Nkhaniyi imapereka kusanthula kochuluka kwa malamulo a zaumoyo ku United States kaŵirikaŵiri kumagaŵikana kwa mphamvu pakati pa maboma a boma ndi boma. Kumvetsetsa mmene malamulo ameneŵa amalinganizidwira nkofunika kwa aphunzitsi ndi ophunzira omwe kumvetsetsa kuvuta kwa kusamala za umoyo wa Amereka. Nkhaniyi imapereka kusanthula kochuluka kwa malamulo a boma ndi a zaumoyo, kufufuza malamulo, ndalama, ndi ziyambukiro zothandiza kwa anthu ndi chitaganya. Mwakusanthula maprogramu otsimikizirika, zitsanzo zalamulo, ndi zotulukapo zenizeni za dziko, timafuna kulongosola amene amasankha bwino ndi mmene zosankhazo zimachitidwira.

Authority Policy ya zaumoyo mu U.S.

Malamulo a zaumoyo ndi malamulo a U.S.: boma limapanga ulamuliro wake wa zaumoyo kuchokera ku maulamuliro a zaumoyo. Ku United States, malamulo ameneŵa angagwirizanitsidwe kukhala a boma ndi boma, limodzi ndi limodzi lokhala ndi mphamvu zake ndi chisonkhezero. Maziko a magawo ameneŵa ali mu U.S. Malamulo: boma a boma limapanga ulamuliro wa zaumoyo kuchokera ku maulamuliro monga Commerce Clause (malonda a boma, kuphatikizapo inshuwalansi) ndi kulipira ndi kugulitsa Classia (maprogramupulogalamu yonga Medicare). Panthaŵiyi, maulamuliro onse a Tenti Amediformer sanalozeredwe ku boma, kuphatikizapo ulamuliro waukulu pa za mabizinesi a zaumoyo, zamalonda, ndi zamalonda a zamalonda a zaumoyo.

M'mbiri yakale, kulinganiza kwasintha. Kwa zaka zambiri za zana la 19 ndi la 20, boma linali madalaivala oyambirira a malamulo a zaumoyo wa anthu onse ndi a zamankhwala. Ntchito ya boma inakula kwambiri ndi kulengedwa kwa Medicaid mu 1965, ndiponso ndi Affordable Care Act (ACA) Act (ACA) mu 2010. Lerolino, dongosolo la zaumoyo la U.S. limagwira ntchito monga msanganizo wa miyezo ya boma, kusintha kwa boma, ndi mbali ya kagulu ka ampatuko. Mabungwe a Adrentirance apanga zonse ziŵiri mwaŵi wa kukonza ndi kuika moyo pangozi.

Polikiti ya Zaumoyo ya Maboma: Miyezo ya Dziko ndi Maprogramu

Boma la boma limachita mbali yaikulu m’kuchirikiza zaumoyo wa anthu odziŵika ndi kuika miyezo yokulira ya malamulo.

Medicare

Medicare ndi programu ya boma yoperekedwa ndi Centers for Medicare & Mdicaid Services (CMS) imene imasamalira zaumoyo wa anthu a zaka 65 ndi zaukulu, limodzinso ndi achichepere ena amene ali ndi ulema (m., awo amene ali ndi End - Santage Renal Disease). Amalipirira ndalama kudzera m'misonkho, ndalama zoyendetsera ndalama, ndi ndalama zoyendetsera. Medicasdara imakhala ndi gawo la Gawo A (inshuwalansi ya za mankhwala), chigawo cha B (inshuwalansi ya mankhwala oletsedwa), chigawo cha Drtic , ndi Medicareas Reagever (Chigawo Creal) yoperekedwa ndi makampani a zachinsinsi a Dreasting (zakuti) ya pachaka chimodzi, ngakhale kuti boma lingasankhe mapulogalamu a pa njira ya pa ndalama za pachaka.

