© 2008 Delmar Cengage Learning. Chapter 7 Federalism Frank J. Thompson and James Fossett.

© 2008 Delmar Cengage Learning.

Chapter 7

Federalism

Frank J. Thompson and James Fossett


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Three Periods of (Health Care) Federalism

• Minimalist period (American Revolution through the Civil War era)– States and federal governments “tested the

waters” as to the policy areas in which one or the other could claim dominance

– Most health functions were consigned to local jurisdictions


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• Emergent period (approx. 1865-1965)– Federal government and, particularly, the

states entered the health policy arena, through state regulation of the incipient medical profession, and such federal measures as Sheppard-Towner and Hill-Burton


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• Contemporary period (post-1965)– Witnessed a vast expansion in federal health

programs– Increased fiscal entrepreneurialism on the part

of the states– Federal grants to states have played a

prominent role in this expansion


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Federal Grant Typology

• Categorical grants are sums issued to states that must then be used for a specific purpose– Usually governed by a specific statute or

statutes


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• Block grants are sums given to states in the interests of achieving a broader goal– Allow states to use them at their discretion


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• Entitlement programs– Opposed to those operating under fixed

budgets– Require states (or, in some cases, the federal

government) to fund any beneficiary as defined by a specific plan or piece of legislation no matter the cost

– Outlays toward such programs can thus only be predicted in a given year, not controlled


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States as Fiscal Entrepreneurs

• States normally try to extract as much federal money as possible under such programs as Medicaid


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States as Fiscal Entrepreneurs

• Many programs match federal funds to state contributions– So states often devise tricks

• Collecting payments from localities or hospitals, to (artificially) inflate their state contribution

– This, in turn, increases their federal match


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Devolution and the States

• With mixed success, recent presidential administrations have attempted to reduce the federal commitment to states

• Many measures of retrenching devolution allow states greater flexibility in administration of programs– Reducing the federal match in exchange


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Chapter 7 Summary

• The nature of the relationship between the states and federal government has changed over time

• Various types of federal grants to states are chief venues of federalism in health policy


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Chapter 7 Summary

• Retrenching devolution has changed the dynamic between the federal government and the states in recent years

© 2008 Delmar Cengage Learning. Chapter 7 Federalism Frank J. Thompson and James Fossett.

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Transcript of © 2008 Delmar Cengage Learning. Chapter 7 Federalism Frank J. Thompson and James Fossett.