Ukama pakati pemitemo yehurumende nemirairo yehurumende hunomirira kusawirirana kukuru mukati megadziriro yehurumende yeAmerica, zvikurukuru munzvimbo yezvoutano. Mutemo weFederal unogadza zvinangwa zvakafara zvorudzi nemipimo miduku, nepo hurumende dzine chiremera chinokosha chokushandisa, kuwedzera, kana kuti, mune zvimwe zviitiko, zvinodzivisa mirayiridzo iyoyo. Uku kuparira kushanda kwemitemo yezvoutano inosiana zvikuru, inotapura chinhu chiri chose kubva muinishuwarenzi nemari inogoverwa kumugariro wengozi woutano wavose kukurumidziro yekurumidziro nekuvandikano yokushivirira. Kunzwisisa kuti mitemo yehurumende inoumbwa sei nechatamende chetsika yetsika iripo neyapanguva yemberi inokosha sei nokuda kwokunzwisisa gadziriro yezvoutano yazvino uno. Nyayamubatanidzwa inonzvera kupfurikidza nomutemo woutano, kupfurikidza nekurukurirano dzinovapo, kupfurikidza nokukurukurirana kwemitemo yehurumende inoparira kukurambirana, uye kupfuurira pamusoro pesimba reWashington.

Kunzwisisa Kushanda Kwoutano

Federalism muUnited States inopa simba pakati pehurumende yenyika nehurumende 50. Bumbiro reMitemo rinopa Mitemo inorongwa, yakadai sechiremera chokudzora kutengeserana kwenyika uye kubhadhara mutero nokushandisa nokuda kwegarikano yose. Masimba iwaya anopa nheyo yemitemo yemitemo yehurumende yezvoutano yehurumende yakadai seMedicare, Médicaid, uye Affordable Care Act (A). Panguva imwe cheteyo, Tenth Amendramendimendices kuhurumende yose isingagoveri pamutemo kuhurumende yehurumende, kubatanidza simba ramagamuchidzanwa rezvoutano hwehurumende kudzivirira utano, chengeteko, uye garikano yavagari vemo. Uku uchangamire huviri hunoreva kuti kunogona uye kugadza mitemo yavo vamene yeinishuwarenzi, yezvokurapa, yezvoutano, uye kushanda kwezvoutano.

Gadziriro yezvoutano muenzaniso webhuku wesangano rehurumende rinobatira pamwe, umo mwero yose iri miviri yehurumende inogoverana mitoro, kazhinji kazhinji kupfurikidza nokutsigira kwemajeresa uye kubatana kwehurumende. Somuenzaniso, Medicaid ipurogiramu inotsigirwa pamwe chete umo hurumende inogadza kuva nemhindu nebetsero mumipimo inodzorwa asi hurumende dzinotarisira gadziriro uye dzinochinjika kuronga gadziriro dzadzo dzokubereka dzoga dzehurumende. Nenzira yakafanana, chinjo dzeinishuwarenzi dzeA dzakagadzira mipimo mitemo miduku yehurumende nokuda kwokubhadharwa, bva nyika dzinopfuurira kudzora mitengo yadzo yavo vamene yeinishuwarenzi, kumanikidza vatengidzi, uye kushandisa miraudzo yavo vamene yeinishuwarenzi. Iyi inodzo inogona kutungamirira kuidzo, sokuedza kubhadharwa kwemitero kana kuti kufukidzwa, asi inogonawo kuita kuoneka nokupesana, sezvinoratidzwa nezvisarumwa zvakajeka munyika yose, sezvinoratidzwa nezvisariranwa nezvisarudziko zvinodzo zvinodzorwa munyika zvakakura.

