Health Care Reform and American Federalism: The Next Inter-Governmental Partnership

Source: Michael Sparer, State Coverage Initiatives, Robert Wood Johnson Foundation, September 2009

Perhaps due to the speed of the current debate, however, federal policymakers have largely ignored two issues critical to the implementation of any new legislation: first, how will new federal rules fit with the nation’s complicated and entrenched set of inter-governmental health care partnerships; and second, how will those rules accommodate the extraordinary inter-state (and intra-state) variation in every aspect of the nation’s health care system? This issue brief addresses these issues. It begins with a review of the evolution of the nation’s inter-governmental health care partnership, followed by a discussion of how proposed federal reforms to expand Medicaid, to create a health insurance exchange, and to restructure the health care delivery system might impact that partnership. The brief concludes by encouraging policymakers to establish a task force, work-group, or some similar institutional mechanism that would focus on the federalism and implementation implications of both proposed and enacted reforms.

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