217275 Health Care Federalism: The Role of States in Health Care Reform

Monday, November 8, 2010 : 2:50 PM - 3:10 PM

Elizabeth Weeks Leonard, JD , School of Law, University of Kansas, Lawrence, KS
There is a long history in the United States of state resistance, or nullification, of controversial federal programs, including the Alien and Sedition Act in 1798, the “Tariff of Abomination” under President Andrew Jackson in 1832, school desegregation in the aftermath of Brown v. Board of Education decision, and the USA PATRIOT Act after 9/11, to name a few. In each of those instances, federal authority ultimately trumped state resistance. Ample scholarly commentary has considered whether those disputes also serve a salutary purpose, giving voice to dissonant views, contributing to the marketplace of ideas, and reinforcing a decentralized system of government.

Amid ongoing current federal health care reform debates, several state governors, legislators, and activists, have advocated similar acts or statements of defiance. The objections focus on the proposed “individual mandate,” which would require all citizens in the United States to purchase health insurance. Opponents proposed state constitutional amendments or legislative resolutions, declaring that the federal individual mandate would have no effect within their states. The objections are grounded in the Tenth Amendment to the U.S. Constitution, which reserves broad state powers, individual rights to be free from compelled purchases or contracts, and policy objections to single-payor, government health care. Any such state enactments would almost certainly be legal nullities. Nevertheless, the ongoing resonance of the proposals has significant implications for federal-state relations and health care delivery. My talk will identify key provisions of the federal reforms that call on state participation and discuss the effect of state resistance.

Learning Areas:
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
1. Describe key provisions of federal health reform proposals that call for state participation. 2. Identify legal and policy bases for state lawmakers' challenging federal health reform. 3. Discuss the effect of state resistance or "nullification" of new federal health laws.

Keywords: Federal Initiatives, Public Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I teach and research health law, health policy, and public health law.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.