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.).
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References: 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 http://www.cms.hhs.gov/MedicaidGenInfo/Downloads/MedicaidAtAGlance2005.pdf
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 http://www.cas.sc.edu/poli/courses/scgov/History_of_Federalism.htm
President Franklin Delano Roosevelt and the New Deal, 1933-1945. (2004). Retrieved July 25, 2009 from http://memory.loc.gov/learn//features/timeline/depwwii/newdeal/newdeal.html
Weil, A. (no date). American Federalism in Health Policy. Retrieved on July 25, 2009 from http://learn.gwumc.edu/hscidist/LearningObjects/Federalism/index.htm
U.S. Constitution, Art.VI, cl. 2.
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