Healthcare State VS. Federal Responsibility

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Healthcare State VS. Federal Responsibility

Healthcare in the United States is a shared responsibility between the federal government and the state governments, with the two having powers to make laws concerning healthcare.
The constitution has burdened the federal government with the role of providing funds to the states for effective provision of health services to the citizens while at the same time, they are allowed to provide broad national policies that would make these services efficient (Goelzhauser, Greg, and David).
On the other hand, state governments are expected to engage in activities that promote healthcare services delivery, such as facilitating hospital management and employing service providers.
However, such cooperation lacks with the federal government using its power to delegate the reserved governmental decisions required by the state governments.
The coronavirus pandemic has challenged the general assumption that poor health for some particular individuals does not affect many others’ health (Gordon, Nicole, and David).
The state and federal governments have made divided governing policies that have affected individuals’ lives. For instance, the federal government has responded to the pandemic by providing uneven assistance to particular states.
The states’ funding and essential supplies were delayed by the federal government, with the addition of insufficient mass testing of the public and inconsistent state messaging to their members indicate the failed mandate of a centralized action (Gordon, Nicole, and David).
The federal government has identified its role in providing orders allowing the reopening of the economy while the governors’ according to the federal government, should work on managing the coronavirus testing.
The federal government is only allowed to advise the states on what policies work best to manage and prevent the pandemic.
States have moved to provide their citizens with divisive policies that have adequately resulted in desperate health results among the community members.
For instance, some states have taken upon themselves the responsibility of forging through their healthcare paths independently, with instances of acquiring essential equipment required to deal with the pandemic and working a way forward to reopening their economies (Gordon, Nicole, and David).
Although such efforts by the state government are paramount at ensuring enhanced public health, it is not enough to replace what the federal government could facilitate if the two were in a good collaboration.
Primarily, the response to the pandemic needs harnessed speed, unity, and equipment requirements efficiencies, but due to divisive governance, unwanted difficulties are created to the states’ citizens.

What Federalism Means for the US response to Coronavirus Disease 2019

The rapid spread of novel coronavirus disease 2019 (COVID-19) across the United States has been met with a decentralized and piecemeal response led primarily by governors, mayors, and local health departments. This disjointed response is no accident. Federalism, or the division of power between a national government and states, is a fundamental feature of US public health authority.¹ In this pandemic, US public health federalism assures that the coronavirus response depends on zip code. A global pandemic has no respect for geographic boundaries, laying bare the weaknesses of federalism in the face of a crisis.

Cited benefits of federalism include the flexibility to customize responses to a local population’s unique characteristics, maintain state budgets, and test new policies.²^,3 Some states have responded to the lack of national leadership by forging their paths by independently acquiring essential equipment or collaborating with neighboring states to reopen their economies. Such efforts are necessary but not a sufficient replacement for a nationally coordinated effort. When our collective fate relies on speed, efficiency, and unity, federalist ideas fall flat. Divided governance creates unnecessary challenges for residents of states that are slow to act or to take up federal policies.

While the Trump administration’s coronavirus response has aggravated the pandemic with uneven assistance to states, funding and supply delays, inconsistent messaging, and insufficient testing, the federal government is limited in its ability to mandate a centralized course action. This is by design; the COVID-19 response is divided among more than 2000 state, local, and tribal public health departments. The Department of Health and Human Services, Federal Emergency Management Agency, and the Centers for Disease Control and Prevention (CDC) has limited authority to direct local officials to take united action.¹^,4

When asked about eastern and western states’ coordinated response to the pandemic, President Trump asserted that the authority of the president is “total…[States] can’t do anything without the approval of the president of the United States.” This is not accurate. The power of quarantine rests primarily with state and local authorities, with substantial variation among jurisdictions.⁵ Under the Public Health Service Act, the Surgeon General, with the permission of the Secretary of the Department of Health and Human Services, has the authority to prevent the spread of disease between states and from other countries. However, the responsibility for other public health functions lies with the CDC, a subdivision of the Department of Health and Human Services that is tasked with hard science, data collection, and surveillance. The CDC’s experts generally have no means to enforce public health measures. As a result, each state is separately responsible for responding to a public health event.

Once the federal government declares a national emergency, state disaster declarations trigger specific, short-term powers, such as stay-at-home orders, and enable the drawdown of federal funding. Resulting state variations have implications reaching beyond infection rates. Lax stay-at-home orders in one area may foil much stricter measures in a neighboring region. For example, Salt Lake City, Utah, mayor Erin Mendenhall issued a stay-at-home order weeks before Utah governor Gary Herbert issued a milder statewide decree, delaying prevention efforts in the state’s most populous city. These differences are even starker in states where residents cross borders for health care, such as New Hampshire and Massachusetts.

The COVID-19 pandemic also intensifies and reveals longstanding inequitable distribution of power and resources, already evidenced by disparate rates of treatment and morbidity for African American patients. Historically, state flexibility in health policymaking has meant that certain communities, such as poor African American families in the deep South, have fewer resources over the long term and suffer entrenched health disparities. As a result, they experience higher rates of asthma and other comorbidities that may exacerbate the severity of COVID-19. As hospitals develop triage plans, racial/ethnic minority patients may be deprioritized for life-saving treatment because of disproportionate burdens of preexisting comorbidities. Moreover, the economic outcome in places such as the Mississippi delta will be extensive, where the most common job is retail cashier, Medicaid eligibility thresholds are extremely low, and health care facilities were already struggling.

Work Cited

Goelzhauser, Greg, and David M. Konisky. “The State of American Federalism 2019–2020: Polarized and Punitive Intergovernmental Relations.” Publius: The Journal of Federalism 50.3 (2020): 311-343.

Gordon, Sarah H., Nicole Huberfeld, and David K. Jones. “What Federalism Means for the US Response to Coronavirus Disease 2019.” JAMA Health Forum. Vol. 1. No. 5. American Medical Association, 2020.