Kutonga Kwehurumende Kwoutano

Hurumende ndidzo dzinotanga kugadzira mapurani okupa utano mumiganhu yadzo, dzichishanda mugadziriro yemipimo miduku yehurumende nepo dzichichengeta uchenjeri hukuru pamusoro pegadziriro yemitemo. Iyi gadziriro, yakavakirwa muTendith Amendment, inogadzira rabhoritari yomuzvarirwo umo mitoo yakasiana - siana yokufukidza, kunaka, uye kudzora ndyiko inogona kuedzwa uye kuenzaniswa. Kunzwisisa kuti hurumende dzinotarisira sei gadziriro dzadzo dzoutano dzinokosha nokuda kwevagadziri vemitemo, vakuru vakuru vezvoutano, uye vagari vemo vanoda kuona kuti zvinoshanda sei nezvisingashandi.

Hurumende imwe neimwe, gavhuna, uye madhipatimendi ezvoutano mitemo inoratidzira zvirongwa zvechiverengero chavagari vemo, zvinhu zvinokosha zvezvamatongerwe enyika, uye zvoupfumi. Muuyo igadziriro yakaisvonaka inoparira miuyo yakasiana---shaikwa zvikuru nokuda kwavagari vamo inotsamira pakwavanogara. Kubva ku mipimo yokuwedzera [ kumhinduro dzoutano dzavanhu, zvisarudzo zvemhesano dzomugariro wapasi zvinoumba kuwanikwa, kukwanisa, uye kunaka kwetarisiro nokuda kwamamirioni eAmerica.

Kugadzirwa Kwemitemo Nokutungamirira

Hurumende dzinoita kuti mimwe yemirau inovapo mukutarisira utano itevedzerwe. Dzinobvumira vanachiremba, vakoti, uye nyanzvi dzezvoutano dzakabatanidzwa, dzinosarudza miganhu yemitemo yeinishuwarenzi inotengeswa mumisika yadzo. Madhipatimendi einishuwarenzi okuongorora mwero weinishuwarenzi anowedzera, anomanikidza kudzivirira vatengi, uye anotarisira kugadziriswa kwemari kwevatakuri. Panguva ino, madhipatimendi ezvoutano ehurumende anotarisira zvirwere, zvinyorwa zvinokosha, uye mitemo yezvezvezvemagariro. Chiremera chokugadza mitemo iyi chinoreva kuti chiremba mukuru anotarisira mumitengo imwe nyika angashanda pasi pezviwiso zvakasiyana chose kupfuura mubatanidzwa munyika iri pedyo.

Mitezo inewo simba rokurondedzera betsero dzoutano dzinokosha kupfuura uriri hwehurumende hunoiswa neAffordal Care Act. Dzimwe nyika dzinopa chibvumirano nokuda kwokurapa kwokubereka, kunzvera mufambiro nokuda kwechiautism, kana kuti mabasa outano hwendangariro akawedzerwa. Iyi mirairo inogona kuwedzera kusvika asi inokwidzawo ndyiko, kumanikidza vaiti vemitemo kuva vadzori vemisi yemisi yemisi yemisi yemisi yemisi yemisiri pakati pokufukidzwa nokuwandisa.

Mosesi weMedicaid: Kukura Negadziriro

Medicaid inzvimbo hurusa inopinzwa dzidzo youtano muUnited States, ichiratidzira mamirioni anopfuura 80 anosvika vana vakaderera, vakuru, vakura, uye vanhu vane urema. Hurumende dzinoshandisa purogiramu mubatira pamwe nehurumende yehurumende, uye dzinofarikanya rusununguko rwakati mukusarudza zvikumbaridzo zvisingachinjiki, zvitsama zvinobetsera, uye mwero yomuripi. Uku kuchinjika kwakaparira basa rakati repurogiramu rakasiyana zvikuru murupo nokusvika.

Kuwedzera Kwemabhedhi Semutsetse Wemitemo Inogumisa

Chimwe chezvisarudzo zvinokatyamadza zvikurusa zvehurumende chakatevera chisarudzo cheDare gurusa ra2012 icho chakaita kuti Medicaid ifutunuke pasi peAffordible Care Act yeHurumende zvisaitwe. Kuvambira pakutanga kwa2025, maruwa 41, D.C., zvakagamuchira wedzero, nepo nyika gumi dzisina. Kukura kwakawedzera nyika kwakatambanudzwa kuvakuru vachiwana mari kusvika ku 138% yemwero wourombo wehurumende, vachifukidza mamiriyoni akambova mumukahaha. Zvikamu zvisina kupfuudzwa, zvakanangidzirwa muSouth nemativi eMidwest, zvakasiya vakuru vazhinji vasina kutenderwa.

