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Federalism and Health Care

  • Virginia Gray (a1)

Extract

Among the many issues in the national health care debate is the role of the states. Some have asked whether the states can tackle health care on their own and have answered with a resounding “no.” Deborah Stone (1992), for example, argues that health care is too big a challenge for the states to handle: they lack sufficient autonomy from the federal government in certain areas and sufficient power over private interests in others.

But apparently, states are undeterred by such thinking. In the early 1990s, three states—Minnesota, Washington, and Florida—passed comprehensive bills incorporating elements of managed competition. Massachusetts, Oregon, and Vermont had already enacted (but not implemented) major reforms based upon different philosophies. And Hawaii led the way in 1974 with its enactment of an employer mandate.

Today, reform activity is everywhere. In 1993, 1,850 health care reform proposals were introduced in state legislatures; this year virtually every governor is working on some health care initiative. Even Lowell Weicker, Jr., governor of Connecticut, home to the nation's largest insurance companies, has announced his intention to provide universal coverage by 1997. The states are definitely not waiting around to see what the feds will do.

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References

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Boeckelman, Keith. 1992. “The Influence of States on Federal Policy Adoptions.” Policy Studies Journal 20 (3): 365–75.
Brown, Lawrence D. 1993. “Commissions, Clubs, and Consensus: Florida Reorganizes for Health Reform.” Health Affairs (Summer): 726.
Dodson, Anthony L., and Mueller, Keith J. 1993. “National Health Care Reform: Whither State Government?Policy Currents 3 (November): 57.
Greenhouse, Steven. 1993. “The States' Stakes in Clinton's Health Plan.” New York Times 10 October: E5.
Hecht, Stacey Hunter. 1993. “Lighthouse, Laboratories or Leaders? AFDC Innovation in a Federal System.” University of Minnesota. Typescript.
Lammers, William W. 1990. “State Health Policy Innovations: A Stimulus for Federal Action?” Presented at the American Political Science Association Annual Meeting, San Francisco, CA.
Leichter, Howard M. 1992. “The States and Health Care Policy: Taking the Lead.” In Health Policy Reform in America, ed. Leichter, Howard M.. Armonk, NY: M. E. Sharpe.
Mashaw, Jerry L. 1993/1994. “Taking Federalism Seriously: The Case for State-Led Health Care Reform.” Domestic Affairs (Winter): 121.
Neubauer, Deane. 1992. “Hawaii: The Health State.” In Health Policy Reform in America, ed. Leichter, Howard M.. Armonk, NY: M. E. Sharpe.
Pear, Robert. 1994. “Governors Ask for Power Over Self-Insurance Plans.” New York Times 30 January: A14.
Stone, Deborah A. 1992. “Why the States Can't Solve the Health Care Crisis.” The American Prospect 9 (Spring): 5160.
Thompson, Frank J. 1986. “New Federalism and Health Care Policy: States and the Old Questions.” Journal of Health Politics, Policy and Law 11 (4): 647–69.

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Federalism and Health Care

  • Virginia Gray (a1)

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