Ubuhlobo phakathi kwemithetho kahulumeni nezimiso zikahulumeni bumelela ukushukuma kweminyopheko kwesimiso sombuso waseMelika, ikakhulukazi enkabeni yokunakekela impilo. Umthetho we-Federal uhlela izinhloso ezibanzi zesizwe nezindinganiso ezilinganiselwe, kuyilapho ohulumeni bakahulumeni benegunya elikhulu lokusebenzisa, lokunezela, noma kwezinye izimo, bemelana nalezo ziqondiso. Lokhu kuveza isimiso sezimiso zezokunakekela impilo esihluka kakhulu ezizweni, esithinta yonke into kusukela kwesithiwa nomshuwalense wemali kuya esimweni esiphuthumayo sempilo nesodwa esibekelwe isineke. Ukuqonda indlela imithetho kahulumeni emile ngayo iklanywe ngayo yi-"nezinga eliphansi elibalulekile ekuqondeni isimiso samanje nesomthetho wezempilo we-U.. Lesi sihloko sihlola izindlela zokulawula kwezempilo, izimiso zezempilo ezibangelwa umthetho womphakathi, ukuhlanganisa izingxoxo eziqhubekayo, nenkulumo eqhubekayo yenkulumo ephakathi ye-Washington.

Ukuqonda Ukulwela Impilo

UFederalist eUnited States wahlukanisa amandla phakathi kukahulumeni wesizwe nohulumeni abangu-50. UMthetho-sisekelo unikeza iSishaya-mthetho amandla ahlelwayo, njengegunya lokulawula ezohwebo zesifundazwe kanye nentela nokusebenzisa imali ebanzi. La mibuso inikeza isisekelo somthetho-mthetho kahulumeni wezokwelapha i-Medicare, Medicaid, futhi umbuso ohlangene u-Affordable Care Act (ACA),. Ngesikhathi esifanayo, iSivumelo seTenth Demendement sokulawula wonke amagunya angawaphathi ngokusemthethweni uhulumeni, kuhlanganise namandla angokwesiko amaphoyisa okuvikela impilo, ukulondeka, ukulondeka, nenhlalakahle yezakhamuzi zawo. Lokhu kubusa okuphindwa kwemithetho ehlangene kusho ukuthi iMishuwayo elawula imishuwayo, i-mishuwasempilo, ukuthuthwa kwempilo, ukuphatha izikhali, nokusebenza kwezempilo.

Isimiso sokunakekela impilo siyisibonelo sencwadi yenhlangano ye-buthorist, lapho womabili amazinga kahulumeni ehlanganyela khona imithwalo yemfanelo, ngokuvamile ngezimali zemibandela nangezinhlangothi zohulumeni. Ngokwesibonelo, iMedicaid iyisimiso esixhaswa izimali ezihlangene lapho uhulumeni umisa khona i-eggrance futhi usiza khona iziqondiso ezibanzi futhi usebenzise iziqondiso kodwa uhulumeni unikeza isimiso futhi ube nosizo lokuhlela izimiso zawo zokuzilungisa ngokuziphathisa ngokwawo. Ngokufanayo, i-AA inshonethilivespita ye-mshuwalense yakha izindinganiso ezisemshuwale, kodwa iyaqhubeka nokulawula izikhungo zawo siqu zomshuwalense, nokusebenzisa imingcele yemishuwalensela. Le dluyawu ingenza ukusungula izinhlelo ezintsha zokukhokha noma ukukhokha, kodwa ingenza nezinguquko, njengoba kufakazelwa ngeMidid ezindaweni ezihlukene ezisezweni ezisezweni ezihlukene.

Izenzakalo ezingokomlando ziye zayihlola ngokuphindaphindiwe imingcele yemithetho kahulumeni ekunakekeleni impilo. Ngokwesibonelo, ukumiswa kukaMedicare noMedicaid ngo-1965 kwandisa kakhulu indima kahulumeni, kodwa ukuphatha kwangempela kukaMedicaid kwashiywa ngamabomu ukuba kuthathwe. Muva nje, i-ACA umthetho kahulumeni wabekwa njengomthetho-sisekelo wokusebenzisa amandla entela kaHulumeni [FULD:0] eMEDIC [FURT] National Federation of Independent Business v. USebelius[FLT:] [20202], kodwa iNkanto enquma ukuthi uhulumeni kahulumeni wombuso kahulumeni ngeke ubeke isijeziso se-ACURCURC’ICA ngokususa zonke izimali ze-Medica. Isinqumo esikhona esingokwenzuzo. Eso sigcizelela ukubusa kwesinqumo sombuso oqhubekayo.