Miuyo inosanonyorwa. Nzvero inobudiswa muUtano yakaratidza yaratidzwazve kuti nharaunda dzinofutunurwa dzinowana mwero yakakwirira yepeyi, mari yokutarisira isina kutsarukana nokuda kwezvipatara, uye kuvandudza kusvika kumabasa anodzivirira. Nyika dzisingaregi dzine mwero yakakwirira yechikwereti chezvokurapa uye kusava nenzvimbo dzinodzivisirwa pakati pevagari vemo vanowana mari yakaderera. Chisarudzo chokuwedzera chinosundwa zvikurukuru nendyiko pamusoro pendyiko dzehurumende, kudziviswa kwouzivi kupurogiramu dzomubatanidzwa wehurumende, kana kuti kuda zvimwe zvikarakadzo zvebasa nebetsero.

Kuchinja - chinja Kwezvakanakira Uye Kwekutungamirira

Kupfuura chisarudzo chokuwedzera, inotaura kuti zvinosiyana zvikuru mumagadzirire azvo mapurogiramu eMedicaid. Dzimwe nyika, dzakadai seCalifornia neNew York, dzinopa betsero huru kubatanidza mazino, kuona, kunzwa, uye utano hwendangariro hwakasimba uye kushandisa zvinodhaka. Vamwe, kubatanidza Alabama neMississippi, vanopa betsero dzakaganhurirwa dzinosvitsa zvinodikanwa zvishoma zvomubatanidzwa asi dzinoganhurira betsero dzakadai sokurapa mazino akura kana kuti mishonga.

Kupinda kwetarisiro kwakarongwa kunosiyanawo. Zvibvumirano zvakawanda zvehurumende namasangano ezvipatara anotarisira anoitwa nomunhu oga kuti ape mibato yeMedicaid, kubhadhara mwero wemitengo inobhadharwa pamunhu mumwe. Dzimwe dzinoshandisa mitero-yokunyoresa yadzo yemitemo yakagadzirwa, kana kuti kushandisa mifananidzo yakavhengana. Kufamba kumwe nokumwe kune zviteshi zvinobviswa: kutarisira kunogona kuvandudza kufambiswa nokutemwa kwemari asi kungaganhurira mibato yezvokutarisira nokugadzira mitoro yehurumende nokuda kwavabhadharwi. Hurumende dzinofanirawo kudzora vadzoreri vehurumende vanobvumira kuedza kusvika zvitsva semisha youtano, zvinhu zvinobhadhara, kana kuti yamuro yemari inobhadharwa nokuda kwokubhadharwa.

Kutungamirira Kwoutano Kworuzhinji Nokugamuchira Kwokukurumidzira

Hurumende dzine mutoro mukuru wokudzivirira utano hwevagari vadzo nokudzivirira zvirwere, kukwidziridzwa kwoutano, uye kukurumidza kukurumidza. Murakatira weCOVID-19 wakaratidza migumisiro yokungwarira kwehurumende, uchiratidza kusiyana kukuru mukuedza, makambani okudzivirira, uye matanho okuderedza zvirwere.

Kukanganiswa Kwoutano Kunodzivirira

Mitemo inoshandisa gadziriro dzokudzivirira hosha dzisingaperi dzinova nezvinoparira rufu nourema zvikuru: hosha yemwoyo, kenza, chirwere cheshuga, uye kufema. Nhano idzi dzinowanzobatanidza masangano efodya, nhimbe dzokudzivirira kufutisa, kuongorora kubuda kwekenza, uye gadziriro dzezvoutano dzenzanga. Mari inobva mumubatanidzwa wezvipo zvehurumende, kupfuudzwa zviremera zvehurumende, uye mishonga yehurumende.