Medicaid

Médicaid ndi programu ya boma limodzi imene imathandiza ndi ndalama za mankhwala kwa anthu opeza ndalama zochepa ndi ndalama. Boma la boma limakhazikitsa zofunika zochepera ndi kukwaniritsa ndi kuthandizira ndalama zofanana (kuyambira pa 50% mpaka 78% ya ndalama, kudalira pa ndalama za boma pa munthu mmodzi. Maboma amayang'anira pulogalamu ndipo angasankhe kukwaniritsa anthu ndi mautumiki oyenera. AAD imalamulira kuti Mdicaid ifutukule anthu onse pansi pa 138% a umphaŵi wa boma, koma Khoti Lapamwamba likhale ndi chigamulo cha 2012 mu [FL: 0. Selius v. [2] kuwonjezeka kwa 2025, 41, ndi zigawo za Mlidio.

Njira Yosamalira Anthu Odwala Mosavuta (ACA)

ACA adalembedwa mu 2010, ndi kusintha kwakukulu kwa zaumoyo kuyambira ku Medicare. Makonzedwe ake aakulu akuphatikizapo: (1) kupangidwa kwa makampani a inshuwalansi ya zaumoyo (kusintha) mwa amene anthu ndi mabizinesi aang'ono angagule mapulani oyeneretsedwa; (2) kuwonjezera ngongole ndi ndalama zochepetsedwa ndi kuchepetsa kutsika kwa ndalama kuti athe kukwaniritsa; (3) mapindu ofunika kwambiri a thanzi (EHB) akulongosola magulu khumi a kukwaniritsa; (4) kuletsa za kuchotsedwa kwa zinthu pasadakhaleko; ndi (5) chiletso cha munthu ndi bwana ndi kulamulidwa (chilamuliro cha munthu aliyense chinachotsedwa bwino mu 2019). ANAkhazikitsanso Center of Medictare Intion Invition ndi MEDI (MI) kuti ayese kulipira ndi kunyamula mafashoni. Ulamuliro wa bungwe la ACAA ndi woyang'anira malonda a ACA ndi woyendetsa malonda ambiri, koma amasinthasinthasintha kwambiri.

Maprogramu Ena a Zaumoyo ndi Azankhondo

  • Program ya Ana ya Inshuwalansi ya Zaumoyo (CHIP): Programu yogwirizana ya boma imapereka kwa ana m'mabanja okhala ndi ndalama zapamwamba kwambiri kwakuti sangayenerere ku Medicaid koma ali wochepa kwambiri kukhoza kugula inshuwalansi yaumwini. CHAP ili ndi ziŵerengero za boma zofanana ndi kulolera kwa boma.
  • Veterans Health Administration (VHA): Dongosolo la boma lokwanira lopereka chisamaliro chachindunji kwa asilikali oyenerera kupyolera m'malo a zamankhwala a Va.
  • [[FLT :0] Service ya zaumoyo ya Indian (IHS): Bungwe la boma mkati mwa Dipatimenti ya Zaumoyo ndi Mautumiki a Anthu limene limapereka chithandizo cha zaumoyo kwa Amwenye a ku America ndi Alaska Eniweni.
  • Food and Drug Administration (FDA): imakhazikitsa chisungiko, mphamvu, ndi kulembedwa kwa mankhwala, zipangizo zamankhwala, ndi akatemera.
  • Madenti a Kulamulira ndi Kuletsa Matenda (CDC): amatsogolera kuyang’aniridwa kwa thanzi la anthu, kuukira kwa mbanda, ndi kuyesayesa kwa kupititsa patsogolo thanzi, kaŵirikaŵiri m'gwirizano ndi madipatimenti a zaumoyo a m'dziko ndi a kumaloko.

Mabungwe a boma ameneŵa amakhazikitsa miyezo ya dziko, koma kaŵirikaŵiri kugwira ntchito kwawo kumadalira pa kugwirizana ndi kukwaniritsa kwa boma.