Imithetho Eyinhloko Ethinta Ukuphathwa Kwempilo KaHulumeni

Izimiso zikahulumeni eziningana ezinkulu ziye zayishintsha kakhulu indlela yokunakekela impilo kahulumeni. Lemithetho imisa iphansi ukuze ihlotshiswe, isivikelo sabathengi, nezindinganiso zokunakekela abathengi, kuyilapho yenza nezinqubo zokuvumelana nezimo noma ukumelana nomthetho.

UMthetho Wokunakekela Ongafinyeleleki (ACA)

Ngo-2017, i-ACA imelela inguquko enkulu kakhulu yezokwelapha yamazwe kusukela eMedicare nase-Medicaid. Izinhlelo zayo eziyinhloko zihlanganisa: (1) ukugunyaza komuntu ngamunye (ngokuzenzakalelayo kuqedwe yi-Thekiscs Cuts ne Jobs Act ka-2017), (2) ukusungulwa kwentengo yezomshuwalense yezempilo, (3) ukuxhaswa kwabantu abaphansi kakhulu, (4) izinguquko zemali yemali yomshuwalense eziqinisekiswe impikiswano nesilinganiso somphakathi, kanye (5) ukwanda kweMedicadidium eqekelekayo kuya ku 138% yesilinganiso sobumpofu bamazwe angohulumeni. I-AAid edingeka ukuba ishintshe imali yabo noma inzuzo ekhushushisiwe kakhulu. Ngokuka kakhulu i-MFelson ekhutshwe kakhulu izifundazwe kakhulu izifunda ezisezweni ezivamile. [Nnyunyunyuswa kakhulu]

IMedicaid neCIP

I-Medicaid, eyasungulwa ngo-1965, iyisimiso sempilo esihlangene nohulumeni wezwe esinikeza abantu abathola imali encane, imikhaya enabantwana, abesifazane abakhulelwe, abantu abadala nabakhubazekile. Amazwe kumelwe anamathele ezindinganisweni ezilinganiselwe futhi ahlanganise izinzuzo ezithile eziyimfuneko (umz., izinkonzo zesibhedlela ezibekelwe isineke, izinkonzo zodokotela, izikhundla zokunakekela asebekhulile, kodwa banenkululeko enkulu yokuhlanganisa imiphakathi engakhethi nezinkonzo, kanye nokubeka izimali zokukhokha. Izinhlelo zezempilo yezingane ze-Unishuwalensikhomu (CHIP), ezadalwa ngo-1997, ngokufanayo zinikeza imali elinganayo yokufihla izingane ngemindendende eholweni ephakeme kakhulu ngenxa yeMidica kodwa ngaphansi kwe-mome. Zombili izinhlelo zezinhlelo zihlelelwe ukuhlanganisa futhi zishintsha isilinganiso esihlangene (MP), uhlelo lwezemali nezinhlelo ze-spign.

UMthetho Wezokuphathwa Kwezigwegwe Zezempilo Nezokulandisa (HIPAA)

I-HIPAA, eyamiswa ngo-1996, ihlanganisa amalungiselelo athinta ngokuqondile isimiso sombuso. I-Amfiscial Lance imisa izindinganiso zesizwe zokuvikela ukwaziswa okubonakalayo ngokomuntu ngamunye kwempilo, inikeza imithetho ebuthakathaka kakhulu kodwa ivumela imibuso ukuba igcine noma imise izivikelo eziqinile. Amazwe aye asebenzisa lokhu kuvumelana ukuze adlulise imithetho efuna ukubekezelelwa okwengeziwe kwemvume yokuthola amarekhodi athile azwelayo (umzk., impilo yengqondo, isimo sesandulela sesandulela se-HIV). I-HIPAAAADSimplitiation inikeza futhi iziqondiso ezigunyaza ukuthengiselwa kwezimiso zawo zemishini yobuchwepheshe yezobuchwepheshe, okumelwe zifake ezimisweni zawo zezempilo yomphakathi. Izivumelwano zemvume zezincwadi ezithile ezingezona ze-ontaneti zingaba yingozi, ezingenisa imali emazweni asebenza ngokulandelana kwezemisebenzi yezemfundo.

