Glass Half Full

Abstract

Intergovernmental health policy has seen centralization and decentralization over the past forty years. The negotiations—and who wins and who loses—often depend on politics more than rational sorting of intergovernmental responsibilities. As in other policies, politics often trumps health policy—even where governors and state legislatures are of the same party as national leadership. Political rhetoric in 2017 once again calls for a larger role for states in possible reform of the nation’s health system, but nation-centered federalism persists. Congressional inaction, executive uncertainty, and partisan polarization can provide states the opportunity for leadership and innovation in health policy.