Zviitiko zvenhau zvakaedzazve miganhu yehurumende mukutarisira utano. Somuenzaniso, kutangwa kwaMedicare naMedicaid muna 1965 kwakakudza zvikuru basa renyika, asi kutarisirwa chaiko kwaMedicaid kwakasiyiwa namaune kuti kuzivise. Nguva pfupi yapfuura, chiremera chaACA chakatsigirwa sechidzoreso chebumbiro remitemo reHurumende mu National Federation of Independent Business v. Sebelius (202), asi Dare rakatongawo kuti hurumende yehurumende yebatanidzwa haigoni kuranga kuti muganhu weACA urege kubvisa kukura kweMidid kupfurikidza neMidia mari yose iripo. Chisarudzo chakadaro chitsiridza kudzoso chamadzo

Mitemo Mikuru Yehurumende Inotapura Utano Hwehurumende

Mitemo mikuru mizhinji yehurumende yakachinja zvikuru muitiro wokutarisira utano hwehurumende. iyi mitemo inogadza uriri nokuda kwokufukidzwa, dziviriro dzavatengi, uye mipimo yokutarisira, nepo ichitangawo miitiro yokuchinjika kana kuti kudzivisa kwehurumende.

Muitiro Wokutarisira Usingadhuri (ACA)

Yakaziviswa muna 2010, ACA inomirira chinjo hurusa yezvoutano yehurumende chifo chaMedicare naMedicaid. Gadziriro dzayo huru dzinobatanidza: (1) chirevo chomunhu oga (chinobviswa nenzira inoshanda neTShosa neMacobs Act ye 2017), (2) kuumbwa kweinishuwarensi youtano, (3) mari yemipinduro yakaderera neyapakati yavanhu, (4) chinjo dzeinishuwarenzi dzakadai sechinovimbiswa nereshiviso yenzanga, uye (5) kukura kweMédidicid ku 138% yemwero yeurombo hwemubatanidzwa. ACAid inodid inoshairwa kuti ishande tsinhando yavo vamene kana kuti kusadzo dzinodzorwa zvikuru. Sakanwa 2025, 18 nenzvimbo yemitengo yemari inodzo yePunionnications inosiderwa zvikuru. Zvikamu zvamagaro zvinonzikwa-Micomeset , zvinonzikashatidzo dzinopfuurwawo dzakato dzakatongedzerwa zvikuru.[10]

Médicaid naCIP

Midicaid, yakatangwa muna 1965, ipurogiramu yehurumende inopa purojekiti youtano kuvanhu vanotambira mari shoma, mhuri dzine vana, vakadzi vane pamuviri, vakwegura, uye vanhu vakaremara. Nyika dzinofanira kunamatira kumipimo mishomanene yehurumende uye kufukidza mibayiro yapamutemo (g., masangano echipatara aitarisirwa nevezvoutano, tarisiro dzevana, tarisiro dzezvokutarisira vakwegura, asi dzine rusununguko rwakawanda rwokufukidza vanhu vasingasarudziri vemo nemabasa, uye kugadza mari yokubhadhara. Vana vezve utano hweInishuwarensisfeyimu Program (CHIP), yakaitwa muna 1997, inopawo mari inowirirana yehurumende yokufukidza vana mumhuri nemari yakanyanya kupfumbira Médid asi pasi pechikamu choruwa. Zvose zviri zviviri zvirongwa zvinoda kudzorwazve nokuchinja nokuchinja kwemitengotengo yehurumende (MP), zvirongwa zvehurumende, zvirongwa zvekurongwa zvemari.

Inishuwarenzi Youtano Yokutapurwa Nokuzvidavirira (HIPAA)

HIPAA, yakaitwa muna 1996, inobatanidza gadziriro dzinotapura zvakananga muitiro wehurumende. Kuisa mitemo yenyika nokuda kwedziviriro yemashoko outano anozivikanwa somunhu mumwe nomumwe, inobvumira mitemo yenyika isina simba asi ichibvumira nyika kuchengetedza kana kuti kuita mitongo inodzorwa zvikuru. Nyika dzakashandisa kuchinjika uku kuti dzipe mitemo inoda kubvumazve kushivirira kwokushivirira zvinyorwa zvakati zvinotapukira (g., mugariro wendangariro, HIV). HIPAAAASTION Simpliation zvinorayirawo mipimo yokutevedzerwa yemipimo yemitemo yemagetsi inowirirana, iyo nyika dzinofanira kubatanidza mumiitiro yadzo yadzo yavo yezvoutano yavose yeMédicaid nemiraunzi. Kubhadharo nokuda kwedzimwe zvinyorwa dzoutano dzinogona kuva dzakakomba, dzinova dzinova dzinova dzinova dzinova dzinova dzinoisa mari mukutengwa kwezvitengwa.

