Ulwalamano phakathi kwemithetho karhulumente kunye nemigaqo-nkqubo karhulumente lumele uxinezeleko olungundoqo kwinkqubo yesizwe saseMerika, ingakumbi kummandla wezonyango. Umthetho wesiZwe umisela iinjongo ezibanzi kunye nemigangatho encinane, ngoxa oorhulumente benegunya elibalulekileyo lokuzalisekisa, izongezelelo, okanye kwezinye iimeko, bechasa ezo migaqo-nkqubo. Le mpembelelo ivelisa inkqubo edibeneyo yezonyango eyahluka-tshintsha kakhulu, echaphazela yonke into esuka kwinkcaso ye-inshorensi kunye nenkcitho yoncedo kwimfuno yempilo elungiselelwe ungxamiseko kunye nemfihlo yezomzelelo. Ukuqonda indlela imithetho yesizwe eyakhiwe ngayo yimeko ekhoyo phakathi kwe-metropite nexesha elizayo ibalulekile ekuqondeni inkqubo yempilo yemeko yesizwe, inkqubo yenkcubeko yezonyango, iziphumo zengxoxo yenkcubeko yoluntu, kunye nengxoxo yengxoxo yengxoxo yengxoxo yengxoxo ye-Washington.

Ukuqonda Ulawulo Lonyango

Umanyano lwamazwe eUnited States lwahlula amandla phakathi korhulumente wesizwe noorhulumente abangama-50. UmGaqo-siseko unika iNgqungquthela ebalalweyo, njengegunya lokulawula urhwebo lwamazwe angaphandle kunye nerhafu nokuchitha imali jikelele. La magunya anika isiseko somgaqo-siseko somthetho wezonyango lwesizwe njengoMedicare, Medicaid, kunye noMthetho weAffordicure Care Act (A). Ngeli xesha linye, ulawulo lweSinyuso seshumi lokuLamla lokuLandliselo lwamazwe angawaphathi ngokuphandle urhulumente, kuquka namandla aqhelekileyo amapolisa okukhusela impilo, ukhuseleko, nentlalo-ntle yabantu bawo. Olu lawulo luthetha ukuba umthetho ohlukene ulawulo lwe-inshorensirensidensi, i-zamayeza, i-odomistmential, ink elungele ukusebenza kwempilo, kunye nezonyango.

Inkqubo yonyango ngumzekelo wezifundo zentsebenziswano yesizwe sesizwe solawulo lwentsebenziswano, apho omabini amanqanaba karhulumente asabelana ngeembopheleleko, ngokufuthi ngenkxaso-mali kunye namaqumrhu orhulumente. Ngokomzekelo, iMedicaid yinkqubo exhasa ngokudityanisiweyo apho urhulumente umisela intlawulo ebanzi kwaye inzuzo elawula inkqubo kwaye abe nobuchule bokuyila iinkqubo zawo zokuhambisa kunye nokusebenzisa iinkqubo ze-ascription. Ngokunjalo, i-AA inshorensi ye-inshorensi iveza imilinganiselo encinane karhulumente yokuhlawula, ukanti urhulumente uyaqhubeka nokulawula ukuthengiswa kwe-inshorensi, ukunyanzelisa iinshorensi yabo, nokusebenzisa ii-inshorensisla zempilo zabo. Oku kusenokukhokelela ekuphuculni iinkqubo zokuhlawula okanye ukwandisa iimpahla ezintsha, kodwa kukwanenzalise, njengoko kuboniswa ngokwezimo zolwahlulo lwemiwandimali ezizinziweyo ze-Mididididi ezizidididididi eziziweyo, ezidityani, ezithe ukukhuthulwayo, kwaye kusetyenziswa kwimizwa

Iziganeko zembali zivavanye iziganeko eziphinda-phindiweyo ze-ACA imodeli yemithetho yolawulo yezonyango. Umzekelo, ukusekwa kweMedicare kunye noMedicaid ngo-1965 kwandisa indima kazwelonke, kodwa ulawulo lweMedicaid lwashiywa ngabom lulawula. Kutshanje, ulawulo luka-ACA lwaxhaswa ngokomthetho-mntwini njengomthetho-siseko wokusebenzisa amandla oMbango ka-Masidem [FU:0] u-National Federation of Independent Business v. USebelius (20202), kodwa iNkulo yathi kwakhona igweba ukuba urhulumente worhulumente worhulumente akakwazi ukugweba ukuthi ukhetha ulwando lweMédid mer esekhoyo ngokufanelekileyo. Isigqibo esinjalo sokulawula ulawulo oluqhubekayo phakathi kolawulo lwamanyuso.

