Federalism in the News

Over the past several decades since formal health care in the United States began, there have been many changes to health care laws ranging from general policies and insurance programs to national reform efforts. One of the many changes in health care the United States has seen is in the roles of the states and the Federal Government. As with many if not most other major issues in the United States, health care has seen more and more involvement by the Federal Government. One example of this, which the article focuses on, is the possibility of the Federal Government running new insurance marketplaces for almost all states.

The Obama administration, while trying to pass legislation, is also meeting with health officials from each state and proposing ways to divide health insurance exchange duties between the government and the states. These health insurance exchanges will "allow individuals and small businesses to shop for coverage from a range of insurers, see if they qualify for low-income subsidies to help them buy policies, or enroll in Medicaid if they meet income requirements." For states that can't or will not run the exchanges, the Federal Government will do so instead. States run by Republic governors have shown great opposition to the law, with a failing to pass legislation in 16 states. The law has different options for state and federal responsibilities. The first would give states the option to share responsibilities for managing the participation of health plans, help consumers navigate the system, or both. The second option would have states handle the personal component of the exchanges, as well as take responsibility for consumer outreach and education. The US department of Health and Human Services would then be left to take care of eligibility and enrollment. The overall goal of the law is "achieving a seamless experience, where people can move between Medicaid and private insurance coverage on an exchange as their income situations change."

In the past, despite an increased role by the Federal Government, there hasn't been much controversy over the roles of the Federal Government and State Governments when it comes to health care. In general, states have traditionally led the movement to reduce costs, expand access, and improve quality of health care. The Federal Government on the other hand, has provided the policy setting and financial foundations of health care, and health care reform. The controversy comes with the latest reforms to health care, the Patient Protection and Affordable Care Act, as well as the Health Care and Education Reconciliation Act of 2010. The greatest controversy and opposition to these reforms comes with the fact that citizens would be forced to purchase some form of health care, as well as the fact that the reforms basically represent a federal takeover of health care. The law proposed in this article, while not representing a total takeover