Gakava pamusoro pemiitiro yezvoutano muUnited States rinowanzonanga pamukaha wesimba pakati pehurumende dzehurumende nehurumende. Kunzwisisa kuti iyi miitiro inoumbwa sei kunokosha sei nokuda kwavose vari vaviri vadzidzisi navadzidzi mukunzwisisa hukukutu hwoutano hweAmerica. Nyaya ino inopa kunzvera kwakakwana kwemiitiro yezvoutano yehurumende neyehurumende ine simba, kunzvera pamutemo, mari, uye migariro inoshanda nokuda kwavanhu nenzanga. Kupfurikidza nokunzvera zvirongwa zvakati, mienzaniso yapamutemo, nemigumisiro chaiyoiyo yenyika, tinovavarira kujekesa kuti ndiani anosarudza zvakanakisisa nokuda kwako uye nzira iyo zvisarudzo izvozvo zvinoitwa nayo.

Kupfuudzira kweGuru Rezvoutano Musangano reU.S.

Mitemo yezvoutano igadziriro yezvisarudzo nezviito izvo hurumende dzinoita kuti dziite miuyo yakati youtano. MuU.S., iyi miitiro inogona kuiswa pamwero yehurumende nehurumende, imwe neimwe ine ukuru hwayo nepesvedzero. Nheyo yeiyi diviti iri muU.S. Constitution: hurumende yehurumende inowana chiremera chayo cheutano chakabatana namasimba akadai seClaus (mutest international shate shopus, kubatanidza inishuwarensi) uye kutengesa mutengo naClassicale (mapurogiramu okupfumisa akafanana neMedicare). Zvinetso zveTenth Amend Corformformation inochengeta masimba ose asingabvumirwi nenzira yomutemo kuhurumende, kubatanidza chiremera chakafara pamusoro pezvoutano, miraudzo yezvokutengeserana yemari yezvemari, yemari yezvemari yemari, yebhizimisi, uye youtano hwehurumende.

Munhau dzakaitika, dzikamo yachinja nokufamba kwenguva. Kwezana remakore rechi19 nerechi20, nyika dzakanga dziri vatyairi vakuru vemitemo yezvoutano hwevoruzhinji nezvekurapa. Basa rehurumende rakakura zvikuru nokusikwa kweMedicare naMedicaid muna 1965, uye zvakare neAffordable Care Act (ACA) Act. Nhasi, gadziriro yezvoutano yeU.S. inoshanda semubatanidzwa wemipimo yehurumende, kuchinjika, uye kubatanidzwa kwemutezo womunhu oga. Iyi dare rinotonga rinoparira zvose zviri zviviri mikana yokuvandudza uye njodzi dzemubatanidzwa.

Politiki Yezvoutano Yakagoverwa Nehurumende: Mipimo Yorudzi Nepurogiramu

Hurumende yehurumende inoita basa guru mukutarisira utano hwemari nokuda kwezviverengero zvakati zvevagari vemo uye kugadza mipimo mikuru yokutungamirira. Mitemo yehurumende inokosha inobatanidza:

Midicare

Medicare ipurogiramu yehurumende inopiwa neCentres for Medicare & Mdicaid Services (CMS) inogovera utano nokuda kwavanhu vane makore 65 navakuru, pamwe chete navanhu vaduku vane urema (g., avo vane End-Stageral Renal Disease). Vanobhadharwa kupfurikidza nokubhadhara mitero, mari yemari, uye mari yesero. Medicara inobatanidza chikamu A (inishuwarenzi yeinishuwa), Window B (inishuwarenziro yemirimo yemari), Transfay D (kubhaisirwa kwemirimo), uye Medicareareve reconvesves Reances (Treagency) inogoverwa nemari yapavhuro yemari inopfumitenzi yegore rimwe. Hurumende inogadza mari yemari inodzo yehurumende inoita kuti ishayere nokubetserwa nebetsero zvayose. Mumakore achangobva kupfuura apashure pejini, $52, $52,000, inodzo yegore yegore yegore yegore rimwe yegore, inopfumite ye