Policies: Mabungwe a Demokrase Osamalira Zaumoyo wa Boma

Mayiko akhala akufotokozedwa kwa nthaŵi yaitali monga "mabungwe a demokrase" ndi Judge Louis Brandeis, kuyesa njira zosiyanasiyana za kayendetsedwe ka zaumoyo. Kuyesa kumeneku kungatsogolere ku kusintha kwakukulu m'kukwaniritsa, mtengo, ndi ubwino m'dziko lonselo. Malamulo apamwamba a boma akuphatikizapo:

Kukula kwa Madesiki ndi Azamba

Chigamulo cha kufutukula Medicaid mwinamwake ndicho chosankha chachikulu cha boma cha zaumoyo pansi pa ACA. Maboma amene anafutukula Medicaid anachepetsa modabwitsa ziŵerengero zosafunidwa . Mwachitsanzo, ziŵerengero za Arkansas zopanda kuyembekezera zinatsika kuchokera pa 22.5% mu 2013 mpaka 7.0% mu 2016. Mayiko osasintha a boma monga Texas, Florida, ndi Georgia akupitirizabe kukhala ndi ziŵerengero zosapendeka pa 12%. Ngakhale mkati mwa kuwonjezereka, maboma angagwiritsire ntchito gawo la 1115 la ma wa wa wars kuyesa kuwonjezera kapena kutumiza zithunzi zina. Mwachitsanzo, Indiana’s Divian's Diace Planciano ikufuna ndalama zowonjezereka ndi kuphatikiza zosunga ndalama zaumoyo, pamene Arkaskans akugwiritsira ntchito chitsanzo chaumwini kumene malonda malonda a zachinsinsi a za m'masitolo.

Kusintha kwa Zipatala za Boma

ACA anapereka chosankha cha kuyendetsa msika wawo, kudalira pa pulatifomu ya boma (HealthCare.gov), kapena kugwira ntchito yosinthana ndi boma pa pulatifomu ya boma (SBM-FP). Pa 2025, maboma 19 ndi DC amayendetsa mokwanira, amene kaŵirikaŵiri amapereka zosankha zolinganizidwa ndi zogwira ntchito. California imatsegulira California, mwachitsanzo, kukambirana ndi makampani opereka ndalama kuti asunge ndalama zotsika ndi kusunga dziŵe losungika. Maboma ndi masinthidwe awo alinso ndi mphamvu yaikulu yopanga maprogramu othandizira kuchepetsa.

Wopereka Chisonyezero ndi Kukula kwa Chizoloŵezi

Maboma amayang'anira akatswiri a zaumoyo kupyolera m'mabungwe okhazikitsa maphunziro, maphunziro, ndi ukulu wa maluso. Zimenezi zimasiyana kwambiri ndi boma kwa osamalira anamwino (NPs), adokotala (PAS), ndi othandizira ena opita patsogolo. Mwachitsanzo, maboma 25 ndi DC amalola kuti NP ziziyeseza popanda kuyang'anira dokotala, pamene ena amafuna mapangano. Malamulo ameneŵa amayambukira mwachindunji kuyang'anira chisamaliro chachikulu, makamaka m’madera akumidzi. Mofananamo, amalamulira malamulo apadera a zofunikira (CON) omwe amalamulira kaya zipata zingafutukuke kapena ziwitso zatsopano; ena alimbikitsa malamulo a Con Coneal kuti alimbitse, pamene ena akuwasunga kuti athetse ndalama.

