Zidzakuthandizani bwanji?
Medicaid inalengedwa pamodzi ndi Medicare mu 1965. Ngakhale kuti Medicare inali ndi cholinga chopereka chithandizo chamankhwala chokwanira kwa okalamba, cholinga cha Medicaid chinali kusamalira anthu omwe sakanatha kutero-omwe ali ndi ndalama zochepa, olumala, kapena onse awiri. Anthu ena akhoza ngakhale kulandira mapulogalamu awiriwo .
Medicaid yakhala ikusintha pazaka, makamaka makamaka ndi Affordable Care Act mu 2010, omwe amadziwika kuti Obamacare.
Kuyambira mu 2014, akuti adasankha kuvomereza ndalama zowonjezera za boma mu nthawi yochepa kufikira chaka cha 2020 kuti apite patsogolo kuwonjezeka kwa Medicaid . Tsopano, zikuwoneka kuti kusintha kwakukulu kwambiri kungathe kuchitika.
Pa January 11, 2018, Centers for Medicare ndi Medicaid Services, pansi pa mutu wa CMS Seema Vera, adalimbikitsa mayiko kuti apange mapulogalamu oyendetsa ntchito omwe amawunikira ntchito kapena maphunziro a ntchito pa ovomerezeka a Medicaid. Cholinga, akuti, ndiko kukweza umoyo wa anthu kwa Medicaid. Mayiko angapange malingaliro awo kupyolera mu zoperekera, koma ayenera kulandira boma.
Nkhaniyi ndi yovuta kwambiri kuposa CMS ikutsogolerani kuti mukhulupirire.
Ntchito ndi Umoyo
Mwinamwake, vutoli ndilochepa pa zaumoyo ndi thanzi kuposa za madola ndi masentimita. Pambuyo pake, oyang'anira Trump anayesa kudula mamiliyoni mazana a madola kuchokera ku Medicaid mu 2017 ndi kulephera kwa American Health Care Act / Better Care Reconciliation Act.
Mmalo mofananitsa ndalama ndi mabungwe, lamulo likanati ligwiritse ntchito malipiro kapena malire a munthu aliyense kuti azilipiritsa ndalama za Medicaid. Madera ambiri sangathe kukwaniritsa zofookazo ndipo amafunika kuchepetsa phindu, kulenga mndandanda wa zodikira, kufuna anthu kuti azilipidwa, kapena kuyika kusintha kwina.
A Republican adanena momveka bwino kuti akukonzekera Medicaid mu 2018. Zofuna za ntchito ndizo zoyamba kutsogolo kwa cholinga chimenecho. Zofunikira izi zikuyembekezeretsa kuchepetsa chiwerengero cha anthu oyenerera Medicaid komanso kuchepetsa chiwerengero cha olembetsa pulogalamuyi. Zonsezi zingakhale kuchepetsa ndalama za Medicaid ndikusamaliranso kusamalira zolinga zaumoyo zomwe zimathandizidwa ndi abwana.
Palibe pulogalamu yosonyeza kuti kugwira ntchito mwa iwo wokha kumalimbikitsa khalidwe la moyo. M'malo mwake, pali maphunziro omwe amasonyeza kuti kuwonjezereka kwa Medicaid kwawongolera zotsatira za thanzi komanso kutenga nawo gawo.
Kuphunzira kwa 2015 mu nyuzipepala PLoS One inayerekeza anthu oposa 16,000 omwe ali ndi ndalama zochepa zomwe zikuwonjezeka komanso popanda Medicaid. Ofufuzawo adapeza kuti sikuti anthu ochepa okha omwe amakhala ndi ndalama zochepa amakhala amdima kapena anthu akumidzi, koma amakhalanso ndi moyo wabwino ngati akadakhala m'madera omwe Medicaid yowonjezera.
Pankhani yokhudzidwa ndi dera lanu, likunena ndi kuwonjezeka kwa Medicaid zasonyeza kuwonjezeka kwa kudzipereka kuchokera kwa ovomerezeka a Medicaid. Izi zikuwonetsedwa mu phunziro la 2017 mu Journal Socius. Kaya kudzipereka kunali kovomerezeka kupyolera mu bungwe kapena osalongosoka m'dera lanu, mitengoyi inkawonjezeka makamaka makamaka m'magulu ang'onoang'ono.
Anthu Omwe Amawotchedwa America ndi Medicaid Zofunikira Zogwira Ntchito
Mu 2016, anthu 72.2 miliyoni analembetsa pulogalamuyi. Nthawi zambiri, ambiri omwe amalandira Medicaid ndi ana. Pamene ana, okalamba, ndi anthu omwe ali pa Supplemental Security Income (SSI) amachotsedwa, akuluakulu 24.6 miliyoni amakhalabe.