IMedicare

Njengesimiso sikahulumeni esihlanganisa abantu abaneminyaka engu-65+ kanye nabantu abathile abancane abakhubazekile, i-Medicare ayihileli ngokuqondile ukulawulwa kwezwe. Nokho, ithonya elikhulu ezimisweni zombuso zokunakekela impilo. Ngokwesibonelo, amazinga okukhokha kukaMedica akhokhelwa isibhedlela ne-Medicaid (ngokukakhulu kakhulu) izinkonzo zesibhedlela nezodokotela ezisebenza njengezimakethe zokuqinisekisa futhi ngokuvamile zimise izindinganiso zokukhokha. Izwe futhi lithembele kuMedicare ukukhomba abantu abanezingalinganisi-kabili (abafanele iMedicare ne-Medicaid), ukuncishwa kwemali esetshenziswa ekunakekeleni abantu isikhathi eside nezidakamizwa ngenxa yalokho ngokomthetho. Ngaphezu kwalokho, iMidiaravers nombukiso (njengezinhlangano ezibonisa ukunakekelwa) zingasetshenziswa esizweni kanye nezinhlelo zokunakekelwa kwemindedia, ezithuthukisa ukunakekelwa.

Eminye Imithetho Yesifunda Ebalulekile

Isimiso sokunakekela impilo semithetho emisiwe kahulumeni esimisiwe. I-EMTA] Expandment Medical Treat and Labor Act (EMTALA) ifuna izibhedlela ezihlanganyela eMedica ukuba zinikeze ukunakekelwa okuphuthumayo kungakhathaliseki isimo somshuwalense wesiguli noma ikhono lokukhokha, ukubeka umthwalo ezibhedlela ze-meta eziphepheni. [[FLT:]] I-UFITCH Act ka-2009] ikhuthaza ukwamukelwa kwamarekhodi empilo e-elective (EH) ngamazamandla emali, futhi izinhlangano zezeneze ukuthengiselwa kwemisebe yempilo. [FLT] [F][3]

Ukwanda Kwesimo SaseMedicaid: Ukufundwa Kwecala Esimweni Esibucayi

Ukwanda kwe-Medicaid ngaphansi kwe-ACA kuyisibonelo esilandelana kakhulu nesiphithiphithi sethonya likahulumeni enkambisweni kahulumeni. Ukwanda kwanwetshwa kubo bonke abantu abadala abathola inzuzo ngesilinganiso sobumpofu obungu-88%, nohulumeni wezwe ekuqaleni ohlanganisa izindleko ezihlanganisa ikhulu lama-100% kubantu abasanda kubhalisa, kancane kancane kuya ku 90% ngo-202020. Amazwe anwebekile aye abona ukwehla okuphawulekayo kwenani elingakholeki, intuthuko ekunakekeleni isibhedlela, futhi anciphisa izindleko zokunakekela okungalawuleki. Ngokwesibonelo, ukuhlola okwenziwa yiNhlangano yeSimali Yomphakathi yathola ukuthi ukwanda kwabantu abadala abambalwa kuyancipha ku - 30% ngokuncipha ezizweni ezinganciphindwanga kakhulu, futhi kuthuthukiswe ukukhula kwezindawo eziphakathi kuka-2017.

Ngokuphambene, ishumi lisho ukuthi alikhuli kakhulu (amandla aphezulu kakhulu) eNingizimu nase Midwest·aneged) kodwa ngaphezu kwemali ehhhala kakhulu ewumbuso kaMedicaid Foundation, cishe abantu abadala abayizigidi ezingu-1,9 abangewona amadala abangaphansi kwenani lokukhokha i-Expansitial jountains, abathola amaphutha amancane kakhulu okuthola imali e ACAIA REA REA (inkulu kakhulu i-FL) kodwa ngaphezu kwemali ehhholo yombuso yabo ephansi kakhulu (ngokuvamile i-FPL kubantu abadala abangenabantwana). Laba bantu ngokuvamile abanakho ukukhokha izikweletu ezikweletini ezibizayo, okuholela ekutholeni izikweletu ezikweletini ezintengayo, ukunakekelwa okubambenezelelwe, nokuvinjelwa ezibhedlela ezibhebhebhe kulezindawo zokunakekelwa kwezimali ezinkulu kakhulu ezingokokunakekelwa yizinkwe emaphandleni, nezinye izibhedlela ezisemaphandleni zeze emaphandleni asemaphandleni, futhi ezinye izibhedlela zezelelwa iMedi.