Thanzi la Onse Limayamba Kuthandiza

Maboma ali ndi ulamuliro waukulu wogwiritsira ntchito mautumiki a zaumoyo wa anthu, kuyambira pa kuletsa fodya mpaka kuteteza anthu. Malamulo a California olimbana ndi kusuta, kuphatikizapo misonkho yokwera ndi malamulo a kuntchito opanda utsi, athandizira kuchepetsa kusuta kuchokera ku 20% m'ma 1990 mpaka 10% mpaka 2020. Kusinthaku, maboma okhala ndi ziwiya zaumoyo zofooka angapereŵe popereka chiŵembu kapena pofufuza matenda. Mliri wa Chovid-19 unagogomezera kusiyana kumeneku: imanena monga New York ndi California inakhazikitsa malamulo a malo ogonako poyambirira, pamene Florida ndi South Dakota inatenga njira zololera. Kudziwirira kochepaku kuchititsa matenda osiyanasiyana ndi kuphana kwa matenda.

Kusamalira ndi Kuperekanso Ndalama Zofunika

Maboma ambiri amagwirizana ndi mabungwe oyang'anira za chisamaliro (MCOS) kupereka mapindu a Medicaid, ndipo ali ndi kulolera kupanga mawonekedwe a mawonekedwe. Oregon ndi Massachusetts akhala apainiya m'ma bajeti a dziko lonse ndi mabungwe oŵerengera (ACO) kaamba ka anthu a Medicaid. Maboma amayang'aniranso kupindula kwa kuyang'anira mankhwala a m'dera la Medicaid, kuphatikizapo kugwiritsa ntchito mankhwala osokoneza bongo ndi mindandanda ya mankhwala okondedwa. Kukhoza kuwonjezera marebita ndi kukhazikitsa chilolezo kumbuyo kungasinthe kwambiri mankhwala ovomerezeka ndi kuwagwiritsa ntchito ndi kuwapeza.

Kugwirizana Pakati pa Ulamuliro wa Boma ndi Wachigwirizano: Kugwirizana ndi Mikangano

Unansi pakati pa malamulo a boma ndi boma a zaumoyo ndi wovuta, kuphatikizapo zonse ziŵiri kugwirizana ndi mikangano. Ngakhale kuti malamulo a boma amakhazikitsa miyezo yochepera, maboma ali ndi ufulu wolinganiza maprogramu awo kuti akwaniritse zosoŵa za kumaloko. Mphamvu imeneyi imafotokozedwa kaŵirikaŵiri kukhala "upani wa boma," koma zaka makumi angapo zaposachedwapa zakhala ndi kusagwirizana kwakukulu, makamaka pa ACA, ufulu wochotsa mimba, ndi mphamvu zaumoyo za anthu zamwadzidzidzi.

Kugwirizana

M’zochitika zambiri, maboma a boma ndi a boma amagwira ntchito pamodzi kupititsa patsogolo kupereka chithandizo cha zaumoyo. Mathernal ndi Child Health Block Grant amathandiza boma mwa kupereka ndalama. Maboma angapemphere ku mipata ya XPF ya Madecaid (Kuthandiza 1115, Gawo 1332 pa malo a zamalonda a ACA) kuyesa njira zatsopano. Mwachitsanzo, Maryland wagwiritsa ntchito njira ya boma yoperekera ndalama zachipatala zonse zoperekera ndalama zimene zimachepetsa kukwera kwa ndalama za chipatala pachaka, kuchepetsa kuchuluka kwa ndalama zimene zimagwira ntchito zachipatala. Ukwatiwo umawonjezeranso thanzi la anthu: CDC imapereka ndalama ndi chithandizo cha boma cha ndalama ndi chithandizo cha boma cha matenda opangika, kukonzanso, ndi kuteteza matenda.

Kulimbana ndi Kuyesedwa

Mantha amabuka pamene malamulo a boma asintha kuchokera ku malamulo a boma kapena pamene maboma ayesa kuchotsa malamulo a boma amene amatsutsa. Chitsanzo chotchuka kwambiri ndicho kufutukuka kwa Medicaid kotchulidwa poyamba: pambuyo pa kufutukuka kwa bwalo Lapamwamba lamilandu, maiko ambiri a Republican oletsedwa kufutukuka, ngakhale ndi 90% ya ndalama za boma. Zimenezi zinapanga mpata wokhuthula kumene achikulire oposa 1.5 miliyoni amagwera mu "donutbod" [1] [mamwaikedwa okulirapo chifukwa cha kuchuluka kwamwambo wa Medicaid koma wotsika kwambiri chifukwa cha kugulitsidwa.