Umthetho ongundoqo ochaphazela ulawulo lwezonyango lukaRhulumente

Imithetho emininzi engundoqo karhulumente iye yayiguqula kakhulu inkqubo yonyango lwaseburhulumenteni. Le mithetho imisela imigangatho yokugquma, yokukhusela abathengi, neyokuxhasa abathengi, ngoxa idala iindlela zokubhetyebhetye-bhetye okanye zokuxhathisa kukarhulumente.

ISebe linika inkxaso-mali

Ngo-2017, i-ACA imela eyona inguqulelo yezonyango yesizwe eninzi ukususela kwiMedicare kunye neMedicaid. Ulungiselelo lwayo olusembindini luquka: (1) ugunyaziso lomntu ngamnye (ngokufanelekileyo lupheliswe yi-Thekis-Cuts kunye neMisebenzis Act ka-2017), (2) ukusekwa kwe-inshorensiniwarensi yezempilo, (3) inkxaso-mali yabantu abaphantsi nabaphakathi, (4) ii-inshorensi ze-inshorensi ezinjelweyo njengoko iziphumo ziqinisekisiweyo kunye nomlinganiselo woluntu, kunye (5) ulwando lweMedicadifidial lwe-Micains ukuya kwi-13% yomgangatho wobuhlwempuzelo. ASAID ifuna ukuba itshintshise okanye ingatshintshiswana okanye ingagqibeli kwimali ekhoyo kakhulu. Ngokufunyaniswayo, i-MFogneat.[10]

I-Medicaid ne-CIP

Inkqubo ye-Medicaid, eyamiselwa ngowe-65, yinkqubo yempilo edityanisiweyo karhulumente enika inkcazo kubantu abafumana imali ephantsi, iintsapho ezinabantwana, amabhinqa akhulelweyo, abantu abadala nabakhubazekileyo. Ama-United States kufuneka anamathele kwimigangatho encinane ye-omilition kwaye agubungele iinzuzo ezithile eziyimfuneko (umz., iinkonzo zoogqirha, iziko lonyango lwasebe lasebe abalupheleyo, ukunyamekela abalupheleyo), kodwa anethuba elibalulekileyo lokugubungela abantu abakhoyo neenkonzo ezingobafakileyo, kunye nokubeka intlawulo lwemali. Abantwana beHeal Health Is Issuranced Program (CHIP), eveyilelwe ngo-1997, ngokufanayo inika imali elinganayo yokufihla abantwana kwimivuzo ezifumanelwayo zeMedid kodwa ngaphantsi kwemiqatha yemo yombuso. Zombini iinkqubo zocwangciso lwe-AP)

I-Inishorensi yempilo eNgabandakanywayo neNkxaso (HIPAA)

IHIPAA, esungulwe ngowe-1996, iquka amalungiselelo achaphazela inkqubo karhulumente ngqo. UMthetho wemfihlelo umisela imilinganiselo yesizwe yokukhusela ulwazi lwempilo olubonakalayo, imisela imithetho yezonyango ebuthathaka kakhulu kodwa ivumela amazwe ukuba agcine okanye amisele imigaqo engqongqo. Amazwe aye asebenzisa obu bugxwayiba ukuze adlulise imithetho efuna ulwamkelo olongezelelekileyo lwemvume yokuba nomonde kwiingxelo ezithile ezichukumisiweyo (umz., ukuma kwengqondo, ubume beHIVH). I-HIPAAAD SMPIS ibonelela imigaqo egunyazisa ukuthengiselwa kwezixhobo ze-elektroniki, nto leyo emele ifake kwiinkqubo zawo ze-Medicaid kunye neenkqubo zempilo kawonke. Ityala lomntu ongengongongongongongomnye unokuba buhlungu, uzuza imongangenisethi yooventi yemali egcina imali kwingeniso.