Isinqumo sokwandisa sisezombangazwe kakhulu nezomnotho. Ezinye izigodlo, njengoIdaho noNebraska, zanwetshwa ngezindlela zokuthatha i-collet naphezu kokuphikisa kwemithetho. Ezinye, njenge-Texas ne-Florida, ziye zenqaba ngokuqinile ukukhomba izindleko zokwenza izindleko zokwenza i-90% futhi impikiswano yemibono kahulumeni imelene nalokho ezibhekwa njengobukhonya. Lamazwe amaningana alandele ezinye izindlela: i-Arthuanias wathola umsekeli wemali yokuthenga umshuwalenseli we-Medicaid ekuthengeni imali ebhananayo; ukwanda kwe-Indianayihlanganisa ukugcinwa kwemali yempilo ne-mali; futhi ukwanda kwe-Utah kuhlanganisa kuphela ukuhlanganisa i-100% FPL. La maruvers, agunyazwe ngaphansi kwe-1115 ye-Actal Act, abonisa omunye ungqimba-mniwe-Mdicidensials (id Minyango ye-MC) futhi agunyaza izimfuneko eziningi zomsebenzi.

Ithonya Lemithetho Yomphakathi Ekuhlinzeni Kwezokwelapha KoMbuso

Ngaphandle komthetho omkhulu, iqoqo lemithetho kahulumeni lihlela ngokuqondile imisebenzi yezokwelapha yezempilo. Lezimiso zivame ukubeka izindinganiso ezilinganiselwe zezinga eliphezulu, ukuphepha, kanye nokuzifihla okumelwe ziqikelelwe, kuyilapho zivumela amazwe ukuba abeke izimfuneko ezengeziwe. Ngokwesibonelo, izimo ze-CMS zokuhlanganyela izibhedlela ne-Medicaidd zinqumela izikhundla zezibhedlela, amakhaya asebezomuntu, izinhlangano zezempilo, nezinye izikhungo zokusiza. Amazwe anomthwalo wokuqhuba ukuhlola nokuvumelana; ukwehluleka ukuhlangabezana nezindinganiso zikahulumeni kungaphumela ekuqedeni izimali. Lokhu kunikeza uhulumeni owesizwe amandla okulawula izibhedlela zesizwe ezisezingeni eliphezulu, kodwa futhi kuphonsa izindleko zokuhlola kwezentengo zikahulumeni, okungase kube ngaphansi kwe-osethi.

Enye indawo ebalulekile i-aCA insurensingssion i-rectory yempilo. I-ACA idinga i-insurensis ukuze ihlanganise izinzuzo ezibalulekile zempilo (EHB) ezimakethe ngayinye nencane, kodwa izifundazwe zinenkululeko yokuchaza ukuthi yiziphi izinzuzo ezihlanganisiwe. Ngenxa yalokho, izinzuzo zempilo ezibalulekile ziyahluka ngokwezwe; ngokwesibonelo, amanye amazwe agunyaza ukukhokhela ukwelashwa kokungazali, ukulahlekelwa kwesisindo, noma ukwelapha nge-autism, kuyilapho amanye engasebenzisi. Ngokufanayo, imithetho esemthethweni yezentengiselwano enci (MLRs) idinga ukuba abakhokhi abakhonzi abasebenzisi okungenani amaphesenti angu-80 (inani elingu-80/iqenjana) noma 85% (iqembu elikhulu) lemishuwayo yemishuwamuselo yokwelapha nentuthuko, kodwa imishuwa kahulumeni i-morensialsuence i-od prosethi.

