Is the federal government in charge of health policy in the United States?

Is the federal government in charge of health policy in the United States?

Answer:  It sure feels like the federal government has the reins of health policy in our country.  Medicare, the government program financing health care for people over 65, is run entirely by the federal government and federal taxation is used to provide the funding for that program.  Medicaid and CHIP are both federal programs but with administration and partial funding coming from the individual states.  The Indian Health Service and the VA health system are both federal programs with hospitals and clinics owned and operated by the federal government.  Additionally, there are many federal health programs funding a wide variety of medical services (AIDS, tuberculosis, vaccine preventable disease, sexually transmitted disease, contraception, newborn care, primary care, etc.) which are generally administered by state or local governments.

However, the US Constitution does not specifically give authority over health policy to the federal government and the 10th amendment states that where authority is not specifically granted by the Constitution to the federal government the presumption should be that the states have primary authority.  Thus, the practice of the federal government has been to incrementally expand its authority over health policy, often by appropriating federal tax money for the myriad of health care services and then using the promise of that funding to lure the states into accepting administrative responsibility, and sometimes partial funding responsibility, for the growing number of health care programs.  But the Constitution would have the states making the principle decisions in health policy.

What to do?

I suggest that the earthquake political moment which happened this past Nov. 8 creates a time and space for substantially shifting health policy making from Washington DC to the fifty state capitols.  Mr. Trump proposes to repeal the Affordable Care Act and has apparent agreement with the Republican controlled Congress.  However, Mr. Trump has proposed no cogent replacement health policy and the Republicans in Congress seem very divided about how to go about filling the gaping hole that would be left by the ObamaCare repeal.

The Affordable Care Act, itself, contains a provision for state experimentation beginning in the present calendar year, 2017.  This is, in effect, what is being proposed by four Republican Senators, as discussed in the attached New York Times article.  However, both the provision of the ACA and the currently proposed legislation do not go far enough in allowing states leeway in the making of health policy.  Let's really open up the laboratories of democracy and allow all of the states a very free hand in determining how best to meet the health care needs of their citizens.  What works in Massachusetts (the state with the highest per capita health care costs in the nation) will likely be quite different from what works in Utah (the state with the lowest per capita health care costs in the nation).  Put all federal funding for health care, including Medicare, CHIP, Medicaid, and everything else, into play with legislation that could allow each state to fashion its own health care system, or do nothing at all.