Midicare

Sepurogiramu yehurumende yose inofukidza vanhu vane makore 65+ uye vanhu vaduku vane urema, Medicare haisati ichibatanidza zvakananga kutarisirwa kwehurumende. Zvisinei, inopesvedzera zvikuru miitiro yezvoutano hwehurumende. Somuenzaniso, mari inobhadharwa naMedicas mumativi akawanda nokuda kwechipatara nachiremba (inoshanda semapepa emipinduro yapachivande yemipini yavanhu voga voga uye mishonga inoiswa mipimo. Hurumende dzinovimbawo neMedicareas kuti dzifukidze vanhu vaviri vanowirirana (avo vanofanirwa neMedicarea neMedicaid), vachideredza kushandiswa kwemari inotarisirwa kwenguva refu nemirimo yechiverengero chavagari vemo. Uyezve, maMedicarever anoshandisawo mipimo yezvirongwa (zvinotarisirwa zvinozvidavirira) zvinogona kuitwa mubatanidzwa negadziriro yemiitiro yemiitiro yemiitiro yemiitiro yemiitiro yemibato.

Mimwe Mitemo Yehurumende Yakaoma

Mitemo yehurumende inoumba gadziriro yezvoutano. Kurapa nokurapa kwechipatara (EMTALA) kunoda zvipatara zvinotora kuti zvipatara zvinotora rutivi muMedica zvipedzere tarisiro yekurumidziro pasinei zvapo nenzvimbo yeinishuwa yemurwere kana kuti mano okubhadhara, kuisa mutoro panzvimbo yezvipatara zvakachengetedzwa nehurumende. [FLT:]] SHITCH Act[[FFLT:3] ya 2009 yakasimudzira kugamuchirwa kwezvinyorwa zveutano zvemagetsi (EHR) kupfurikidza nezvinosunda zvemari, uye masangano akabatanidza izvi nokuchinja mashoko outano. [FLT:] Kudzivirira uye AFFFFFFFF] kunobatsira pakurapa, kunobatanidzawo mutengo mutengo, uye kudzoresa mashoko okubetsera kurapa, kuti adzoredze basa rokubetsera kurapa. [F]

Kuwedzera kweMedicaid: Fundo Mutsika Yakaoma

Wedzero yeMedicaid muACA nenzira inotevedzerwa zvikurusa muenzaniso wepesvedzero yehurumende pamuitiro wenyika. Kuwedzera kwakatambanukira kwakaenzana kuvakuru vose vane mari panzvimbo kana pasi pe 138% yemwero wemari yehurumende yourombo (FPL), nehurumende yehurumende pakutanga inofukidza 100% yendyiko dzevanyoresi vazvinowirirana, zvishoma nezvishoma zvichidzika kusvika ku 90% pa2020. Nyika dzakakudzwa dzakaona kuderera kukuru mumwero isina kutsarukana, kuvandudza mukuvadziko yezvokudzivirira, uye kuderedza chipatara mari yokutarisira. Somuenzaniso, fundo yakaitwa neFosseal Fund yakawana kuti kukura kunowana 30% yavanhu vakuru mukuderera kwe5 muzana munyika dzinoderera, dzinowedzera pakati pa2020 000, uye kuwedzerwa, zvakawedzera kuwedzera, uye kupfuudza zvirwere.

