American federalism in practice : the formulation and by Michael Doonan

By Michael Doonan

American Federalism in perform is an immense contribution to our figuring out of up to date healthiness coverage in the USA. constantly a big subject, the difficulty holds distinctive foreign money this day given the prominence of well-being care in cutting-edge political and fiscal panorama. Michael Doonan presents a special standpoint on American federalism and U.S. overall healthiness coverage in explaining how intergovernmental relatives form public  Read more...

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American federalism in practice : the formulation and implementation of contemporary health policy

American Federalism in perform is an important contribution to our knowing of up to date wellbeing and fitness coverage in the United States. continually a tremendous subject, the problem holds specific foreign money this present day given the prominence of health and wellbeing care in state-of-the-art political and fiscal panorama. Michael Doonan presents a different viewpoint on American federalism and U.

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Congress was far more active in the period immediately after the law was passed but then moved on to other priorities. The rulemaking process was an ongoing political struggle to clarify ambiguity in the statute, and it even added provisions, like the patient’s bill of rights, that were not in the statute. Again, a very different program could have emerged if the rule were written by a different administration with different priorities. In this way, presidential elections directly influence how programs are ultimately shaped and structured.

These findings foreshadow the opportunities and challenges for national reform; they also hint at potential unanticipated consequences. Simply boosting federal funding for Medicaid expansions and for health care exchanges will not be enough. Political opposition at the state level can slow, stall, or completely prevent reform, but opposition can be quieted by early success and a greater awareness among federal officials of the challenges that states face. States will need flexibility to make national reform work; the federal government cannot expect Texas to follow the same rules as Rhode Island.

States have more flexibility to determine cost-sharing rules for families with incomes of more than 150 percent of the federal poverty level; they are far less trusted with setting cost sharing for families under that line. States strongly objected to federal cost-sharing requirements. indd 40 6/25/13 5:33 PM chip: federalism and rulemaking / 41 percent cap was arbitrary and noted that it was not mentioned in the statute. CMS came up with this arrangement to implement the statute’s requirement that lower-income recipients not pay costs that were greater relative to those of higher-income recipients.

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