New Federalism and Health Policy

Abstract

The making of health policy in the United States is a complex process that involves the private and public sectors, including multiple levels of government. Five characteristics of the policy process are identified, which establish the means by which policies are formulated and which affect the nature of the policies that emerge. These characteristics include (1) the relationship of the government to the private sector; (2) the distribution of authority and responsibility within a federal system of government; (3) the relationship between policy formation and implementation; (4) a pluralistic ideology as the basis of politics; and (5) incrementalism as the strategy for reform. The article focuses on the impact on health policy of the distribution of authority and responsibility within the federal system, particularly the impact of new federalism policies as they emerged during the past decade. The effects of dual federalism, cooperative federalism, creative federalism, and new federalism are examined in relation to health policies. The article concludes with an examination of the challenge to long-established values and health policies posed by new federalism.

Assessment of the design and implementation challenges of the National Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare and insurance providers

“…According to Cassells [42], actors' interests and power imbalance among them usually results in conflicts especially when it has to do with resources allocation [43][44][45]. This was the case of NHIS where most states resisted the adoption of the scheme, attributing it to lack of transparency since they were not allowed in the governance role [46,47].…”

Promoting universal financial protection: constraints and enabling factors in scaling-up coverage with social health insurance in Nigeria

“…More specifically, reforms involving policies for social health insurance may result in conflicts because the outcome may favour or disfavour various interest groups [3]. Similar conflicts may be observed between national and sub-national governments in environments where political power over resources and reforms is shared amongst different levels of government, typified by the federal system of government [4-6]. Such systems of government are known to allow opportunism, dynamism and self expression by sub-national governments [7]; their existence underscores the relevance of inquiry into the actor roles and influences in the policy environment that promote or constrain scaling-up of public policies.…”

ERISA Reform as Health Reform

“…Statutory waivers can soften the federalism impact and unintended consequences of federal laws, 90 giving states the flexibility to work within a federal statutory scheme and reopening the “laboratories of democracy” despite preemption. 91 States urgently need this flexibility to adapt to federal dysfunction and to test the transformative models being debated at the national level. The ACA’s federal regulatory infrastructure, meanwhile, has diminished the justifications for maintaining the ERISA preemption obstacle to state health reforms.…”