i-Medicare

Njengenkqubo yorhulumente egquma abantu abaneminyaka engama-65+ kunye nabantu abathile abancinane abakhubazekileyo, iMedicare ayibandakanyeki ngqo kulawulo lukarhulumente. Noko ke, inempembelelo enzulu kwiinkqubo zolawulo lwezonyango lwezombuso. Umzekelo, iMadicare inkcitho yemali yesibhedlele kunye neyoogqirha (ngokukhethekileyo isebenza njengemiqathango yezibhedlele ze-inshorensi ezizimeleyo kwaye ngokufuthi imisela imigangatho yama-de comporence. Amazwe axhomekeke kwiMidica ekwanelisa abantu abanokukwazi ukugquma (abo bafanelekela iMedicare neMedicaid) kwiinkqubo zokusebenzisana.

Eminye Imithetho Ebalulekileyo YamaPhondo

Inkqubo yokwandiswa kwemithetho yezonyango yesizwe yongezelelweyo. I-EMTALT Act yokhuseleko lonyango kunye noMsebenzi (EMTALA) ifuna izibhedlele ezithatha inxaxheba eMedicas ukunikela inkxalabo yexesha likaxakeka okanye amandla omguli okuhlawula, ukubeka umthwalo kwizibhedlele ezikhuselekileyo ze-Ukhuseleko lwezonyango. [[FLT:]] UMthetho we-I-HAYITH[ ka-2009] ukhuthaza ukusetyenziswa kweengxelo zempilo ye-elektroniki (EH) ngoncedo lwemali, kwaye ukwandisa oku kuxhomekeke ekunikezelweni kolwazi lwazonyango. [FF] [5]

Ulwahlulo Lolwando LweMedicaid: Isifundo Setyala Kwimeko Emanyeneyo

Ulwando lwe-medicaid phantsi kweACA lungumzekelo ophambili othe ngqo nowokungavisisani wempembelelo karhulumente kwinkqubo karhulumente. Ulwandiso lwandisiwe kubo bonke abantu abadala abafumana ingeniso okanye ngaphantsi ko-88% kumgangatho wobuhlwempu obumanyeneyo (FPL), norhulumente wesizwe ekuqaleni egubungela iindleko zee-100% zeendleko zabaqeshwa abatshayo, ngokuthe ngcembe ukwanda kwemali ukuya kuma-90% ngo-2020. Amazwe anwebekileyo abona uhliso oluphawulekayo kwimiba engakhange iphumelele, unyuso kwimibanzo ethintelweyo, kwaye acuthe iziphumo ezithe kra iziphumo zokungacotho. Umzekelo, uhlolisiso oluye lwafunyanwa yiNgxongo yemali efana nolwando oluthe kratya kumazwe amalunga nama-5% asezantsi phakathi kolawulo oluphakathi konyaka ka-20202017, kunye nolwando oluthe kokugqibela, kunye neziphumo ezithe kokugqibela.

Ngokuchaseneyo, i-10 ithi ayizange yande ngokubhekiselele kwimiba emikhulu yokugquma izithuba ezithe kratya eMzantsi naseMbindini. Ngokutsho kweKaiser Family Foundation, malunga nomntu osisi-1.9 wezigidi zabantu abadala abangengobantwana bawela kwisithuba sokugquma, befumana intlawulo encinci kakhulu ukuba bafaneleke kwi-ACAIA REARGATION (iiindawo eziqala kwikhulu zeFL) kodwa ngaphezu kwemida yemali ephantsi kakhulu yelizwe labo (osoloko bengaphantsi kwama-50% yeFPL kubantu abadala abangenabantwana). Aba bantu badla ngokungenayo ingeniso engenakuthengwa, nto leyo ekhokelela kwinani eliphezulu letyala lezezonyango, ukulibaziselwa, ukugcinwa kwezibhedleleko ezithintelayo. Ezibhedlele zezi zithwala iingxaki zemali ezingaphezulu kakhulu ukusuka kwinkathalo ezikhoyo zemali ezihlala emaphandleni, nezinye izibhedlele ezihlala phantsi, kunye neemfutho ze-Metac.

