Health Policy Federalism And The American States

First published in 1997, this volume emerged in the ongoing struggle between those favouring centralized and those favouring decentralized government, and has three goals: 1) To illustrate how theories of federalism and intergovernmental relations can provide a useful framework for examining how to 'divide up the job in the health care area'; 2) To assess the capacity of the states to actually implement health care policy changes; 3) To weigh the merits of alternative visions of the future roles of states and the federal government in health care policy.

First published in 1997, this volume emerged in the ongoing struggle between those favouring centralized and those favouring decentralized government, and has three goals: 1) To illustrate how theories of federalism and intergovernmental relations can provide a useful framework for examining how to 'divide up the job in the health care area'; 2) To assess the capacity of the states to actually implement health care policy changes; 3) To weigh the merits of alternative visions of the future roles of states and the federal government in health care policy.

The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.

American Federalism in Practice is an original and important contribution to our understanding of contemporary health policy. It also illustrates how contentious public policy is debated, formulated, and implemented in today’s overheated political environment. Health care reform is perhaps the most divisive public policy issue facing the United States today. Michael Doonan provides a unique perspective on health policy in explaining how intergovernmental relations shape public policy. He tracks federal-state relations through the creation, formulation, and implementation of three of the most important health policy initiatives since the Great Society: the State Children’s Health Insurance Program (CHIP) and the Health Insurance Portability and Accountability Act (HIPAA), both passed by the U.S. Congress, and the Massachusetts health care reform program as it was developed and implemented under federal government waiver authority. He applies lessons learned from these cases to implementation of the Affordable Care Act. “Health policymaking is entangled in a complex web of shared, overlapping, and/or competing power relationships among different levels of government,” the author notes. Understanding federal-state interactions, the ways in which they vary, and the reasons for such variation is essential to grasping the ultimate impact of federalism on programs and policy. Doonan reveals how federalism can shift as the sausage of public policy is made while providing a new framework for comprehending one of the most polarizing debates of our time.

American Federalism in Practice is an original and important contribution to our understanding of contemporary health policy. It also illustrates how contentious public policy is debated, formulated, and implemented in today's overheated political environment. Health care reform is perhaps the most divisive public policy issue facing the United States today. Michael Doonan provides a unique perspective on health policy in explaining how intergovernmental relations shape public policy. He tracks federal-state relations through the creation, formulation, and implementation of three of the most important health policy initiatives since the Great Society: the State Children's Health Insurance Program (CHIP) and the Health Insurance Portability and Accountability Act (HIPAA), both passed by the U.S. Congress, and the Massachusetts health care reform program as it was developed and implemented under federal government waiver authority. He applies lessons learned from these cases to implementation of the Affordable Care Act. "Health policymaking is entangled in a complex web of shared, overlapping, and/or competing power relationships among different levels of government," the author notes. Understanding federal-state interactions, the ways in which they vary, and the reasons for such variation is essential to grasping the ultimate impact of federalism on programs and policy. Doonan reveals how federalism can shift as the sausage of public policy is made while providing a new framework for comprehending one of the most polarizing debates of our time.

Because of federalism, Medicaid takes very different forms in different places. This has dramatic and crucial consequences for democratic citizenship.

Examining the changing nature of health care federalism within a competitive global context, Comparative Health Care Federalism provides a rich and nuanced account of the way in which the interplay of federal relationships impact health care within an array of systems. The editors have gathered together some of the leading international health policy scholars to provide detailed accounts of the dynamics of federal health policy-making within their respective jurisdictions. Complementing the theoretical and methodological objectives, this book provides a detailed, empirical description of the challenges faced by different states and the ways in which health policy-making works within the federal, quasi-federal, and functional federal systems presented. In chapters on the United States, Australia, Canada, Germany, Spain, Italy, Austria, the United Kingdom, the EU, India, China, Brazil, and the Russian Federation the authors consider what variables contribute to, and stand in the way of, the formation of robust and sustainable health care systems.

States of Health identifies the practical relevance of federalism in the United States to people facing ethical decisions about health and health care, and it considers the theoretical justifications for permissible differences among states. It asks whether authority over important aspects of health is misaligned in the United States today, with some matters problematically left to the states while others are taken over by the federal government.