Pa gululi, 60 peresenti (14.8 miliyoni) akugwira ntchito-42 peresenti nthawi zonse (maola 35 pa sabata) ndi 18 peresenti nthawi yochepa. Mwa anthu osagwira ntchito (9,8 miliyoni), 14 peresenti ali ndi matenda kapena olumala, 12 peresenti akugwira nawo ntchito yosamalira, 6 peresenti ali kusukulu, ndipo 7 peresenti sagwira ntchito pa zifukwa zina.
CMS imanena mosapita m'mbali kuti zofunikira za ntchito ziyenera kuganiziridwa kwa odwala okha, koma sizikutanthawuza zomwe zikutanthawuza.
Anthu omwe amayenerera a Inshuwalansi ya Disability Disability (SSDI) amayeneranso kuti apeze Medicaid. Komabe, kukhala ndi chilema chodziwika ndi mapulogalamuwa sikophweka nthawi zonse. Zotsatira ndizovuta ndipo ambiri amatsutsidwa. Mu 2010, 34,8 peresenti yokha ya 2,838,485 inavomerezedwa, kuchokera pa 56.1 peresenti mu 2000. Ndipotu, chiwerengero cha kuvomereza kwachepa chaka chilichonse kuchokera mu 2005. Chimene chimachititsa anthu ambiri omwe ali ndi vuto lolephera kulumala.
Dziko lirilonse lidzafunika kukhazikitsa ndondomeko zake pa zomwe zikuwoneka kuti "zatha". Mwachitsanzo, Kentucky, yoyamba ndi yokhayo yokhala ndi ntchito yovomerezeka yovomerezeka, imazindikira anthu omwe ali ndi khansa, matenda odziletsa magazi, kapena matenda oledzera kapena oledzeretsa monga "mankhwala osokoneza bongo."
Kukwaniritsa Chofunika cha Ntchito ya Medicaid
Ponena za zofuna zawo zokha, Kentucky ndi mayiko ena asanu ndi anai apempha zochotsa. Arkansas, Kentucky, ndi Wisconsin amafunika maola 80 pamwezi; Indiana mpaka maora 20 pa sabata; Arizona, Maine, ndi Mississippi ntchito maola 20 pa sabata; Kansas ndi New Hampshire maola 20 kapena 30 pa sabata; ndi Utah miyezi itatu yotsatizana ya kufufuza / ntchito yopanda ntchito pokhapokha ngati akugwira ntchito maola 30 pa sabata.
Chomwe chimapanga "ntchito" chimasiyananso ndi dziko. Ntchito zimachokera kuntchito mpaka kudzipereka. Uku ndiko kuwonongeka malinga ndi ntchito ya Medicaid waiver yomwe ilipo tsopano.
- Kusamalidwa kwa munthu wosadalirika ndi matenda olepheretsa - Kentucky
- Mankhwala osokoneza bongo - Kentucky
- Maphunziro - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, New Hampshire
- Ntchito - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, Mississippi, New Hampshire, Utah, Wisconsin
- Kufufuza kwa Job - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, New Hampshire, Utah
- Maphunziro a Job - Arkansas, Indiana, Kansas, Kentucky, Mississippi, New Hampshire, Utah, Wisconsin
- Kudzipereka - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, Mississippi
Zowonongeka Kuchokera ku Kugonjetsa Zofunikira za Ntchito
Osati aliyense adzayang'aniridwa ndi ntchito ya Medicaid. Dziko lirilonse lomwe limagwiritsidwa ntchito pa kuchoka limatanthawuza amene akuchotsedwa kufunika. Chifukwa cha gawo lililonse, boma lingayesedwe kuti zikhale zosiyana.
Zowonongeka kwambiri ndi zaka. Zonsezi zimakhululukira aliyense wazaka 65 kapena kupitirira kuchokera ku zofunikira za ntchitozi. Ena amatilola kulolera kusinthasintha. Arkansas ndi Wisconsin amalepheretsa anthu zaka 50 ndi achinyamata; Arizona zaka 55 ndi wamng'ono; ndi Indiana ndi Utah zaka 60 ndi zazing'ono.
Kusamalira ana a zaka zisanu ndi chimodzi kapena wamng'ono kapena mwana wodwala wodwala kapena wamkulu kumapangitsa kuti munthu asathenso kumasulidwa. Ena amati akhoza kuwonjezera izi kwa ana achikulire komanso kusamalira abambo. Ku Kentucky, munthu m'modzi yekha pa banja amakhala wosasamala ngati amasamalira wodwalayo kapena wamkulu wodwala.
Ngakhale kuti maola ambiri ogwiritsira ntchito mankhwala akugwirizanitsa ntchito ku Kentucky, amaonedwa kuti ndi oyenera ku Arkansas, Indiana, Maine, Mississippi, New Hampshire, Utah, ndi Wisconsin. Ophunzira amapezedwanso ku zofunikira. Komabe, msinkhu wa wophunzira komanso maola angapo omwe amapita kusukulu angakhale nawo. Kupeza malipiro a ntchito kungakulepheretseni kukhala ku Maine, Utah, ndi Wisconsin koma osati zina zomwe zagwiritsidwa ntchito kuti zitheke.