Isigqibo sokwandisa sisekwe nzulu kwezobupolitika nakwezoqoqosho. Amanye amaphondo, njengoIdaho noNebraska, anwenwe ngeendlela zokuthatha amanyathelo e-odoli nangona bechase i-odoli. Amanye, njengoTexas kunye noFlorida, aye akwala ngokuqinileyo ukuchaza iindleko zeendleko ezinxulumeneyo. Nangona ulwandiso lwamazwe lungu-90% kwaye ukuchaswa kwendlela yemiqathango ejongene noko bakugqala njengeqhathayo. La maphondo amaninzi athe afumana ezinye iindlela: Arkansatism wafumana umxhasi wemali yeMedicaid ukuthenga imali ye-inshorensi (Medica) kwi-Mdicsss (id Office); ulwandiso lwase-ooo-oooooooooooksigcidentineyo; kunye nolwando olunolwamqobo lwe-Utacitylllll. Ezi zizinto ezininzi ze-Fog.

Impembelelo yeMithetho yoManyano kwiMisebenzi yoNcedo-ntle yoRhulumente

Ngaphandle komthetho omkhulu, ingqokelela yemithetho eninzi emisela imigaqo elungelelanisa ngokuthe ngqo imisebenzi yonyango lwezonyango lwesizwe. Le migaqo idla ngokumisela imilinganiselo encinane yomgangatho, ukhuseleko, kunye neyobuqu ekufuneka inyanzeliswe, ngeli xesha ivumela amazwe ukuba amisele iimfuno ezongezelelekileyo. Umzekelo, iimfuno ze-CMS zokuthabatha inxaxheba kwiMedicare ne-Medicaids, amakhaya asebe lasekhaya, amasebe empilo, kunye nabanye abasebenzi bezonyango. Amazwe anetyala lokuqhuba uhlolisiso kunye nokuthobela; ukusilela ukuhlangabezana nemilinganiselo yesebe ekhoyo kungaphumela ekupheliseni inkxaso yemali. Oku kunika urhulumente onamandla abaphathi beminxela yemigqesho yesizwe ukunyanisa iibhedreji zemali zesizwe, kodwa kwakhona abeka iindleko zolawulo kumaziko esebe besizwe, nto leyo enokuthi isetyenziswe phantsi koohlolonke.

Enye indawo ebalulekileyo ngumgaqo we-inshorensi yempilo. I-ACA efunekayo ukugquma iingenelo eziyimfuneko zempilo (EHBs) kwiimarike ezizodwa nezeqela elincinane, kodwa amaphondo aneziqumrhu zokuchaza ezona ingenelo ziqukiweyo. Ngenxa yoko, iinzuzo zempilo ezibalulekileyo zahluka-hlukeneyo ngurhulumente; umzekelo, amanye amazwe ayayalela ukugutyungelwa konyango lokungaqhami, utyando lobunzima, okanye unyango lwe-autism, ngelixa ezinye zingabi. Ngokufanayo, imithetho yolawulo lwelahleko yezamayeza (MLRs) ifuna ukuba abaxhasi bachithe ubuncinane be-80% (iqela elincinane) okanye 85% (iqela elikhulu) lemiqatha) lemiqatha yeenkcitho yemiqathango zonyango nomgangatho wonyango, kodwa i-inshorensiventi ye-ondrensiss, kodwa i-odool ezi zixhasa ezi zibonelelo ze-othenti.

Ukhuseleko lomntu osisigxina nokhuseleko logcino-lwazi lusaqhubeka lusebenza ngokudibeneyo. I-HIPAA’s Privacy Lage imisela umgangatho wesizwe, kodwa amaphondo aye amisela imithetho eyongezelelekileyo yolwazi lwemfuza (GINA), iingxelo zempilo yengqondo, kunye ne-HIV/AIDS. Okwangoku, umthetho we-HITECH Act wokwazisa ufuna ukuba kubekho izinto ezigqunyiweyo ukuze kwaziwe abantu ngabanye, i-HHHS, yaye ngamanye amaxesha amajelo ezinto zogcino-lwazi ezaphulayo. Amazwe amaninzi anemithetho yawo yokwazisa engqongqo efuna ixesha elingqongqo okanye iziphumo zeemfuno zemali, nto leyo ebangela ukuba izibonelo eziqikelesiweyo zilungele ukulawulwa kwemigaqo-miqatha. Ngaphezu koko, i-21 Centumbers Ceting Acts Act izigwebo ezithintela ukutshintsha utshintsho lwe-elektropidem, iMidid elungele ukuqinisekisa iinkqubo zawo ezikhoyo.