Médicaid

Hurumende igadziriro inobatira pamwe yehurumende inobetsera nendyiko dzezvokurapa nokuda kwavanhu vane mari yakaganhurirwa nezviwanikwa. Hurumende yehurumende inogadza kuva netsananguro nemhesano uye inogovera mari inowirirana (kuvambira pa 50% kusvikira ku 78% yendyiko, kuchitsamira pachisarudzo chehurumende pamari pamunhu mumwe). Manyika anotungamirira purogiramu uye anogona kusarudza kufukidza mitengo yavanhu nemabasa. ACA yapa pakuvamba inoraira kuti Mdhicaid ifukidze vakuru vose pasi pa 138% vemari inopfuurombo hwemubatanidzwa, asi Dare Gurusa reFoctal 2012 mu Gation of Independent Busition. Sebel v[FLT1] yakaitwa kusava pamutemo. Sangano re2025, 41, uye Gwadhi reM151, rina mari inokwenetesaidzo yeMidikaromezi yeMiri yeMicrome, neadioti yeMaritime.

Muitiro Wokutarisira Usingadhuri (ACA)

Yakaziviswa muna 2010, ACA ndiyo chinjo hurusa yezvoutano chifo cheMedicare. Gadziriro dzayo huru dzinobatanidza: (1) kuumbwa kwemisika yeinishuwarenzi yezvoutano (kuchinja) kupfurikidza nayo vanhu vamwe navamwe namabhizimisi maduku vanogona kutenga zvirongwa zvakatarwa; (2) kupfuudza zvikwereti zvemitero nendyiko dzinoderedza mari kuti zvive zvisingabhadharwi; (3) betsero dzoutano dzinokosha (EHB) dzinorondedzera mapoka gumi ezvinodikanwa; (4) kurambidzwa kwemitengo yapamberi; uye (5) chirango chomunhu oga nomushandirwi zvinodzorwa (chinotarwa chakabviswa zvinobudirira muna 2019). CHATAUSA yakatangawo Center yeMedictare Intion and MdicI Invotion (MMI) kuti iedze kubhadharo nokutakura. Chiremera chehurumende cheACA chinodzorwa munyika dzinodzorwa zvikuru.

Dzimwe Gadziriro Dzoutano Dzakafanana Nedzezvirongwa

  • program yeVana yeUnishuwarenzi yoUtano hweVana (CHIP): Chirongwa chakabatana chinogovera kufukidzwa kwavana vari mumhuri dzine mari dzakakwirira zvikuru zvokusagona kukwaniriswa nokuda kweMedicaid asi dzakaderera zvikuru zvokusagona kubhadhara inishuwarenzi yavanhu. CHAP ine mwero yemubatanidzwa inowirirana neyakafara yehurumende.
  • Veterans Health Administration (VHA): Gadziriro yehurumende yakazara inogovera ngwariro yakananga kuvarwi vakazvimirira vakakodzera kupfurikidza nenzvimbo dzezvokurapa dzeVA.
  • Indian Health Service (IHS): Isangano rehurumende mukati meBato roUtano neMabasa avanhu rinogovera betsero dzoutano kumaIndia eAmerica namaIndia eAlaska amaIndia.
  • Food and Drug Administration (FDA): inoronga chengeteko, kushanda, uye kunyorwa kwemirimo, zvishandiso zvokurapa, uye nhomba.
  • Madate eDPAS Control and Prevention (CDC): anotungamirira nzvero dzoutano hwavose, davidzo yokuvamba, uye nhamburiko dzokusimudzirwa kwoutano, kazhinji kazhinji mubatira pamwe namadhipatimendi outano omunzvimbomo.

Aya masangano ehurumende anogadza mipimo yorudzi, asi kubudirira kwawo kazhinji kazhinji kunotsamira pabatira pamwe yehurumende nokushandisa.

