Medicaid waivers and negotiated federalism in the US: is there relevance to other federal systems?

Abstract:

:Medicaid waivers have been a principal tool of innovation in health policy in the US since at least the mid 1970s. As Republicans seek to give the states more flexibility in their implementation and management of both Medicaid and the Affordable Care Act or its replacement, waiver authority is likely to be one of the key work arounds for avoiding political barriers in the US Senate. While block-granting Medicaid may require 60 senate votes, waiver authority already exists in both Medicaid law and the Affordable Care Act. Waivers also have great potential for application in other federal nations. Yet there is no theory to explain the way the application and review process evolves or the factors likely to shape the outcome. After a discussion of the theoretical underpinnings of what we call 'negotiated federalism', we apply it to examples of Medicaid waivers to see if the theory's key elements - politics, party congruence, leverage, credit taking and experience - offer a useful perspective on this federal-state interaction so important to health policy.

authors

Weissert CS,Weissert WG

doi

10.1177/1355819617702175

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

261-264

issue

4

eissn

1355-8196

issn

1758-1060

journal_volume

22

pub_type

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