SCI is pleased to release a new issue brief: Health Care Reform and American Federalism: The Next Inter-Governmental Partnership, by Michael Sparer of Columbia University. 

Given the intensity of health reform negotiations in Washington, D.C. and perhaps due to the speed of the current debate, federal policymakers have thus far largely ignored two issues critical to the implementation of any new legislation:

• How will new federal rules fit with the nation’s complicated and entrenched set of inter-governmental health care partnerships?

• How will those rules accommodate the extraordinary inter-state (and intra-state) variation in every aspect of the nation’s health care system? 

The SCI brief addresses these very issues, reviewing the evolution of the nation’s inter-governmental health care partnership and discussing 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.  It also encourages policymakers to establish some type of institutional mechanism that would focus on the federalism and implementation implications of both proposed and enacted reforms.  

Responses from state officials in Minnesota, New York, Rhode Island, Vermont, and Wisconsin highlight practical examples of how the state-federal relationship can impact their health reform efforts and provide case studies that underscore the elements of the federal and state partnership that are essential.

Read the full brief.



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