Zvirongwa zvehurumende zvinobatanidza Massachusetts ’ nhamburiko dzinobatanidza kudzora fodya, dzinobatanidza mitero yakakwirira, mitemo isina utsi, uye mabasa akasimba okusvuta kuti zviwane kumwero wekusvuta kwakadzikasa munyika. Zvitsauko izvi zvinosimbisa kudzivirira kufutisa kupfurikidza nokuchinja kwemabhayisere anenge akavakwa, zvakadai sokushandisa mari nokuda kwemigwagwa yebhasikoro nevarimi ̱ misika, yakaratidza migumisiro inoshanda pakushanda kwomuviri nezvokudya zvinovaka muviri. Mienzaniso iyi inosimbisa kuti kudzivirira kwemari yehurumende mukudzivirira kunogona sei kuparira kudzoka kukuru muutano hwavagari vemo.

Kutarisira Kurwara Kwoutano Hworuzhinji

Kupindura kwehurumende kumigariro youtano kunosiana mukuwirirana nechiremera chemitemo, vatungamiriri vezvamatongerwe enyika, uye simba routano hwevanhu. Mukati medenda reCOVOVAD-19, zvakafanana neVermont neHawaii zvakatanga kunzvera kwoutsinye nepurogiramu dzokuonana uye zvakachengeta kumwe kuwanda kwetapuro yakaderera zvikurusa nekufa munyika. Dzimwe nyika, kubatanidza Florida neSouth Dakota, dzakashandisa mitoo inobvumira maitiro okuwedzera kwemari norusununguko rwomunhu, zvichiguma nemwero yakakwirira yehosha asi zvakabatanidzawo kunzvera kwakasiana kwezvo zvokutengeserana pakati poutano nemigumisiro yemari.

Denda reopioid rinopa imwe yemhinduro yenzvimbo yehurumende. Mitemo yakadai seOhio neWest Virginia, iyo yakatarisana nemimwe mwero yakakwirira zvikurusa inouraya, yakafutunura kusvika kugadziriro dzemirimo yenaloxone, yakagadzwa, uye mari inotsigirwa nokuda kwokurapa nemirimo. Iyi nhano yakaparira kuderera kuchangobva kuderera kwenzufu dzinoshandiswa zvisina kufanira, inoratidzira kuti chiito chehurumende chinonangidzirwa chinogona kudzosa mamiriro ezvinhu kunyange panjodzi dzoutano dzavanhu dzinodzorwa nemhindu.

Kutarisira Basa Routano

Vashandi vakakwana uye vanosanotarisirwa vezvoutano ndivo vanokosha kugadziriro ipi neipi yeutano inoshanda.

Ricensire, Kukura Kwetsika, uye Zvibvumirano zveInterstate

Zvinodikanwa zvehurumende zvendaza yemushonga zvinotapura zvakananga kugoverwa nokuparadzirwa kwenyanzvi dzezvoutano. Mitemo inoganhurirwa yemiitiro inosarudza izvo varapi vemibato, vabetseri vezvipfuyo, uye vagadziri vemishonga vanogona kuita vari voga. Nyika dzine chiremera chakazara chokushandisa nokuda kwavanachiremba, kubatanidza nyika 26 somuna 2024, dzinoona kukura kunokurumidza muukoshi hwokutarisira kwokutanga uye kusvikika kuri nani mumaruwa. Mitezo inoganhurirwa inoda kuti chiremba atarisire varapi vazvinorapa vafambira mberi zvikuru zvipingamupinyi zvikuru.

Interstate Medical Licensure Compact, inogamuchirwa nehurumende 39, inopinza mutoo wokuti vanachiremba vawane maraise munyika dzakawanda, inovandudza kugona kwetelemedicine nemhinduro yengwavaira. Mabumbiro akafanana aripo nokuda kwavanamukoti, varapi vemiviri, nyanzvi dzendangariro, uye mamwe mabasa. Kubatanidzwa muaya macoctal kunoratidza nyika ̱ kuzvipira kushanda uye kunogona kuva betsero yamakwikwikwi mukupinza basa mutaretare rezvoutano.

Zvirongwa Zvemari Nezvepaipi

Nyika dzinopinza mapurogiramu okubhadhara chikwereti, mari yokubhadhara mari, uye maroja okurovedza vanhu kuti vakwevere vavakiriniki kunzvimbo dzinoda kurapwa zvikuru. National Health Service Corps, yakawedzerwa nepurogiramu dzenzvimbo yenzvimbo yehurumende, inoisa vanachiremba, vanachiremba vemazino, uye vagoveri vezvoutano hwepfungwa muMasangano eHlorial Professional Shortges anosarudzwa nomutemo. Madokero akadai seTexas neCalifornia akashandisa zvikuru mapurogiramu okuwedzera ezvokurapa kupfurikidza nokudzidzisa nzvimbo dzoutano nemiitiro yokurovedza nzanga, zvichiwedzera zvakananga michina yezvokutarisira varwere vakuru.

