© 2008 Delmar Cengage Learning. Chapter 7 Federalism Frank J. Thompson and James Fossett.
-
Upload
meghan-phelps -
Category
Documents
-
view
212 -
download
0
Transcript of © 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
© 2008 Delmar Cengage Learning.
2
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
© 2008 Delmar Cengage Learning.
3
Three Periods of (Health Care) Federalism
• 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
© 2008 Delmar Cengage Learning.
4
Three Periods of (Health Care) Federalism
• 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
© 2008 Delmar Cengage Learning.
5
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
© 2008 Delmar Cengage Learning.
6
Federal Grant Typology
• Block grants are sums given to states in the interests of achieving a broader goal– Allow states to use them at their discretion
© 2008 Delmar Cengage Learning.
7
Federal Grant Typology
• 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
© 2008 Delmar Cengage Learning.
8
States as Fiscal Entrepreneurs
• States normally try to extract as much federal money as possible under such programs as Medicaid
© 2008 Delmar Cengage Learning.
9
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
© 2008 Delmar Cengage Learning.
10
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
© 2008 Delmar Cengage Learning.
11
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
© 2008 Delmar Cengage Learning.
12
Chapter 7 Summary
• Retrenching devolution has changed the dynamic between the federal government and the states in recent years