Nenzira yakapesana, 10 inotaura kuti haina kunyanyowanda muSouth neMidwest . Mukuwirirana neKaiser Family Foundation, inenge 1.9 mamirioni avanhu vakuru mudzimwe nyika dzisati dziri dzepashure dzinowira mumukaha unopfuudzwa, dzichiwana mari shoma zvikuru yokukwanirisa nokuda kweACA puroficiation (masangano anovamba pa100% FPL) asi pamusoro pemibairo yenyika yavo yakaderera zvikuru zvikuru yeMédicaid FPL (kazhinji kazhinji kamari iri pasi pe 50% FPL nokuda kwavakuru vasina vana). Ava vanhu havawanzova nendyiko yokupfuudzira kukwira, vachitungamirira kumwero yakakwirira yechikwereti zvokurapa, tarisiro inononotswa, uye kugadzikiswa kwezvipatara. Zvipatararo muidzidzidzidzino dzinotakura ganhurniro dzemari kubva mukuchengetwa kwemitengo, uye zvimwe zvipatara zvemari zvakavha zvezvipfuro zvakavha.

Chisarudzo chokuwedzera ndechezvamatongerwe enyika nezvemari. Dzimwe nyika, kufanana naIdaho naNebraska, dzakakudzwa kupfurikidza nezvirongwa zvokuvhota pasinei zvapo nechishoro chemitemo. Dzimwe, kufanana neTexas neFlorida, dzakaramba zvakasimba kufutunurwa kwendyiko dzinobatanidzwa mutengo(kunyange zvazvo kugoverana kwehurumende kuri 90%(na kupesana kwepfungwa dzinopesana nezvinonzi nehurumende. Masangano anoverengeka akatsvaka dzimwe nzira: Arkansatian akagamuchira mari yeMédicaid kuti atenge mari yakavanzika yokutenga patsinhano; kuwedzera kweIndiana kunobatanidza mari youtano nemitengo; uye kukura kweUtah'kudzo dzorusarira kupfuudza bedzi kusvikira ku 100% FPL. Iyi mitengo, yabvumirwa pasi pechikamu 1115 cheSocial Secureal Act, seyarences Centers Mediccure ared Minity (Mabasa) uye zvinodikanwa zvakawanda zvebasa.

Tapuro Yemitemo Yehurumende Pamabasa Okutarisira Utano Ehurumende

Kupfuura mutemo mukuru, mitemo mizhinji yemirau yehurumende inoumba zvakananga mabasa ezvoutano hwehurumende. Iyi mitemo inowanzogadza mipimo miduku nokuda kwevara, chengeteko, uye kuva woga izvo nyika dzinofanira kuita, nepo dzichibvumira nyika kuisa zvinodikanwa zvakawedzerwa. Somuenzaniso, migariro yeCMS yokutora rutivi nokuda kweMedicare naMedicaid inoraira mipimo yezvipatara, misha yougwinyi, masangano outano, uye mamwe masangano ezvoutano. Hurumende ine mutoro wokuita nzvero nebvumirano; kukundikana kusvitsa mipimo yehurumende inogona kuguma nokudzorwa kwemari. Ikoku kunopa hurumende ine simba kuti itsigire mireza yokushandisa mabheji akanaka enyika, asi inoisawo ndyiro dzokutarisira pamasangano ehurumende, izvo zvingava pasi pokunzvera kwehurumende.

Imwe nzvimbo inokosha imirakanyo yeinishuwarenzi youtano. ACA inodikanwa kuti iitese betsero dzoutano dzinokosha (EHB) mumisika imwe neimwe neboka duku, asi nyika dzine kuzvitonga kurondedzera chaizvoizvo kuti ibetseroi dzinobatanidzwa. Somuuyo, betsero dzoutano dzinokosha dzinosiana nehurumende; somuenzaniso, dzimwe nyika dzinorayira kubhadharwa kwokurapa kwokusabereka, kurasikirwa nouremu, kana kuti kurapa kwechisvutina, nepo dzimwe miraundiro yesangano pamusoro pemipimo yezvokurapa kunoda kuti vabhadharitsiridzi vape vanenge 80% (mudhidhidhisi kana kuti boka duku) kana kuti 85% (rakura) yemitengo yezvirongwa zvokurapa nokuvandudza, asi madhireshi einishuwarenzi anoshandisa izvi uye shoo.

