The concept of federalism, or the sharing of political power between federal and state governments, is important for the American governmental system. Healthcare is no exception to this, and federalism can be seen in how regulation is divided by federal programs, regulatory bodies and state governments.
The US federal government regulates overall health insurance policies, as well as the Medicaid/Medicare programs, pharmaceuticals, and has many supporting regulatory bodies, such as the Center for Disease Control (CDC), Health and Human Services (HHS), and the Food and Drug Administration (FDA). In terms of regulating the practice of healthcare, the federal government oversees hospitals. State governments have their own regulatory bodies that oversee things such as water quality, and license the physicians that work in their state. While the federal and state governments have many common goals, such as public health and safety, they divide the accomplishment of those goals.
The benefit of a federal system in healthcare is that a state can tailor their responses and legislature according to the priorities of the people who live there. This can be a benefit for a country as large as the US as it is varied in every single way. Federalism allows the states to have flexibility within the larger federal decisions.
An example to illustrate federalism in action is the expansion of Medicaid. Medicaid is a federal program that provides health insurance to those who live below a certain percentage of the Federal Poverty Line (FPL). However, the states have the ability to expand eligibility as it sees fit. The overall goal for the federal government is to decrease the uninsured population, so they support Medicaid expansion in providing more funds to states with greater low income populations through matching a certain percentage of what the state spends or hospitals that see a large volume of Medicaid patients.
There are many other common examples of this concept at work in the healthcare field, such as abortion laws. The Supreme Court decision of Roe v. Wade gave the right for a woman to get an abortion, but allows the states to create their own regulation about funding, setting/doctors involved, counseling, and waiting periods. Another example is with HPV vaccination policies, and how requirements for school entry vary in many states.
A modern and very relevant example of federalism is the policies surrounding the COVID-19 pandemic. While many countries look towards its federal government for sole authority in times of pandemic, the US gives most responsibility to state governments, and in fact has little control over states’ decisions. While many states use federal guidelines as an example, this system allows states to alter their containment policies based on what their population needs. However, there are downsides to this system such as uneven response to epidemics, as well as aggravation of interstate inequalities.
Overall, giving power and flexibility to state governments allows for specific, population centered medical care and, in theory, is aimed at helping the overall health of a large country such as the US. However in practice there are many downsides as well, as can be seen from the irregular response to the COVID-19 pandemic.