Administering Health Care: Lessons from the Health Care Financing Administration's Waiver Policy-Making
![handle is hein.journals/jlp10 and id is 225 raw text is: Administering Health Care: Lessons from the
Health Care Financing Administration's
Waiver Policy-Making*
Elizabeth Andersen**
The President and two (often clashing) branches of Congress
compete to oversee a federal bureaucracy, itself complicated by the
intricacies of American federalism and bedeviled by an extensive
(and much called upon) judiciary. It is not an apparatus designed
for fast action. I
I. INTRODUCTION
Professor Morone's lament describes the inescapable reality of
modern social welfare policy. The challenge to policy-makers is to
find administrative mechanisms by which they can best manage
the aspects of the separation of powers and federalism that so of-
ten jam the gears of policy-making and program implementa-
tion.2 Perhaps nowhere is this challenge more glaring than in the
current debate over health care reform. Most national reform
proposals, including the Clinton administration's Health Security
Act, contemplate a division of fiscal and administrative responsi-
bilities between federal and state government entities.3 In various
* The author wishes to thank Professors Jerry Mashaw and Michael Graetz for their
thoughtful comments on this article.
Law Clerk, The Honorable Kimba M. Wood, United States DistrictJudge, Southern
District of New York. BA, Williams College; MPA, Princeton University;, JD, Yale Law
School.
1 James A. Morone, Administrative Agencies and the Implementation of National Health
Care Reform, in Implementation Issues and National Health Care Reform 47, 50 (Charles
Brecher ed., 1992) [hereinafter Implementation Issues].
2 James R. Tallon, Jr. & Richard P. Nathan, A Federal/State Partnership for Health
System Reform, Health Aff. 7, 9 (Winter 1992).
3 See Office of Management & Budget, Comprehensive Health Reform: Observations
About the Problem and Alternative Approaches to Solution, app. (outlining components of
major health care proposals, many of which involve both federal and state government
roles); White House Domestic Policy Council, Health Security: The President's Report to](ViewImageLocal?handle=hein.journals/jlp10&div=14&collection=&method=preview&ext=.png&size=3)
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Administering Health Care: Lessons from the Health Care Financing Administration's Waiver Policy-Making
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