Mpikisano wina wa nkhondo umaphatikizapo kuchotsa mimba. Kutsatira chigamulo cha Women’s Health Organization mu 2022, chimene chinagwetsa Roe v. Wade, boma linapeza pafupifupi ulamuliro wathunthu woletsa kutaya mimba. Mayiko ena, monga California ndi New York, anakhazikitsa malamulo a kukhala "maiko ochotsa mimba" kwa ofunafuna mimba, pamene ena, monga Texas ndi Missouri, anakhazikitsa pafupifupi kuletsa kotheratu. Oyang'anira a Biden anayesetsa kukakamiza za kuchiritsa ndi Act (EMTALIA) kuti afune zipatala kuti apereke chithandizo cha kutaya mimba m'mwaŵi, ayang'anizana ndi mavuto a lamulo, akuchitira chitsanzo kumbuyo kwa nkhondo zothetsa nkhondo.

Boma likuyesetsa kuyendetsa mitengo ya mankhwala osokoneza bongo ndipo zimenezi zimapangitsanso kuti pakhale mkangano. Mu 2023, Colorado ndi Maryland anakhazikitsa malamulo owonjezera kuti apereke ndalama zambiri pa mankhwala ena operekedwa ndi dokotala, koma makampani a mankhwala anazemba mlandu, kutsutsana ndi kukhazikitsa malamulo a boma ndi ntchito yopuma pantchito Income Security Act (ERISA). Zotsatira za milandu imeneyi zidzasonyeza malire a mphamvu ya boma pa ndalama zimene boma limagwiritsa ntchito pa mankhwala osokoneza bongo.

Mmene Zimakhudzira Anthu: Kupeza, Kugula, Kuwononga Ndalama, ndi Zotulukapo

Kugaŵikana kwa lamulo la zaumoyo kumayambukira kwambiri anthu kutha kupeza chisamaliro, mautumiki abwino, ndi kuchuluka kwa ndalama. Mfundo zotsatirazi zikusonyeza mmene maulamuliro a boma amasinthira kukhala kusiyana kwenikweni kwa dziko:

Kupeza Inshuwalansi

Malamulo a Federal onga ACA cholinga cha kuwonjezera kupezeka kwa mafashoni ndi kuwonjezera Medicaid, koma zosankha za boma zingachepetse kapena kuwonjezera ziyambukiro zimenezo. Munthu wolandira $200,000 pachaka amakhala m'dziko losalimba monga Texas sangakhale woyenerera Medicaid ndipo angafikenso pansi pa mlingo waung'ono wa msika (ngati sangakhale wogonjera ku lamulo la "banja" lokhazikitsidwa mu 2022). Munthu yemweyo angayenerere Medid m'boma lofutukuka monga California kapena New York. Mkhalidwe wosatetezereka pakati pa achikulire osakhala achikulire umasiyana kuchokera pa 5% a Massachusetts ku ma 18% ku Texas, malinga ndi [F:] Facteds FaxFFFF]

Kusamala Ena

Mitengo yolimba monga kuŵerengera chipatala, zizindikiro za kutetezeka kwa odwala, ndi njira zotetezera zimasiyana ndi boma, chifukwa cha kusiyana kwa malamulo ndi kuyendetsa zaumoyo wa anthu. Maboma okhala ndi zosamalira zosamalira zambiri (m’chitsanzo, kuwonjezera pa kuchuluka kwa zofunikira za Pennsylvania) amayesa kupeza bwino poloŵa m'chipatala. Komabe, mkhalidwe umadaliranso pa njira zosungira ndalama ndi mpikisano. Maboma amene sanakulitse Médicaid kaŵirikaŵiri amaona kukwera kwa chisamaliro chapamwamba, chimene chingachepetse ndalama za chipatala ndi kuchepetsa ndalama zothandizira kuwongolera.

