15 Ind. Health L. Rev. 1 (2018)

handle is hein.journals/inhealr15 and id is 1 raw text is: 







    Indiana Health Law Review

Volume  XV                         2018                         Number   1



                           ARTICLES


   THE   NEW   HEALTH CARE FEDERALISM ON THE GROUND



                  ABBE  R. GLUCK  & NICOLE  HUBERFELD*


                             I. INTRODUCTION
    The  central question posed by this symposium  concerns the methods  of
evaluating health policy. Our empirical work on that topic centers on American
health care federalism, the relationship between the federal and state governments
in the realm of U.S. health care policy and regulation. We recently completed a
five-year study tracking implementation of the Patient Protection and Affordable
Care Act (ACA)  from 2012-2017.1  The study focused on the two key pillars of
the ACA,  which  also happen to be the most state-centered aspects of the law.
Those pillars are the expansion of Medicaid-the U.S. health insurance program
for  low-income   individuals, originally  established in  1965-and the
implementation of the ACA's  new  insurance marketplaces, known  as health
insurance exchanges. Our results shed light on what we call the new health care
federalism- federalism in the modern era of nationally enacted health laws that
preserve key roles for state leadership. At the same time, our study reveals the
theoretical and empirical challenges of quantitatively evaluating health care
federalism at all. What is it really? Does it exist? It is successful? Why do we
choose federalism-oriented models in the first place?
    The full study and its implications are presented in a forthcoming article in
the Stanford Law  Review.2  Our purpose  here is to offer a more accessible
snapshot; to discuss the methodological challenges we faced; and to offer in more
detail than the longer article one aspect of our methodology: interviews of
approximately twenty high ranking former state and federal officials who were
at the forefront of the first years of ACA implementation. What we heard from



      * Professor of Law and Faculty Director, Solomon Center for Health Law and Policy, Yale
Law School; Professor of Health Law, Ethics & Human Rights, Boston University School of Public
Health & Professor of Law, Boston University School of Law. We are deeply thankful to our
interviewees for their insights, candor, and time, and to our colleagues in the Indiana Health Law
Program for the invitation.
     1. We  began the work of studying implementation with colleagues at the University of
Pennsylvania, Tom Baker and Theodore Ruger, in a project we detail in the Stanford Law Review.
We are indebted to them for their contributions.
     2. Abbe R. Gluck& Nicole Huberfeld, What Is Federalism in Health Care For?, 70 STAN.
L. REv. _ (forthcoming 2018).

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