Politics and the Public Health Workforce: Lessons Suggested from a Five-State Study.

Unlabelled: Policy Points The United States public health system relies on an inadequate and inefficient mix of federal, state, and local funding. Various state-based initiatives suggest that a promising path to bipartisan support for increased public health funding is to gain the support of local elected officials by providing state (and federal) funding directly to local health departments, albeit with performance strings attached. Even with more funding, we will not solve the nation's public health workforce crisis until we make public health a more attractive career path with fewer bureaucratic barriers to entry.

Trump v. The ACA.

Before his incoherent response to the COVID-19 pandemic, the focus of President Trump's health policy agenda was the elimination of the Patient Protection and Affordable Care Act (ACA), which he has called a 'disaster'. The attacks on the ACA included proposals to repeal the law through the legislative process, to erode it through a series of executive actions, and to ask the courts to declare it unconstitutional. Despite these ongoing challenges, the ACA remains largely intact as the U.

Why Did the ACA Co-Op Program Fail? Lessons for the Health Reform Debate.

The ACA created a new type of nonprofit health insurance entity, the "Consumer Operated and Oriented Plan" ("co-op"). Most of the newly created co-ops soon lost money, and only 4 of the original 23 remain. We interviewed key stakeholders and conducted in-depth case studies of 3 of these co-ops.

Redefining the "Public Option": Lessons from Washington State and New Mexico.

Policy Points States are enacting a host of policy initiatives designed to reduce the number of Americans without health insurance. Policymakers and policy analysts need to examine whether this "laboratory of federalism" is producing ideas that can and should be replicated on a national scale. This article evaluates reform efforts in two states: Washington state, which enacted what its policymakers call a "public option" and New Mexico, which failed in its effort to enact a Medicaid buy-in.

Federalism And The ACA: Lessons For The 2020 Health Policy Debate.

Establishing a balance of power between states and the federal government has defined the American Republic since its inception. This conflict has played out in sharp relief with the implementation of the Affordable Care Act. This article describes the interplay between state and federal governments in the implementation of the act in three areas: the expansion of eligibility for Medicaid, implementation of the insurance Marketplaces, and regulation of insurers.

States as Policy Laboratories: The Politics of State-Based Single-Payer Proposals.

Although the focus for most single-payer advocates is in Washington, DC, and on proposals for Medicare for all, there are also efforts in a handful of states to enact a state-based single-payer program. Moreover, the odds of legislative passage are better in a state like New York than at the federal level.Even if enacted, however, state-based single-payer proposals face a distinct set of obstacles, including (1) the need to obtain federal permission (via waivers) to repurpose federal dollars, (2) the federal Employee Retirement Income and Security Act, and (3) the burden of state-only action in an interconnected 50-state economy.

Factors That Distinguish High-Performing Accountable Care Organizations in the Medicare Shared Savings Program.

Objective: To identify factors that promote the effective performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program.

Data Sources/study Setting: Data come from a convenience sample of 16 Medicare Shared Savings ACOs that were organized around large physician groups. We use claims data from the Center for Medicaid and Medicare Services and data from 60 interviews at three high-performing and three low-performing ACOs.

Medicaid At 50: Remarkable Growth Fueled By Unexpected Politics.

Medicaid has grown exponentially since the mid-1980s, during both conservative Republican and liberal Democratic administrations. How has this happened? The answer is rooted in three political variables: interest groups, political culture, and American federalism. First, interest-group support (from hospitals, nursing homes, and insurers) is more influential than the fragmented group opposition (from underpaid office-based physicians).

US health care reform and the future of dentistry.

The Patient Protection and Affordable Care Act has grand ambitions: to provide insurance coverage to more than 30 million currently uninsured Americans, to slow increases in health care costs, to reorganize the health care delivery system, and to improve the quality of care provided to all. Where does the oral health community fit in this initiative? Should dentists "scope up" to become a more active part of the primary care workforce? Or should dentists "scope down" and delegate parts of the traditional dental tool kit to midlevel practitioners? Our nation's public health largely depends on whether we can create a more integrated and public health-oriented delivery system. The oral health, physical health, and public health communities should address this challenge together.

Inching toward incrementalism: federalism, devolution, and health policy in the United States and the United Kingdom.

In the United States, the recently enacted Patient Protection and Affordable Care Act of 2010 envisions a significant increase in federal oversight over the nation's health care system. At the same time, however, the legislation requires the states to play key roles in every aspect of the reform agenda (such as expanding Medicaid programs, creating insurance exchanges, and working with providers on delivery system reforms). The complicated intergovernmental partnerships that govern the nation's fragmented and decentralized system are likely to continue, albeit with greater federal oversight and control.