Impikiswano Eqhubekayo: Amalungelo KaRhulumente Achasene Nolawulo Lwamasebe

Uxinezeleko oluphakathi kwamalungelo karhulumente kunye nolawulo lukarhulumente luyimbambano engapheliyo kwezobupolitika zezonyango zaseMerika. Abaxhasi bolawulo lorhulumente baphikisa ngelithi oorhulumente basekuhlaleni bakwisikhundla esingcono sokusabela kwiimeko ezikhethekileyo zabemi, zezoqoqosho, kunye nenkcubeko yabantu. Bakhomba kwilingelo lwezombuso olunempumelelo njengee-Oregon (CCOS) ze-Micaid, ezidibanisa umzimba, isimilo, kunye nokunyanyekelwa kwamazinyo kwaye zifikelele iindleko kunye nenkqubela-ntle. Amazwe ayakwazi ukusebenza njengeeprojekthi zedemokhrasi, imigaqo yokuvavanyanisa imigaqo enokuthi kamva isetyenziswe ngokwesizwe simisela utshintsho lwezempilo lwama-ACA. Ngaphezu koko, uphuhlisorhulumente uyabuphepha iingozi zobugxandelo lwelizwe elinye eline-entlobo-entlobo-entlobo-entlobo ze-ogromaviniat zenza amaqela asebenza kwiimeko zasedologlobalk ango.

Ngokuchaseneyo, abameli bolawulo lukarhulumente baphikisa ngelithi ukushiya ukhathalelo lwempilo kumazwana luqhubekeke kwaye lude luzinzise umahluko. Iziphumo zempilo eUnited States zahluka kakhulu ngokwemeko: uqikelelo lobomi lusuka kwiminyaka engama-75 eMississippi ukuya kuma-80 eHawaii naseCalifornia; amaqondo okufa kweentsana kunye nokuxhaphaka kwezifo ezingapheliyo kwakhona kubonisa ukwahlukana okuthe ngqo. Yindima enamandla kuphela yesizwe engaqinisekisa ukuba ukufikelela okungaguquguqukiyo kwizinto zongxamiseko, ukuvalelwa kwemiqatha, ukunqandwa kolwano olusekelwe kwiimeko ezikhoyo, kunye nemilinganiselo entle yamakhaya asebe eliphethe. Ulawulo olulungelelanisiweyo luye lubonakala ngokukhethekileyo ngexesha longxamiseko lwempilo yasekuhlaleni, njengoko kuboniswa yi-COVID-19, xa kukhutshwa iziphumo ezithengingqiniswe ekuvavanyweni, ukudityaniswe, nokusetyenziswa kwemiqatha kwemiqatha.

Amadabi asemthethweni angolawulo lukarhulumente wezonyango axhaphakile. Iinkundla ziye zavavanywa kwimibandela esukela kwimiqathango yokukhutshwa kokuqhomfa (ukudityaniswa kweSihlalo seHyde noqingqo-mali) ukuya kutsho kumthetho-siseko wogunyaziso luka-ACA kunye nolwandiso lwe-Medicaid. INkundla ePhakamileyo yowama-2012 iqinisekisa ukuba ulwandiso lwe-ACAid alunakunyanzeleka ukuba lugcinwe lunengqiqo yesizwe enyanzelekile, kodwa olulandelayo luquka ukulawulwa kwemithetho ye-Rhulumente yexesha elizayo. [[FLT:] uBurwelll[[FLT:] [20] (20] u-2015] ukulondoloza irhafu yowiso-ncomo lwerhafu kuwo onke amazwe, ngokufuthi luye luqinisekise ukuba igunya likarhulumente lokuyila nokuxhasa inkqubo yemali yezentlalo-mali. Le ndawo ibangela ukungenzelelwa kweemeko zexesha elizayo.

