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Federalism in Relation to health policy

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Federalism in Relation to health policy

Introduction

Federalism has played a significant role in shaping the implementation of the

Affordable Care Act (ACA), which aimed to expand access to affordable healthcare services.

While federalism has brought positive and negative impacts to the ACA, it has allowed for

greater flexibility, state-based marketplaces, and Medicaid expansion. However, challenges

have arisen due to barriers imposed by both federal and state governments, hindering the

smooth implementation of the policies within the act.

Federalism has positively and negatively impacted the Affordable Care Act with the

act expanding access to affordable health care services. The implementation of the policies

within the act has been infringed with barriers from both federal and state governments,

making the implementation process challenging. Some of the pros of federalism in line with

the Affordable Care Act include flexibility, state-based marketplaces, and Medicaid

expansion. Osuagwu (2021) points out that the Medicaid expansion provided a framework to

include more persons in the act to access affordable healthcare services. By moving medical

care to states, the act achieved a more reflective healthcare provision with improved

efficiency, and locals could access affordable healthcare easily.

Federalism also improved the flexibility of states to meet healthcare needs. Some of

the cons of federalism include inequality as most people do not receive effective health care

services as predetermined by the Affordable Care Act. Additionally, the Federalist structure

has allowed the ACA to become a subject of political polarization. Differing ideological

perspectives and partisan politics have influenced states' responses to the law. Some states

with opposing political views have actively opposed or undermined the ACA's

implementation, leading to challenges in achieving nationwide coverage and consistency.

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Federalism has influenced the pros and cons of the Affordable Care Act. While it has

provided flexibility and opportunities for states to tailor healthcare approaches to their

specific needs, it has also led to disparities in implementation, political polarization, and

inequities in coverage across states. The impact of federalism on the ACA highlights the

ongoing interplay between federal and state powers in shaping healthcare policy and its

outcomes.

Federalism in public health phases out in different forms creating a continuous

reflection of evolving system in the United States. Konisky and Nolette (2021) explain that

the phases showcase the balance between responsibility and power which shapes policies

within the healthcare sector. Dual federalism established between 1789 and 1930 established

that the healthcare policy was under the state government with the federal government

playing a limited role in the policy formulation and implementation. The two governments

had different and distinct roles in policy implementation and formulation. Additionally, the

state government was more concerned with licensing professionals and regulating the

function of healthcare facilities. The federal government focused on immigration and

international quarantine policies.

Cooperative federalism was structured due to the effects of the great depression and

the new deal era. The federal government intervened in the policy formulation implementing

programs that expanded the functions of the Social Security Act of 1935. In so doing, the

federal government could care for the country's most vulnerable persons. The government

could implement programs that facilitate better health by providing funds. New federalism

which superseded the former federalisms, intended to shift policy formulation from federal

governments to state governments. Through policies enshrined within the 2010 Affordable

Care Act, the states expanded their medical capacities by establishing affordable health

insurance.
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Conclusion

The impact of federalism on the ACA demonstrates a complex interplay between the

federal and state governments in healthcare policy. The pros of federalism, such as flexibility

and state-based initiatives, have provided opportunities for tailored healthcare approaches and

improved efficiency. On the other hand, the cons, including inequalities and political

polarization, have led to disparities in coverage and challenges in achieving nationwide

consistency. Understanding the influence of federalism on the ACA is crucial for

comprehending the ongoing dynamics and power balance in healthcare policy formulation

and implementation in the United States.

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References

Konisky, D. M., & Nolette, P. (2021). The state of American Federalism, 2020–2021:

Deepening partisanship amid tumultuous times. Publius: The Journal of

Federalism, 51(3), 327-364.

Osuagwu, E. S. (2021). Balancing the principles of Federalism and intergovernmental

relations under the Affordable Care Act. Available at SSRN.