Front Cover

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pp. 1-3

Title Page

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pp. 4-4

Copyright Information

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pp. 5-5

Table of Contents

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pp. v-vi

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Acknowledgments

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pp. vii-viii

This book is the result of more than a decade of exploration of intergovernmental relations and U.S. health care reform at the national and state levels. It has been influenced by my work in Congress, for federal government agencies, and with the states as well as by my academic work at the Heller School for Social Policy and Management at Brandeis University, ...

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1. Federalism Creates Health Policy

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pp. 1-15

Friends in my small town know that I have been involved in national health care reform efforts as well as those in our home state of Massachusetts. When conversation at the local pub turns to health care, they’ll ask me questions. Because I’m a political scientist, not a medical doctor, I don’t get pelted with questions everywhere I go, ...

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2. CHIP: Federalism in Congress

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pp. 16-29

The State Children’s Health Insurance Program of 1997 (CHIP) was enacted during an especially turbulent time in American politics. The Clinton health care plan had failed, and conservative members of Congress were emboldened to make some big moves. ...

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3. CHIP: Federalism and Rulemaking

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pp. 30-42

Laws passed by Congress do not emerge as finished products. Before they can be fully implemented, they have to go through the underappreciated but crucially important process of administrative rulemaking. This phase defines how a law will work in the real world, thereby creating policy. ...

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4. CHIP: Federalism and Implementation

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pp. 43-56

Implementation is where the rubber hits the road, where abstract policies and rules have real impacts on people, where intergovernmental relations are solidified in practice. As a process, implementation turns out to be every bit as political as rulemaking. ...

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5. HIPPA: Federalism in Congress

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pp. 57-70

When I tell my graduate students, “Today we will be talking about something truly fascinating [dramatic pause]: health insurance regulation,” the line never fails to elicit groans. The truth is that health insurance can be intriguing—except for the parts that are bone dry. ...

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6. HIPAA: Federalism and Rulemaking

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pp. 71-83

The rulemaking process that turned HIPAA legislation into policy should serve as a cautionary tale for national reform through the Patient Protection and Affordable Care Act. The HIPAA rule used the threat of a federal takeover of a state regulatory function to enforce the insurance portability provisions. ...

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7. HIPAA: Federalism and Implementation

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pp. 84-98

As HIPAA became the law of the land, the federal government continued to defer to the states in important ways. Because of passive federal oversight, states took control of the scope and shape of insurance reforms, particularly in the individual market. ...

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8. Massachusetts Leads the Way

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pp. 99-114

Today, the suggestion that a Republican administration had anything to do with Massachusetts health care reform would be more shocking to folks on the right than the left. After President Obama used Massachusetts as a model for national reform, Republican and Tea Party activists started to take a much dimmer view of the scene in Massachusetts. ...

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9. Federalism and the Affordable Care Act

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pp. 115-130

Beginning with President Franklin D. Roosevelt’s New Deal in the 1930s, Americans began to look to the federal government to remedy some of the country’s most pressing social, economic, and environmental ills. The Social Security Act of 1935 created federal pensions, unemployment insurance, and welfare assistance programs. ...

Notes

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pp. 131-152

Index

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pp. 153-159

Back Cover

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pp. 169-169