Hurumende Inotarisira Utano Policies: Mibato Yehurumende Inosarudzwa Navanhu

Nyika dzave dzichirondedzerwa se "Masangano ehurumende inosarudzwa navanhu" naMutongi Louis Brandeis, kunzvera mitoo yakasiana kumiitiro youtano. Uku kuedza kunogona kutungamirira kumisiano mikuru mukufukidza, ndyiko, uye kunaka munyika yose. Nharaunda dzenzvimbo dzenzvimbo yenzvimbo yehurumende inobatanidza:

Kukura Kwemabhedhi Nemazai

Chisarudzo chokuwedzera Medicaid zvichida ndicho chisarudzo chemiitiro yehurumende yezvoutano muACA. United States yakakudza Medicaid yakaona kuderera kunoshamisa mumwero usina kufutunurwa. (muenzaniso, mwero weArkansas usina kufutunurwa wakaderera kubva pa 22.5% muna 2013 kusvika pa7% muna 2016. Zvikamu zvisingachinjiki zvakadai seTexas, Florida, uye Georgia zvinopfuurira kuva nemwero yakasiyana neyapakuwedzera inopfuura 12%. Kunyange mukati mewedzero, masangano anogona kushandisa nokuda kwechikamu 1115 chemichina yokuedza kubhadha kana kuti mifananidzo yokuendesa. Somuenzaniso, Indiana’s Departles Clantic Indianatic Plan 2.0 inoda mipiro inotengo inotengwa nokubatanidza mari, nepo kupfumba dzoutano apo Arkans anoshandisa muenzaniso womunhu oga oga apo kukwira puro dzinogamuchira zvirongwa zvemari.

Migove Yeinishuwarenzi Youtano yeHurumende

ACA akapa chisarudzo chokushandisa musika wavo vamene, vimba nechikuva chehurumende (HealthCare.gov), kana kuti shambiso yakavakirwa pahurumende pachikuva chehurumende (SBM-FP). Kusvikira muna 2025, 19 yehurumende neDC inoshandisa zvizere mitauro yakavakirwa pahurumende, iyo inowanzogovera zvisarudzo zvakagadzirirwa zvikuru uye zvinoshanda. California yakafukidza California, somuenzaniso, kutaurirana nesimba navarendi kuti vachengete mitero yakaderera uye yachengeta dziva nyu yakachengetedzwa. Mitengo yavo vamene inokwanisawo zvikuru kupfuudzira purogiramu (kushandisa 1332) kuderedza. Mumagariro akarongwa, anodzorwa kudzorwa kupfurikidza negadziriro shoma.

Mugoveri Womuitiro Noukuru

Mitezo inodzora nyanzvi dzezvoutano kupfurikidza namabhodhi okuronga dzidzo, rovedzo, uye ukuru hwezvinodikanwa. Ikoku kunosiana zvikuru nehurumende nokuda kwavanachiremba vavakoti (NPs), vabetseri vavarapi (PAS), uye vamwe vatarisiri vazvino uno. Somuenzaniso, maDC anobvumira NP 25 kurovedza pasina tarisiro yachiremba, nepo dzimwe dzinoda zvibvumirano zvokubatirana. Iyi mirau inotapura zvakananga kusvika kutarisiro huru, zvikurukuru munharaunda dzomumaruwa. Nenzira yakafanana, inotaura kuti, mitemo yezvipatara inogona kudzora kana zvikagona kukudza kana kuti kuwana zvishandiso zvitsva; dzimwe nyika dzinokurudzirazve mitemo yeCern Conces kuti idzirinde, nepo dzimwe dzinoichengeta kuti dzidzore.

