Interplay between states and federal government in implementing the ACA

March 03, 2020

March 3, 2020 --The fierce national debate over health care reform includes deep divisions over the appropriate roles of the federal and state governments. For example, while Sen Bernie Sanders (I-VT) calls for expanding the federal Medicare program to cover all Americans, the Trump administration pushes for the states to have far greater authority. However, according to Michael Sparer, JD, PhD, chair of health policy and management at the Columbia Mailman School of Public Health, the Affordable Care Act (ACA) points towards a more effective inter-governmental partnership, one in which the states have significant policy and administrative discretion, bounded by strong national standards designed to limit unacceptable inequities.

In a policy paper titled "Federalism And The ACA: Lessons For The 2020 Health Policy Debate" in a special issue of the journal Health Affairs, Professor Sparer writes: "States are too prominent and too engaged in every aspect of the nation's health care system not to insist on playing an important ongoing role." Proposals to eliminate a significant state role are both unlikely to be enacted and at odds with 250 years of American history. But he adds that future reforms also need strong national standards to guarantee the desired policy outcome (such as universal coverage) and to limit unacceptable inter-state inequities

The ACA offers several models for combining centralized and state-based approaches for policy makers to develop the next generation of health reform, notes Sparer, and each of them could achieve universal coverage without eliminating the private insurance system. Indeed, rather than abandoning the ACA, reformers ought to recognize that the law suggests "the sort of intergovernmental partnership that just might lead to a US version of affordable universal coverage.

On March 10th Professor Sparer will take part in a briefing in Washington hosted by the journal. Here is more information. Registration is free.
-end-
Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the seventh largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master's and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.

Columbia University's Mailman School of Public Health

Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.200852.

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.