NURS 8100 Discussion: Federalism’s Impact on Policy ANSWER

Overlapping of Federal-state Health Policies

Historically, the elderly and the disabled receive long-term care in institutionally setting because Home and Community Base Care services (HCBS) were less available. However, in the 1980s, an amended federal law passed a federal-state Medicaid waiver authority for states to expand HCBS services to cover individuals at risk for institutionalized care (Musumeci et al., 2020). These individuals will receive broader services that were not allowed by Medicaid state plans. The HCBS 1915 (c) waivers authorized states to provide targeted services to populations such as seniors, people with physical or developmental disabilities, and individuals with specific conditions such as HIV/AIDS or traumatic brain injuries(Merryman et al., 2015). Essential to note every state’s eligibility requirement and criteria are different; however, HCBS waivers are limited to three years but may extend five years for those dual

ly enrolled in Medicaid and Medicare (Merryman et al., 2015).

In response to the COVID-19 pandemic, President Biden signed the American Rescue Plan Act (ARPA), which provides $1.9 trillion for several provisions to include in the pandemic relief package (Miller & Beauregard, 2022). This legislation will significantly impact state and federal health policies and programs, such as federal funding for state Medicaid spending on HCBS. The ARPA will provide a one time10% increase in federal matching payment to states’ HCBS to supplement state expenditure which would only be available for a year(Miller & Beauregard, 2022. Therefore, states would have the flexibility in overlapping with federal policies targeting HCBS to specific populations. Nonetheless, the ARPA ensures that states benefit from the federal investment for HCBS to achieve the best outcomes for Medicaid beneficiaries to receive high-quality, cost-effective, person-centered care in their home (Watts et al., 2020).

Duplication Advantages & Disadvantages

The advantage to the federal-state funding of HCBS is that it provides states with good flexibility to utilize these funds that align with the priorities of local policies (Musumeci et al., 2020). As a result, states will be able to enhance their HCBS models (Watts et al., 2020). Furthermore, states taking advantage of access to federal funds will also address the shift in demand for healthcare needs because of COVID public health emergencies (Miller & Beauregard, 2022). On the other hand, states will need to determine how they will sustain this investment once the expiration of federal matching.

Implications of Federalism

Nevertheless, the enactment of the American Rescue Plan Act (ARPA) with the inclusion of increasing state funds to HCBS foreshadowed the United States as a federalist system. Oversight of health policy decisions responsibility is shared among federal and state in areas of administration and funding. The state and federal are jointly responsible for the healthcare financing for the health and long-term care of low-income populations with the appropriate balancing of these responsibilities (Collins, & Lambrew, J2019). However, federalism contributes to the fragmentation of the U.S healthcare system due to the different financing and service delivery modes, leading to duplication of services.

Federal Government Involvement in Healthcare Policymaking

According to Bialik (2018), the Pew research reported that 60% of American believe that the federal government should be responsible for ensuring healthcare coverage for all Americans. Essentially, the federal government plays a central role in the oversight and shaping of the American health care arena to develop policies that support cost-effective quality programs for the population’s health needs. Therefore, the federal government should maximize its involvement given its unique position as regulators, healthcare purchasers, sponsors of applied healthcare research, healthcare provider education, and healthcare providers (Crowley et al., 2020). Furthermore, federal leadership is a crucial stakeholder having extensive healthcare programs and market influence, which helps acquire sustainable healthcare reform and better quality and value in healthcare (Gluck & Huberfeld, 2018). For instance, the federal government has been a critical player in establishing Medicare and Medicaid to ensure access to insurance coverage for a large segment of the population, legislation for employer-sponsored health insurance, and expanded federal healthcare programs (Collins & Lambrew, 2019 ). Currently, the federal leadership plays a pivotal role in the Affordable Care Act by expanding health insurance coverage to the uninsured. Hence, the federal government plays an essential role in promoting healthcare services that contribute to healthcare efficiency and saving, so the federal government should maintain a central role in healthcare policymaking.

References

Bialik, K. (2018). More Americans say government should ensure health care coverage. Universal Health Care, 94.