Kutanga Kwoutano Hworuzhinji

Nyika dzine chiremera chikuru chokushandisa nhimbe dzoutano hwavanhu vose, kubva pakudzora fodya kusvikira kuzvinodikanwa zvokudzivirira kuputiswa. Mitemo yeCalifornia inodenha inodzivisa kusvuta, kubatanidza mitero yakakwirira nemitemo yebasa isina utsi, inoparira kuderera kwemwero yokusvuta kubva kuinopfuura 20% muma1990 kusvika ku 10% pa202020. Uku kuderera kwemitengo youtano yavanhu kungaderera mukudzivirira utachiona kana kuti kunzvera hosha. Chirwere cheCHOVAD chepamberia chinosimbisa iyi misiyano: inotevero yakafanana neNew York neCalifornia yakaisa mirayiridzo yenzvimbo pakuvamba, neyokuregeredzano. Uku kumhanya kunoparira Florida neSouth Dakota kutapura kwakasiyana-zhinji.

Kutarisira Kwakaitwa neMedicaid Nokuzvibhadharira

Masangano mazhinjisa ehurumende anobatirana namasangano etarisiro anoshandiswa kuendesa betsero dzeMedicaid, uye ane mhesano yokugadzira mabhadharo. Oregon naMassachusetts vave vari mapiyona mumari yemari yenyika yose namasangano okutarisira anozvidavirira nokuda kwavagari vemo veMedicaid. Mado anodzorawo mishonga inobetsera kutarisirwa mukati meMedicaid, kubatanidza mishonga inopinza zvinodhaka mumirimo nenheve dzinoda. Mano okukurukura kuwedzerwa kwemirimo uye kubvumira pamberi pezvi anogona kuchinja zvikuru kushandiswa nokupinzwa kwemirimo.

Kupindira Pakati Petsika Dzehurumende Nehurumende: Kushandira Pamwe Nokukakavadzana

Ukama pakati pemitemo yezvoutano yehurumende nehurumende hwakaoma, hunobatanidza zvose zviri zviviri kushanda pamwe chete nerwisano. Kunyange zvazvo mitemo yehurumende ichigadza mipimo mishomanene, Hurumende dzinoda kugadziridza mapurogiramu adzo kuti asvitse zvinodikanwa zvomunzvimbomo. Iri simba rinowanzorondedzerwa se "hurumende yehurumende," asi makumi amakore achangobva kupfuura aya aona kusawirirana kwakawedzera, zvikurukuru paACA, kodzero dzokubvisa pamuviri, uye masimba outano avanhu anokurumidzira.

Batira Pamwe

Muzvinoitika zvakawanda, hurumende dzehurumende nedzehurumende dzinoshandira pamwe kuti dziwedzere kupiwa kwezvoutano. Kutsigira mari kunotsigira zvirongwa zvehurumende kupfurikidza nezvipo (somuh., Mathernal and Child Health Block Grant, Prevention and Public Health Fund). Nyika dzinogona kunyorera nokuda kwemiringi (Kushandisa 1115 nokuda kwaMedicaid, Chikamu 1332 nokuda kwemisika yeACA) kuedza kusvika kutsva. Somuenzaniso, Maryland akashandisa mutengi wehurumende kushandisa gadziriro yemari yepa chipatara yose inokanganisa kukura kwemari yechipatara pagore negore, kuderedza kupedza kukura kwemari kwechipatara pagore. Mubatanidzwa wacho unotambanurira kuutano hwavose: CDC inogovera mari nebetsero yezvokubetsera zvehurumende nokuda kwezvokuyera zvirwere zvinoiswa mumuviri, kugadzirwa kwezve kwehosha kwezvirongwa zvezviwirira.

Kurwisana uye Kuedzwa

Makakatanwa anomuka apo mitemo yehurumende inopesana nemirau yehurumende kana kuti apo hurumende dzinoedza kusarudza mumirairo yehurumende iyo dzinoshora. Muenzaniso wakatanhamara zvikurusa ifutunuko yadudzwa yeMedicaid: pashure pokunge Dare Gurusa rasarudza kufutunuka kusingatedzerwi, nyika zhinji dzeRepublican dzakaramba kukura, kunyange nemari yehurumende 90%. Ikoku kwakaparira mukaha unofukidza apo vakuru vanopfuura mamirioni 1,5 vanowira mu "donutbod""(* inowana yakakwirira zvikuru nokuda kwemiitiro yegamuchidzanwa yeMedicaid asi yakaderera zvikuru nokuda kwemari yomusika.