Kuunganidzwa kwemashoko ebasa ndirimwe basa rinokosha. Madhipatimendi ezvoutano ehurumende anobudisa mishumo yegore negore pamusoro pokugoverwa kwemari, mitsara, uye zvimiro zvevagari vemo, kuzivisa kunyoreswa kwakarongwa uye nzira dzokuziva nadzo. Dzimwe nyika dzakatanga masangano avashandi vezvoutano anounza vadzidzisi, vashandirwi, uye vagadziri vemiitiro yokubatanidza kurovedza nezvinodikanwa zvenzanga.

MaModel Akatanga Kubhadharwa uye Kupiwa Zvibereko

Hurumende dziri kushanda nenzira inowedzera semarabhoritari okubhadhara kugadziridzwa nokupiwa kwetarisiro. Nokushandisa simba radzo rokutenga mugadziriro dzoutano dzevezvemari nehurumende, uyewo chiremera chadzo chokutungamirira pamisika yeinishuwarenzi, mapepanhau anogona kuedza vanhu vanopa mubayiro wekuwanda kwemashandiro adzo.

Masangano Okutarisira Anozvidavirira Netarisiro Yakasanogoverwa

Masangano anoverengeka akatoita gadziriro dzesangano rokutarisira reMedicaid, iro rinoita kuti masangano anopa mitoro ane mutoro wendyiko nokunaka kwekutarisirwa kwevagari vemo vanonzi. Oregoṉ Masangano eAuntwindid Care Organization, atangwa muna 2012, akaunganidzwa pamwe chete utano, mufambiro, uye mabasa emazino pasi pemasangano esangano rimwe, kuwana kuderera mukushandiswa kwedhipatimendi rekukurumidzira uye kura chipatara uku zvichidzora kukura kwemari inotengwa. Colorado ne#817; Varenterveric Carence Col Carection Colt vanoshandisaworomistworosate shores kuti vavandudze migumisiro yezvinodikanwa zvikuru, vanobatira mari yakawanda.

Mitezo iri kupayonawo mifanikiso yokutarisira yakavhengana nokuda kwechiverengero chavagari vemo chavanhu chakaenzana nemativi maviri ̵ vanhu vanokwaniriswa nokuda kwezvose zviri zviviri Medicare naMedicaid. Purogiramu dzekuratidzira muCalifornia, Massachusetts, uye Minnesota dzinowirirana mumibatanidzwa yose iri miviri yepurogiramu kuti dzigovere kufukidzwa kusina mukwambo nokuda kwavakura vakaderera uye vanhu vane urema. Iyi mienzaniso inoderedza kuputsika ndokuvandudza kunaka kwoupenyu nokuda kwechiverengero chavagari vemo chinoparira goverano isingachinjiki yemari yezvo youtano.

Kutenga Nokupa Chinjo Yemari Yakavakirwa Pamutengo

Masangano eMedicaid munyika kubatanidza Arkansas, Tennessee, uye Vermont akagamuchira zvirongwa zvokutenga zvinokosha zvinobatanidza mari yokudzosera mari yokushandisa pakushanda zvakanaka, ruzivo rwokushivirira, uye kudyika. Arkansas ̱ Health Prepency Reconfice Program, somuenzaniso, akatamisira mari yakawanda yemibhadharo yeMedicaid mumifanikiso inotsiva mukati mamakore mashomanene, achibatanidza mari yemiuyo yemiuyo yemiuyo yavose setsinhano netarisiro yechibereko.

Gadziriro dzoutano dzehurumende dzinobatirawo senzvimbo dzokuedza kubhadhara. Nhano dzinoratidza kuti hurumende dzinogona kushandisa simba radzo rokutenga kuti dzifambise nyika yose pasina kukumbira kuti ishande.

Zvinetso Zvinoramba Zvichimuka uye Kutanga Kuisa Zvinhu Zvokutanga Panzvimbo Yezvinhu

Pasinei nezvakabudirira, hurumende dzinotarisana nezvipingamupinyi zvakaoma pakutarisira utano hwevanhu vadzo.

