Izwe alikwazi ukukhokhela i-Medicaid ngaphandle kokusekelwa kwezemfundo
Ngaphambi kokuba singene engxoxweni mayelana nendlela yokuguqula i-Medicaid , kudingeka siqonde ukuthi uhulumeni wesifundazwe manje usemali kanjani uhlelo. Kukhona umehluko ekuxhasweni ngokusekelwe ukuthi ngabe isimo sezwe singasetshenziselwa ukunwetshwa kwe-Medicaid ngaphansi koMthetho Wokunakekelwa Ongathintekayo, i- Obamacare .
Uhulumeni wesifundazwe wanikeza imali eyengeziwe yokuthi ukwanda kweMedicaid kuqhutshekwe, ukukhokha izindleko zokukhulisa iMedicaid ngonyaka ka 2016 kanye namaphesenti angu-90 alawo mazinga ngo-2020.
Yonke into, ukuthi ingabe iqhaza ekuthuthukiseni i-Medicaid, noma ngabe ayihlanganyeli ekuthuthukiseni i-Medicaid, yaqhubeka yathola imali evela kuhulumeni kusukela kulezi zinsuku ezintathu: Izinkokhelo ezingabonwayo ezingabonwayo (DSH), Izinkokhelo ze-Federal Medical Asscentages (FMAP), kanye namaThintana okuThuthukiswa okuThuthukisiwe.
Izinkokhelo Zokwabelana Ngezibhedlela ezingavumelani
I-medicaid ayiyazi kahle ngokuphana uma kuziwa ekukhokheni ukunakekelwa kwempilo. Ngokusho kwedatha evela ku-2005 Medical Expenditure Panel Survey, kulinganiselwa ukuthi ukusetshenziswa kwezempilo kunamaphesenti angama-26 ngaphezulu komuntu omdala onomshuwalense wangasese kunokuba othile ku-Medicaid athole ukunakekelwa okufanayo.
Izibhedlela ezikhathalela abantu abaningi kwi-Medicaid noma kubantu abangaqinisekisiwe, ekugcineni, zibuyiselwa kakhulu kakhulu kunezikhungo ezisebenza ezindaweni lapho kunabantu abaningi abahlanganiswe umshuwalense wangasese. Ngo-2016 yedwa, izibhedlela ezingu-21 zavala iminyango yazo ekunakekeleni iziguli ngenxa yezinga eliphansi lokubuyisela nokunye okukhathazayo ngokwezezimali.
Ukuphuma ngisho nasenkundleni yokudlala, izinkokhelo ze-Disproportionate Share Hospital (DSH) zaqala ukusebenza. Izimali ezengeziwe zikahulumeni zinikezwa izifunda ukuba zihlukanise phakathi kwezibhedlela ezifanelekile ezibona isibalo esingenakubalwa kwabantu abanomshwalense omncane. Umcabango wawuwukunciphisa umthwalo wezezimali kulezi zakhiwo ukuze baqhubeke nokuhlinzeka abantu abanemali ephansi.
Amafomula ahlukene asetshenziselwa ukubala izimali ze-DSH zikahulumeni esifundazweni ngasinye. Lezi zimfomula zicabangela isabelo se-DSH sonyaka odlule, ukwehla kwamandla emali, kanye nenani labantu abagula izifo ezingelapheki kubantu abagulayo noma abangaqinisekisiwe. Izinkokhelo ze-DSH azikwazi ukudlulisa amaphesenti angu-12 enkampanini yezindleko zosizo lwezokwelapha eMedicaid zanoma yimuphi unyaka onikeziwe.
Amaphesenti we-Federal Medical Assistance
Amaphesenti we-Federal Medical Asscentages (FMAP) ahlala engumthombo oyinhloko wezimali ze-Medicaid ezesekelayo. Umqondo ulula. Kuwo wonke ama-dollar angu-1 izwe elikhokhela i-Medicaid, uhulumeni wesifundazwe ulinganisa okungenani ngamaphesenti angu-100, okungukuthi i-dollar ye-dollar. Umbuso ophana kakhulu uhlanganisa abantu, uhulumeni wesifundazwe kufanele abe nomusa kakhulu. Ayikho i-cap ecacisiwe, futhi ukwanda kwezindleko zombuso kuncike kwizidingo zombuso.
Uma ucabanga ngakho, i-FMAP inomusa kepha kungase kungabi ncamashi ukusho ukuthi kunomthelela wokuthola imali ephansi uma kuqhathaniswa nezwe elinemali ephakeme. Ngokukodwa, kungase kube nomthwalo okhuphuka ukubeka izigaba eziphezulu zabantu abampofu, futhi i-FMAP inganikeza ukubuyisela okuphansi ngokungahambisani naphezu kwezidingo zomnotho zombuso.
