafiya: umarnin mutum ==
The kiwon lafiya inshora kungiyar bayar da shawarar Amurka ta Health Insurance Plans was willing to accept these constraints on pricecing, capping, and resigning because of the individual mandate: The individual mandate yana buƙatar duk mutane su sayi inshorar lafiya.] Wannan abin da ake bukata na ACA yana bawa masu inshora damar yada haɗarin kuɗi na sababbin insured mutane tare da yanayin da suka rigaya a cikin babban tafkin mutane. 

Bugu da ƙari, binciken da Pauly da Herring suka yi ya kiyasta cewa mutanen da ke da yanayin da suka rigaya a cikin kashi 99 na haɗarin kuɗi suna wakiltar 3.95 sau matsakaicin haɗari (ma'ana).[1]  Alkaluma daga Kwamitin Majalisar kan Makamashi da Kasuwanci zai nuna cewa kusan mutane miliyan 1 masu hadarin gaske za su bi inshora a musayar fa'idodin kiwon lafiya.[2]  Majalisa ta kiyasta cewa mutane miliyan 22 za su sami sabbin inshora a cikin musayar fa'idodin kiwon lafiya.[3]  Don haka mutanen da ke da hatsarin gaske ba sa ƙididdige su a cikin adadi mai yawa don ƙara haɗarin yanar gizo ga kowane mutum daga aikin da ya gabata.  Don haka yana da fa'ida a ka'ida don karɓar umarni na mutum don musanya don buƙatun da aka gabatar a cikin ACA. 

HIX (Health Insurance eXchange) is emerging as the ''de facto'' acronym across state and federal government stakeholders, and the private sector technology and service providers that are helping states build their exchanges.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">&#x5B;**'&#x5D; The acronym HIX differentiates this topic from health information exchange, or HIE.

The de facto acronym of HIX will be replaced with HIEx in the *3rd Edition of the HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations*, 

## Rashin amincewa da jayayya

; Rashin mutane da yawa masu karamin karfi
: NPR ta ba da rahoton cewa an cire adadi mai yawa na mutanen da ba su da isasshen kuɗi a cikin jihohin da ba su ba da faɗaɗa Medicaid zuwa 133% na layin talauci ba.
; Tsaro na bayanai
: An bayar da rahoton musayar kiwon lafiya ta Minnesota cewa ba zato ba tsammani ta aika da bayanan sirri na sama da wakilai 2,400 na inshora ga dillalin inshora, a cewar Minnesota Star Tribune . 
; Rashin ɗaukar rukuni ga ma'aikata na ɗan lokaci
: A cewar NPR, wasu ma'aikata kamar Trader Joe's da Home Depot sun yanke shawarar dakatar da inshorar lafiya ga ma'aikatan su na ɗan lokaci.
; Yaudara
: Ana sa ran yaudara saboda rikice-rikice game da rajista.
; Ƙuntataccen cibiyoyin sadarwa
: An soki wasu musayar saboda bayar da tsare-tsaren kiwon lafiya wanda ke buƙatar da'awar da yawa daga cikin cibiyar sadarwa. A ranar 5 ga Oktoba, 2013, asibitin yara na Seattle ya shigar da kara saboda "rashin tabbatar da isasshen hanyar sadarwa" lokacin da masu inshora biyu kawai suka haɗa da Yara a cikin shirin kasuwar su.
: An kuma nuna damuwa game da kokarin masu ɗaukar inshora don iyakance yawan masu ba da sabis a cikin hanyoyin sadarwar su don rage farashin. Binciken kasuwar California ya tabbatar da waɗannan damuwa, amma kuma ya nuna cewa samun damar ƙasa iri ɗaya ne kuma inganci a wasu lokuta ya fi girma a cikin shirye-shiryen kasuwa.
; "Cherry-picking"
: Masana'antar inshorar kiwon lafiya masu zaman kansu suna tsoron cewa ƙuntataccen cancanta da girman kasuwa wanda ya yi ƙanƙanta zai iya haifar da mafi girma, ƙarfafa "karɓar shinkafa" na abokan ciniki ta masu inshora, da kuma tilasta sharewa musayar. Wannan shi ne abin da wasu suka yi imanin zai faru a Texas da California a cikin musayar da suka gaza. Ɗaya daga cikin waɗannan dalilai, "tsarin shinkafa" na abokan ciniki, ba zai yiwu ba a cikin musayar da ACA ta ba da umarni, saboda duk shirye-shiryen inshora za su kasance "bayani mai tabbatarwa" a cikin 2014. Bugu da ƙari, dokar za ta kawo miliyoyin sabbin masu shiga kasuwa ta hanyar buƙatun umarni na mutum ga duk 'yan ƙasa su sayi inshorar lafiya da haɓaka girman kasuwa.