Uhlolisiso Lwetyala: Iimpendulo ZeRhulumente Kumthetho Wesizwe

Xa sihlolisisa indlela amazwe angqalileyo aye asabela ngayo kwimithetho yezonyango yesizwe, sifumanisa ukuba kukho umahluko omkhulu kwezopolitiko, kwezoqoqosho neentswelo zasekuhlaleni.

EKhalifoniya: Ukufikelela Kwindlela Yokwandisa

IKhalifoniya iye yaqhubela phambili ngokuqhubekayo imida yenkqubo yonyango lwaseburhulumenteni. Yandisa uMdicaid (Medi-Cal) kwangoko nangonya, kuquka ukwandiswa kwengxelo yabatsha abatsha abangaxelwanga (ukutyhubela iminyaka engama-26) ukususela ngo-202020 kunye nayo yonke ingeniso ephantsi yabantu abadala abadala abangabhalwanga phantsi kwengxelo yabo ngo-2024. IKhalifoniya iqhuba i-Medicaid yayo ngokwayo (iMedi-Cal), ekwayimodelifafa imodeli yesizwe yokufumana nokungena exesheni. Umthetho wesizwe ngo-2023 wasungula icebo likawonke (IKhalifoni yenze ishishini encinane) kwaye ibeka amaxhoba okusetyenziswa kweziyobisi eziphantsi kwemiqatha zeziyobisi ezisetyenziswa ngurhulumente. IKlifoni ye-colinia iquka iimfuno zenkciso zenkciso zenkciso zemali ezikhoyo zemali ezikhoyo.

ITexas: Imodeli Echasayo

Ngomahluko omkhulu, iTexas inesinye semigangatho ephakamileyo engakhange isetyenziswe kwilizwe (ngaphezulu kwe-18% njengo-2023), ubukhulu bemeko igalele ukwandisa iMedicaid phantsi kwe-ACA. Nangona izama ngokuphindaphindiweyo ukumisela imithetho kunye nenkxaso ye-bipartisan evela kwezinye iinkokeli zasekuhlaleni, ulwando luhlala lungenakuthengwa ngokwezobupolitika. ITexas ixhomekeke kwintelekelelo yemali exhotyiswe ngurhulumente, kunokuba ivelise eyayo. Umbuso uye wagxininisa kwiindlela ezingezinye: ukuqinisa amaqula aphezulu e-riskid kwiimeko ezikhoyo (indawo ezikhoyo phambi kwe-ACA), ukunyuselwa kwemeko yempilo yasekuhlaleni, ukusetyenziswa kwexabiso elikhuthayo elikhuthayo kwimiqatha lemiqatha lemibutho yemibutho yemichizalo. Noko ke, ukuswela kwemiqatha kwemiqatha yezonyango, ukusetyenziswa kwemali esetyenziswa kwemali esetyenziswayo ekulawuleni kwe-Texane.

INew York: IFederal Framess eyandisiweyo

I-New York ibonisa enye indlela: isebenzisa izichasi-mali zolawulo nohlobo oluthile lwesizwe ukuze yandise ukugutyulwa okungaphaya koko kufunwa ngumthetho wesizwe. Umzekelo, inkqubo yeMedicaid yaseNew York yenye yezona zinto zikhululeke kakhulu kweli lizwe, kuquka ukunikezelwa kweenkonzo zexesha elide kunye nezixhasayo, inkathalo yobuqu, kunye nempilo entle. Ilizwe lisebenzisa utshintshiso lwalo (Izwe lezempilo le-Mdica) kwaye liye laba yinkokeli ekusebenziseni inkxaso engundoqo yempilo ye-ACAISPA, ukongezelela imiyalelo efana nonyango olunika ukungazaliseki nokunceda abantu bendlebe. I-New York isebenzisa kwakhona i-Restory Sy Sy Sy Insinfacendice Incowation (DRIP) i-ocercerrencesss, i-ognorencesssss, i-operance, i-operal-omativey i-o yoncedo ye-ognentinentine.