Kuva woga kwourwere uye kuchengeteka kwemashoko zvinoramba zviripo. HIPAA’s Aypy Relage inoisa uriri hwenyika, asi nyika dzakaita mimwe dziviriro nokuda kwemashoko anogarwa nhaka (GINA), zvinyorwa zvoutano hwepfungwa, uye kuva neHIV/AIDS. Panguva ino, HUTECH Act yomutemo wokuzivisa kunoda masangano anovharwa kuti azivise vanhu, HHS, uye dzimwe nguva manyuko emashoko anoputsa mashoko. Masangano akawanda ane mitemo yawo amene yokuzivisa inoisa nguva inodzorwa kana kuti kushuma zvinodiwa, zvichiita mutoro unobvumira nokuda kwezvirongwa zvakawanda. Mukuwedzera, 21 Century Cures Acts Acts anorambidza miitiro inodzo inodzorwa nokuchinja mashoko outano, kumanikidza masangano eMidica kuti achengete masangano awo emitemo anoshanda pamwe chete.

Nharo Dzinopfuurira: Kutarisirwa Kwekodzero dzeUnited States

Dambudziko riri pakati pekodzero dzehurumende nokutarisira kwehurumende inhau isingaperi mune zvematongerwe enyika zvezvoutano zveAmerica. Vatsigiri vokudzora kwenyika vanotaura kuti hurumende dzomunzvimbomo dziri nani kuti dzidavidze migariro yezviverengero zvavagari vemo, zvemari, uye zvetsika. Dzinonongedzera kumienzaniso yehurumende inobudirira semasangano eOregon akarongwa (CCOS) nokuda kweMEDicaid, iyo yakabatanidza muviri, uye kutarisirwa kwemazino uye yakawana mari yakachengetwa nokunatsiridzwa. Hurumende dzinogonawo kushanda segadziriro dzinonzvera hurumende inosarudzwa navanhu veserogiravhiriyo, kuedza kungagamuchirwa norudzi rwaMassachusetts anoshanda somuenzaniso woutano hweACA. Uyezve, kugadziridzwa kwehurumende kunodzivisa ngozi dzeimwe nyika yehurumende yehurumende yehurumende yezvipuko.

Nenzira yakapesana, vatsigiri vezvoutariri hwehurumende vanotaura kuti kusiya kutarisira utano kunyika dzinopfuudzirwa uye kunyange kuderedza paradzano. Migumisiro yeutano muUnited States inosiyana zvikuru nehurumende: nduramo dzinovambira pamakore 75 muMississippi kusvikira ku80 muHawaii neCalifornia; mwero yekufa kwevacheche nehosha dzinogara kwenguva refu zvinoratidzawo kukamukana kwakajeka. Basa rehurumende rakasimba rinogona kuvimbisa kudzivirira zvishoma zvishoma pakutarisirwa kwapachimbichimbichimbichimbi, zvakadai sokurambidzwa kwekuwana mamiriro ezvinhu enguva isati yasvika, uye mipimo yakanaka yemisha inochengeterwa. Kutarisira kwematunhu kwakakomba kunonyanya kuoma mumugariro woutano wavose womunyika yose, sezvinoratidzirwa neCOVID-19, apo kuderera kwehurumende kunoitwa kuti kuonekwe, kuparadzira, kuparadzira, nokuparadzira, kugovera nokudzorwa kwemitezo.

Hondo dzapamutemo pamusoro pourongwa hwezvoutano dzinogara dziripo. Matare akayera pamusoro penhau dzinovambira paganhuriro dzokubvisa pamuviri (kubatanidza kweHyde Amendment nebhajeti rehurumende) kusvikira kurumano rwebumbiro remitemo reACA neMédicaid. Dare Gurusa renhau rinobvumirana kuti fambiro mberi yeACA’s Médicaid haingagoni kumanikidzirwa kuchengetwa kuchenjera kwehurumende kukuru, asi rutongeso rwakatevera, kubatanidza King v. Burwell[FLT:] (20) (20) achitsigira chikwereti chinobhadhara mitero muruwa yose, kazhinji kazhinji akasimbisazve chiremera chehurumende chehurumende chekuronga nokuwandirira mari. Iyi nzvimbo inoparira kusawirirana nokuda kwezvirongwa zvoutano.