Imfihlo yesineke nokulondeka kokwaziswa kusalokhu kuyisici esiyisici. I-HIPAA’s Fisk Leap ihlela indawo ephansi yesizwe, kodwa izifundazwe ziye zamisa ezinye izivikelo zokwaziswa kwezakhi zofuzo (GINA), amarekhodi engqondo, nesimo sesandulela-HIV/AIDS. Okwamanje, umthetho wesaziso owehlulekayo udinga izinhlangano ezifihlwayo ukuze kwaziswe abantu ngabanye, iHHHS, futhi ngezinye izikhathi imithombo yezindaba yemininingwane yemininingwane ephukayo. Izifundazwe eziningi zinemithetho yazo yezaziso ephoqelela izimpawu eziqinile noma ezifaka izimpawu ezidiza imingcele yemithetho yemithetho eminingi. Ngaphezu kwalokho, i-Preast Centurs Act i-rect i-rect evimbela ukuncitshiswa kokwaziswa kwezempilo, i-Midica ephoqelela izinhlangano ezihlela izinhlelo zazo ezilandelanisa izimiso zezimiso zezimiso zezimiso ezisebenza phakathi kwazo.

Impikiswano Eqhubekayo: Izivumelwano Zamalungelo Abantu Base - United States Zokunakekela

Ukungezwani phakathi kwamalungelo ezwe nokuphathwa kwezwe kuyimpikiswano engapheli kwezempilo zaseMelika. Abasekeli bokulawula uhulumeni baphikisa ngokuthi ohulumeni bendawo basesimweni esingcono sokusabela ezimweni eziyingqayizivele zenani labantu, ngokwezomnotho, namasiko abantu babo. Bakhomba ekuhloleni okuphumelelayo kwezwe njengezinhlangano ze-Oregon ezihlangene (CCOS) ze-Medicaid, ezihlanganisa umzimba, isimilo, kanye nokunakekela amazinyo futhi ezithene izindleko nentuthuko. Izizwe zingasebenza futhi njengezindawo zokuhlola intando yeningi, izimiso zokuhlola kamuva ezingase zithathwe njengezesizwe ngesibonelo, umthetho kaMassachusetts 2006 wokulungisa impilo ye-ACA. Ngaphezu kwalokho, ukusungula kombuso kugwema izingozi zesilinganiso esisodwa sombuso wombuso ozingasebenza ngokumelene nezindawo ezisemadolomugwaneni noma ezihlukene.

Ngokuphambene, abameleli bezengameli zikahulumeni baphikisa ngokuthi ukushiya ukunakekelwa kwempilo kuqhubekele phambili futhi ngisho nokuhlukanisa. Imiphumela yempilo eUnited States ihluka kakhulu ngokwezwe: ubude beminyaka yokuphila busukela eminyakeni engu-75 eMississippi kuya kwengu-80 eHawaii nase California; amazinga okufa kwezinsana nokubhebhebhethekiswa yizifo ezingapheli kubonisa ukuhlukana okusobala. Indima eqinile yezwe ingaqinisekisa ukuthi isivikelo esiqinile esiqinile esikhona sokuthola izindleko zokunakekela, ukuvinjelwa kobandlululo okusekelwe ezimweni ezingaphambili, nezindinganiso ezisezingeni eliphezulu zamakhaya asebe abagugile. I-Federal ibucayi ikakhulukazi phakathi kwezimo eziphuthumayo zempilo zomphakathi, njengoba kuboniswa umqedazwe, lapho kusuka umbuso owehlaziswe ekuhlolweni, ukusakazwa, ukugonywa kwemijovo, nokusetshenziswa kwemali ehlangene kanye nezindawo ezidingekayo ezidingekayo ezimele ukuhlanekelelene.

Izimpi ezingokomthetho ezimayelana nombuso wezobuzwe zezempilo zivamile. Izinkantolo ziye zalinganisela ezindabeni ezisukela ezithi iSichibiyelo seHyde sifakelwe ekukhipheni izijeziso zemali yombuso (iSichibiyelo seHyde esihlangene nesimiso sikahulumeni) kuya ekusebenziseni komthetho-mthetho we-ACA kanye nonyuko lukaMedicaid. INkantolo Ephakeme ka 2012 iqinisekisa ukuthi ukwanda kwe-ACAId akunakuphoqelelwa ukuba kugcinwe ukwahlulela okubalulekile kwezwe, kodwa izinqumo ezilandelayo, kuhlanganise iNkosi ye-v. Burwell[FLT:] (20) [20] isekela ukukhokhwa kwentela okungantengozo zonke, ngokuvamile iye yaqinisekisa futhi igunya likahulumeni lokuhlela nokunakekela izinhlelo zempilo. Le ndawo yokwahlulela ibangela ukungaqiniseki ukufuna ukungezwa kwezimo zesikhathi esizayo.