Collins, S. R., & Lambrew, J. M. (2019). Federalism, the Affordable Care Act, and health reform in the 2020 election. The Commonwealth Fund.

Crowley, R., Daniel, H., Cooney, T. G., Engel, L. S., & Health and Public Policy Committee of the American College of Physicians*. (2020). Envisioning a better US health care system for all: coverage and cost of care. Annals of Internal Medicine, 172(2_Supplement), S7-S32.

Gluck, A. R., & Huberfeld, N. (2018). What is federalism in healthcare for. Stan. L. Rev., 70, 1689.

Merryman, M. B., Miller, N. A., Shockley, E., Eskow, K. G., & Chasson, G. S. (2015). State adoption of Medicaid 1915 (c) waivers for children and youth with autism spectrum disorder. Disability and health journal, 8(3), 443-451.

Miller, E. A., & Beauregard, L. K. (2022). Enhancing Federal Revenue under the American Rescue Plan Act: An Opportunity to Bolster State Medicaid Home and Community-Based Services Programs. Journal of Aging & Social Policy, 1-15.

Musumeci, M., Watts, M. O., & Chidambaram, P. (2020). Key state policy choices about Medicaid home and community-based services. Kaiser Family Foundation.

Watts, M. O., Musumeci, M., & Chidambaram, P. (2020). Medicaid home and community-based services enrollment and spending. Kaiser Fam Found.

The overall division of the US health care system is something that must be discussed.  There are different models of financing and services that are presented within the US health care system.  Policy making is something that is done within the US health care system but done on many different levels of the government.  This is a shared responsibility.  When you have many different hands in the process of policy making then it does take time.  This process can be perceived as slow.  People have to meet, make choices, need to time to respond in able to make the best choices for policy making.  The purpose of this discussion is to discuss the role of the federal government in health care policy making.

On a federal level the law that comes to mind is the Affordable Care Act of 2010.  The law stated that each state needed to expand eligibility for Medicaid.  “The lay also required insurers to cover healthcare services within a standard set of benefits and prohibited coverage denials based on preexisting conditions” (Public policy in Michigan, n.d.).  Even though the Affordable Care Act is a federal policy its very individual on a state level.  As far as Michigan goes there has been positive shift.  “Between 2013 and 2016 the number of uninsured individuals in Michigan declined by 50.8%.  About 284,000 individuals in Michigan were enrolled in health plans offered through the health insurance exchange in 2017.  Enrollment in Medicaid amounted to about 2.4 million in May 2017” (Public policy in Michigan, n.d.).  On a state level the program that will be discussed is the Michigan’s Medicaid program.  This program allows individuals with low incomes to have access to health insurance.  This is an example of how Medicaid is a nationwide program but it’s jointly funded by the federal government and the states.  Medicaid is a separate program from Medicare.

The advantages of both programs are the increase amount of insured people and additional funding at both levels.  “Federalism, mode of political organization that unites separate states or other polities within an overarching political system in a way that allows each to maintain its own integrity. Federal systems do this by requiring that basic policies be made and implemented through negotiation in some form, so that all the members can share in making and executing decisions” (Britannica, T. Editors of Encyclopedia, 2020). Therefore, the Affordable Care Act and Michigan’s Medicaid Program are a good example of the implications of federalism.  The federal government’s involvement on health care policy should be mostly financial and insurance basis.  What works in healthcare in some places would not work for others, therefore it is not feasible to make healthcare policies at a federal level for more individual issues.  “The question of financial accessibility in the comparator federations is somewhat more complicated to treat, and all three perform less well here than on the other HCF performance criteria” (France, 2008).

Reference:

Britannica, T. Editors of Encyclopedia (2020, May 14). federalism. Encyclopedia Britannica. https://www.britannica.com/topic/federalism

France, C. (2008). The form and context of federalism: Meaning for health care financing. Journal of Health Politics, Policy & Law, 33(4), 649-705.doi: 10.1215/03616878-2008-012

Public policy in Michigan. Ballotpedia. (n.d.). Retrieved April 23, 2022, from https://ballotpedia.org/Public_policy_in_Michigan#Healthcare_information

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