Fundo Dzemhosva: Kupindura kweHurumende Kumitemo Yehurumende

Kuongorora kuti masangano akaita sei kumitemo yezvoutano yehurumende kunoratidza kubatanidzwa kwematongerwe enyika, upfumi, uye zvinodiwa zvomunzvimbomo.

California: Kusvika Kwokuwedzera

California yakasunda nguva dzose miganhu yemiitiro yezvoutano yehurumende. Yakawedzera Medicaid (Medi-Cal) pakuvamba uye nenzira youtsi, kubatanidza kubhadharwa kwevaduku vasina kunyorwa (kusvikira zera ra 26) kutanga muna 2020 uye kumiuyo yose yakaderera isina kunyorwa yakaitwa mu 2024(a inotsigirwa nehurumende. California inoitawo purofiti yayo youtano (Medi-Calian), iyo yave muenzaniso wenyika yose wokuwana nokuwana nokunyoresa. Mitemo yehurumende muna 2023 yakatanga purogiramu yavose (Forgania yeMishoni Miduku) uye inoisa zvipfuro zvemari inodzodzo inodzorwa nezvinodzorwa nemirimo yehurumende. California inobatanidzawo zvikwaro zvine nhevedzano nokudzodzodzodzodzo dzomutemo.

Texas: Muenzaniso Wokuramba

Mumusiano mukuru, Texas ine mumwe wemwero yakakwirira zvikurusa isina kutsarukana munyika (inopfuura 18% sa 2023), zvikurukuru nemhaka yokuti hurumende yakaramba kukudza Medicaid pasi peA. Pasinei zvapo nokuedza kwokuwedzera kwemitemo netsigiro yebipartisan kubva kuvatungamiriri vomunzvimbomo, kukura kunoramba kusingabviri mune zvamatongerwe enyika. Texas inotsamirawo patsinhano inorerudzwa nehurumende, panzvimbo pokuita kukura kwayo imene. Nyika yakanangidzira ngwariro pakuedza kukuita zvimwe zvinhu: kusimbisa madziva echirokidhaka nokuda kwavanhu vane migariro yapamberipo (nzvimbo isati yasvika yeA), kuiswa mari munzanga, uye kushandisa ukoshi hunokudzwa hunoiswa nemutengwa nehurumende mukati mamiriro ezvinhu anodzorwa mumitengo. Zvisinei, kushaidzwa kwekuwedzera kwezvipataradziko kudika chamapfuudzo kupfurikidza kukuva pedyo nezvinopa zvirwere, uye kupfurikidza nokudzosera mamiriro ezvo kudzo yezvo kudzoro yetsika dzinodzokoro dzinodzosera kutodzosera kutodzo.

New York: MaFederal Frameworks anokura

New York inoenzanisira imwe nzira: ichishandisa zvipfuudzira zvenyika nehurumende kufutunura kupfuudza kupfuura izvo mutemo wehurumende unoda. Somuenzaniso, purogiramu yeMedicaid yeNew York ndeimwe yemifungo inopa zvikuru munyika, kubatanidza kufukidzwa kwemibato yenguva refu netsigiro, tarisiro yomunhu oga, uye utano. Hurumende inoshandisa kutsinhana kwayo imene (NY State of Health) uye yave iri mutungamiriri mukushandisa ACA’s Effectal Health Belief Benence Benence, inowedzerawo mipimo seyamuro yokusanzwa. New York inoshandisawo Mutepfekedzo weTrangedzero yeResury Reformation Incentation (DRIP) kurongazve kugadzirwa kwemitengo yehurumende kupfurikidza nokugadzira nokuwedzera kugadzirwa kwegadziriro kukuru kwegadziriro kwehurumende kugadzirwa kwegadziriro kwemitezo.