IFlorida: Ukufumana Abantwana Abangabo Kunye NeeWaivers

IFlorida ayiyandisanga inkqubo yeMedicaid, kodwa isebenzisa ezinye iinkalo zomgaqo-nkqubo wezonyango lwaseburhulumenteni ngokwayo. Imo yephondo iqhuba izicwangciso zayo ze-Medicare Freeation (ngeentlangano ezilawulwayo) kwaye ifumene izixhasi zokulungisa kwakhona inkqubo yayo yeMedicaid kwisixokelelwano sokunyamekela abasebenzi abalawuleke ngokupheleleyo. IFlorida iqhuba utshintshiso lwezonyango kodwa iqhube ukunciphisa ingeniso olulinganiselweyo kwimiqathango yemali. Imo ibingumthathi-nxaxheba osebenzayo kwinkqubo ye-1115 ye-raver, ifuna imvume yokusetyenziswa kweemfuno kunye neenkqubo zoncedo ezithengwano, nangona imigudu emininzi yomsebenzi iye yavalwa enkundlekweni. Indlela yokusebenza yeFlorida ibonisa ukuthandwa kwezisombululo ezisekelwe kwinkcuku

Izifundo ezisuka kwi-COVID-19 Pandemic

Isifo sombutho wesizwe esivavanywe ngokuvavanywa kwe-COVID-19. Urhulumente wacela uMthetho weNkonzo yoLuntu yempilo ukuba unikezele iinkqubo ze-Emergency (PHE) isindululo sokuba kuqaliswe amatyala eMedicara, uMdicaid, kunye ne-inshorensi yangasese, kuquka ukukhutshelwa okuqhubekayo kweMdicaid (ukungaqhubeki kwemeko”) kunye nokuphuculwa kwemeko yesizwe ye-Medicaid (ukungaguquguqukiyo) kunye nokuphuculwa kwentsebenziswa kwemeko ye-orhulumente ye-orhulumente ye-medicaid iinkqubo ze-yongasayi kwe-yokuba ne-Exponen. I-bicdries (ethentiage engaphezulu ye-65). I-United States yazama ukwamkela ezi zinto ezithenjiweyo ngexesha lokuvavanywa, ukusetyenziswa kwe-amfazanya, ukuthintela i-zibomzakhono, kunye nokusetyenziswa kwe-Phirlivel.

Imibandela Yexesha Elizayo Yemithetho Ephathelele Ulawulo Lwesizwe

Ulwalamano phakathi kwemigaqo-nkqubo yonyango karhulumente neyorhulumente luya kuqhubeka luguquka ukuze kuphendulwe ukutshintsha kweemeko zobupolitika, iingcinezelo zemali kunye neengxaki zempilo ezivelayo.

Ii-Shifts ezinokwenzeka kumgaqo-nkqubo woFederal

Isiphumo sonyulo lwesizwe siya kuchaphazela ngokuphawulekayo ukhetho lwesizwe. Ulawulo lwexesha elizayo lungafuna ugqumo jikelele ngokhetho lukawonke-wonke okanye kwaneMedicare kawonke wonke, nto leyo eza kucinezela ngokuphawulekayo ulawulo oluthe tye lunika urhulumente uTshintsha-guquko olungaphezulu ngezipho ezizithintelo zeMedicaid okanye izithinteli ezivumela amazwe ukuba amisele iimfuno zomsebenzi, asebenzise iinkcitho, okanye ayile ezinye iimo ze-inshorensi. Ingxoxo eqhubekayo ngomlinganiselo wetyala noqingqo-mali ingacutheza kwixabiso elingurhulumente le-Medicaid okanye ukuhliswa kwemali ehlawulwayo, enyanzelela ukuba amaxabiso okanye akhutshwe okanye ancitshiswe.