Ukuxazulula le nkinga, uMthetho wezokuThuthukiswa koMphakathi uhlele ifomula ukubala amanani we-FMAP ngokususelwa kumholo wesilinganiso sombuso esihlotshaniswa nesilinganiso sikazwelonke. Nakuba wonke amazwe athola okungenani i-FMAP yamaphesenti angu-50 (uhulumeni wesifundazwe ukhokha ama-50% wezindleko ze-Medicaid, okungukuthi imali engu-$ 1 kuwo wonke ama-dollar 1 asetshenziswe nguhulumeni), amanye amazwe azothola amaphesenti aphakeme.
I-Alaska, i-California, i-Connecticut, i-Maryland, i- Massachusetts , i-Minnesota, i-New Hampshire, i-New Jersey, i-New York, i-North Dakota, iVirginia, iWashington ne-Wyoming yiyona kuphela e-2017 yokuthola i-FMAP ngamaphesenti angu-50. Zonke ezinye izifunda zithola iphesenti ephakeme yama-Medicaid izimali ezivela kuhulumeni wesifundazwe.
Ngokuphawulekayo, i-Mississippi inezinga eliphezulu lokuthola imali ngayinye nge-2017 FMAP yamaphesenti angama-74.63. Lokhu kusho ukuthi uhulumeni wesifundazwe ukhokhela amaphesenti angaba ngu-74.63 wezindleko zikahulumeni zeMedicaid, enikeze u-$ 2.94 imali yonke i-$ 1 idolobha elichitha.
Amanani afanisiwe ahambelanisiwe
Amazinga afanayo afana nawo afana ne-FMAP kodwa athathwa isinyathelo esisodwa. Bakhulisa iphesenti yezindleko ezikhokhelwa uhulumeni wesifundazwe ngezinsizakalo ezithile. Lezi zinsizakalo zifaka kodwa azikhawulelwe ku:
- Ukwelashwa komdlavuza wesibeletho nesisu somlomo wesibeletho (ukhokhelwe ngesilinganiso se-CHIP FMAP * sikahulumeni)
- Amasevisi okuhlela umndeni (akhokhelwa ku-FMAP ngamaphesenti angu-90)
- Izinsizakalo zezempilo zasekhaya (ezikhokhelwa FMAP zamaphesenti angu-90)
- Izinsizakalo zokuvimbela abantu abadala (ezikhokhelwe kuma-FMAP + 1 amaphesenti wombuso)
* I-CHIP yiNhlelo Yomshwalense Wezempilo Yengane
Lezi zinsizakalo zibonakala ziyigugu ngoba zingasiza ukunciphisa umthwalo wezindleko zezempilo esikhathini esizayo. Ngaleyo ndlela, ukukhokhela imali eyengeziwe phambili kuyabonakala njengotshalomali olufanele.
Ukuxhaswa kukahulumeni ngeMedicaid
Masingakhohlwa ukuthi ohulumeni bakahulumeni nabo banikeza amaRandi ku-Medicaid. Indlela abenza ngayo lokhuhlukahluka kusuka kuhulumeni kuya kwesifunda, kodwa ukuthi banganikeza umthelela omkhulu ekuthinteni usizo olutholakala kuhulumeni kahulumeni. Iqiniso liwukuthi uhulumeni noma umbuso kahulumeni angakwazi ukukhokhela iMedicaid kuphela. Kuphela kuphela abangakwazi ukuhlanganisa imithombo eyanele yokunakekela izigidi zabantu abadinga.
> Imithombo:
> Ukunakekelwa okungenakunakekelwa komthetho wokunakekelwa kwe-Medicaid. I-National Conference of State Legislatures website. http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx. Kubuyekezwe i-Disemba 1, 2016.
> Clemans-Cope L, Holahan J, Garfield R. Medicaid Ukuchitha Ukukhula Ngokuqhathaniswa Nabanye Abakhokhi: Ukubukela Ubufakazi. UHenry Kaiser J. Family Foundation. http://kff.org/report-section/medicaid-spending-growth-compared-to-other-payers-issue-brief/. Ishicilelwe ngo-Ephreli 13, 2016.
> Ellison A. Ukuvalwa kwezibhedlela ezingu-21 ngo-2016. Ukubuyekezwa kweBergker Hospital. http://www.beckershospitalreview.com/finance/21-hospital-closures-in-2016.html. Ishicilelwe ngoJanuwari 6, 2017.
> FY2017 I-Federal Medical Assistance Percentages. Ihhovisi likaMnumzane uNobhala Wezokuhlela Nokuhlola, Iwebhusayithi YaseMelika YezeMpilo kanye NezemiSebenzi Yabantu. https://aspe.hhs.gov/basic-report/fy2017-federal-medical-assistance-percentages. Ishicilelwe ngoJanuwari 13, 2016.
> Mitchell A. Ukuxilongwa Okungafaniyo Yabelana Ngezikhokhelo Zezibhedlela. Isevisi Yokucwaninga Nge-Congressional. https://fas.org/sgp/crs/misc/R42865.pdf. Ishicilelwe ngo-Juni 17, 2016.