Florida: Kurerwa Nevana Vaduku Nevana Vawaivers

Florida haina kukudza purogiramu yeMedicaid inoshandiswa zvizere, asi yabatanidza mamwe mativi emiitiro yezvoutano yehurumende payoga. Hurumende inoshandisa gadziriro yayo yeMedicare Begconst (kupfurikidza namasangano ezvokutarisira adzorwa) uye yakawana zvirongwa zvokushandisa kugadziridza gadziriro yayo yeMedicaid kuva gadziriro yokutarisira inoshanda yose. Florida inoitawo kutsinhana kunopfaviswa nehurumende asi yakaronda kuderedza kuderera kwemitengo yayo. Hurumende yave iri mubatanidzwa unoshingaira mumuitiro webasa uye purogiramu dzebetsero dzinodzorwa, kunyange zvazvo nhamburiko zhinji dzebasa dzakavharwa mudare. Kusvika kwehurumende kuratidzira kuda kwokuzvirongwa zvemari zvinoiswa mumitengo uye kusada kukudza mari nokuda kwetsika, nepo dzichiridzwa nokuda kwemari yetsika yetsika yetsika.

Zvidzidzo zvomuCOVID-19 Pandemic

COVID-19 yakaedzwa kubatana kwehurumende yakaedza sekare. Hurumende yakakumbira Public Health Service Act kuti ipedzise Public Health Emergency (PHE) chiziviso chokuti yakatanga kuva neMirioni muMedicare, Mdhicaid, uye inishuwarenzi yomunhu oga, kubatanidza kunyoresa kunopfuurira muMedicaid ( “kuramba kufambiswa kwechinjo”) uye yakawedzera mwero yehurumende yegadziriro dzehurumende dzeMidicaid (imwe nhamba 6,2 muzana muFMAP). United States yakashinga kugamuchira izvi zvisaririra apo inoshandisawo miitiro yavo vamene pakuedza, kudzivirira, mabhakitiro, uye kutengeserana mutengo mutengo mukati medzodzo. Muuyo wakanga uri mhinduro yehurumende, apo inoparira kuvhiringidzwa kwehurumende, uye kudzorwa kwemari inodzorwa kwemari inodzorwa.

Mitemo Yehurumende Yemitemo Yakaoma Munguva Yemberi

Ukama huri pakati pemitemo yehurumende neyehurumende yezvoutano hucharamba huchichinja zvichienderana nokuchinja kwemamiriro ezvinhu ezvematongerwe enyika, kuoma kwemari, uye zvinetso zvoutano.

Mashanduko Anobvira Mumutemo WeFederal

Muuyo wesarudzo yenyika uchatapura zvikuru zvisarudzo zvehurumende. Kutarisirwa kwomunguva yemberi kungagona kuronda kuvekwa musengwa wenyika yose kupfurikidza nechisarudzo chavose kana kuti kunyange Medicares yeVose, uko kungatodzvinyirira zvikuru hurumende kugona kupa nyika mvumo kupfurikidza nezvipo zvemitengo kana kuti zviteshi zvinobvumira nyika kuisa zvinodikanwa zvebasa, kushandisa mitengo yeinishuwarenzi inotsiva kana kuti purofiti. Kukurukurirana kunopfuurira pamusoro pemitengo yemari yehurumende neganhuriro yemari kungaderedza mwero yemari yemari yemari yemari yemari kana kuti kudzo yemitengidzo yemari inobhadhanyiswa, kumanikidza nyika kutora zvimwe zvitsaratidzo zvemari kana kuti kuderedza puro.

