Discussion: Federalism’s Impact On Policy

Discussion: Federalism’s Impact on Policy

The fragmentation of the U.S. health care system, with its differing modes of financing and service delivery, is a reflection of a dispersed government structure. Policy making is shared and distributed across various branches and levels of government. As a result, policy making processes can be slow to respond, manipulated towards personal interests, and often redundant. Consider, for example, the public entitlement programs such as Medicaid, Medicare, the State Children’s Health Insurance Program (SCHIPS), and the PPACA of 2010. Where is there overlap between these policies? How do they demonstrate a dispersed government structure?

This week, you will analyze the role of the federal government in health care policy making.

To prepare:

• Review this week’s Learning Resources focusing on the France article and the textbook readings.
• Identify two nursing or health care policies that address similar needs, one passed at the federal level and the other at another level of government (state or local).

By Day 3

Post a cohesive response that addresses the following:

• Provide an example of two policies that address similar needs, passed at two levels of government (i.e., federal, state, or local).
• What are the advantages and/or disadvantages of this duplication? How does this example reflect the implications of federalism? Provide support from the literature for your position.
• To what degree should the federal government get involved in health care policy making? Provide concrete examples to support your position.

Read a selection of your colleagues’ postings.

By Day 6

Respond to at least two of your colleagues in one or more of the following ways:

• Ask a probing question, substantiated with additional background information, evidence or research.
• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
• Validate an idea with your own experience and additional research.
• Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.

Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

JULIE

RE: Discussion – Week 8

COLLAPSE

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The Affordable Care Act (ACA) provided a modern-day opportunity for Federalism to demonstrate its ability to move policy forward.  It is a seemingly simple concept, but not one that is understood by all, myself included.  Huberfeld (2019) describes federalism using the terms sovereignty (authority of a state to govern itself) and accountability (responsibility of policymaking).  Among multiple goals of the ACA was the idea of universal health care. The expansion proposal in the ACA created national standard for eligibility but continued the tradition of state adoption of federal rules (Butler, 2019).   The ACA identified public and private insurance standards but looked to individual states to adjust to their market and needs. Although states could decide to participate, and if they opted in, there was federal money and resources available to accomplish the goal of expansion (Medicaid specifically) and well as building insurance exchanges where citizens could apply for aid and purchase commercial insurance plans. Most states achieved this with the assistance of Health and Human Services (HHS).

Gluck et. al., (2018) discussed several states including Indiana and Connecticut who demonstrated the appearance of not opting in (to expansion) but were actually working behind the scenes (with HHS) to accomplish expansion goals all the while negotiating federal monies and support. An example of how Federalism in health care may allow for shifting responsibility. This scenario demonstrates possible disadvantages of duplication as several states were manipulating the situation for their own gains. It does make sense however, that the federal government be involved in health policy development.  The Congress and Senate are made up of leaders from across the U.S. and are representative of their States.  One would hope they have the best interest of their constituents in mind. 

Julie

References

Butler, S. M. (2019). Federalism as an Antidote to Polarization Over Health Care Policy. JAMA, 322(12), 1131–1132. https://doi.org/10.1001/jama.2019.14114

Gluck, A. R., & Huberfeld, N. (2018). What Is Federalism in Healthcare For? Stanford Law Review, 70(6), 1689–1803.

Huberfeld, N. (2019). Epilogue: Health Care, Federalism, and Democratic Values. American Journal of Law & Medicine, 45(2–3), 247–252. https://doi.org/10.1177/0098858819860612

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