Mtengo wa Kusamalira

Kusamalira thanzi kumakhala ndi ndalama zosiyanasiyana m'mayiko. M'chaka cha 2023, avareji ya ndalama zoyendetsera mabanja pachaka yoyambira pa madola 200,000 ku Utah mpaka kupitirira $25,000 ku Alaska, malinga ndi Commonwealth Fund . Kuwonjezera pa ndalama zowonongedwa pa makampani, kumakhalanso kusiyana chifukwa cha malamulo a inshuwalansi, kugulitsa, ndi Médicaid kulipira ndalama. Maboma amene amalamulira kwambiri kuphatikiza ndi kulumikiza (m. g., lamulo la California loletsa kuyendetsa malonda ali ndi misika yopikisana ndi mitengo yotsika kuposa mmene amanenera ndi kuyang'anira.

Mmene Thanzi Limakhalira

Kuposerapo kwa maulamuliro a zaumoyo kumatembenuza mwachindunji kukhala zotsatira za thanzi. Kafukufuku 2020 mu Affairs anapeza kuti pakati pa 2013 ndi 2017, Medicaid , mayiko akuchepetsa imfa zambiri poyerekezera ndi maboma osafuna kudwala matenda a m’mapapo, ndi kupambana kwakukulu pakati pa achikulire ndi anthu oyera. Mofananamo, ndi malamulo amphamvu oletsa fodya (m), malamulo apamwamba a utsi, kuchuluka kwa utsi wambiri wa matenda a kansa ya m’mapapo ndi matenda a mtima. Moyo wa kubadwa kwa mwana umasiyana ndi zaka 7 pakati pa maiko (Msipipepu. Zigawo 74. Zimodzimodzi, ziphatikizi zikufotokozanso mu 2023, malamulo a CD C.

Kumaliza: Kuyendetsa Gawo la Gawo la Zaumoyo

Kugwirizana kwa malamulo a boma ndi a boma a zaumoyo sikuli kokha nkhaŵa ya maphunziro . Kumaumba mwachindunji thanzi ndi ubwino wa ndalama wa munthu aliyense wa ku America. Maprogramu a Federal onga Medicare, Mdicaid, ndi ACA afutukula kufutukula ndi kukhazikitsa miyezo ya mtundu, koma maboma amasunga zipangizo zamphamvu zopangira ndi kudodometsa zolingazo. Chotulukapo ndicho njira yopangira zipolo.

Kwa aphunzitsi, kuzindikira zimenezi n’kofunika kwambiri pophunzitsa ophunzira za pangano la ukwati, kupenda malamulo, ndi zotsatira zenizeni za dziko za maulamuliro. Mwa kuphunzira mmene mgwirizano wa boma umasewera m'madera osiyanasiyana . . Medicaid, misika ya inshuwalansi, mankhwala osokoneza bongo, mavuto a zaumoyo wa anthu. Anthu angayambe kuyamikira kwambiri malonjezo ndi mavuto a boma la America. Pamene dziko likupitirizabe kutsutsana za tsogolo la zaumoyo, funso lakuti ndani adzasankha zimene zili zabwino kwa inu pa mtima wa kukambirana. Anthu odziwa bwino angachirikize malamulo amene amakambirana pafupi ndi mipata, kuchepetsa ndalama, ndi kukonzanso bwino ndalama zaumoyo wawo.

kaamba ka kuŵerenga kowonjezereka, onani ntchito ya [[FLT: 1] Madenti a Medicare & Mautumiki a Medicaid pa kuyang'anira ndi kutumiza kwa boma, ndi Kaisner Family Foundation [[FLT:] pa mathekishoni a zaumoyo a boma.