Which way for federalism and health policy?
The current balance of responsibility between states and the federal government for low-income people's health coverage has achieved a great deal. It covers many of the neediest people, supports the safety net, responds to emerging needs, and supports some experimentation. However, it leaves more than forty million people uninsured, allows excessive variation across states, places unsustainable pressure on state budgets, creates tension between the two levels of government, and yields too few benefits from experimentation. This mixed record argues for a significant simplification of and increase in eligibility for public programs, with the federal government either providing extra funds to states to meet these needs or assuming full responsibility for insuring the poor.
Holahan
John
J
Health Policy Center, Urban Institute, Washington, DC, USA. jholahan@ui.urban.org
Well
Alan
A
Wiener
Joshua M
JM
D002017:Budgets; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D035082:Federal Government; D006291:Health Policy; D006301:Health Services Needs and Demand; D011203:Poverty; D013219:State Government; D014481:United States