Ukuhlola Icala: Ukusabela KukaHulumeni Emithethweni Yama - Federal

Ukuhlola indlela imibuso ethile eye yasabela ngayo emithethweni yombuso yezokwelapha kwembula ukuhileleka okuyinkimbinkimbi kwezombangazwe, ezomnotho, nezidingo zendawo.

ECalifornia: Icebo Lokwandisa

ICalifornia iye yasiqhubezela ngokuqhubekayo imingcele yesimiso sokunakekela impilo kahulumeni. Yandisa uMdicaid (Medi-Cal) kusenesikhathi futhi yandisa i-Media, ihlanganisa nokuhlanganisa ukukhokhela intsha engabhaliwe (ukuze idlule eminyakeni engu-26) kusukela ngo-202020 kuya kuleyo miphumela ephansi, futhi kuzo zonke izimali ezingekho zibhalwe phansi, abantu abadala abadala abashiywe yi-Scomputer yonke nge-2024. i-California yenza futhi isebenzisa umshuwalensela wayo wempilo (i-California), eyikhomba i-mfashoni yesizwe yokuphumelela nokuthola imali. Imithetho kahulumeni yasungula icebo lomphakathi (izeMisebenzi encinci) futhi ibeke izisulu zokuncishiswa kwemilaliso yezidakamizwa ngokuthanda ukudayisa imfutho yezidakamizwa ezindaweni zezidakamizwa ezisemoyeni. I-California ihlanganisa nezimfuneko eziqinile ze-semgadrome.

ITexas: Isibonelo Esimelana Nezithiyo

Ngokungafani okukhulu, i-Texas inenani eliphakeme kakhulu elingakholeki ezweni (ongaphezu kuka-18% njengo-2023), ikakhulukazi ngenxa yokuthi umbuso uye wenqaba ukwandisa i-Medicaid ngaphansi kwe-ACA. Naphezu kwemizamo ephindaphindiwe yokulawula nokusekela kwe-bipartisan evela kubaholi abathile bendawo, ukwanda kuhlala kungenakwezombangazwe. I-Texas futhi incike ekuhwebelaneni okulula, kunokuba udale ukwakhiwa kwayo. Izwe liye lagxila kwezinye izindlela: ukuqinisa amachibi aphezulu e-trikid abantu abanezimo (ekhona ngaphambi kwe-A), ukutshala imali ezikhungweni zempilo zomphakathi, futhi isebenzisa izindleko ezikhukhwakhwayo ezikhutshwayo ezimweni ezilinganiselwe zeMidiad. Nokho, ukuswela kwezindawo zokuzimela izibhedlele ezisezindaweni zasemaphandleni kusondelene, ukuhlanganiswa nokubulala kwempilo, ukuphatha izindleko zemali ezisezingeni lezigidi ze-Texane, ngaphandle kokumelana nokusetshenziswa kwenani elikhulu kakhulu kwemithetho, ngisho nokukhishwa kwenani lokukhishwa kwemithetho.

New York: Izakhiwo zeFederal Frames ezandayo

I-New York iveza enye indlela: isebenzisa iziphakamiso zikahulumeni kanye nokusungulwa kwezwe ukuze ihlanganise okungaphezu kwalokho okufunwa umthetho kahulumeni. Ngokwesibonelo, uhlelo lwe-Medicaid yaseNew York lungenye yeziphakamiso ezinkulu kakhulu ezweni, kuhlanganise nokuhlanganisa izinkonzo zesikhathi eside nenkxaso, ukunakekelwa komuntu siqu, nempilo yokuziphatha. Umbuso usebenza ushintshisa uqobo lwawo (Izwe Lempilo Yezempilo) futhi ube umholi ekusebenziseni i-ACA’s Health Seal Health Benence Beances, futhi wenezele izimvume ezinjengokwelashwa kwezehluleko nokuzwa kwezindlebe. Izinhlelo ze-New York u-New York usebenzise i-Reresy Sy Sy System Incentive Preary (DRIP) ukuhlela kabusha izinqubo ze-Micaid ngokunakekela nokunakekela okwengeziwe kwezwelo lonke i-ose.