Ukwanda Kweengxaki Zempilo

Ingxaki yempilo kawonke-wonke elandelayo (nokuba isifo esasulelayo, ubhubhani osulelayo, iziphumo zemozulu, okanye ukunyuka kwempilo yengqondo) iza kuvavanya kwakhona ukusebenza kwentsebenziswano yesizwe. Izifundo ezikwi-COVID-19 zingakhokelela ekufuneni iinkqubo zonyango olusembindini, kuquka imilinganiselo enyanzelekileyo yorhulumente yokuqokelela ulwazi kunye nokuhlola, okanye ukuqina kwemeko ngokuzimela ngokwasezimalini. Umthwalo okhulayo wesifo esinganyange-Atlanti kunye nowabantu abalupheleyo uya kubangela ukuba kube nobunzima bombini obumayela neMedicaid, incoko engakumbi edibanisa izihloko-zingcingo zogcino-lwazi kunye neMidida ye-operaid, okanye ukusetyenziswa kwemali elungele ukuxhamkelwa ngokweemali elungeleneyo kwi-entlalo-eHofisi yempilo ye-Fredictic Health Yoographic Areat)

Ulungiso-mthetho oluLetlwe

Amazwe aza kuqhubeka ezama iindlela ezintsha: umgudu wokuyila inkqubo yokuhlawula enye kumgangatho wesizwe (SB 770 ukwenzela inkqubo yezempilo eyomeleleyo) ajongene nemiqobo eyoyikekayo, kodwa amanye amazwe angasukela umboniso kawonke-wonke okanye umnikelo womnikezelo. Iimodeli zexabiso elisekelwe kwimibutho ejongene nemali exhotyisiweyo, njengeendleko zononophelo-mali kunye nentlawulo exhotyisiweyo, sele ziphuhliswa ngabaququzeli borhulumente kunye nabaphathi-nkqubo yorhulumente. Amazwe angakhuphisana nabaceli-mali abazama ukuvavanya imo entsha, njenge-Medicaid ye-oregon ukuze kuqinisekiswe indawo yokuhlala nokuzinziswa kwempilo, okanye ulwanongezo lwe-Medicaid oluces. Ezi zingcebisiso ziveza ubungqina obunokuthi bazise inkqubo yesizwe.

Iintsuku-mali ezisemthethweni nezingokomGaqo-siseko

Uqikelelo olungaphaya kwe-ACA luyaqhubeka; umzekelo, ukucelw'ucelomngeni kugunyaziso lomthetho-siseko womntu ngamnye . ICalifornia v. Texas [202] [201] yagxothwa kwiindawo ezimileyo, kodwa amanye amatyala ajolise kwii-access zothintelo lwe-ACA, ugunyaziso lokuthintela, kunye nemithetho ye-inshorensivel ye-inshorensivel isebenza kwiinkundla ezisezantsi. Ngokufanayo, ukusetyenziswa kwemithetho yombuso yokukhupha isisuko, ingakumbi emva kwemida ye-Dobbs v. Jackson’s Health Organization of Health [202], ivuse ingxuba ngxolo-mali yezentengo yemali (njengoMdibanisombululo) kunye nendima ye-mali ye-ovementat) ekukhuseleni kwemiqatha lemiqatha yemeko yemeko yemeko yempilo.

Isiphelo

Impembelelo yemithetho karhulumente yezonyango lwaseburhulumenteni inzulu, ijikelele, kwaye isoloko itshintsha. Ukusuka eMedicaid kunye neeinshorensi zentengiso kwimigangatho yobulunga kunye neempendulo zongxamiseko, ukusetyenziswa kwemigaqo karhulumente kunye nobuchule besizwe kudala amathuba okutshintsha kunye nomngcipheko wokungahambelani. Ukuqonda olu lwalamano lubalulekile kubafundisi, abafundi, abenzi bemithetho, kunye nabemi abazama ukujika imigaqo yezonyango eMelika. Njengoko umhlaba uqhubeka uhamba-hamba-hamba-hamba ngezobupolitika, ngobuchule bobugcisa, kunye nengxoxo phakathi kwemeko yorhulumente kunye nabadlali abajongeneyo iza kuhlala iphakathi kokuqinisekisa ukuba ukukhathalela impilo kuyafikeleleka, akunaku, nokungabi nakwenzi kuyo yonke into. Ucelomngeni olugqibeleleyo alukho ekukhetheni indlela yokulawula inkqubo yolawulo lwezonyango okanye ukuphatha ulawulo olulungelelwanolawulo lwelizwe, kodwa luqhubekeka ukulungiselela ukusetyenziswa kwendlela elungele ukulawulwa kwemeko kumgangatho wolawulo kulawulo kulawulo lwemeko, urhulumente ngako.