Sample Essay on Federalism and Health Care Policies

Federalism and Health Care Policies

The article by Gluck Abbe entitled “The Law of Medicare and Medicaid at Fifty” in Health Affairs Journal is a discussion of the issues of health care laws. In addition, there is a debate on the execution of the recent Patient Protection and Affordable Care Act (ACA). Over the years, America has struggled to enact a law that would lead to implementation of a national health care insurance. Medicare and Medicaid have been efforts toward increasing coverage of health care insurance to the majority of American citizens (Hoffman 1). One of the issues has been divisions on the constitutional mandate of federal and state governments in administration of health care. What does the constitution say about federal government mandate and jurisdiction over enactment of laws? The amplified control of the national government in the management of health care has elicited support and criticism over federalism (Gluck n. p).

The debate on federalism escalated following the proposition of President Obama’s Obama care plan under the ACA. The Act required that every citizen must have health care insurance, and continued Medicare assistance to the elderly citizens (Obamacare Facts n. p). However, there was contention in the requirement that states implement Medicaid expansion or face federal withdraw of funding for Medicaid. In upholding the constitutionality of ACA law, the Supreme Court repealed the coercive part that made Medicaid expansion obligatory (Independent Business v. Sebelius 2012, n. p). The anti-commandeering doctrine inhibits compulsion of federal laws on states. Decisions on whether health policies should be governed by the federal or state government have faced political and legal battles (Leonard 73).

Health matters are an issue of public policy, and the power to legislate health laws has been a constitutional enigma. The federal laws guiding health policies have been viewed as interference with the autonomy of the states. Federalism involves the separation of powers between the federal and state or local government (Schubert 88). According to the Tenth Amendment to the Constitution, powers that have not been explicitly granted or implied to be for the federal government are to be governed by the states or the people (97). However, there are some powers that are shared, and thus exercised by both state and federal governments. Some of the powers granted to the federal government as defined in Article 1 of the U. S constitution include regulating interstate commerce, operating post offices, declaring war, and coining money (88). States have the police power, allowing legislation of sensible laws to be applied at state level. However, there are limitations to the authority, which requires such laws to maintain social order, and preserve the citizens’ rights (97).

The constitutionality of ACA reached the Supreme Court with a number of arguments by the supporters and critics. In Independent Business v. Sebelius (2012) case the Obama administration argued on the legality of the Act based on three provisions. Firstly, under article 1section 8 of the U.S constitution, Congress has authority to regulate interstate commerce (Schubert 90). The argument based on the Commerce Clause considered the decision to purchase health care insurance as not an economic and interstate activity. However, the court found it inconsistent on grounds that the mandatory purchase of health care insurance would be a compulsion to participate in a commerce activity and not regulation. Second, the essential and correct clause was argued to allow Congress to make ACA act (Somin n. p). Nonetheless, the court found that the personal directive could be required but not proper if based on Commerce Clause. A final basis of enacting ACA was on the basis of requiring the uninsured to pay a penalty that was implied by the court to be a form of taxation. The Congress has the power to impose taxes; thus, people could be compelled to buy insurance or else pay taxes to cater for health care provided through federal funding.

Federalism has been an impediment in allowing states to regulate health care market and come up with innovative solutions, which would solve the issues of inadequate access and steep charges of health care. There has been a rapid rise in cost of health care, with about 18 percent of the federal budget being allocated to health care. Despite the large health care budget, universal health care has not been achieved. Some of the constitutional stumbling blocks to the states have been caused by federal statutes such as the Social Security Act and the constitutional clauses, for instance, the Commerce Clause (Parmet 121). It will be of great help if roles of the two governments are clearly stipulated in order to have unrestrained state solutions. The implementation of federal ACA would challenge the state in administration of the insurance exchange rules. Therefore, it would be reasonable for the federal government to create a framework that would be supportive of state initiatives, and that would be sustainable at state level (Greer 203).

It is evident that the doctrine of federalism has been at the centre of implementing health care policies. Fifty years after the enactment of Medicare and Medicaid programs have witnessed federal influence over health care laws. Although there have been shared powers by the two levels of government, it has also been a period of tension and political mistrust between Congress and states (Schneider 1). The role of the governments, health care rights and autonomy as well as political issues has also been mixed with federalism disputes. Despite the federal Medicare and Medicaid programs being administered from the federal level, and states have retained powers to create policies regarding the sharing and use of health funds in states. The responsibilities of health, welfare and protection of citizens have been under the states, which form laws to administer health care systems and licensing of professionals. In addition, commercial health care insurance companies have been regulated from the state level (Leonard 74). The ACA act will change insurance practices under Medicaid by requiring choices to be made between state or federal insurance exchanges.

Since health needs vary among states, a top-bottom approach in coming up with policies may ignore the uniqueness in states. In trying to appease the states, the federal government has allowed states to experiment on feasible health care systems. One of the consequences of this has been a fragmented health care insurance and health care provision. ACA is a significant effort towards realizing a national health insurance for universal health care. The existing Medicare and Medicaid programs would be difficult to reorganize or scrap, and hence Medicaid expansion has been proposed. On the other hand, the high cost of healthcare has been caused by the more than 46 million uninsured people (Hoffman 1). Mandatory contribution towards healthcare will be a step towards realizing universal health care and will decrease the burden of those who already contribute towards the insurance funds. Subsidizing insurance payment to the poor would enhance affordability, and enable increased acquisition of health care insurance. Thus, the decision by Supreme Court was considerate of the historical efforts to create a national health insurance. Achieving universal coverage of health care is the endeavor of ACA, which should be supported for social benefit.

Work Cited

“Obamacare Facts.”Supreme Court ObamaCare | Ruling on ObamaCare. 2012. Web. 8 Nov 2014. <>

Gluck, Abbe. “The Law of Medicare And Medicaid At Fifty.” 4 Nov, 2014. Web. 8 Nov 2014.

Greer, Scott L., and Peter D. Jacobson. “Health Care Reform and Federalism.” Journal of health politics, policy and law 35.2 (2010): 203-26. ProQuest. Web. 8 Nov. 2014.

Hoffman, Catherine. “National Health Insurance-a Brief History of reform efforts in the U.S”. Kaiser Family Foundation (2009): 1-8.Web. 8 Nov 2014. <>

Leonard, Elizabeth W. “Rhetorical Federalism: The Role of State Resistance in Health Care Decision‐Making.” The Journal of Law, Medicine & Ethics 39.s1 (2011): 73-76.Web. 8 Nov 2014. <>

Parmet, Wendy E. “Regulation and Federalism: Legal Impediments to State Health Care Reform.” American Journal of Law and Medicine 19.1-2 (1993): 121-44. ProQuest. Web. 8 Nov. 2014.

Schneider, Saundra K. “Introduction to the Publius Virtual Issue: Federalism and Health Policy.” Publius: The Journal of Federalism, 2012: 1-5. Web. 8 Nov 2014.  <>

Schubert, Frank. Introduction to the Law and Legal System of the United States. 10th ed. Boston, MA: Cengage Learning, 2010. Print.

Somin, Ilya. “Why the health care reform law is unconstitutional” 26 Mar. 2012. Web. 8 Nov 2014. <>

Supreme Court of the United States, “National Federation of Independent Business v. Sebelius” (2012). Patient Protection and Affordable Care Act Litigation. Paper 333. 648 F. 3d 1235<>