Rimwe rwisano inobatanidza muitiro wokubvisa mimba. Kutevera chisarudzo cheDobbs v. Jackson Women’s Health Organization muna 2022, iyo yakatendeutsa Roe v. Wade, nyika dzakawana chiremera chesechinokwana chokudzora kubvisa pamuviri. Dzimwe nyika, kufanana neCalifornia neNew York, dzakagadza mitemo yokuva "nyika dzinoda kubvisa mimba" nokuda kwavatsvaki vemimba, nepo dzimwe, dzakadai seTexas neMissouri, dzakaisa pedyo nezvurudzo. Vadzori veBiden vakawana chiremera chokumanikidzira kurapa nokurapa nokutsiva zvipatara kuti vapedze kubvisa mimba mumigariro yakakomba yokurapa, vachienzanisira kupfuurira kuvamba hondo dzinoparadza.

Kuedza kudzora mitengo yezvinodhaka kunokonzerawo kurwisana. Muna 2023, Colorado naMaryland vakapa mitemo kuti vape miganhu yakakwirira yokubhadhara mimwe mishonga inonyorwa nemishonga, asi makambani emishonga akakwikwidza mhosva, achiitirana nharo dzokurwisana kwemabhizimisi nemutemo wekodzero yehurumende uye Mushandi Aresie Income Security Act (ERISA). Migumisiro yezviitiko izvi icharondedzera miganhu yesimba rehurumende pamusoro pemari inotengwa nezvinodhaka.

Zvazvakaita Pavanhu Vamwe Nevamwe: Kuwana, Kudhura, uye Kubuda Kwazvinoita

Kupesana kwegadziriro yezvoutano kunotapura zvikuru kusvika kwomunhu kutarisiro, kunaka kwebasa, uye mutoro wemari. Zvinhu zvinotevera zvinoratidzira kuti hurumende inoshandura sei kuva misiyano chaiyoiyo yenyika:

Kuwana Inishuwarenzi

Mitemo yeFederal seACA inovavarira kuwedzera kusvika kupfurikidza netsigiro dzinodiwa zvikuru neMedicaid, asi zvisarudzo zvehurumende zvinogona kuderedza kana kuti kuwedzera miuyo iyoyo. Munhu anowana $200,000 pagore anorarama munyika isiri yemapapatisa seTexas haagoni kukwanirisa nokuda kweMedicaid uye angawirawo pasi pechikumbaridzo chemari inotengwa pamusika (kana pasina kuzviisa ku "mhuri" mutemo unogadzwa muna 2022). Munhu mumwe cheteyo angakwaniriswa nokuda kweMidid munyika yakakura seCalifornia kana kuti New York. Mwero usingaendi inopesana pakati pavakura zvikuru nokuda kwe 5% muMassachusetts kusvikira ku18% muTexas, maererano ne [FF:]

Kutarisira

Mitemo yakaisvonaka yakadai semirau inonyorwa yapachipatara, zviratidzo zvokudzivirira zvirwere, uye kushandiswa kwokudzivirira zvinosiana nehurumende, zvimwe nemhaka yemisiano mumitemo uye mitengo youtano hwavanhu. Nyika dzinotarisira zvikuru (zvikuru, zvinodikanwa zvokushuma zvakakomba zvePennsylvania) dzinova dzinowana zviri nani pakuiswa muchipatara kunodziviswa. Zvisinei, kunaka kunotsamirawo pamibatanidzwa yemitengidzo yemipi nokukwikwidza. Hurumende dzisina kuwedzera Médid kazhinji kazhinji dzinoona mwero yakakwirira yetarisiro isingakwaniswi, iyo inogona kuderedza mari yezvipatara kuti ive nani.

