1977年修正并增加第160至169条款，《洁净空气法案》要求，《州实施计划》应包括“防止空气质量严重恶化”的措施。
As amended in 1977 by addition of sections 160-169, the Clean Air Act requires that SIPs include measures to "prevent the significant deterioration" of air quality.
美国也有几个州在类似方式实施学券计划。
Vouchers programmes in several American states have been run along similar lines.
马萨诸塞州已经制订计划并开始实施，其中涉及个人购买保险的规定、对特困者的津贴制度及由州进行监管的保险外汇制度。
Massachusetts already has a plan up and running that involves an individual requirement to buy coverage, subsidies for the poorest and a state-supervised insurance exchange.
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