## Kasuwancin da ke da tushe
Kasuwar da ke da tushe a Jiha (SBM) kasuwa ce ta kan layi ta musamman inda 'yan ƙasar Amurka da mazauna doka za su iya kwatanta shago, neman, da kuma yin rajista a cikin shirye-shiryen inshorar kiwon lafiya ta hanyar hukumar gwamnati. Ya yi kama da Healthcare.gov, amma an kirkireshi kuma ana kiyaye shi ta kowane jiha. Wani lokaci ana kiransa Musayar Jiha (SBE),  Kasuwancin Jiha suna ƙoƙari su iyakance rikicewar mabukaci ta hanyar daidaita bayanai game da fa'idodin shirin da kuma sauƙaƙa kwatanta farashin inshora da inganci.

Jihohin da suka zaɓi aiwatar da Kasuwa ta Jiha ana buƙatar su ba da nau'ikan taimako da yawa ga masu siye da ke neman ɗaukar hoto, kamar layukan wayar tarho na kyauta don taimakawa masu siye da zaɓin tsari, taimako wajen tantance cancantar tallafin tarayya ko Medicaid, da gudanar da wayar da kai don ilimantar da masu amfani akan zaɓuɓɓukan ɗaukar hoto a cikin su.

### Jihohin da ke da Kasuwancin Jiha
Kasuwancin da ke cikin jihohi sun bunkasa yayin da fasaha ke girma kuma kasuwa da bukatun jihohi sun canza. Jihohi da yawa sun zaɓi aiwatar da nasu SBM.

Wannan ya hada da:

* California - An rufe California 
* Colorado - Haɗuwa don Lafiya Colorado 
* Connecticut - Samun damar Kiwon Lafiya CT 
* Gundumar Columbia - DC Health Link 
* Idaho - Lafiyarka Idaho 
* Kentucky - kynect 
* Maryland - Maryland Health Connection 
* Massachusetts - Mai Haɗin Kiwon Lafiya 
* Minnesota - MNsure 
* Nevada - Nevada Health Link 
* New Jersey - Ku rufe NJ 
* New York - Jihar Lafiya ta New York 
* Pennsylvania - Pennie (tm) 
* Rhode Island - HealthSource RI 
* Vermont - Vermont Health Connect 
* Washington - Washington Healthplanfinder  

### Rashin shafin yanar gizon Oregon
 
A watan Maris na shekara ta 2015, Oregon a hukumance ta soke kasuwar inshorar kiwon lafiya ta jihar, "Cover Oregon", don neman musayar tarayya.

