The Dynamics of Health Care: Federalism and State Choice
Alan Weil, president of the National Academy of State Health Policy (NASHP), gave a very thoughtful presentation at the annual conference earlier this month. In celebration of NASHP’s 25th anniversary, he provided a retrospective of major trends, programs and investments in health policy.
What captivated my interest is the ongoing dynamic between federalism and state choice so splendidly articulated by Weil. It’s a dynamic that’s been with us since the birth of our nation (my son happens to be studying American history this year, so the timing is remarkable) but one we have seen writ large in health policy over the past two and a half decades.
From Diagnosis-related group (DRG) enactment to Health Information Technology for Economic and Clinical Health (HI TECH) and the American Recovery and Reinvestment Act (ARRA) to the Health Insurance Portability and Accountability Act (HIPAA), as well as Obamacare, the federal government has focused on the “what” that needs to be changed, often leaving ample room for states to figure out the “how.”
We see that in many of the programs emerging from the Center for Innovation at the Center for Medicare & Medicaid. We aspire to the Triple Aim of improving patient health, improving the care experience and reducing costs. We see this goal playing out, as evidenced by the “Money Follows the Person” program in long- term services and supports to our recent State Innovation Models (SIM) grant application to support the integration of physical and behavioral care.
The “how” – that’s more elusive. It’s also what makes our work here in Colorado so vital and important.
Alan concluded with the following observations:
- Federalism is a defining feature of American health policy;
- Economic cycles drive health policy;
- State health policy never sleeps;
- Health system improvements are as hard to sustain as they are to attain;
- Healthy system improvements do not spread like mayonnaise.
We’ll let you think a bit about that last insight!