EFlorida: Ukutholwa Kwezingane Ezingasolwanga Nabazali Abancane NabakwaWaivers

IFlorida ayizange yandise uhlelo lwayo lweMedicaid, kodwa iye yahlanganisa ezinye izici zenqubo yombuso yokunakekela impilo ngokwayo. Izwe lisebenzisa izinjongo zalo zeMedicare Convetion (ngezinhlangano eziphethweyo) futhi liye lathola iziphakamiso zokulungisa uhlelo lwalo lwe-Medicaid oluhlelwe ngokugcwele. IFlorida futhi yenza i-metain transfer elulayo kodwa iqhubeke isebenzisa i-medias ekunciphiseni izimali. Izwe liye laba umbambi qhaza okhuthele enqubweni ye-1115 ye-raver, ifuna imvume yokulungisa izimfuneko zomsebenzi nezinhlelo ezisekela izinhlelo zosizo, nakuba imizamo eminingi yomsebenzi iye yavinjelwa enkantolo. Indlela ye-Florida ibonisa ukuthandwa kwemikhankatho yezeli yezentengo ebanzi nentengo yokwandisa imfutho yezeko yezeko yezeko, kuyilapho isekelo yemali elawulwa futhi isalawulwa yimali ye-omiculomu ye-omistner.

Izifundo Ezitholakala Kuyi -COVID-19 Pandemic

Ubhadane lwe-COVID-19 oluye lwahlolwa kakhulu ukubambisana kwesizwe nohulumeni (isimo sezwe). Uhulumeni wanxusa i-Public Health Service Act ukuba inikeze izinhlelo zempilo ka- Public Emergency (PHE) isimemezelo sokuthi kwaqala i-Foperalities eMedicare, iMedicaid, nomshuwalense womuntu siqu, kuhlanganise nokuqashelwa okuqhubekayo kwe-Medicaid (isimo sokuzifihla”) futhi kwathuthukisa amazinga afanayo kahulumeni e-Medicaid (a amaphuzu engeziwe angu-6,2 e-FMAP). I-United States yazama ukwamukela lezizinto ezizimele ngesikhathi sokuzivivinya, ukuvimbela imingcele yazo yokugoma, ukuvala izifihla isikhumba, nokuvala izifihla intengo phakathi nenkampane yokulawula phakathi nezindleko zezentengo eziqhubekayo zezentengo yezelele, i-Phildul.

Izinkinga Zesikhathi Esizayo Zemithetho Ephathelene Nombuso

Ubuhlobo phakathi kwezimiso zombuso zokwelapha nohulumeni buyoqhubeka bushintsha ngenxa yokushintsha kwezombangazwe, izingcindezi zezimali, nezinselele zempilo ezivelayo.

Kungenzeka ama-Shifts kuMagule KaFederal

Umphumela wokhetho lwesizwe uzothinta ngokuphawulekayo izinketho zikahulumeni. Ukuqondisa kwesikhathi esizayo kungaqhubekisela phambili yonke indawo ngenkokhelo yomphakathi noma ngisho neMidiya amacala aso sonke, okungacindezela ngokuphawulekayo ukuzibusa kukahulumeni. Ngakolunye uhlangothi, ukuqondisa okuguquguqukayo kunganikeza izifunda ukuba zikwazi ukuvumelana ngisho nezimvume ezithintela izithiyo ze-Medicaid noma iziphakamiso ezivumela amazwe ukuba afake izimfuneko zomsebenzi, asebenzise izisekelo zemali, noma aklame ezinye izimboni zomshuwalenselo. Ingxoxo eqhubekayo ngesilinganiso sesikweleti sikahulumeni kanye nokungamali ehlelekisiweyo inganciphisa izilinganiso ezihambisana nemali emishayo ye-Medicaid noma ukuncitshiswa kwemali, iphoqeshelela amazwe ukuba athathe izindleko noma anciphise izindleko.

