For major domestic policy initiatives, congressional action and debate is often the last stage of policy development before implementation. Prior to the legislative stage, there can be years of spadework by experts who hash out policy differences and argue over the best pathways to achieve policy success. A recent multi-stakeholder conference sponsored by The Century Foundation sought to spark the next round of policy development on health reform. Princeton’s own Paul Starr helped to organize the conference and in a keynote address, offered trenchant analysis on the history of health reform and proposed “A New Strategy for Health Care,” based on an essay he authored in the current issue of The American Prospect.
Much of the conversation focused on leveraging current federal programs – namely Medicare and Medicaid – to expand coverage to more Americans. CHW’s Heather Howard focused on the role of states as the agents of change, rather than federal authorities and programs, and outlined the opportunities and limits of state-based reforms.
The Affordable Care Act provided states with new opportunities to craft health coverage programs that are more tailored to state needs through what are known as Section 1332 Waivers. Professor Howard has written extensively on these waivers 1, 2, 3, 4, 5 and two recent policy workshops for MPA students have used Section 1332 Waivers as policy options for states 1, 2.
Rather than relying on Congressional action, Howard argued, states can move the needle on health coverage and affordability, but they face challenges (such as federal policy uncertainty and inherent structural challenges, such as balanced budget requirements), and need three key ingredients for success: state political leadership, sustained federal dollars, and policy flexibility from reliable federal partners. Howard’s presentation focused on the efforts underway in a number of states and highlighted how states have often served as the policy laboratory for the federal government. Slides from Professor Howard’s presentation are available here.