Mutengo Wetarisiro

Ndyiko dzezvoutano dzinosiana zvikuru munyika dzose. Muna 2023, avhareji yemitengo yegore negore yetsinhano yemhuri dzinobhadharwa nevashandi inovambira pasi pe $20 000 muUtah kusvikira kuinopfuura $25 000 muAlaska, mukuwirirana ne Commonwealth Fund[. Kupera kwokushandisa mari kunosiyanawo nemhaka yemiraudzo yeinishuwarenzi, kuisa mari mumusika, uye mwero wokubhadhara mari yeMedicaid. Masangano anodzosa zvikuru kubatanidzwa nokubatanidza (g., anodzivisa kubatira mari yeCalifornia ane misikaro yemakwikwikwi nemitengwa yakaderera kupfuura kutaura nokuregeredza.

Utano Hunovapo

Kupesana muhurumende dzemitemo kunoshandura zvakananga kuva miuyo youtano. Nzvero 2020 mu Health Affairs yakawana kuti pakati pa 2013 na 2017, Medicaid nyika dzakawana kuderera kwezvisakiso zvose zvinoparira kufa zvichienzaniswa nezvinoitika zvehosha dzeutano, nebudiriro huru pakati pavakuru navachena. Nenzira yakafanana, dzinotaura nemitemo yakasimba zvikuru yokudzora fodya (g., mitero yakakwirira yemitero yefodyando yepfuvutsi) ine mwero yakaderera yetsanga yekenza yemapapu nehosha dzemwoyo. Upenyu pakuberekwa kunosiyana namakore manomwe pakati pezvisaririra zvamaruwa (Misipipepu.646.646. Hawari mumitengo dzinoratidzwa mumadata 2023, mitengo yemitengo yematoo yezvero yemari yezve, mamiriro ezvemari yezve, mamiriro ezvemari, mamiriro ezvo dzenzanga.

Kupedzisa: Kudzika nzvimbo yeFederal - State Health Policy

Kubatanidzwa pakati pemiitiro yezvoutano hwehurumende nehurumende hakusati kuri kungova bedzi itiro hanya yedzidzo nejeni nerokunatsa mamiriro ezvinhu eAmerica. Gadziriro dzeFederal dzakadai seMedicare, Mdhicaid, uye ACA dzakakudza kufukidzwa nokugadza mipimo yenyika, asi hurumende dzinochengeta zvishandiso zvine simba zvokushandisa uye pane dzimwe nguva kukanganisa nharidzano idzodzo. Muuyo igadziriro yebasa yokugadzira zvikamu umo bumbiro remipi kazhinji kazhinji kazhinji inosarudza kunaka nokukoshairwa kwetarisiro yavo.

Kuvadzidzisi, kunzwisisa simba iri kunokosha pakudzidzisa vadzidzi nezvokuvimbisana kwehurumende, kuongorora mitemo, uye migumisiro chaiyo yenyika yezvivako zvinotonga. Nokudzidza kuti kufambidzana kwehurumende kunoitwa sei munzvimbo dzakati kuti_Medicaid, misika yeinishuwarenzi, zvinodhaka, njodzi dzoutano dzevanhu, zvinogona kutanga kunzwisiswa kwezvipikirwa uye ngozi dzehurumende yeAmerica. Nyika yacho painoramba ichikurukura nezvenguva yemberi youtano, mubvunzo wokuti ndiani achasarudza zvakanakisisa kwauri. Vagari vemo vanogona kutsigira miganhuro yezvokukurukurirana. Vavaki vehurumende vanokwanisa kutsigira kudzivirira miganhuro iri pedyo, kuderedza mari, uye kuvandudza utano.

nokuda kwokuravazve, ona basa re [[FLT: 1] Komber nokuda kweMedicare & Mitedhicaid Services pamitemo yepurogiramu yehurumende neromaster raisition, uye Kaiser Family Foundation[[FLT:]] pamiitiro yezvoutano yehurumende.]