It is no exaggeration to say that American health policy is frequently subordinated to budgetary policies and procedures. The Affordable Care Act was undeniably ambitious, reaching health care services and underlying health as well as health insurance. Yet fiscal politics determined the ACA’s design and guided its implementation, as well as sometimes assisting and sometimes constraining efforts to repeal or replace it. In particular, the ACA’s vulnerability to litigation has been the price its drafters paid in exchange for fiscal-political acceptability. (...) Future health care reformers should consider whether the nation is well served by perpetuating such an artificial relationship between financial commitments and health returns. (shrink)

[P]layers line up in a long line and hold hands. The player at the front of the line is the ‘head’ and the player at the end of the line is the ‘tail’.… The game begins when the head begins to run wildly in any direction, making sharp turns and quick double-backs.… The force created by the twists and turns will often send the tail of the whip flying.… It may be best for the tail to hold on with both (...) hands to keep from flying off the end. Sometimes, however, the tail will go flying no matter how hard they hold on... Be prepared to get dirty if you play this game!--"Crack the Whip: Party Game CentralIf the evolution of American health policy is compared to the children’s game of Crack the Whip, then there is no question that the Medicaid program is the tail of the line. When those at the head of the line start to move. Medicaid receives whatever shocks and unintended consequences result, and when the line “begins to run wildly in any direction,” it receives them faster and harder than the players at the center.Shocks also come from other sources. When the economy slumps, an epidemic arises, or a path in another part of the system becomes a cul-de-sac, new twists and turns occur, with Medicaid absorbing much of the change. (shrink)

The law has traditionally been, and will remain, a fundamental tool for addressing health care reform in the United States. With this premise in mind, the “Legal Solutions in Health Reform” project was initiated. The project overview provides a broad understanding of the purpose and layout of the project; the formulation and definition of key legal issues; a brief review of each of the topics covered in the project; a survey of current health statistics in the United States; a discussion (...) of the role of the federal versus state roles in health reform; a review of agencies and committees with jurisdiction over health reform issues; and a survey of means of enforcing health reform efforts. (shrink)

The American public has increasingly identified health care as a key issue of concern. In order to address the multiple problems relating to the access and affordability of health care, President Obama and federal lawmakers across the political spectrum continue to call for major health reform. In any debate on health reform, a predictable set of complex policy, management, economic, and legal issues is likely to be raised. Due to the diverse interests involved, these issues could lead to a series (...) of high-stakes policy debates. Therefore, it is critical that advocates of reform strategies anticipate such issues in order to decrease the likelihood that legally resolvable questions become barriers to substantive health reform. In an effort to frame and study legal challenges and solutions in advance of the heat of political debate, the O’Neill Institute for National and Global Health Law at Georgetown University and the Robert Wood Johnson Foundation have crafted the “Legal Solutions in Health Reform” project. (shrink)

[P]layers line up in a long line and hold hands. The player at the front of the line is the ‘head’ and the player at the end of the line is the ‘tail’.… The game begins when the head begins to run wildly in any direction, making sharp turns and quick double-backs.… The force created by the twists and turns will often send the tail of the whip flying.… It may be best for the tail to hold on with both (...) hands to keep from flying off the end. Sometimes, however, the tail will go flying no matter how hard they hold on... Be prepared to get dirty if you play this game!--"Crack the Whip: Party Game CentralIf the evolution of American health policy is compared to the children’s game of Crack the Whip, then there is no question that the Medicaid program is the tail of the line. When those at the head of the line start to move. Medicaid receives whatever shocks and unintended consequences result, and when the line “begins to run wildly in any direction,” it receives them faster and harder than the players at the center.Shocks also come from other sources. When the economy slumps, an epidemic arises, or a path in another part of the system becomes a cul-de-sac, new twists and turns occur, with Medicaid absorbing much of the change. (shrink)