Kutanga Zvinetso Zvoutano Zvoruzhinji

Njodzi youtano hwavanhu inotevera (kungava hosha inotapukira, opioid denda, tapuro dzinobatanidzwa nemamiriro okunze, kana kuti kuwedzera kwoutano hwendangariro) ichaedzazve kushanda zvakanaka kwebatira pamwe yehurumende. Zvidzidzo zvinobva kuCHOVID-19 zvingatungamirira kukumbira gadziriro youtano hwavanhu vose yakadzika mitemo, kubatanidza mipimo yehurumende yemitemo yokuunganidzwa kwamashoko nokunzverwa, kana kuti nokuda kwemipimo mikuru yehurumende netsigiro yehurumende yezvomari. Mutoro unokura wehosha dzenguva refu nenhamba yevagari vemo uchadzvinyirira yose iri miviri Medicare naMedia, inosundazve kurukurirano pamusoro pezvirongwa, zvakadai sokubatanidza Medicaria naMidid nokuda kwokuva neyamutengiri inova inovakwa namativi ose anowirirana neyamubatanidzwa neyatina yemari kupfurikidza nokutsigira kwemari yeFederal Health Carence Office (FSSA).

Hurumende-Ingaitwazve

Nyika dzichapfuurira kunzvera mitoo mitsva: nhamburiko yokugadzira gadziriro yomubhadhari mumwe pamwero wehurumende (SB 770 nokuda kwegadziriro yemari yakabatana yezveutano) inotarisana nemhinganidzo dzinotyisa, asi dzimwe nyika dzingaronda mitoo yavose kana kuti mwero wemari inoisa. Mitengo inobhadharwa yakavakirwa pamitengo inobhadharwa, yakadai semasangano anozvidavirira etarisiro nemibhadharo yakaunganidzwa, iri kutokufambira mberi navose vari vaviri vagadziri vemitemo yehurumende. Hurumende dzinogona kukwikwikwidza nokuda kwavaveridzi kuti vaedze mifananidzo mitsva, yakadai seMidicaid yemiedhio kuratidzira dzimba nezvokudya zvinovaka muviri zvinovaka muviri nezvinovaka utano, kana kuti kufutunurwa kwaMassachusetts kuti zvibatani vatami kuti vatami. Kunzvera uku kuchaita ufakazi hunozivisa munamato wenyika.

Kupindira Mumitemo Nebumbiro Remitemo

Kuramba kuripo pamusoro peACA kunopfuurira; somuenzaniso, denho kumurairo wemitemo womunhu oga mu California v. Texas (2021]) yakarambwa panzvimbo dzakamira, asi dzimwe nhau dzinonanga zvinodikanwa zveACA’s es accoption, chireat communito, uye miraundi yeinishuware iri kushanda mumatare maduku. Nenzira yakafanana, kudzika kwemitemo yehurumende yokubvisa mimba, zvikurukuru pashure pe Dobs v. Jackson’s Health Organization of Adomes [FLT:] [202]), yakatoodza kurukurirano yemubatanidzwa pamusoro pokubereka nokuda kwemijeko (kudzo yemitezo) uye basa rehurumende mukudzivirira mamiriro ezvinhu ehurumende. Iyi migano yenhau yezvero yezvero yezveutano ichava mumigariro yesimba resimba renhau yezve.

mhedziso

Kushanda kwemitemo yehurumende pamitemo yezvoutano yehurumende kwakakura, kwakajeka, uye nguva dzose kunochinja. Kubva paMedicaid kugadziridza nokuchinja kwemipimo yemipimo yezvoutano uye mhinduro dzengozi dzehurumende, kubatana pakati penhungamiro yehurumende nechisarudzo chehurumende kunoparira mikana yokuvandudzika nenjodzi dzekusatendeseka. Kunzwisisa ukama uhwu hunokosha kuvadzidzisi, vadzidzi, vagadziri vemitemo, uye vagari vemo vanotsvaka kudzora gadziriro yezvoutano hweAmerica. Sezvo nyika inopfuurira kudzorwa nezvamatongerwe enyika, ruzivo rwokugadzirwa kwezvinhu, uye njodzi dzinosafanotarisirwa nehurumende, zvicharamba zviri pakati pezvo kuchengetera kuti kuchengeteka utano kunosvika, kunobvira, uye kugona kugadzirirwa nokuda kwezvose. Chinetso chakakomba chinopesana hachisi mukusarudza kudzora kudzora kana kuti kudzorwa kwoudzore, asi kugadziridza kudzodzodzodzo dzakadzorwa kutsika kumativi ose ehurumende.