Misiyano Yenzvimbo Nenzvimbo

Nzanga dzomumaruwa munyika yose dzinotambura nokuvharwa kwechipatara, kuperevedza kwezvokudya, uye kuganhurirwa kwokuwana tarisiro chaiyo. Zvipatara zvomumaruwa makumi mana nezvinomwe zvakavharwa pakati pa 2020 na 2024, njodzi dzisingaenzaniswi idzo dzisina kuwedzera Medicaid. Telehealth wedzero mukati medenda yakaderedza zvishoma mipata iyi, asi kuwanikwa kwakafara kunoramba kusina kufanira.

Mwero yokufa kwavanaamai vanobereka yakakwirira nekatatu kusvika kana kupfuura nhamba yevachena vanofa munyika yose, asi mukaha wacho wakafara munyika dzine mitemo inodzvinyirira yeMedicaid uye mabasa okubereka mashoma. Nyika dzakaisa mupurogiramu dzedaula, kurovedzwa kwokusarura kwakakwana nokuda kwevagove, uye kuunganidzwa kwemashoko nedzinza zviri kufambira mberi mukuderedza miganhu iyi.

Dzvinyiriro Dzemari uye Kutsigira

Midicaid chinhu chimwe chikurusa mumari dzehurumende zhinjisa, chinoparadza inenge 20 muzana yehwerengedzo yemari inopedzerwa paavhareji. Mukati mekuderera kwemari, kunyoresa kunowedzera nenzira inozvidira sezvo mari inoderera, kuisa dzvinyiriro yokuwedzera pamari yehurumende. Nyika dzinofanira kukwidza mitero, mari inobhadhara, inoganhurira mibayiro, kana kuti kubvisa matura emari kuti itsigire mapurogiramu adzo. Kuguma kwekurumidziro yehurumende yeutano yehurumende muna 2023 kwakaita kuti kutsakatike zvikuru zvinodikanwa zvokubhadhadhadhadharwa zvinopfuurira, kuchitungamirira kumamiriyoni ezvitsarudzo nezvindzo zvehurumende nokuda kwemasangano ehurumende.

Mitoo yemari itsva yokupa mari, yakadai semitero yokupa mari, kutarisirwa kwemitero yokutarisira, uye kuchinjwa kwehurumende, zvinobvumira nyika kukudza mari yemubatanidzwa wehurumende. Zvisinei, iyi gadziriro inowanzoitiranwa nharo uye inoitwa kuti itarisire nehurumende. Kuchengeteka kwenguva refu kuchada nyika kuti dzirambe dzichirangwa mukutarisira mari apo dzinotevera chinjo dzokupa dzinovandudza kushanda zvakanaka.

Kutarira Mberi: Nguva Yemberi Yokutarisira Utano hweHurumende

Hurumende dzichapfuurira kuumba nhevedzano yezvoutano hweAmerica mumakore ari mberi. Kuchinjika kunopinzwa mubatira pamwe wehurumende wenyika kunobvumira kuedza kuita ufakazi hwemabasa. Kupfuudzwa kweInflatiation Reduction Act, kunobatanidza gadziriro dzemitengo inotenderwa yemirimo inobvumirwa uye kukwira kwepegi yomutengo wemari inobhadharwa yeMedicare avhotera vatengi, kunoparira simba idzva iro nyika dzichada kufamba. Munguva ino, kuvamba ruzivo rwokugadzirwa souchenjeri mukunzvera nokutarisira, kukura kwemitengo yakananga yemari inobhadharwa namari inobhadharwa, uye kukura kwemitengiswa kwemipi yemipi yemitero yemari iripo yose iripo yose iripo uye njodzi idzo hurumende dzichada kugona kutungamirira.

Vagadziri vemiitiro yehurumende vanogona kudzidza kune mumwe nomumwe kupfurikidza namasangano akadai seNational Gavhuna Association neNational Academy for State Health Policy, izvo zvinopfavisa mashoko anogoverana miitiro yakanakisisa. Bipartisan pakufunga nezvemipimo yendangariro, kuhwirudzura kwokufa kwaamai, uye kudzivirira vana kunoratidzira kuti kutangwa kwemitemo yehurumende kunogona kukunda kukamukana. Sezvo rudzi runorwisana nenhamba yenhamba yezviverengero zvevakwegura, kuwedzera kwehosha dzinopfuurira, uye utano hunopfuurira, sayenzi yedemocracyryryworyryy pamwero yehurumende icharamba iripo nokuda kwefambiro mberi.