Chochititsa chidwi n'chakuti Kentucky yonjezeranso njira yatsopano kwa anthu omwe sagwirizana ndi ntchito, maphunziro a zaumoyo ndi zachuma. Kuwonjezerapo kwakhala kudandaula. Zingakhale zopanda chilungamo kutsutsana ndi anthu omwe sali olembedwa bwino kapena olankhula bwino. Zingakhale zovuta kuti anthu akwaniritse ngati sanamalize maphunziro apamwamba.
Nkhazikitsano pazofunika za ntchito zofunikira
Omwe amathandizira ntchito za Medicaid akugogomezera momwe zidzasungire ndalama kwa mayiko. Mosiyana ndi GOP kutsutsana ndi Affordable Care Act, ntchito izi zikhoza kukhala zotsatira zosavomerezeka kulimbitsa. Kuyambira mu Jan. 2018, mayiko 33 okha, kuphatikizapo District of Columbia, adakulitsa kuchuluka kwa Medicaid. Poyang'ana kufunikira kwa ntchito monga njira yochepetsera ndalama za purogalamu, mayiko ena-Idaho, Kansas, North Carolina, Utah, Virginia, ndi Wyoming-akuyang'ana kuti akule.
Ngakhale kuti Kentucky ikuyenera kupulumutsa $ 2.4 biliyoni ku Medicaid ndalama zoposa zisanu ndi zisanu ndi zisanu ndi zisanu ndi zisanu ndi zisanu ndi zitatu, zomwe zikuyembekezeredwa, ziyembekezere kuti anthu 95,000 adzataya thanzi lawo. Chotsatira cha sukulu chinatumizidwa ku khoti lamilandu pa Jan. 24 ndi 16 a Kentucky Medicaid omwe alandira. Iwo amati ntchito zofunikira zimasintha cholinga cha Medicaid chomwe chimapereka chisamaliro kwa osauka.
Zikhoza kukhala ndi suti m'mayiko ena ngati boma limavomereza zina zowononga Medicaid. Zotsatira za mlandu zingakhudze tsogolo la Medicaid. Kupambana kungapangitse kuti kukhale kovuta kuti utsogoleri wamakono ukhale ndi kusintha kwa Medicaid pamene kutayika kungalolere kusintha kwa pulogalamuyi posachedwa.
Mawu Ochokera
Medicaid yatsala pang'ono kusintha zina. Kuyambira mu 2018, mayiko angagwiritse ntchito kuwonjezera zofuna za ntchito ku mapulogalamu awo a Medicaid. Mpaka pano, mayiko khumi agwiritsidwa ntchito ndipo dziko loyambirira, Kentucky, laperekedwa ndi kusintha koyamba kudzachitika mu July.
Ngakhale kuti anthu ena angakhale opanda zofunikira za ntchitoyi malinga ndi zaka, kusamalira, kulemala, kapena kukhala wophunzira wophunzira, ambiri sangatero. Kaya muli kapena mukutsutsana ndi ntchito ya Medicaid, mayiko ena angasankhe kuwonjezera Medicaid monga zotsatira.
> Zotsatira:
> Han X, Nguyen BT, Drope J, Jemal A. Zotsatira Zokhudzana ndi Zaumoyo pakati pa Osauka: Kuwonjezeka kwa Medicaid vs. PLOS One. 2015 Dec 31; 10 (12): e0144429. lembani: 10.1371 / magazini.pone.0144429.
> Mager-Mardeusz H, Lenz C, Kominski GF. "Cap" pa Medicaid: Momwe Block Grants, Per Capita Caps, ndi Capped Allotments Zingasinthe mwachangu kusintha Safety Net. Ndondomeko Mwachidule UCLA Cent Health Policy Res. 2017 Apr; (PB2017-2): 1 10. http://healthpolicy.ucla.edu/publications/Documents/PDF/2017/363%20Medicaid_PB.pdf
> Musumeci M, Garfield R, Rudowitz R. Medicaid ndi Zofunikira Zogwira Ntchito: Zitsogozo Zatsopano, Mfundo Zowonongeka Zowonongeka ndi Mavuto Ofunika. Henry J. Kaiser Family Foundation. Chiwongola dzanja Lofalitsidwa pa January 16, 2018.
> SMD: 18-002, Mwayi Wothandizira Ntchito ndi Kuyanjanitsa Pakati pa Omwe Amalandira Madokotala. Maofesi a Medicare ndi Medicaid Services. https://www.medicaid.gov/federal-policy-guidance/downloads/smd18002.pdf. Lofalitsidwa pa January 11, 2018.
> Sohn H, Timmermans S. Social Effects ya Health Care Reform: Kuwonjezereka kwa Medicaid pansi pa Ndalama Zothandizira Zosasinthika ndi Kusintha Mwa Kudzipereka. Socius. 2017 Jan-Dec 3. Chitani: 10.1177 / 2378023117700903. Epub March 24, 2017.