American Federalism in Practice
The Formulation and Implementation of Contemporary Health Policy
Publication Year: 2013
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.
Published by: Brookings Institution Press
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Table of Contents
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...ration 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, the Politics Department at Brandeis, and the George Washington ...
Federalism Creates Health Policy
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...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, so I welcome the opportunity to respond. I only wish that there were better answers....
CHIP: Federalism in Congress
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...(CHIP) was enacted during an especially turbulent time in American poli-tics. The Clinton health care plan had failed, and conservative members of Congress were emboldened to make some big moves. Under the leadership of Speaker of the House Newt Gingrich, Republicans passed a plan to end the federal entitlement to Medicaid and replace it with block grants to the states. ...
CHIP: Federalism and Rulemaking
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...ucts. Before they can be fully implemented, they have to go through the underappreciated but crucially important process of administrative rulemak-ing. This phase defines how a law will work in the real world, thereby creating policy. Rulemaking is nearly as important as the legislative process, but it is often ignored. It?s not as sexy as the podium-pounding, headline-grabbing ...
CHIP: Federalism and Implementation
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...abstract policies and rules have real impacts on people, where intergov-ernmental relations are solidified in practice. As a process, implementa-tion turns out to be every bit as political as rulemaking. Analysis of CHIP implementation reveals that in a collaborative effort to make the program work, broader national safeguards remained even as states regained some ...
HIPPA: Federalism in Congress
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...talking about something truly fascinating [dramatic pause]: health insurance regulation,? the line never fails to elicit groans. The truth is that health insur-ance can be intriguing?except for the parts that are bone dry. But grasping the complexity of the issue is essential to understanding how the U.S. health care system works and how it might be shaped by national reform. ...
HIPAA: Federalism and Rulemaking
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...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. However, because the federal government did not have the resources, staff, expertise, or desire to back up the threat, it ...
HIPAA: Federalism and Implementation
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...ment 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. In contrast to the implemen-tation of the CHIP rule, which resulted in greater uniformity between states, implementation of HIPAA maintained the diversity that already existed ...
Massachusetts Leads the Way
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...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 Mas-sachusetts as a model for national reform, Republican and Tea Party activists started to take a much dimmer view of the scene in Massachusetts. Though George W. Bush did not exactly highlight the fact in his memoir, his admin-...
Federalism and the Affordable Care Act
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Deal in the 1930s, Americans began to look to the federal government to remedy some of the country?s most pressing social, economic, and environ-mental ills. The Social Security Act of 1935 created federal pensions, unem-ployment insurance, and welfare assistance programs. In the 1960s, President Lyndon B. Johnson?s War on Poverty and other Great Society?era programs ...
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Page Count: 159
Publication Year: 2013