Izinselele Zempilo Yomphakathi Eziqalisayo

Inkinga yempilo yomphakathi elandelayo (nakuba izifo ezithathelwanayo, umqedazwe, imiphumela ehlobene nesimo sezulu, noma ukukhuphuka kwempilo yengqondo) izophinde ihlole ukusebenza kahle kokubambisana kwezwe. Izifundo zeCOVID-19 zingaholela ekubizeni isimiso sempilo yomphakathi esiqinile, kuhlanganise nezindinganiso ezisemthethweni zokuqoqa ukwaziswa nokuhlola, noma ukuzimela kwezwe okuqinile kakhulu ngokusekela kwezwe kwezezimali. Umthwalo okhulayo wesifo esingamahlala-ade kanye nokwaluphala uzoba negalelo elinamandla kokubili eMedicare naMEdid, okuthuthukisa ingxoxo ehlela izisusa ezimisweni, njengaleyo ehlanganisa iMedicare neMidia ye-Medicare, noma ukuhlola ukusekela kwezimo ezihlangeneyo ezihambisana nokusekela kwezezimali ezingokombuso kwe-oFople Health Treal Office Treat (FS).

Isiqalisi Esibekwe Umbuso

Izwe lizoqhubeka lizama izindlela ezintsha: umzamo weCalifornia wokwakha isimiso sokukhokha umholo owodwa ngokwezinga lombuso (SB 770 ukuze kutholakale isimiso sempilo esihlangene) ubhekene nezithiyo ezinkulu, kodwa amanye amazwe angafuna ukuboniswa komphakathi noma isibambiso semali. Izibonelo zemali enikezwayo, njengezinhlangano zokunakekela nokukhokha okugcwele, kakade zithuthukiswa yikhokha kokubili abaphathi bemithetho yezwe neyombuso. Amazwe angancintisana nabaceli bemikhokhi abafuna ukuvivinya izimo ezintsha, njenge-Medicaid ukuhlanganisa izindlu nokudla okunempilo, noma ukunweba kwe-Medicaid ehlongolwe ukuba kuhlanganise nabafuduki. Lokhu kuhlolwa kuyokwenza ubufakazi obungase bukwazise umphakathi wonke umthetho.

Izivumelwano Ezingokomthetho NezoMthetho - sisekelo

Ukubekwa indinganiso nge-ACA kuyaqhubeka; ngokwesibonelo, inselele emfunweni womthetho-mthetho ogunyaziwe womuntu ngamunye ikhokhafonia v. Texas [202] [201] yaxoshwa ezisekelweni ezimile, kodwa ezinye izenzakalo ezibheke phambili ezimfunekweni ze-ACA’s semniciso, isithiyo sokuvimbela ukuvimbela ukuvimbela, nemithetho yomshuwalense isebenza ngezinkantolo eziphansi. Ngokufanayo, ukuvalwa kwemithetho kahulumeni yokukhipha isisu, ikakhulukazi ngemva kwemingcele ye-Dobs v. Jackson’s Health Organization [202]), iqhube izimpikiswano ezingokomthetho zokuxhasa ukuzala kwezenda (njengezentengiselwano) nendima yemithetho kahulumeni ekuvikeleni imingcele yemithetho embusweni yezomthetho kahulumeni. Lemigqa yemithetho yeze yeze yezempi yezeminyaka yezempi yempilo.

Isiphetho

Ithonya lemithetho kahulumeni ezimisweni zokunakekela impilo likhulu, ligcwele, futhi linezici eziningi. Kusukela ekunwebeni kweMedicaid, izinguquko zezentengiselwano zomshuwalense ukuya ezindinganisweni ezisezingeni ezifanele nasekusabelweni okuphuthumayo komphakathi, ukubhalisa phakathi kwesiqondiso sikahulumeni nezimiso zikahulumeni kudala amathuba okusungula nezingozi zokungalawuleki. Ukuqonda lobu buhlobo bubalulekile kubafundisi, abafundi, abenzi bemithetho, nezakhamuzi ezifuna ukuqondisa isimiso sezempilo yaseMelika. Njengoba indawo iqhubeka ihlelwa yizombangazwe, izibalo, ezobuchwepheshe, kanye nezingxoxo ezingalindelekile phakathi kwezwe nemidlalo yombuso nezokuhlola ihlala ikhona ukuze kuqinisekiswe ukuthi ukukhathalela impilo kufinyelele, kufinyelele, futhi kungcono kakhulu. Inselele ekukhetheni phakathi kokulawula ukulawula ukulawula kwesimiso sombuso, kodwa ukuklama kwesimiso sesimiso sezentelelo ngasinye sezwe, kodwa ukuklama kwesimiso sesimiso sezwe sezenkangamele kusenzeka kuhulumeni ngasinye sesimiso somthetho, ukuqondisa isilinganiso esisemuva sesimiso sezwe ngokumelene naleso sisemuva