## Kasuwancin inshora na kiwon lafiya mai zaman kansa
Musanya inshorar lafiya mai zaman kansa musanya ce ta kamfani mai zaman kanta ko mai zaman kanta.  Shirye-shiryen lafiya da masu ɗaukar inshora a cikin musayar sirri dole ne su cika wasu sharuɗɗan da gudanarwar musayar ya ayyana.  Musanya masu zaman kansu sun haɗu da fasaha da shawarwarin ɗan adam, kuma sun haɗa da tabbatar da cancantar kan layi da hanyoyin ba da damar ma'aikata waɗanda suka haɗa ma'aikatansu ko waɗanda suka yi ritaya tare da musayar su ba da tallafi.  An ƙirƙira su don taimaka wa masu siye su sami tsare-tsare na keɓance ga takamaiman yanayin kiwon lafiyar su, fitattun likitocin cibiyoyin sadarwa na asibiti, da kasafin kuɗi.  Ana kiran waɗannan musanya wasu lokuta wuraren kasuwa ko masu shiga tsakani, kuma suna aiki kai tsaye tare da masu ɗaukar inshora, suna aiki yadda ya kamata azaman kari na mai ɗauka.  Mafi girma kuma mafi nasara  musayar kula da lafiya masu zaman kansu shine CaliforniaChoice, wanda Ma'aikatan CHOICE suka kafa a 1996.    

Kasuwancin kiwon lafiya na sirri sun riga sun riga sun wuce Dokar Kulawa mai Arewa. Ɗaya daga cikin misalai na musayar kiwon lafiya na farko shine musayar kiwo ta kasa da kasa (IMX), kamfani ne da aka ba da kuɗi a Louisville, Kentucky, ta Standard Telephones and Cables, babban kamfanin fasahar Burtaniya (yanzu Nortel), don haɓaka manufar musayar a Amurka ta amfani da fasahar kan layi. An kirkiro samfurin ne a tsakiyar shekarun 1980. IMX ta haɓaka tsarin tabbatar da cancanta, tsarin gudanar da da'awar, da tsarin gudanar da biyan kuɗi na banki wanda zai sarrafa biyan kuɗi tsakanin mai haƙuri, mai aiki, da mai ɗaukar inshora. Kamar musayar da aka tsara a yau, ya mayar da hankali kan ka'idojin kulawa, bita na amfani da wani ɓangare na uku, shiga mai inshora mai zaman kansa, da rage farashin tsarin kiwon lafiya ta hanyar sauƙaƙe samfurin. An mayar da hankali kan ƙirƙirar musayar gida ko yanki wanda ya ba da jerin shirye-shiryen kiwon lafiya da suka rage rikitarwa da farashin samun ko fahimtar inshorar kiwon lafiya, yayin da yake sauƙaƙe gudanar da'awar. An tsara tsarin ne bayan daidaitaccen musayar hannun jari da tsarin ofishin baya na masana'antar banki. Babban bambanci shi ne cewa musayar kiwon lafiya ta IMX za ta samar da samfuran su ta hanyar cibiyar sadarwa ta bankunan kasuwanci na yanzu maimakon kafa tsarin biyan kuɗi da tsarin gudanarwa kamar yadda aka tsara a yau. Anthem (sa'an nan Blue Cross da Blue Shield of Kentucky) ne suka sami haƙƙin samfurin IMX. Samfurin musayar ya zama tushen sasantawar da'awar tsakanin masu ɗaukar inshora na kasuwanci da kungiyoyin Blue Cross. Wadanda suka kafa IMX sun fito ne daga manyan gudanarwa a Humana, da kuma manyan gudanarwa na First Tennessee National Corp (yanzu First Horizon).

A cikin kasuwannin da suka haɗu, kasancewar shirye-shiryen musayar jama'a da masu zaman kansu na iya haifar da rikicewa yayin da suke magana game da "tsarin musayar". A California, Anthem Blue Cross yana ba da shirye-shirye na HMO ta hanyar musayar California da ke gudana da kuma musayar CaliforniaChoice mai zaman kansa, amma hanyoyin sadarwar likita ba iri ɗaya ba ne. Likitoci suna tallata karɓar Anthem Blue Cross Exchange HMOs na iya kuskuren sanar da mutanen da suka yi rajista a cikin Anthem Blue Cruz Exchange HMOS ta hanyar musayar masu zaman kansu.