Federalism, the Affordable Care Act, and health reform in the 2020 election
- Collection:
- Health Policy and Services Research
- Author(s):
- Collins, Sara R., author Lambrew, Jeanne M., author
- Contributor(s):
- Commonwealth Fund, issuing body.
- Publication:
- [New York, N. Y.] : The Commonwealth Fund, July 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Federal Government Health Care Reform -- legislation & jurisprudence Politics State Government Healthcare Disparities -- legislation & jurisprudence Health Services Accessibility -- legislation & jurisprudence Insurance Coverage -- legislation & jurisprudence Insurance, Health -- legislation & jurisprudence Medicaid -- legislation & jurisprudence Medically Uninsured -- statistics & numerical data Medicare -- legislation & jurisprudence Humans United States United States.
- Genre(s):
- Technical Report
- Abstract:
- ISSUE. Under the U.S. federalist system, governing responsibility is allocated between the federal and state governments. The Affordable Care Act (ACA), which expanded Americans' coverage options, among other health system changes, reflects this structure. While the federal government provides most of the financing for subsidized coverage and sets a federal floor for insurance market regulations, states have flexibility to implement the law. Current health reform proposals from the political right aim to give greater responsibility to states; proposals from the left expand the federal role. GOALS. To review the federal--state governance balance regarding health care, assess how Republican and Democratic proposals might alter that balance, and assess the potential impact on insurance coverage and access to care. METHODS. Evaluation of federal and state governing responsibilities under the ACA and in emerging reform proposals, along with assessment of regional differences in coverage and access using state-level federal data. KEY FINDINGS AND CONCLUSIONS. The ACA's blend of federal standards and subsidies combined with state regulatory authority significantly improved coverage and access nationally and narrowed regional differences. However, the law's federalist structure, established in statute and altered through regulations and court decisions, resulted in disparities in coverage and access across states. These differences would likely widen under proposals that expand state authority and narrow under those that reduce it.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (12 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101755683 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101755683