Learning from the States? Federalism and National Health Policy

Abstract

In its 1993 report, the Winter Commission gave direction to the federal government in the area of health policy and Medicaid: lead, follow, or get out of the way. This article examines how the federal government responded to that advice, specifically asking what has happened in the allocation of responsibility in health policies between 1993 and 2006. In short, unlike the suggestion that there be a better‐defined direction in federal–state policy assignments in health, the ensuing years have resulted in more of the same. The authors examine what has happened, particularly focusing on vertical diffusion—where the states have acted first—and on the role of policy learning in federal decision making. They find little recognition of policy learning in recent federal health laws—even in areas in which state experience was extensive. The federal government is leading in some health policies—but it is leading without learning.

The Politics of Need: Examining Governors' Decisions to Oppose the “Obamacare” Medicaid Expansion

“…Some states take cues from the federal government on health care spending, others are not as welcoming (Weissert and Scheller 2008). The division over Medicaid expansion is consistent with other recent partisan divisions, but differs in part because of Medicaid's prominence in state health coverage and its crucial role in the ACA plan.…”

Policy Diffusion: Seven Lessons for Scholars and Practitioners

“…Lessons also may not be learned at all, such as with the lack of recognition of state health policy experiences during the formulation of national policy (Weissert and Scheller ).…”

Breaking Gridlock: The Determinants of Health Policy Change in Congress

“…Such diffusion has received mixed or conditional empirical support (e.g., Boeckelman 1992;Shipan and Volden 2006), and while there are similar limitations on vertical policy diffusion specific to health policy making (e.g., Hanson 1993;Weissert and Scheller 2008), there remain compelling accounts of specific state experiences that have been crucial to the development of national health policies (e.g., Mayes 2007). One reason that leadership and legislative strategy are ostensibly so crucial in health policy making is the inherent complexity of the issues surrounding health. Health care spending is a major and rapidly growing component of the U.S. economy, and each significant policy change has had unforeseen consequences requiring further policy modifications.…”