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The Impact of New Federalism on Healthcare Delivery

By jenjelf Oct 18, 2009 682 Words
The government of the United States of America operates on the principal of federalism which is defined as “the allocation of responsibility and authority between the states and the federal government” (Weil, n.d.). Historically, federalism in the United States favored a central government (Ladenheim, 1999). The early framework is set in the U.S. Constitution which established the authority of the federal government over state governments (U.S. Constitution). Federalism favoring the authority of the federal government was further strengthened as a consequence of President Franklin Roosevelt’s New Deal and accompanying civil laws (President, 2004).
The political philosophy of New Federalism first emerged in the United States under President Ronald Reagan’s administration. New Federalism reverses Federalism, transferring power back to state governments (Caraley & Schlussel, 1986). The phrase “devolution revolution” has also been used to describe New Federalism (Hovey, 1998). Under New Federalism programs are typically implemented with the federal government providing block grants providing the funding for states to implement them (Ferejohn & Weingast, 1997).

The impacts of New Federalism on healthcare delivery can be understood by reviewing one program operating under similar circumstance, Medicaid. The Federal government provides funding and some program guidelines for Medicaid (Weil, n.d.). Specific program requirements are established and enforced by each state (Department Of Health And Human Services, 2005). Patient eligibility varies by state and each state sets the policy for who is eligible, what gets covered, and how much the coverage will be (Department Of Health And Human Services, 2005; (Weil, n.d.). Operationally, New Federalism will impact health care delivery by indicating who will have the authority to establish, responsibility to finance and the obligation to put into operation the programs needed (Weil, n.d.).

From a patient perspective, New Federalism would apply the strengths and weaknesses of state run versus Federal run programs. According to Weil (n.d.), state run programs offer the following benefits, each state can test different policies, each policy can be customized for local needs, officials would be more accessible to the constituents, and the program could be more adaptable to changing needs. Programs establish similarly to Medicare would leverage the Federal government’s ability to more efficiently fundraise (Weil, n.d.). Conversely, New Federalism would offer the following weaknesses, lack of standardization and efficiency in crisis response, in ability to utilize national sources of data, inability to redistribute resources, create redundant management and processes, and prioritizing states rights over the common good (Weil, n.d.).

Reflecting on these strengths and weaknesses, New Federalism brings the potential to develop a more robust local healthcare system, in the opinion of the author, by being able to factor in local variables and by being able to see options implemented in other states. It is the opinion of the author that the weaknesses around a lack of standardization would promote a healthcare system with a fundamental inequality towards patient illness and care. The benefits and the weakness of a New Federalist healthcare delivery system do not appear to be in balance, it is the author’s opinion that a partnership between state and Federal governments has the greatest potential for creating a more functional healthcare delivery system.


Caraley, D. & Schlussel, Y. (1986). Congress and Reagan’s New Federalism. Publius: The Journal of Federalism, 16, 49-80.

Department Of Health And Human Services. (2005). Medicaid At-a-Glance. Retrieved July 25, 2009 from

Ferejohn, J & Weingast, B. (1997). The new federalism. Hoover Press.

Hovey, H. (1998). The Devolution Revolution Can the States Afford Devolution. New York: Century Foundation Press.

Ladenheim, K. (1999). History of U.S. Federalism. Retrieved on July 25, 2009 from

President Franklin Delano Roosevelt and the New Deal, 1933-1945. (2004). Retrieved July 25, 2009 from

Weil, A. (no date). American Federalism in Health Policy. Retrieved on July 25, 2009 from

U.S. Constitution, Art.VI, cl. 2.

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